Sleep Part 4- What can get in the way of our ZZZZZs

By Pete

 

There are so many reasons why people struggle to sleep.

What follows is a list of common things that make it harder to get to, or stay, asleep. Sadly it reads a bit like a list made by the fun police!… but these things are important to consider in the context of what you can do to improve your sleep.

 

Environment

This can make a massive difference. Having light in your sleeping space and having your room too hot or cold can make it harder to get to or stay asleep. Noise and smell are other biggies in terms of sleep disruption. Tech in your bedroom (telly, tablet, laptop etc) – especially devices that emit lots of blue light can reduce melatonin release and therefore stop you getting to sleep.  Poor or uncomfortable (too soft / hard) mattresses can be problematic. Also (sorry pet lovers) but pets can often disrupt our sleep if they sleep in our bedrooms.

 

Not winding down

Working, exercising or just generally being engaged in any task that’s not relaxing just before we bedtime can disrupt sleep and also make it hard to get to sleep.

 

Routine

Getting up too early or too late can be problematic as can going to bed at different times every day. Even though it can be tempting, especially when we’re really tired, sleeping during the day (napping) can disrupt the sleep we get at night – although there is some evidence that regular sleeping such as siestas (same time, length etc) can be helpful. Working shifts or nights (especially when this effects the amount of exposure you have to natural light), or having to sleep in different places can also be problematic.

 

Illness

Being in pain or having a physical health condition that affects your sleep (like apnoea or snoring) can negatively impact on your sleep. These can often result in it being harder to get to, but also stay, asleep.

 

Drugs

Most illicit drugs have a negative impact on our sleep, for example:

  • Cannabis – Although some people report using cannabis to induce sleep, tetrahydrocannabinol (THC - the main agent in cannabis), reduces the length of REM sleep.
  • Amphetamines (e.g. speed) - Artificially stops sleep. Can also cause are anxiety and insomnia following initial effects.
  • Cocaine and crack cocaine –Cocaine has been shown to negatively affect circadian rhythm. This drug can also result in a type of hypersomnia (oversleeping) called "cocaine-induced sleep disorder."
  • MDMA – Artificially stops sleep.

 

Medication

This is another big topic and if you are on medication it is definitely worth speaking to your GP about how it might affect your sleep. That said, here are some common drug classes that can influence our sleep …

  • Nonbenzodiazepine such as eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien) are commonly used as sleep aids prescribed by doctors but can result in lethargy. They have also been linked to depression.
  • Benzodiazepines are commonly used sleep aids as well, though benzodiazepines have been found to decrease REM sleep and increase risk of sleep apnoea. Dependency is also common if taken for an extended period. However, taken in the short term, they can help break habits.
  • Antihistamines, such as diphenhydramine (Benadryl) and doxylamine often can make you drowsy but decrease sleep quality. However, there is research that people with Chronic Fatigue Syndrome have too much histamine and therefore antihsitamines can help sleep.
  • Barbiturates cause drowsiness and have actions similar to alcohol in that they have a rebound effect and inhibit REM sleep, so they are not used as a long-term sleep aid.
  • Psychiatric medication can have a profound impact on sleep. For example, common side effects in antidepressants include insomnia, oversleeping and disturbed sleep.

 

Alcohol

There’s tons of research on this. Alcohol is a sedative and will often initially encourage sleep. However, consuming alcohol can lead to disrupted sleep, because alcohol also has a rebound effect later in the night (which often results in waking or disturbed sleep). People tend to wake in the early hours because the alcohol wears off (not to mention the urge to pee!) and causes our rhythm to try and return to ‘normal’. Also alcohol reduces REM sleep and so you can’t just blame the late night and hangover on feeling crap the next day – you’ve had poor sleep too!

Top tip, if you are drinking, try to get the alcohol metabolised before bed!

 

Caffeine

Caffeine is a stimulant that slows the action of the hormones in the brain that cause somnolence (sleepiness). Therefore, it can interfere with you falling asleep and prevent deep sleep. If caffeine is consumed (energy drinks, coffee, tea etc) it can still be effective in some way for up to 24 hours! The half-life for caffeine is 4 hours, so if you have your last cup at 5, there is still half of it in your system at 9pm.

