Are you suffering from insomnia? Sleepless and stressed-out? Here are the likely culprits as well as 17 tips to help you get a good night’s sleep.
By Dr. Mel Borins, Family Physician and Author
You may not have realized how important a good night’s sleep was until you could no longer get one. It has been said that between 15-35% of adults have sleep problems and up to 50% of people over the age of 65 have sleep complaints. Many with chronic or continued insomnia report decreased feelings of well-being during the day – including decreased attention, energy, and concentration – and an increase in fatigue and malaise. This causes considerable impairment in social, occupational, and other areas of functioning. Chronic insomniacs also have 2.5 times more fatigue-related automobile accidents than good sleepers.
What Causes Insomnia?
Insomnia is usually caused by multiple factors. Problems with sleep onset, mid-cycle awakening and early morning awakenings are very commonly associated with depression, and it has been estimated that 80% to 90% of patients with major depression experience sleep difficulty. Persistently disturbed sleep may be in itself a risk factor for the development of depression and early treatment of sleep disturbance may prevent the onset of major depression. Of 70 patients with a recent heart attack, 39% reported having insomnia for two weeks or longer before their MI and 48% were depressed. Insomnia can also be related to an anxiety disorder, obsessive-compulsive personality disorder, schizophrenia, or another mental illness.
Insomnia Due to a Medical Condition
Conditions like thyroid disorders, heart failure, Parkinson’s disease, Dementia, and sleep apnea are associated with problems of insomnia. Sometimes viral and bacterial infections, coughing related to lung diseases, and pain from a musculoskeletal disease like fibromyalgia, arthritis, or even fractures can cause the beginning of disturbed sleep. Sometimes the sleep problem can continue even after the medical condition is resolved.
Alcohol, coffee, tea, chocolates, and soft drinks containing caffeine can aggravate insomnia. Some medications can also disturb sleep.
Substance-induced insomnia can occur during intoxication as well as during withdrawal from alcohol, amphetamines, cocaine, opioids, caffeine, sedatives, sleeping pills, and anti-anxiety medications.
Primary or psychophysiological insomnia is not related to another mental disorder, a physical disease, or substance abuse. People primary insomnia are often preoccupied with not being able to sleep or worry about falling asleep, and they often experience an improvement in sleep when away from their usual sleep environment. These people often have poor sleep hygiene (see “Help for Your Insomnia,” below), and negatively reinforced conditioning. The more the individual tries to sleep, the more distressed and frustrated the person becomes and the less able he or she becomes to sleep. Lying in bed feeling frustrated causes increased arousal and agitation.
I sometimes see patients who have experienced the death of a loved one, divorce, or some other major stressful life event that affects their sleep. They eventually get over the grief or stressful situation – but negative conditioning, heightened arousal, and negative associations can perpetuate insomnia after the original cause is resolved.
Circadian Rhythm Insomnia
- Night and rotating-shift workers have shorter sleep duration and more frequent disturbances than morning or afternoon workers.
- People who travel through many time zones especially eight or more time zones in 24 hours and those who travel far in an eastward direction by plane can suffer from jet lag.
- “Night owls” – people who delay going to sleep until the wee hours of the night – can have trouble getting to sleep at socially acceptable hours. They also have difficulty waking up when required and often say they need many alarm clocks scattered around the room to ensure they actually get up on time. This problem is common in teenagers.
Other Causes of Insomnia
People can also have difficulty with sleep if they have nightmares, sleep terrors, restless leg syndrome, need to urinate several times at night, or if there are environmental factors like noise, light, restless sleep partner, or crying-baby interruptions. Normal elderly people have greater difficulty falling asleep and staying asleep and their sleep is more shallow with more involuntary movements and abnormal breathing.
Psychotherapy or Counseling
Sometimes insomnia is associated with known traumatic life events. The loss of a loved one, loss of a job, marital and family breakups, losses related to accidents and operations, or a frightening medical diagnosis can cause grief and anxiety – and if those feelings are persistent and unresolved, they can lead to insomnia and clinical depression.
Counseling or psychotherapy can help to advance the recovery phase and stimulate new psychological strength and personal growth. Psychotherapy can focus on the feelings of resentment and anger that have been suppressed or turned back on the self as well as help resolve the guilty feelings, which are usually self- destructive.
Learning a progressive relaxation exercise to use at bedtime and using a tape, app, or listening to a relaxation podcast or online exercise very helpful in getting to sleep – and getting back to sleep if you wake up too early.
Help for Your Insomnia
Once your doctor has ruled out medical conditions as a cause of your insomnia, what can you do to stop those never-ending sleepless nights? Try following these Sleep Hygiene rules to reduce or even eliminate chronic insomnia.
- Keep a sleep diary. If you have difficulty getting to sleep because you review past unresolved problems or are pre-occupied with future planning then write your thoughts and feelings in the diary. Having the thoughts expressed on paper prevents them from being perpetuated endlessly in your mind.
- No heavy meals at bedtime. Limit fluids after six o’clock.
- Avoid stimulus before retiring. No fighting in the evening.
- Eliminate alcohol, caffeine, and recreational drugs completely.
- Increase the daily amount of exercise but leave at least four hours free of exercise before going to sleep.
- Use the bed for sleep and sex only, not for watching TV, doing work or reading. Don’t sleep elsewhere in the house.
- Go to sleep at the same time each night. If it takes longer than 20 minutes to get to sleep then get up and do something like a hobby or reading in dim light until you feel drowsy and then return to bed.
- If you wake up at night, remain in bed and relax. Let yourself fall asleep again. If you don’t fall back to sleep get out of bed and do some quiet activity in dim light. When you feel sleepy, go back to bed.
- Keep the hours of awakening consistent. No matter how bad the night’s sleep, have an alarm wake you up at the same time each day. Don’t oversleep. Apps like the Sleep Cycle alarm clock can help by tracking your sleep patterns and waking you during light sleep – which feels like awakening naturally without an alarm clock.
- Keep your clock turned away from you so you don’t watch the minutes and hours tick by.
- Download a guided audio – such as Relaxation Exercise, a simple-to-use auditory session designed to help you achieve deep relaxation – or a relaxation app – such as Calm – to help you learn to banish nagging thoughts and let go of physical tension before trying to sleep. Practicing a relaxation exercise is an important tool to quiet your active mind and relax your physical body.
- No naps during the day. Go out for a walk instead.
- If you work a swing or night shift, stay with your regular sleep-wake schedule as closely as possible.
- Develop bedtime rituals. e.g., Lock the doors. Brush your teeth. Wash your hands and face. Get into pyjamas. Set your alarm. Turn off the lights. Perform relaxation exercise or listen to a relaxation app. etc.
- Eliminate noise by soundproofing, or wearing earplugs. Set the temperature at an ideal condition for you. Make sure your bed and pillow are comfortable.
- No one died from not sleeping but many people make themselves sick by worrying about not sleeping.
- No screen time at least an hour before bed. No TV, cell phone, tablet, computer, or video game exposure. Unless you’re using a sleep app, leave your cell phones and tablets in another room when you go to bed. Modems and other electrical devices should be placed outside the bedroom as well.
Dr. Mel Borins is a family physician, public speaker, author, travel writer based in Toronto, Canada. He is the author of the books Go Away Just for the Health of It, An Apple a Day: A Holistic Health Primer, and A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t and Why. www.melborinscreative.com.
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