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“Why Can’t I Sleep At Night?”

The 11 Question Quiz that Will Uncover Why You Are Having Trouble Sleeping and What You Can Do About it

Why Cant I sleep at night - Woman on Bed

GRUMPY, SNAPPY AND EXHAUSTED by day?

Suffering from sleepless nights? Can’t get to sleep? Disturbed wakeful sleep? Wake up far too early – and still feel tired. You are not alone!

While about 40 million Americans suffer from and inability to get a good night’s sleep at some time in their lives, it is perfectly normal to have the occasional restless night. Some people panic, and lie awake fretting – but for others, the quiet time for themselves, in a warm cosy bed, can be a delight.

But if the lack of sleep is affecting your life – then it requires further attention. And the first thing to do is figure out, why you aren't getting the sleep you should be

Just as there are many causes for lack of sleep, so there are many ways to deal with it. The difficulty lies in finding what works for you.

We have listed a series of questions – the answers you give will direct you to successful ways to sort out your sleeping and get the night’s sleep you need.

The 11 Question Quiz

1 – Does Your Bedroom Promote Sleep?

  • Would you describe your bedroom as ‘restful?
  • When was the last time you replaced your mattress, bed coverings and pillows?
  • Do you look forward to going to your bedroom at night, or would you rather be somewhere else?
  • Does closing the blinds/curtains in your bedroom create total darkness?

Feeling cluttered, disorganized or uncomfortable in your bedroom can really hinder your sleep.

Although you are asleep and you may not think you notice your bedroom, it does make a difference to your quality of sleep

Setting up your bedroom as a place you want to go at night is important. It may sound like a lot of money for no particular gain, but feeling positive about where you sleep is very important.

Having a bedroom that promotes sleep means:

  • It is close to if not in total darkness
  • A good mattress that is less than 7 years old
  • Good sheets and pillows not more than 2 years old
  • A color scheme that is relaxing and restful

Man using his mobile phone in the bed

2 – Do You Have A Poor Sleep Routine?

  • Are you glued to your phone, video games console or computer before bed?
  • Do you drink coffee, tea or alcohol near bedtime?
  • Do you eat a heavy meal before trying to sleep?

Having your brain working overdrive from too much stimulation or energy before bed is an easy way to fall into sleeplessness

Your brain gets ready for sleep throughout the whole day, but night time is very important. The conditions inside and outside of our heads needs to be conducive to sleep , otherwise it wont happen

Stimulants and over excitement should be avoided at least 2 hours before bed time.

These things do affect the length and quality of your sleep so it is important to pay attention to them

3 – Are You Overly Anxious Nervous or Stressed?

  • Are you nervous, highly strung or anxious?
  • Are you under a lot of pressure: work or home?

To treat the sleeplessness associated with stress means making lifestyle changes – you have to believe you are worth taking a little time over. If you are able to do this, your sleep will improve and your daytime efficiency will also improve.

It is also important that when we go to sleep we don't have things racing around in our mind. Although there are some things biologically that can help prevent ‘overthinking' at night, it is important to do what you can during the day

For example, if you are worried about a particular issue, try to deal with it that day if possible, rather than next day when you are thinking about it all night

Why Cant I Sleep at Night - Anxiety and Stress

Biologically what happens when we are stressed

The stress hormone, cortisol, is produced by your adrenal gland, close to your kidneys.

The adrenals respond to signals from the brain which involves neurotransmitters. These are chemicals produced by the brain to enable the nerve endings to interact with other nerve endings and so carry an action along the nerves to other organs on the body. When these are in disarray, so other hormones, like cortisol, are also affected.

When you are in danger the level of cortisol rises, and when the danger goes away the levels should fall. Unfortunately, in our busy, busy lives, the stress may continue, and the cortisol levels never really fall.

More on how to lower your cortisol level here

4 – Are You Depressed?

  • Are you suffering from depression?

Sleep problems and depression have an intertwining relationship. Lack of sleep may make depression worse, and depression may make sleeping difficult. Yet research into sleep patterns are finding that sleep deprivation may be a treatment option for people with depression. This should be medically supervised to reduce the risk of making matters worse.