 

Smoking

Tobacco consumption has been found to make it harder to fall asleep, cause frequent waking and reduce total sleep time. Research also shows that smokers describe more daytime drowsiness than non-smokers.

 

Food & Nutrition

Simply put, when you eat and what you eat matters!

Let’s start with what you are eating. Nutritional choices affect sleep duration and quality. Although it is difficult to suggest an ‘ideal’ diet for sleep generally, a varied diet containing fresh fruits and vegetables, low fat proteins and whole grains are thought to be best for sleep promotion. High carb meals before bed can promote sleep – as can kiwis!!

And now we get to sugar! When we eat sugar, our kidneys try to get rid of it, so we urinate. So, we have to get up a lot at night, which results in us feeling tired. What do we do when we're tired during the day? Eat more high energy foods such as sugar = big fat vicious cycle. Doh!

In terms of when we eat, too much food before going to bed – particularly late at night – can also disrupt sleep patterns.

 

Physical activity

A lack of exercise has been shown to correlate with poor sleep, reduced tiredness at night and disturbed sleep… but as mentioned above, exercise too close to bedtime can also be problematic!

 

Overtiredness

Irritatingly, if we are overtired it can also make it harder to get to sleep. All the more reason to get that routine down!

 

Stress / Work / Life!

I’m sure everyone has had that experience. You know the one where your brain just refuses to be quiet when you’re trying to get off to sleep?! Work and life stresses can often mean we are left ‘stressed out’ when we are trying to go to sleep.

Equally, there are things in our lives that sometime just get in the way of our sleep no matter how well we try to manage them.. I’m thinking babies, bereavements etc…

 

Previous experiences

If we have difficulties or aversive experiences when sleeping (e.g. struggling to get to sleep or night terrors) it can naturally increase concerns about going to sleep and therefore impact on your sleep and sleep quality.

 

Trauma

It is common in Posttraumatic Stress Disorder (PSTD) that people will experience flashbacks and vivid nightmares / terrors. This can be extremely distressing and can increase reluctance to sleep.

 

Mental health difficulties

As I’m sure you can imagine there is a close relationship between sleep and mental health. Sleep has an effect on us all in terms of mood, anxiety, emotional regulation etc. and over an extended period poor sleep can negatively impact on our mental health. For example:

  • Physical fatigue can make it harder to do everyday tasks which can negatively impact on our self-esteem and also potentially lead us towards being more socially isolated.
  • If you don’t get enough sleep or if your sleep is disturbed for a long time, there is evidence to suggest it can increase the likelihood of experiencing low mood and anxiety. Simply put, our ability to cope with stress/emotions is massively reduced if we don’t have enough sleep.
  • A substantial lack of sleep can trigger mania, psychosis and paranoia where people have experience ‘psychotic’ disorders or Bipolar affective disorder.

 

Onwards and upwards!

I’m aware this part of the blog has been a bit of a ‘downer’ but I thought it was important to be really honest about the number of things that can impact on all of our sleep. We’ll talk a lot about what you can do to manage and change some of these in the last blog of the series but if you are worried about your sleep you might want to consider contacting a professional such as your GP or one of the team at Avenue Therapies to think about what you might be able to do to help.

 

What’s in the next blog?

In the next blog we’ll focus on what can be helpful to promote a solid 40 winks… There are loads of things you can do and many of them are obvious developments from the things that we have identified here (e.g. create a routine, avoid stimulation before bed, increase coping strategies).

 

References & further reading

American Psychological Association – http://www.apa.org/topics/sleep/index.aspx

NHS Live Well - http://www.nhs.uk/LiveWell/sleep/Pages/sleep-home.aspx

(American) National Sleep Foundation - https://sleepfoundation.org/

Mind (charity) - http://www.mind.org.uk/information-support/types-of-mental-health-problems/sleep-problems/

Pinel, J. P. (2011). Biopsychology. Boston, MA: Pearson.