Why You Can’t Sleep & What to Do About It
Why You Can’t Sleep & What to Do About It
- The number of hours of sleep has decreased 20% over the last 100 years.
- Fifty to seventy million Americans suffer chronically from difficulty sleeping.
- If you take medications, speak with your doctor to learn if they might be disturbing your sleep.
- Natural approaches to sleep may help you finally get the rest you need.
by Dr. John Neustadt
About a third of our lives are spent sleeping, so it’s not surprising that something we spend so much time doing effects every aspect of our lives. Sleep is required for learning new tasks; immune function, creating a healthy, positive mood; having enough energy to do everything we want; for cardiovascular and neurological health; for communicating effectively by improving word recall and memory. And so much more.
But despite the importance of sleep, us humans seem are doing a pretty bad job of getting enough. The number of hours of sleep has decreased 20% over the last 100 years. One major reason for this is the invention of the lightbulb. Previously when it was dark, it was time for bed. There wasn’t a way to simply flip a switch and have as much light as we wanted. And as I discuss further down in this article, technology (computers, smartphones and tablets) are causing even more problems with our sleep. The bottom line is that the on average Americans are getting less than 7 hours of sleep per night when sleep studies have shown that the optimal amount of sleep for adults is 8 hours. And while one hour might not seem like a lot, the cumulative impacts of chronic sleep deprivation are deadly.
Each year $16 billion is spent on medical care related to sleep problems. And twenty percent of all car crash injuries are associated with driver sleepiness. Driver impairment after sleep deprivation is comparable drunk driving.
Not surprising to anyone should be the fact that people with poor sleep are tired during the day. Poor sleep causes depression, increases anxiety and stress, makes it hard to cope with the demands of work and family, and decreases your ability to complete tasks. Sleep deprivation also effects your ability to pay attention, think and process information; impairs memory; and makes it harder to find the right words. And if that weren’t enough, studies show that poor sleep reduces your quality of life as much as congestive heart failure and major depression.
The problem is poor sleep is at epidemic levels. Fifty to seventy million Americans suffer chronically from sleep disorders. The most common cause of sleep disturbance is insomnia, which affects 10-15% of people. However, it’s important to understand that the technical diagnosis of insomnia requires someone to report that they’re having problems for 3 weeks. But many more people suffer from short-term insomnia that health insurance companies don’t recognize as a diagnosable issue. Up to 80% of people suffer from insomnia lasting 2 weeks or less. And in primary care medical settings, approximately 80% of patients report problems with sleep. Sleep apnea affects about 10% of people and up to 15% of people have periodic leg movement disorder or restless leg syndrome (RLS).
More Isn’t Always Better
While getting too little sleep can be devastating, getting too much sleep also isn’t good. The sweet spot for sleep is an average of about 8 hours per night. People who are short sleepers (< 6 hours per night) have double the risk for high blood pressure. Short sleepers and long sleepers (> 9 hours per night on average), however, are both at increased risk for metabolic syndrome and diabetes. And men who are short sleepers have four times greater risk for dying early.
Your Sleep Cycle Clues
What happens to our bodies during the night while we sleep is called sleep architecture. Healthy sleep progresses in predictable stages. When deciding what might be helpful for someone with insomnia, understanding sleep phases can provide clues about what might help.
- Sleep latency. This is the amount of time to fall asleep. Adults with healthy sleep will fall asleep in 30 minutes or less. As we get older, the time it takes increases, so that for folks 50 years or older it can take up to 45 minutes. People who have difficulty falling asleep may benefit from the nutrients melatonin, magnesium, glycine and L-tryptophan.
- Non-REM sleep. REM stands for Rapid Eye Movement. You may have seen people asleep who’s eyes are moving back and forth as they sleep. That’s REM and it occurs during dreams. Non-REM sleep typically takes up 75 to 80% of the total time of sleep. And within Non-REM there are different stages of sleep. Stage 1 and 2 are lighter sleep stages when the person is easily woken up by noise. Stages 3 and 4 are the deepest stages of sleep, when it’s hard for people to wake up. That’s where sleep helps improve memory. These are refreshing stages of sleep. If you wake up and don’t feel refreshed in the morning, you may not be falling into the deep, restorative stages of sleep.As we age, we tend to spend less time in the restorative sleep stages and tend to experience more insomnia and less refreshing sleep. That alone is a stress on the body that can cause people to have even worse sleep. Other causes of stress, such as financial stress, post-traumatic stress disorder (PTSD) and relationship issues can also cause you to wake feeling unrefreshed. That’s because stress in any form can causes people to sleep lighter (not get into deep phases of sleep) and wake up easier during the night.In situations, stress reductions techniques such as exercise and meditation are helpful. Nutrients such as magnesium, glycine, GABA and adaptogenic herbs as part of a sleep formula that provides support for all stages of sleep can also help.
