Can't Get a Good Night's Sleep? 5 Surprising Reasons

Insomnia

It's natural to blame sleep problems on stress or physical changes that come with age. But many cases of either sleeplessness or poor sleep are caused by a handful of specific problems, most of them fixable with lifestyle changes or the help of a doctor. Here, five little-known causes of sleep problems and what to do about them.

1. Light

How it disrupts sleep: You probably already know that when you stay up late under bright lights, you interrupt your body's natural sleep-wake cycle, because light tricks your brain into remaining in daylight mode. Less well known is that the light from computer screens and iPads shining directly into your eyes at close range is especially troublesome. Why? Part of the problem is that the light from these devices is at the blue end of the spectrum, which scientists believe is particularly disruptive to circadian rhythms. Blue light, although common during the day, doesn't occur naturally during the evening.

Similarly, light shining in your eyes while you sleep -- even very small amounts coming from, say, a lighted clock -- makes your brain think it's morning and emerge out of deep sleep. Darkness triggers production of the hormone melatonin, the hormone that triggers sleepiness and the onset of sleep. Light prevents this release or shuts it off.

The evidence: Studies have long shown that shift workers and those who work late at night have poorer sleep and higher incidences of certain conditions associated with lack of sleep than those who regularly sleep eight or nine hours at night. A recent study published in Cancer Causes & Control, for example, found that the countries generating the most light at night have the highest incidence of breast cancer. And studies at the Light Research Center at Thomas Jefferson University in Philadelphia have found that the use of computers, lighted readers, and TVs at close range is tied to a higher incidence of sleeplessness.

Who's at risk: Everyone exposed to light shortly before bed or during sleep. Light is also bad for hearts, which need deep sleep to recharge. Surprising fact: Every year there's a spike in the number of heart attacks just after the start of daylight savings time in the spring.

What to do: Dim the lights and turn off all lighted screens at least an hour before bed. If you use a reading light, make sure it's not any brighter than necessary and doesn't shine in your eyes. Do a "light police" room check: Are there streetlights outside your windows? Use blackout curtains or shades and make sure they fit the windows tightly so no light seeps in around the edge. Charge laptops, phones, cameras, and other devices in another room. Use an alarm clock without a lighted dial, or turn it to face the wall. Keep a flashlight next to your bed and use it whenever you have to get up to use the bathroom or let the dog out -- and be careful to point it away from yourself so you don't look into the beam. Don't turn on an overhead light, and never use nightlights.

If you must use a laptop, turn down the screen brightness as low as you can tolerate and prop the laptop as far away from you as your typing arms will reach. If you love eReaders, try a Kindle or other device with a screen that's not backlit.

Pain and breathing problems

2. Pain

How it disrupts sleep: Just about any kind of pain signals sent by the brain -- jaw pain, headaches, back pain, or arthritis, for example -- disrupt sleep, lifting you from the deep, restful REM cycle into lighter sleep or causing you to sleep fitfully and partially wake up over and over, which experts call "microarousals."

The evidence: Surveys of chronic pain sufferers reveal that between 60 and 90 percent sleep poorly. But many don't realize that their pain is the cause of their poor sleep. "This can become a vicious cycle," says Thomas Roth of the Sleep Disorders and Research Center at the Henry Ford Hospital in Detroit, because "even partial sleep disruptions can increase sensitivity to pain." In other words, even mild pain causes poor sleep, which in turn leads to more pain.

Who's at risk: Anyone who suffers chronically painful conditions such as arthritis, back or neck pain, jaw alignment problems, dental pain, fibromyalgia, headaches, or any other type of chronic pain.

Note: The pain doesn't need to be severe; studies show that even mild pain disrupts sleep. According to Roth, frequent microarousals can occur throughout the night without your being aware of them. The result is that you never attain deep REM cycle sleep and wake up feeling tired and grumpy, but you don't know why.

What to do: Take steps to treat your pain proactively. Using over-the-counter pain relief is a start, but it's always best to consult with a doctor and develop a comprehensive pain-relief program. For example, you may need physical therapy to combat back and neck pain, or migraine medication if your frequent headaches might be migraines. If bruxism (teeth grinding) or jaw clenching is leading to jaw pain, a mouth guard is often the solution.

3. Disrupted breathing

How it disrupts sleep: When oxygen flow to the brain is interrupted, your brain sends a warning signal that wakes you up either fully or partially, causing fitful sleep or preventing deep, restful sleep. The result: You wake feeling like you didn't sleep well, even if you were out for nine hours straight.

