Early Birds: Why Some People Don't Sleep In

Sleep is an essential part of our lives, and getting enough of it is crucial for our health and well-being. However, many people struggle with sleep deprivation and insomnia, which can have negative consequences on their daily lives and overall health. Sleep deprivation can be caused by various factors, such as poor sleep habits, stress, anxiety, depression, and certain medications. It can lead to fatigue, low energy, poor balance, mood changes, and an increased risk of accidents and health issues such as heart disease and obesity. Understanding the causes and effects of sleep deprivation is essential to improve sleep quality and overall health.

Caffeine and alcohol consumption

Caffeine and alcohol are two of the most widely consumed psychoactive substances in the world. While their adverse effects on sleep have been studied separately, their combined effects are less understood. A recent study published in the journal PLOS ONE is the first to examine how the use of both substances together affects overall sleep.

The study found that caffeine and alcohol consumed on the same day appeared to offset each substance's expected negative impact on sleep. This finding suggests that the sedating effects of alcohol and the psychoactive stimulant effects of caffeine may obscure each other's impact on sleep quantity and quality, respectively. This could potentially explain their interdependent use, with individuals using alcohol to counteract the reduced sleep caused by caffeine and vice versa.

Caffeine promotes wakefulness by blocking adenosine, a sleep-inducing chemical. It can make you fall asleep later and reduce the amount of deep, slow-wave sleep you get, which is critical for feeling refreshed the next day. The effects of caffeine typically begin within 30 minutes and may last up to five hours or longer. It is recommended to avoid caffeine at least eight hours before bedtime to ensure better sleep quality.

Alcohol, on the other hand, is a sedative that depresses the central nervous system. While it can help you fall asleep initially, it interferes with staying asleep and can lead to frequent wakings and overall low-quality sleep. Experts recommend avoiding alcohol at least three hours before bed.

It is important to note that while caffeine and alcohol may seem to aid sleep in the short term, their habitual use can lead to a cycle of self-medication, resulting in poor sleep quality and quantity. This cycle may contribute to continued substance use despite its negative effects on sleep.

Sleep disorders

• Insomnia: Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or getting enough sleep. It can be acute (short-term) or chronic (long-term), and can be primary (occurring on its own) or secondary (a symptom of another condition). Insomnia may be caused by stress, anxiety, depression, life circumstances, changes in routine or work schedule, caffeine consumption, or sleep hygiene practices such as napping during the day. About 10% of the world's population experiences insomnia that qualifies as a medical condition.
• Sleep Apnea: Sleep apnea is a disorder characterized by repeated pauses in breathing during sleep. It can affect people of any size and gender, and is often associated with obesity. Sleep apnea can be treated with lifestyle changes, such as sleeping on one's side or losing weight, or with the use of oral appliances or CPAP machines.
• Restless Legs Syndrome (RLS): RLS causes uncomfortable sensations and uncontrollable movements in the legs at night. It is more common in women and has been linked to an increased risk of heart disease and depression. Simple interventions such as exercise, hot baths, leg massages, and reducing caffeine and tobacco intake can help manage RLS.
• Delayed Sleep Phase Syndrome (DSPS): DSPS is a disorder where individuals fall asleep 2 or more hours later than what is considered normal (10 pm to 12 am), making it difficult to wake up in the morning. DSPS is more prevalent in young people, affecting about 7-16% of them, while about 1% of adults have this condition.
• Circadian Rhythm Disorders: These disorders occur when an individual's internal body clock, which regulates sleep and wake cycles, is out of sync. Jet lag and working night shifts are common causes of circadian rhythm disruption. Maintaining a consistent sleep schedule, even on weekends, and optimizing your bedroom environment for sleep can help.
• Mental Health Disorders: Sleep problems are often linked to mental health disorders, especially mood disorders. Anxiety disorders, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), depressive disorders, and substance use disorders can all contribute to sleep disturbances.
• Chronic Pain: Individuals with chronic pain often experience sleep interruptions or difficulty falling asleep. The link between chronic pain and sleep is bidirectional, meaning that a lack of sleep can also lead to increased pain and physical inactivity.

It is important to note that sleep disorders can have various causes, and a combination of factors may contribute to an individual's sleep difficulties. If you are experiencing persistent sleep problems, it is recommended to consult a healthcare professional for guidance and treatment options.

Mental health

Sleep and mental health are closely intertwined. A lack of sleep can have a detrimental impact on your mental health, and mental health issues can, in turn, affect your sleep.