A random survey of 24,686 individuals in Japan were surveyed in the year 2000. They found that people who slept between 6-8 hours per night were less likely to be depressed. [1]

Other studies have looked at sleep deprivation as a way to help depressed patients. One study resulted in a 57.9% improvement in depression following total sleep deprivation – but partial sleep deprivation is better tolerated – and may be as effective. Oddly enough, done correctly, having less sleep can improve depression! [2]

Another study showed that people with endogenous depression (as opposed to neurotic depression) responded favourably to one night’s sleep deprivation. [3]

Research is on going. The actual quality of sleep is being measured – the cycles or REM (rapid eye movement) and Non Rem sleep are different in people with depression. It seems that the first period of non REM sleep shows the greatest specific deviation and in time, no doubt treatments to help depressed patients get better sleep will come of this research. [4]

However, if you are depressed you need to see your doctor and discuss sleeping issues with him. A change in medication may be advised.

medicine_intake

5 – Are You Currently Taking Drugs and Over the Counter Medications?

  • Are you taking any drugs: prescription or over- the-counter?

If you are taking prescribed medication and you can’t sleep discuss it with your doctor. It is more likely to be the underlying illness that is keeping you awake.

If you take vitamins or over the counter remedies, also see your doctor. Some of them may be helpful, but others- even popular ones like St John’s Wort, can have very serious side effects and it also reacts with many other medications you may be taking. But in the right circumstances St John’s Wort can help you get to sleep especially if you are depressed. [13] [14]

6 – Do You Suffer From Restless Leg Syndrome?

  • Do you wake up at night to your arms and legs moving?
  • Do you move your legs and arms often in bed?
  • Do you sometimes feel uncomfortable sensations in your legs?

People suffering for restless syndrome (RLS) have an almost irresistible urge to move their legs – less often arms or torso. This may be accompanied by an unpleasant feeling in the legs. It can be difficult to fall asleep and may people are woken up by repetitive jerky movements.

Between 4% and 15% of adults may be affected in the west, and RLS is associated with many immune conditions. These include Parkinson’s, Crohn’s Disease, multiple sclerosis, diabetes, Alzheimer’s and depression. [7] [8]

But there are some simple things you can do to alleviate the symptoms of RLS

Mild exercise in the evening or late afternoon may help – but not too close to bedtime. Some people find a hot shower beneficial – or a relaxing bath. Also getting up for a short while and doing something you really feel involved in if you just can’t get to sleep.

If you have medicines for restless leg syndrome– make sure you take them just BEFORE the usual time of onset of symptoms. Also, it is worth going over your drug schedule with you doctor as some medications can make matters worse.

Alcohol, caffeine and nicotine all have an adverse affect on RLS. Cheese and tomatoes contain high quantities of tyramine, which can also make matters worse. Even antihistamines – a common remedy for sleeplessness, may do so.

7 – Do You Suffer From Sleep Apnea?

  • Does your partner complain about you snoring/sleeping or even choking at night?
  • Do you wake up in the morning with a headache?

This common disorder happens when your breathing passage is partly or completely blocked while you are asleep. It can happen over 30 times an hour and last from a few seconds to minutes. Typically, there is a loud snort as normal breathing resumes.

Because you are asleep, you may not realize you have it – it’s the long- suffering partner who realizes. However, because of the poor quality of sleep you are likely to feel tired in the day time. Sometimes this happens to children with very large tonsils.

A less common form of sleep apnea – central sleep apnea can happen when your brain doesn’t send the right signals to you breathing muscles. It is commoner in some medical conditions and when taking certain medicines.

Once diagnosed there are various treatments to be tried – and risks if untreated.

8 – Is Your Schedule Hindering Your Sleep?

  • Do you exercise regularly?
  • Do you indulge in daytime naps?

Our body has been finely tuned over the course of thousands of years to a schedule. The ‘day wake, night sleep' schedule is as much apart of us as any other.

The schedule also means that there is peak times for things during particular times. One of those is exercise. Exercising during the day helps use our energy and prepare us for sleep

Sleeping during the day can have the opposite affect of what our schedule wants.

If you are caught out of your regular wake/sleep schedule then it can take some time to get it right. But exercising regularly during the day and avoiding naps if possible is the best way to get your proper sleep schedule back

Why Can't I Sleep At Night - Pain

9 – Is Pain Keeping You Awake?