The best known version of this is apnea, which is a complete stoppage of breathing. A much more common and less recognized problem is upper airway resistance syndrome, or UARS. In UARS, structural blockages somewhere in the airway -- nasal congestion, your tongue falling back and blocking the back of the throat, or just having a smaller airway to begin with -- begin to interfere with the flow of air. What happens is that you wake up over and over again without knowing it, but the sleep interruptions last only a few seconds, too short to be detected by a standard sleep apnea test.

The evidence: "Even subtle levels of restricted breathing can lead to deep brain stimulation and arousals that prevent your ability to stay in deep sleep," says otolaryngologist Steven Park, an otolaryngologist and author of Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired. "You don't realize you're waking up, but your brain wakes up, so it's now in a light sleep. We see people who are waking up 100 times a night."

Who's at risk: People who breathe through their mouths or have chronic congestion, such as from asthma or allergies. If you sleep more poorly on your back, this can be a sign of UARS, because when you sleep on your back your tongue is more likely to sink back and block the entrance to your throat. If you have a narrow face, a thin neck, or had extensive orthodontic work to correct a crowded jaw, you're likely to be at particular risk for UARS, says Park.

What to do: Start with some self-tests. Try using pillows to keep yourself on your side, or put a tennis ball in the back pocket of pajama bottoms, so you can't sleep on your back. If your nose often feels stuffed up, you might find relief with breathing strips, available at the drugstore. Another option is to try is a device designed to hold the nostrils open; brand names include Nozovent and Breathe with Eez. A saline nasal spray works for many people. If you have congestion due to seasonal allergies, try an antihistamine. (But if you take one that can act as a stimulant, such as Claritin or Sudafed, don't take it too close to bedtime.)

If none of these help, ask your doctor to refer you to an ear, nose, and throat (ENT) specialist, who can evaluate whether you're a candidate for Continuous Positive Airway Pressure (CPAP), a nasal mask that delivers air directly through your airways. An ENT can also determine whether tongue position is causing your UARS, in which case a dental device that pushes the jaw and tongue forward can help.

For many people, losing a few pounds can be the ticket to better sleep, since excess weight is linked to all kinds of breathing problems, including UARS, snoring, and sleep apnea.

Medications and depression

Medications

How they disrupt sleep: Medications sometimes have side effects that trigger sleeplessness or interfere with deep sleep. Most common culprits: asthma medications, corticosteroids, blood pressure medications, and antidepressants.

Also, many ingredients in common medications act as stimulants. They may cause jitteriness during the day and trigger sleeplessness or prevent deep sleep at night. Example: Bronchodilators like albuterol and salmeterol, commonly used to treat asthma, bronchitis, and COPD, can amp you up and interfere with sleep, yet patients are often directed to use them at the end of the day. Other common medications that can interfere with sleep include SSRIs, such as Prozac and Paxil, and beta-blockers taken for high blood pressure and heart disease.

Sometimes medications sabotage your sleep indirectly. Diuretics, for example, can interfere with sleep by causing you to use the bathroom at night. Tagamet (generic name cimetidine), taken to control reflux and ulcers, can cause sleeplessness, especially when combined with caffeine or other medications. Like many side effects, sleeplessness from medications can affect some people but not others; Propecia, used to treat hair loss, and the antihistamine loratadine (brand name Claritin) are both known to cause sleeplessness in a percentage of those who take them. Some people react to opioid pain medications with rebound sleeplessness, feeling sleepy at first but then waking up and being unable to get back to sleep.

The evidence: Although every medication is tested for side effects during the FDA approval process, in many cases evidence of side effects mounts over time as a drug enters more widespread use. Albuterol has been widely reported to cause restlessness, nervousness, and sleeplessness. An article in the European Journal of Clinical Pharmacology also found that beta-blockers interfere with melatonin release.

Recent studies have found that Prozac, Zoloft, Celexa, and other SSRIs affect sleep in a significant number of patients. If you're using an antidepressant, be sure to talk to your psychiatrist about any possible sleep problems and ask about alternative antidepressants if this is an issue.

Who's at risk: Those taking regular medication for a chronic condition such as asthma, depression, high blood pressure, or pain. A medication that you take once is less likely to cause an ongoing sleep issue because you take it for a short period of time and are more likely to notice the side effect. When you have a chronic condition, you're more likely to attribute any sleep problems to the condition rather than the treatment.

