While You Sleep, Your Brain Works Overtime

Sleep is a necessity, not a luxury. It accounts for a significant portion of our lives, and its quality has a direct impact on our health and daily functioning. However, many people struggle with interrupted sleep or insomnia, and understanding the reasons behind this is essential for improving sleep quality and overall well-being. Various factors, including age, lifestyle choices, medications, and underlying health conditions, can disrupt sleep patterns and have both short-term and long-term consequences on our health.

Lifestyle choices

• Avoid caffeine close to bedtime: Consuming caffeine can provide an energy boost and make you feel more awake, but the effects can last for up to six hours. If you have a caffeinated beverage within six hours of your typical bedtime, it can disrupt your sleep.
• Limit alcohol consumption: While a nightcap may help you fall asleep initially, alcohol can disrupt your sleep later in the night and cause more trips to the bathroom. It also affects how long you spend in the REM stage of sleep, which is essential for processing emotional memories.
• Avoid heavy meals before bed: Eating a large meal within a few hours of bedtime can cause heartburn, making it harder to fall asleep and stay asleep.
• Limit daytime naps: Long naps in the afternoon or evening can make it harder to fall asleep at night.
• Avoid stimulating activities before bed: Activities that increase your heart rate or screen time right before bed can make it difficult to fall asleep.
• Establish a bedtime routine: Practicing good "sleep hygiene" can help normalize your sleep schedule. This includes going to bed and waking up at the same time each day, avoiding electronic devices at least two hours before bed, and keeping your bedroom cool, dark, and comfortable.
• Exercise regularly: Regular exercise can improve your sleep quality, but avoid exercising within an hour of bedtime as it may energize you too much. Morning workouts are ideal.
• Manage stress: Stressful events and high sleep reactivity can lead to greater sleep disturbances. Try relaxation techniques such as deep breathing exercises or meditation to calm your mind and body.
• Create a comfortable sleep environment: Ensure your bedroom is quiet, dark, and maintained at a comfortable temperature. Consider using a white noise machine or app to block out any disturbing noises.
• Limit fluid intake before bed: Drinking too many fluids before bed can lead to frequent trips to the bathroom, disrupting your sleep.

Medication

Many commonly prescribed medications can interfere with sleep. For example, heart medications such as alpha-blockers and beta-blockers can prevent you from getting deep, restful REM sleep and make you feel sleepy during the day. Beta-blockers can also lower your body's melatonin levels, causing you to wake up at night and experience nightmares. Antidepressants, corticosteroids, cholesterol medications, Alzheimer's drugs, stimulants, and asthma medications can also negatively impact sleep.

Over-the-counter drugs, such as cold and allergy medications, pain relievers, weight loss products, stop-smoking aids, and certain supplements, can also cause insomnia. For example, non-drowsy antihistamines, decongestants, and cough suppressants can induce anxiety or jitteriness, making it difficult to fall asleep. Additionally, pain medications, weight loss products, and stop-smoking aids often contain caffeine or other stimulants that can keep you awake.

On the other hand, certain medications can help treat insomnia and improve sleep quality. These include both prescription and non-prescription options:

• Prescription Sleeping Pills: These medications are designed to help you fall asleep and stay asleep. They include benzodiazepines, Z-drugs (such as zolpidem and eszopiclone), dual orexin receptor antagonists (DORAs), and antiseizure medications. However, it is important to use these medications with caution as they can be habit-forming and may have side effects.
• Sedating Antidepressants: Certain antidepressants have sedating effects and can help with sleep. Examples include doxepin, amitriptyline, and trazodone.
• Melatonin and Related Drugs: Melatonin is a hormone that helps regulate sleep. It is available in prescription strength and lower strengths over the counter. Synthetic drugs that work similarly to melatonin, such as ramelteon, are also available.
• Antihistamine Drugs: Antihistamines, commonly used to treat allergies, can also cause drowsiness and improve sleep. Diphenhydramine and doxylamine are examples of antihistamines that can aid sleep.

Tips for Better Sleep

• Establish a consistent sleep schedule, even on weekends.
• Avoid large meals, alcohol, and caffeine close to bedtime.
• Engage in relaxing activities before bed, such as listening to soothing music, reading, or meditating.
• Limit screen time and put away electronic devices at least 30 minutes before bed.
• Maintain a cool, dark, and quiet bedroom environment.
• Stay physically active during the day and get plenty of natural light exposure.

Age

Sleep requirements do not change with age. While it is a common misconception that older adults need less sleep, the truth is that they need just as much sleep as younger adults. The American Academy of Sleep Medicine recommends that adults aged 18 and over get seven to nine hours of sleep each night, and this does not change with advanced age.