- REM sleep. REM is about 20 to 25% sleep. This is where you dream, which helps you process emotions and experiences. For men, REM sleep is also where they experience erections. While there are multiple potential causes for this, if a man is able to have erections while awake, but doesn’t seem to every have them during the night while he’s sleeping, then he may not be reaching the REM sleep stage.
Unfortunately, in our uber-stimulated world of 24 hour television and computers, people taking medications (up to 70% of people are taking at least one medication) and high levels of stress, people’s sleep is worse than ever. Here are some of the biggest sleep destroyers and what you can do to about them.
More than 70% of adults now own a smartphone or tablet computer. Those incredible little devices have revolutionized our daily lives. At the touch of a button you can learn about anything in history you want, or about a symptom you may be having, or natural approaches to the cold or the flu. It’s in the palm of your hand, day or night.
But these little screens have become one of the biggest disruptors to our sleep since the invention of the artificial light bulb. The light emitted from the screens deplete melatonin. Melatonin is responsible for helping you fall asleep. Therefore, if you’re using a smartphone or tablet computer in bed before you go to sleep, you may be inducing your own insomnia. A 2015 study published in the Proceedings of the National Academy of Science had healthy adults read ebooks from their devices before bed for five nights before bed. A comparison group read good old-fashioned print books.
What they discovered was that melatonin decreased by 55% in those using the electronic devices. That’s a huge decrease. But even more importantly, the impact it had on their sleep and daytime functioning was devastating. Their entire sleep cycle was thrown off. Not only was melatonin depleted, the brain’s own rhythm for releasing melatonin was shifted by 1.5 hours later in the night. That resulted in people staying awake later and having a harder time falling asleep. It took them 10 extra minutes on average to fall asleep, but for some people it took them up to an hour longer to fall asleep.
And once they finally fell sleep, their sleep quality was worse. They had less REM (dreaming) sleep and woke up less refreshed in the morning. If that wasn’t bad enough, they’d wake up feeling groggy and it took them hours longer in the morning to feel completely alert and awake. Reading print books didn’t cause any problems, but the e-readers wreaked havoc on their sleep. For more information on technology and its health impacts, read Three Ways Smartphones are Ruining Your Sleep and Relationships.
Fitbit creates wearable activity monitors. Because devices’ popularity, the company can access to an amazing amount of data. Fitbit did a study of six billion data points generated by its customers. It was the largest data analysis in the history of sleep science. The biggest finding was the link between sleep quality and sleep consistency. That is, they discovered that going to bed at the same time every night is the biggest predictor of sleep.
Frequently people will go to bed at roughly the same time during the week. But when the weekend comes they go out with friends, stay up watching television or hit the bars. On the weekends they’re staying up later and sleeping less. If somebody goes out on a Friday night, and then they go out again on Saturday and they’re up until 12:00 or 1:00 or 2:00 in the morning, their training their bodies that bedtime is later.
When Sunday roles around and they try to go to sleep earlier because they have work or school the next day, many people had problems falling asleep. They had created their own insomnia. It’s as if they took an airplane to a different time zone and have jet lag, but this jet lag was caused by their social life, a phenomenon Fitbit called social jetlag. Sleep consistency, going to bed every night and training the body when it’s time to go to sleep, is crucial high-quality sleep.
Medications that Cause Insomnia
Many medications effect sleep and create insomnia and other sleep disorders. If you’re taking medications and experiencing difficulty sleeping, increased daytime fatigue or decreased mood, check with your pharmacist or healthcare provider to see if the prescriptions might be creating the problem.