What to do: Any time you're prescribed a new medication, ask the doctor to discuss in detail all side effects you should be alert to. It's always a good idea to ask both the doctor and the pharmacist, "How will this medication affect my sleep?" Because some medications cause sleepiness, some interfere with sleep, and some do both, asking the question in an open-ended way will get you the most information.

5. Depression

How it disrupts sleep: Fatigue is one of the most prevalent symptoms of depression, yet many people don't realize how closely related depression and poor sleep can be. Depression wreaks havoc with your natural biological rhythms; many people with depression have trouble getting out of bed in the morning, and they oversleep or get fatigued and nap during the day. Yet their sleep is fitful and of poor quality, so despite spending more hours ostensibly sleeping or trying to sleep, they don't feel well rested. Then at night, depression sufferers often have trouble maintaining a regular bedtime routine. Having slept late in the morning or napped late in the day, they may not feel sleepy. Anxiety, which often accompanies depression, may cause excessive late-night worry that contributes to sleeplessness.

The evidence: Because the relationship between depression and insomnia is a chicken-and-egg cycle, experts have studied it from both directions. Psychological studies have found that a high proportion of those with depression suffer from either sleeplessness or disrupted sleep, and a recent study by the University of Maryland found that 40 to 60 percent of people with sleeplessness show signs of depression.

Who's at risk: Those with a history of mood disorders such as depression and anxiety, or anyone who has recently undergone a stressful life event likely to trigger depression.

What to do: One of the most effective steps you can take in this situation is to exercise vigorously during the day. According to experts at the University of Maryland, exercise combats depression by increasing serotonin levels in the brain. It's also one of the best ways to get your sleep-wake cycle back on track. Do 45 minutes to an hour of physical activity before dinner, and you'll feel tired earlier and sleep more deeply. If your low mood persists, consult a therapist or ask your doctor for a referral to a psychologist or psychiatrist.

What to Do When You Wake up Too Early and Can't Get Back to Sleep >>


almost 1 year ago, said...

Hey there! I you're suffering from insomnia let me tell you somenthing that worked really great for me :) Two months ago my life changed completly, I got fired from my job and two days later my boyfriend left me for another girl. By that time my head was full of thoughts and my nights started to be a nightmare, sleeping an average of two or three hours a night, leaving me tired and unable to concentrate the rest of the day. Two weeks ago I came across this website: http://sleepsync.co.nf, like you will see they promise you to "get 8 hours of unbroken deep sleep" using audio recordings. At that time I was really desperate and decided to give it a try... Thanks to god I've done that! I don't really understand what this audio recordings contain (they're so relaxing) but when I play them i fall asleep in minutes, they help me to keep my mind clear and without thoughts. I wanted share this because I know how fustrating can be having insomnia and if this worked for me probably will work for you too :) Hope this cane helpful for someone :D


almost 2 years ago, said...

I heard in recent study about kindles, it doesn't help you sleep due to it's light. So if you want to read, it's best to read the old fashion way, like Abe Lincoln did with a candle. Then again, that's what I heard over the radio.


about 2 years ago, said...

"Studies have long shown that shift workers and those who work late at night have poorer sleep and higher incidences of certain conditions associated with lack of sleep than those who regularly sleep eight or nine hours at night" so time sleep not that shift work


about 3 years ago, said...

Check out THE GOLDILOCKS FACTOR http://tuesdayswithlaurie.com/2013/07/16/the-goldilocks-factor/


over 4 years ago, said...

There is one simple solution I didn't see for the light problem - a sleep mask! Due to limited space and other life restrictions, eliminating light from my bedroom is virtually impossible. On top of this, for years before he passed my late husband insisted on keeping the TV on 24/7, as due to his illness he could not sleep at night. As long as he kept the volume down I could tolerate the sound, but that flick on my eyelids made restful sleep all but impossible. Then I got the fist of several sleep masks, and finally found the perfect one for me. It is puffy, with a built-in hollow over the eyes, so there is no pressure on the eyeballs or irritation to the eyelashes. It totally blocks light from TV, reading light, clocks, windows etc. Even now that he is gone and the TV spends more time off than on I use the mask to shot out the world, and finally can sleep ;-)


almost 5 years ago, said...

This information just reinforces what I either knew or learned "the hard way!'.


almost 5 years ago, said...

The information about medication & exercise was what I have either all ready known or have discovered "the hard way!".


about 5 years ago, said...