However, older adults may experience changes in their sleep patterns and sleep experience. They tend to go to bed and wake up earlier than they did when they were younger. They may also have more fragmented sleep, resulting in poorer quality sleep and less total sleep overall. This can be due to a variety of factors, including medical conditions, medications, lifestyle changes, and changes in the body's internal clock.

Medical Conditions and Medications

Medical conditions such as pain, arthritis, diabetes, and heart disease can interfere with sleep. Older adults are also more likely to experience sleep disorders such as sleep apnea and restless legs syndrome. Additionally, older adults tend to take more medications, and the combination of drugs and their side effects can impair sleep.

Lifestyle Changes

Retirement, loss of independence, and social isolation can increase stress and anxiety, contributing to sleep issues. Retirement may also lead to a less structured sleep-wake schedule, disrupting an older adult's circadian rhythms.

Changes in the Body's Internal Clock

The body's internal clock is located in the hypothalamus and is made up of cells that form the suprachiasmatic nucleus (SCN). The SCN controls 24-hour daily cycles, called circadian rhythms, which influence when a person feels sleepy or alert. As people age, the function of the SCN deteriorates, disrupting circadian rhythms and affecting sleep patterns.

Sleep Tips for Older Adults

To improve sleep quality, older adults can try improving their sleep environment, maintaining a regular sleep schedule, reducing caffeine and alcohol intake, exercising regularly, and developing a bedtime routine that includes relaxing activities.

Chronic pain

Sleep and chronic pain are closely linked and impact each other. Chronic pain can make it difficult to fall asleep and stay asleep, leading to long night awakenings and poor sleep quality. This can result in feeling very tired in the morning and increased pain sensitivity the next day, creating a vicious cycle.

• Set a bedtime routine: Go to bed and wake up at the same time every day, even on weekends. Spend 30 minutes before bed doing the same calming activities in the same order, such as getting ready for the next day, showering, brushing your teeth, and reading a book. Avoid stimulating activities like watching TV or using electronic devices.
• Only sleep when you're tired: If you don't fall asleep within 30 minutes, get up and engage in a quiet, non-stimulating activity until you feel sleepy again.
• Create a sleep-conducive environment: Keep your bedroom cool, dark, and quiet. Reduce light exposure in the evening and increase sunlight exposure during the day. Avoid heavy, fatty, or sugary foods and caffeine close to bedtime.
• Exercise during the day: Even light exercise can improve sleep. However, avoid exercising within 2-3 hours of bedtime as it may interfere with sleep.
• Choose a comfortable sleeping position: Find a sleeping position that doesn't aggravate your pain. Consider investing in a supportive mattress and pillow.
• Practice relaxation techniques: Try relaxation techniques such as deep breathing, mindfulness, or guided imagery to calm your nervous system and reduce pain sensitivity.
• Seek professional help: If sleep difficulties persist, consult a doctor or a psychologist who can help with sleep management and underlying mood and anxiety issues.

Sleep disorders

There are numerous reasons why someone may experience sleep disorders, including lifestyle habits, medications, and physical or mental health conditions. For example, consuming caffeine or alcohol close to bedtime can disrupt sleep. Caffeine can provide an energy boost and its effects can last for up to six hours, while alcohol can affect the duration of the rapid-eye movement (REM) stage of sleep, which is essential for processing emotional memories. Napping during the day, especially in the evening, and engaging in activities that increase the heart rate or eating heavy meals close to bedtime can also impact sleep.

Chronic pain is another common cause of sleep disorders, creating a bidirectional link where chronic pain leads to difficulty sleeping, and lack of sleep increases pain duration and intensity. Mental health disorders, such as anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD), are also associated with insomnia. Stressful events and working night shifts can further contribute to sleep disturbances.

Additionally, certain medications can interfere with sleep. These include heart medications, over-the-counter allergy or cold medications, antidepressants, beta-blockers, and corticosteroids.

The impact of sleep deprivation goes beyond feeling tired and can affect various aspects of health. Sleep deprivation can lead to fatigue, low energy, mood changes, poor balance and coordination, forgetfulness, and increased risk of accidents. It also has negative consequences for cardiovascular health, metabolic health, brain health, and immune function. Sleep loss can contribute to weight gain, high blood pressure, heart disease, diabetes, and an increased risk of developing Alzheimer's disease and other cognitive impairments.

To address sleep disorders, it is important to identify and address the underlying causes. This may involve changing lifestyle habits, such as reducing caffeine and alcohol intake, improving sleep hygiene, and establishing a consistent sleep schedule. For those struggling with chronic pain or mental health disorders, seeking appropriate treatment can help improve sleep. Additionally, relaxation techniques, such as controlled breathing, meditation, and progressive muscle relaxation, can aid in falling asleep and improving sleep quality.

Frequently asked questions