  • Are you in some type of constant pain/uncomfortableness?

First – check it out with your doctor or physiotherapist. You may need medication, either to relieve the pain at bed time or simply to alter the time at which you are advised to take your medication.

Be aware that many analgesics require you to take food at the same time to avoid stomach ulcers and acid reflux. Or you may need a different mattress or pillow, or propping up to avoid reflux.

Low vitamin D levels?

If you suffer from long standing pain, and have low Vitamin D levels, then Vitamin D will help you sleep better – but get your levels checked before taking supplements as too much can have adverse effects. [5] However, the actual dosage needed still needs to be clarified. [6]

For a detailed guide on Vitamin D and sleep – go here

GABA

GABA (Gamma-amino-butyric-Acid) is one of the brain neurotransmitters. Its effect is to calm the brain, making one feel relaxed and at peace. It would be so nice to just take GABA pills, but there is a problem. GABA cannot be absorbed from your bloodstream into the brain. It cannot cross the blood brain barrier.

To overcome this, doctors have prescribed benzodiazepines, which activate GABA receptors in the brain. Sadly, because of their addictive qualities, not only do they not work after a period of time, but it is difficult to stop taking them.

For more information on GABA and sleep – see our 3 part series here

 

Why Cant I Sleep at Night - Medical Condition

10 – Do You Have Any Existing Medical Conditions?

  • Do you have any existing medical conditions?
  • When was the last time you got a check up?

Your own doctor has to be your first port of call. But he can only help you if you tell him exactly how your illness if affecting your sleep. Sounds obvious – but many people feel shy about “wasting” the busy doctors time with sleep problems. A simple example – but not uncommon – is the patient taking pills to reduce swelling. The pills make them urinate more often, but some patients take the pills in the evening – and then need to get up during the night.

Even more common is the worry that may go with illness. This can keep you awake, and discussing your fears with your doctor, or a referral to some kind of counselling may be very beneficial.

Pain, headaches and stomach problems need and deserve individual advice from your doctor – so write down exactly how you are not sleeping and then discuss it with your own doctor.

Doctors are a little reluctant to prescribe sleeping pills as the old standbys – benzodiazepines were addictive. However, antihistamines have been shown to relax you and may be a temporary solution. You can buy these over the counter, and are popular and safe in correct dosage, and may cause daytime drowsiness which is a driving hazard. [11] [12]

More detail about antihistamines and sleep here

11 – Are You Sleeping Irregular Hours?

  • Do you work shifts or irregular hours?
  • Do you travel across time zones frequently?

We have a natural rhythm inside us which keeps very roughly to 24 hours – and daylight and night darkness make this feeling stronger. When we disrupt the natural order of things, then we may find it hard to sleep.

The lighting is also important, it has been shown that the bright “daylight” bulbs may upset our won inborn circadian rhythms, and especially blue light may make it harder to get to sleep

Night workers may benefit from cutting out blue light – but so far the use of goggles to do this has not been convincing – although there are people who find them helpful.

A Note on Waking Up Through the Night

If you do wake during the night – can you get back to sleep?

It is not uncommon to wake during the night. Maybe our ancestors need to check on things during the night. But frequent night time wakening can be exhausting.

Some people find a relaxation technique may help. But if you wake up at least 3 times a week, it’s been going on for longer than 30 days and it takes you longer than 30 minutes to get back to sleep, you may wish to consult your doctor in case there are other preventable causes.[15]

Summary

There are many ways to help yourself get to sleep, but above all, don’t panic. You can try the methods here, you can probably think up some just for you, and when necessary, don’t be afraid to “bother” your doctor.

References

[1] MDJ Clin Psychiatry 2006;67(2):196-203

The Relationship Between Depression and Sleep Disturbances: A Japanese Nationwide General Population Survey.