Some of the most commonly prescribed drugs with these side effects are:
- Beta blockers. These drugs include Acebutolol (Sectral), Atenolol (Tenormin), Bisoprolol (Zebeta), Metoprolol (Lopressor, Toprol-XL), Nadolol (Corgard), Nebivolol (Bystolic), Propranolol (Inderal LA, InnoPran XL). They’re used to treat high blood pressure (hypertension), arrhythmia, heart failure, chest pain (angina), heart attacks, migraine headaches and certain tremors, and they cause insomnia because they deplete melatonin.
- Alpha agonist. These are also high blood pressure medications and include Catapres (Clonidine), Doxazosin, Phentolamine, Phenoxybenzamine, Prazosin, Terazosin, Tolazoline
- Mixed alpha + beta blockers go by the names Bucindolol, Carbedilol, Labetalol
- Anti-inflammatory and immune modulating steroids. These are prescribed to treat autoimmune diseases such as Lupus and Rheumatoid Arthritis. They’re sold under the names of prednisone, prednisolone and methylprednisone. In addition to causing insomnia, these drugs cause osteoporosis and fractures.
- Antidepressant medications. Many antidepressant medications cause insomnia and there are too many of them to list all of them. Some of the most common ones are Prozac, Zoloft, Celexa, Lexapro and Paxil. If you’re taking an antidepressant medication and are having difficulty sleeping, speak to your healthcare provider or pharmacist to see if sleep disruption is a known side effect.
Poor Sleep Hygiene
Sleep hygiene is about creating a sleep environment that helps you sleep and doesn’t keep you awake. Make sure your bedroom:
- is dark. Light can keep the body in a lighter sleep state and can signal the body that it’s time to wake up. Some people like wearing sleep masks to keep the light out if they’ree particularly sensitive to the light.
- is at the optimal temperature for sleep. While this can vary from person to person, the optimal temperature for most people seems to be 69 or 70 degrees Fahrenheit.
- is quiet or has white noise. Some people find they sleep better with some background noise. You can download an app on your smartphone that will play white noise, such as the sound of wind, rain or waves.
Fortunately, natural approaches can help people improve their sleep and promote healthy, restorative sleep.
Regulate Your Blood Sugar
If blood sugar drops during the night, it can cause an increase of cortisol and epinephrine. These hormones release sugars stored as glycogen for your body to use. But they also wake you up.
When I worked with patients in my medical clinic I’d ask them if they were waking up in the middle of the night. If they were, the way to test if poor blood sugar regulation might be causing this is to eat about 10 grams of protein before bed. Many people don’t realize that protein is one of the best dietary ways to regulate blood sugar. While this approach of eating protein doesn’t help everyone, when someone reported back that they tried this and they were sleeping better they were thrilled. And so was I. This is a simple, no-cost solution that’s easy to try.
Some ideas for protein before bed are:
- Nuts, which contain about 5 grams per handful, depending on the nuts.
- A hardboiled egg, about 6 grams of protein.
- Chicken, which provides 26 grams in a three-ounce serving. A serving is about the size of a deck of cards in the palm of your hand.
- For amounts of protein in other foods, download the NBI Protein Handout.
If you’re waking up at night to go to the bathroom, one simple solution is to make sure you stop drinking earlier in the evening. Try stopping all liquids, unless you need a little water to take medications or dietary supplements, at least three hours before bed. If that doesn’t do the trick, try four hours before bed.
People who have difficulty falling asleep or staying asleep may be struggling with increased stress. Stress can cause insomnia and poor sleep and a whole host of other health issues. There are fantastic strategies that can help you decrease stress.
Here are a few:
- Get it out of your head. If your mind is racing at night with everything you have to do the next day, write it all down before bed. Get it out of your head. Making a list of everything you have to do can help you drift off to sleep knowing that you have it all handled.
- Medication. Meditation has phenomenal health benefits. One of them is to reduce stress, which can help you sleep better. Even just 10 minutes once daily of meditation can have wonderful benefits. There are some excellent meditation apps for your smartphone that can help you, especially if you’re a beginner. One I like is Headspace.
- Exercise. Exercise is an excellent stress buster.
- Get into nature. Taking a walk outside or going for a hike reduces stress and improves mood.
If you struggle with sleep, speak with your healthcare provider for for suggestions tailore to our specific situation.
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