The Impact of Sleep Deprivation on Mental Health

Poor sleep can lead to a range of emotional and cognitive issues. Research has shown that lack of sleep can cause:

• Increased irritability and mood changes
• Feelings of anxiety and depression
• Increased anger and aggression
• Difficulty interacting with others
• Impaired concentration and memory
• Poor decision-making and problem-solving skills
• Increased impulsivity, hyperactivity, and emotional outbursts
• Heightened stress and worry

Not getting enough sleep can also lead to severe sleep deprivation, which has been linked to the development of temporary psychotic symptoms, such as hallucinations and delusions.

People with mental health disorders are more likely to experience sleep problems. Insomnia, for example, is often a symptom of anxiety and depression. Additionally, sleep disturbances are common in trauma, pain, addiction, and bipolar disorder.

Bidirectional Relationship

The relationship between sleep and mental health is complex and bidirectional. While mental health issues can cause sleep problems, sleep deprivation can also contribute to the development and exacerbation of mental health disorders. Sleep problems can increase the risk of:

• Depression: Research has found that people with insomnia have twice the risk of developing depression compared to those without sleep issues.
• Anxiety: Sleep deprivation can contribute to feelings of anxiety and increase the risk of anxiety disorders, especially in children and teens.
• Post-Traumatic Stress Disorder (PTSD): Sleep deprivation is a common symptom of PTSD, affecting 80%-90% of people with the disorder, and it also plays a role in its development and maintenance.
• Bipolar Disorder: Sleep disturbances, including insomnia and irregular sleep-wake cycles, are common in bipolar disorder and can impact treatment outcomes and overall quality of life.

Breaking the Cycle

Given the bidirectional relationship between sleep and mental health, addressing sleep problems is crucial for maintaining overall health and well-being. Here are some tips for improving sleep:

• Establish a consistent sleep schedule: Try to wake up and go to bed at the same time every day, even on weekends.
• Create a relaxing bedtime routine: Engage in calming activities before bed, such as reading or meditating.
• Avoid screens before bed: Put away electronic devices at least an hour before bedtime.
• Exercise regularly: Avoid exercising too close to bedtime.
• Limit caffeine, nicotine, and alcohol: Refrain from consuming stimulants like caffeine and nicotine late in the day, and limit your alcohol intake.
• Maintain a comfortable sleep environment: Keep your bedroom cool, dark, quiet, and free of distractions.

Jet lag and shift work

Travelling across time zones can cause jet lag, a temporary sleep disorder that occurs when your body's internal clock is out of sync with the current time zone. Jet lag can cause excessive daytime sleepiness, nighttime insomnia, headaches, loss of appetite, gastrointestinal problems, and irritability or mild depression.

• Shift your schedule before travelling: Gradually adjust your sleeping habits and mealtimes to the schedule of your destination in the days leading up to your trip.
• Avoid caffeine and alcohol: These can cause dehydration, which worsens the symptoms of jet lag, and disturb sleep.
• Switch your bedtime: Try to stay awake until bedtime in the new time zone.
• Use sunlight to help you adjust: Morning sunlight can help you wake up earlier, while evening sunlight can help you stay awake later.
• Take melatonin: Melatonin is a hormone that signals to your body that it's time to sleep. Taking melatonin supplements can help shift your circadian rhythms.
• Use light therapy: Light therapy devices can expose you to bright artificial light, acting like natural sunlight to help align your body clock with your destination's time zone.
• Take medication: Sleeping pills and stimulants can help you sleep at night and stay awake during the day, respectively. Melatonin agonists can also help adjust your body clock.

Poor sleep habits

Another poor sleep habit is napping during the day, especially in the evening. Long naps and napping later in the afternoon can interfere with nighttime sleep, causing difficulty falling asleep and poorer sleep quality. Maintaining a consistent sleep and wake schedule is recommended, even on weekends, to promote a healthy sleep cycle.

Furthermore, underlying anxiety and stress can also contribute to insomnia. A racing mind and anxious thoughts can make it challenging to fall asleep. Setting aside time during the day to address worries and practising relaxation techniques before bed can help calm the mind and improve sleep.

Finally, physical activity and diet can also impact sleep. Regular exercise can improve sleep quality, but it is important to avoid high-energy aerobic exercise close to bedtime as it may be too energising. A heavy or spicy meal close to bedtime can cause discomfort and contribute to conditions like sleep apnea.

Addressing these poor sleep habits through sleep hygiene strategies and lifestyle adjustments can help improve sleep quality and duration.

Frequently asked questions