Can't sleep at night
It is not uncommon to find oneself wondering, 'why can't I sleep' at night. This thought can be extremely overwhelming in the dark, when it seems everyone else in the world is already sound asleep. Thinking about not sleeping can then lead to worry, feelings of hopelessness, fears about how one will cope the next day.
Could the following factors be contributing to your sleepless nights?
Lifestyle
We know that certain lifestyle factors can greatly influence how one sleeps once the nighttime rolls around.
Nicotine, for example, can make it harder to wind down in the evening and get to sleep. It also causes frequent short awakenings during sleep that one might not be aware of but which will have an impact on one's sleep quality.
Caffeine is another big offender which, if ingested later in the day, can lead to poorer sleep. People are often advised to stop drinking caffeinated beverages after 6 or 7pm, however, as caffeine may be metabolized at a slower rate as we age, you may need to experiment to find the right time for you.
Stress
Stress has been shown to interfere with one's ability to fall asleep and stay asleep. It may also reduce the length of time spent in deep sleep and increase time spent in the lighter phases of sleep, making our sleep more vulnerable to disruption due to light or noise.
Light levels
Melatonin is a naturally occurring hormone which the brain produces in the late evening and throughout the night. It is associated with the light-dark cycle and promotes the onset of sleep.
Strong light can inhibit the production of melatonin and delay sleep onset, leaving you counting sheep well into the night.
There is emerging research that light from a standard laptop directly before bed may disrupt melatonin production and delay sleep onset.
You may find it helpful to dim the lights in the period close to bedtime and, if you are easily disturbed by light, it may be time to invest in a sleep mask.
Daytime naps
Napping during the day has, in recent years, undergone something of a renaissance, with more companies allowing employees to take power naps within office hours. However, whilst napping during the day may work for some people, they may also be preventing you from sleeping at night.
Avoiding naps during the day may prepare you better for a continuous, longer sleep at night. Instead, you might prefer to introduce a stimulating activity, such as a walk, at the point during the day when you start to get tired.
Irregular sleep schedule
An irregular sleeping pattern is not conducive to good sleep. For this reason, poor sleep may be more common in shift workers with variable working hours.
Whilst some people are able to adjust well to irregular hours, research suggests that people with an irregular sleep schedule may be more likely to experience sleep disturbance, fatigue, work-related accidents, cardiovascular problems, gastrointestinal problems and, in women, breast cancer.
Light is crucial to our natural 'body clock', so your sleep may benefit from exposure to light in the morning and avoiding brief light later in the evening.
Trouble sleeping
Having trouble sleeping is an extremely common phenomenon and poor sleep can occur at any time in our lives. Indeed a third of us at any one time will experience disturbed sleep. It is however, more common at certain stages of life, during pregnancy or menopause for example, or simply at times of high stress.
The root cause of sleep troubles can also vary widely; from the physical problems seen in Obstructive Sleep Apnoea patients, to the unpredictable schedules of shift workers.
It is important to remember that even the common cold can give us a sleepless night, or two. The key is to try not to worry too much about missing a little sleep, and trust your body to compensate with deeper, more restorative, sleep on following nights.
Acute trouble sleeping at night
People experiencing short-term trouble sleeping may find that some simple adjustments to their lifestyle and habits have a positive impact on their sleep.
We know, for example, that factors such as your daily schedule can greatly influence how you sleep during the night and that people who have an irregular schedule are more likely to experience poor sleep.
Everything, from what and when you eat in the evening, to the light levels you are exposed to during the day, has the potential to affect your sleep at night. Everyone responds differently to these factors however, so it is important to work out those that affect your sleep and how.
Chronic sleep troubles
Longer-term sleep problems are also very common. It is thought that around 10% of the population experience persistent trouble sleeping, rising to as high as high as 20% in people over 65 years of age.
Unfortunately, the options available to these chronic poor sleepers can be limited to prescription sleeping pills and over-the-counter remedies. Despite the steady increase in prescriptions for these medications and sales of over-the-counter sleep aids, studies have shown that people with poor sleep actually prefer a non-pharmacological approach to sleep improvement.
Research has also consistently shown that long-term sleep problems are helped most effectively by Cognitive Behavioral Therapy, or 'CBT', which aims to improve sleep using techniques that target the vicious cycle of negative thoughts and behaviors that maintain poor sleep.
CBT is usually delivered over the course of 6 to 8 weekly face-to-face sessions with a trained therapist, who teaches the person techniques that they can use at home to help themselves improve their sleep. Now online programs such as Sleepio allow people to access these proven, tailored techniques and receive continuous support, all via the web.
Tired but can't sleep
In conversation, we tend to use 'tired' and 'sleepy' interchangeably but in reality they signal very different things and it is important to be able to tell the difference between them.
A person might feel extremely fatigued but, in fact, not be ready for sleep. As you may have experienced, feeling tired does not necessarily make sleep inevitable!
Feeling sleepy, on the other hand, is what is called a 'discriminative stimulus' for sleep; it predicts sleep is about to occur. So how can you tell if you really are sleepy-tired? Look out for signs such as: itchy eyes, a lack of energy, aching muscles, yawning and a tendency to “nod off”.
Heading to bed without having experienced any of these signs may make it less likely that you'll get to sleep quickly, and more likely that you'll find yourself lying awake, thinking about not sleeping.
An active mind
The 'racing mind', as it is known, is very common in poor sleepers. In fact, respondents to the Great British Sleep Survey revealed it to be the most frequent cause of their sleeplessness.
Whether you find yourself thinking about past or future events, or even trivial things that hold little importance, persistent thoughts can be enough to keep a very tired person from feeling sleepy.
The more your thoughts race, the more alert you become, even if you feel extremely tired.
Heightened arousal
It isn't just your thoughts that can prevent you from falling asleep – exercising shortly before going to bed or ingesting stimulants too late in the day can also deter sleepiness from setting in.
Whilst exercise has been shown to correlate with better sleep, intense aerobic exercise too close to bedtime may actually boost your energy, making it more difficult to get to sleep.
Similar effects can be caused by stimulants such as caffeine and nicotine. As stimulant drugs they can make it more difficult to reduce arousal and initiate sleep. Caffeine consumption, in particular, has been shown to result in a longer time to fall asleep.
What should you do when you are tired but cannot sleep?
The key is to stick to activities and habits that you find relaxing and help to reduce over-arousal, allowing sleep to overcome wakefulness.
People with sleep problems often have difficulty relaxing and 'letting-go'. It is really important therefore that you learn to let it happen and do not try to force it.
Different people find different activities relaxing so experiment to find what works best for you!
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy, or 'CBT', works by addressing both the mental (cognitive) and behavioral factors that can prevent you from getting to sleep.
CBT trains you to use techniques that help overcome the negative emotions that accompany the experience of being unable to sleep. Alongside this, CBT can help you to establish a healthy sleep pattern and achieve a strong connection between bed and successful sleep, meaning that falling asleep becomes more automatic and natural.
The Sleepio course, based on cognitive and behavioral techniques, has also been shown to help people get to sleep faster and stay asleep through the night. In fact, participants in the clinical trial of the program, saw an average reduction in time to get to sleep of approximately 50% (Espie et al., 2012).
Reference:
Espie, C.A., Kyle, S., Williams, C., Ong, J.C., Douglas, N.J., Hames, P., Brown, J.S.L. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35(6), 769-781.