Yoshitaka Kaneita, MD; Takashi Ohida, MD; Makoto Uchiyama, PhD; Shinji Takemura, MD; Kazuo Kawahara, MD; Eise Yokoyama, MD; Takeo Miyake, MD; Satoru Harano, MD; Kenshu Suzuki, MD; and Toshiharu Fujita,

[2] J.Christian HYPERLINK “http://www.sciencedirect.com/science/article/pii/0278584683901239” HYPERLINK “http://www.sciencedirect.com/science/article/pii/0278584683901239” HYPERLINK “http://www.sciencedirect.com/science/article/pii/0278584683901239” HYPERLINK “http://www.sciencedirect.com/science/article/pii/0278584683901239” HYPERLINK “http://www.sciencedirect.com/science/article/pii/0278584683901239” HYPERLINK “http://www.sciencedirect.com/science/article/pii/0278584683901239″Gillin Special topic: Clinical mode of action of antidepressants: New advances

The sleep therapies of depression Progress in Neuro-Psychopharmacology and Biological Psychiatry Volume 7, Issues 2 HYPERLINK “http://www.sciencedirect.com/science/journal/02785846/7/2″– HYPERLINK “http://www.sciencedirect.com/science/journal/02785846/7/2″3, 1983, Pages 351–364

[3] Pflug, B.; Tolle, R. Disturbance of the 24-hour rhythm in endogenous depression and the

treatment of endogenous depression by sleep deprivation. International Pharmacopsychiatry, Vol 6(3), Dec 1972, 187-196.

[4] Reynolds, Charles F.; Kupfer, David J Sleep: Sleep research in affective illness: State of the art circa 1987. Journal of Sleep Research & Sleep Medicine, Vol 10(3), Jun 1987, 199-215.

[5] Huang, Wei MD, PhD; Shah, Shivani DO; Long, Qi PhD; Crankshaw, Alicia K. MD; Tangpricha, Vin MD, PhD. Improvement of Pain, Sleep, and Quality of Life in Chronic Pain Patients With Vitamin D Supplementation. Clinical Journal of Pain: April 2013 – Volume 29 – Issue 4 – p 341–347

[6] Grandner, M. et al. Sleep symptoms associated with intake of specific dietary nutrients. Dietary nutrients and sleep, 2014.

[7] Hoek PD1, Smits MG, de Roos NM, Rijsman RM, Witteman BJ Increased prevalence of restless legs syndrome in patients with Crohn's disease. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):951-5. doi: 10.1097/MEG.0000000000000386.

[8] Weinstock LB1, Walters AS, Paueksakon P, Restless legs syndrome–theoretical roles of inflammatory and immune mechanisms. Sleep Med Rev. 2012 Aug;16(4):341-54. doi: 10.1016/j.smrv.2011.09.003. Epub 2012 Jan 17.

[9] http://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side

[9] Irina V. Zhdanova, Richard J. Wurtman, Aygul Balcioglu, Alex I. Kartashov, and Harry J. Lynch Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology. Endogenous Melatonin Levels and the Fate of Exogenous Melatonin: Age Effects] Journal of Gerontology: BIOLOGICAL SCIENCES 1998, Vol. 53A, No. 4, B293-B298 Copyright 1998 by The Gerontological Society of America

[10]Cochrane Database Syst Rev. 2002;(2):CD001520. Melatonin for the prevention and treatment of jet lag.

[11] Krystal AD1, Richelson E, Roth T.Review of the histamine system and the clinical effects of H1 antagonists: basis for a new model for understanding the effects of insomnia medications. Sleep Med Rev. 2013 Aug;17(4):263-72. doi: 10.1016/j.smrv.2012.08.001. Epub 2013 Jan 26.

[12] Vande J, Griend JP1, Anderson SL.Histamine-1 receptor antagonism for treatment of insomnia. Am Pharm Assoc (2003). 2012;52(6):e210-9. doi: 10.1331/JAPhA.2012.12051.

[13] Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial.Hypericum Depression Trial Study Group. JAMA. 2002 Apr 10;287(14):1807-14

[14] Common herbal supplement can cause dangerous interactions with prescription drugsDate: June 30, 2014 Wake Forest Baptist Medical Center

[15] National sleep foundation and Havard medical school education

DISCLAIMER: This web site does not take the place of your usual medical practitioner, it is intended to give information only and not to diagnose or provide medical treatment. It cannot cover all possible uses, interactions and adverse side effects. If you are at all worried about your health - please see your own doctor. Do not delay this as a result of anything you may have read about on the web. Many symptoms can result from a variety of causes, some may require specialist diagnosis and treatment. You should also consult your medical practitioner before taking any supplements as some of them may react with essential medicines or have harmful side effects.