I'm lucky if I get 3 to 4 hours of sleep each night when I have to get up every once in a while to check on my mother to make sure that she is still breathing. I'm her soul caregiver 24/7 and when I get up @ 6:30 am to start my day I try to take my shower then I get her up @ 7:00 am and have to do just about every thing for her like washing her up and getting her dressed for the day we leave the house @ 8:30 am so I can drop her off @ daycare then I go to work @ a local High school where I work in the cafetiera making the students and the staff their lunches then when I get off work after 3 hours I go back and pick mom up @ 1:30 and my time is taking up until the next morning and it starts all over agian the same routein 5 days a week. I try to get as much rest as I can inbetween taking care of her, I have to go and have Knee surgery after Xmas tghis year and I'm hoping to get help caring for mom while I'm in the hospital for about 4 to 5 days then I'll be back at the same routine again after I have my rehab and I'll have to get an aide to help out for about two weeks while I have theropy @ home.


about 5 years ago, said...

Knowing that antidepressants can interfere with sleep.


over 5 years ago, said...

The articles conveyed more useful and explanatory information than so many of the other health websites, and in a manner that was understandable without using words or info ovrt the top for rhe avg. reader, and not too insultingly simple, either.


over 5 years ago, said...

Confirming my suspisions about the posible causes.


over 5 years ago, said...

thank you for my friend whom she send this health tips...truly it can help me to be aware of my health for me to have a long and satisfied life. God bless this articles and even all the topics that are related to this...


over 5 years ago, said...

I think my mom's biggest problem is she misses my father since he passed away!


over 5 years ago, said...

Charlyne S.... That's so wonderful....everything healthy food I eat lots of fruits....vegetables....salads....no salt...no calories pop or iced tea w/sugar..no drink sugar pop...I drink lots of water...vita rain....I feel so great....That's so great to learn about everything...Thanks for the helping!!!


over 5 years ago, said...

It's very interesting to learn....I know but I eat heatlhy food more better than...no salt....no high calories pop or any sweet pop....I drink lots of water....healthy fruits...vegetables with dip hummnus....salad...I feel so great and feel better....I lose some pounds....


over 5 years ago, said...

Hi Anonymous, thanks for your interesting question. I'm not sure how you can turn off dreams, but if you'd like you can post your question to our Ask & Answer section, here: http://www.caring.com/ask -- Emily


over 5 years ago, said...

I would like to know how to stop dreaming so much. I already have a sleep apnea machine. I do eat late many times, but dreaming happens no matter what. They are so vivid that it is disturbing to my emotions as well. How do you turn off the dream channel?


over 5 years ago, said...

Pretty much all medications, even (maybe especially) sleeping medications, are bad for a good session's sleep. Light is not a trigger unless you associate it with something. Ditto noise. Ask any sailor who has caught a snooze in between launching and landing jets off a carrier. Cut the meds back, a little at a time -- cold turkey never works, and remember, pretty much all of them are physically addictive, and absolutely all of them are psychologically addictive. Get more exercise. Get away from the boob tube babysitter and use your mind to think for yourself instead of having crapola packed into it. Tackle a project. Play at a hobby. Engage mind and body. Live for the moment. Fear nothing you can't do anything about. And don't let the dog hog the bed.


over 5 years ago, said...

This article is very misleading and potentially dangerous for diabetics and those who are pre-diabetic. The last thing people in these categories should eat at bedtime is high insulin producing foods because their bodies cannot adequately metabolize the insulin. Most practicioners caution diabetics not to eat insulin producing foods after 6 p.m.. You may want to do additional research on this issue and write a caveat addendum to your article.


over 5 years ago, said...

Ok article until the very end. I detest health articles that mindlessly parrot "experts" who tell patients with fatigue to exercise vigorously. If they could exercise vigorously on a regular basis, they wouldn't also be seriously fatigued now would they? Common sense: if it's going to help, start out slow and easy. Serious chronic fatigue is not just feeling a bit lethargic, it's invisibly disabling. While mild exercise like walking may help avoid further decline, excessive exercise can make chronic fatigue syndrome (CFS) worse. If synthetic drug treatment seems to make fatigue worse, it might be CFS that responds better to bioidentical hormone balancing. (Search PubMed for the latest research abstracts on the hormonal causes of CFS - and common depression.)


over 5 years ago, said...

I read several reasons here of why I'm now sitting here reading this at 12:30 AM. My main reason is an English Bulldog that sleeps with us, and just fine I might add. ;-)


almost 6 years ago, said...

Clarity of analysis.


almost 6 years ago, said...

This is an understandable, well-organized article with obvious empathy for those needing this information. It presents the most valuable of findings about sleep problems and their remedies in a way lay people can understand and use. It should be very helpful to everyone who reads the whole article carefully.