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Stephanie Silberman, Ph.D.

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What's Really Causing Your Sleepless Nights?

Posted: 07/21/2011 8:38 am

There are many factors that may cause trouble sleeping at night and even lead to chronic insomnia. You've probably heard about the basic principles of good sleep hygiene, like not drinking too much caffeine during the day, not exercising late at night and not reading or watching TV in bed if you have trouble sleeping. But good sleep hygiene alone may not solve your sleep problem, especially if there is an underlying issue that hasn't yet been discovered. If you aren't sure what's keeping you up at night, it's a good idea to rule out some of these common sources for sleep problems.

Medications and Other Substances That Can Keep You Awake

Certain medications may cause insomnia. For example, medications used to treat asthma, such as bronchodilators and corticosteroids, may cause difficulty sleeping at night. Other medications that may cause problems sleeping include activating antidepressants (used for depressive and/or anxious symptoms), antiepileptics (for seizure disorders), and dopaminergics (used for Parkinson's disease and Restless Legs Syndrome). Stimulants used for ADHD and decongestants used to treat the common cold may also keep you awake at night, while hypertensive agents such as beta blockers may increase nightmares. Speak to your doctor about any side effects with drugs -- but don't stop any without speaking to him or her first.

Other substances that can worsen your sleep include caffeine and nicotine. If you have trouble sleeping at night, it's a good idea to stop all caffeine up to 12 hours before bedtime. If you smoke cigarettes, try decreasing the amount that you smoke in the evening hours to lessen the nicotine's impact on your sleep.

Common Sleep Disorders That Can Cause Insomnia

Certain sleep disorders can cause the symptoms of insomnia. In these cases, identifying and treating the underlying sleep disorder can be the key to improving in your sleep.

Discomfort in Your Legs at Night
Restless legs syndrome (RLS) involves a creepy-crawly, uncomfortable tingling sensation in the legs while sitting or lying down in the evening hours. Since they usually occur at bedtime, RLS can make it difficult to fall asleep. The symptoms of RLS are typically relieved by massaging the legs or moving around. There are pharmacological and nonpharmacological treatments for RLS. The natural approach includes taking a hot bath about one hour before bedtime, daily exercise emphasizing the legs and eliminating nicotine and/or caffeine. If you try these strategies and they don't improve your symptoms, seek the advice of a physician who's knowledgeable about RLS.

Painful Leg Cramps That Disturb Your Sleep
Nocturnal leg cramps are different from RLS. Whereas RLS is an uncomfortable, tingling sensation that makes it difficult to fall asleep, nocturnal leg cramps are sudden painful muscle spasms in the legs that can occur upon falling asleep or after you've already fallen asleep. The pain can cause you to have trouble falling asleep or staying asleep. The cramps may occur in the calf muscles, feet or thighs, and last from a few seconds to several minutes. Common causes include dehydration, overuse of the leg muscles and pregnancy. Staying well hydrated during the day may help prevent nighttime leg cramps from occurring, along with stretching your legs, especially your calves, just before going to bed. Some people find it helpful to add more potassium, calcium and magnesium to their diets, as deficiencies in these minerals can cause muscle cramping.

You're Asleep by 8 PM and Up at 4 in the Morning
Advanced sleep phase syndrome is characterized by the inability to stay awake until your desired bedtime and being unable to remain sleeping until your desired wake time in the morning. If you fall asleep earlier in the evening than you would like and wake up earlier in the morning than you wish and aren't able to fall back asleep, then you may have advanced sleep phase syndrome. Since many people with this sleep problem remain in bed, trying to fall back asleep, it can lead to insomnia. Instead, it's important to seek the advice of a sleep specialist who can guide you on the best way to reset your biological clock, such as exposure to bright light in the evening hours and engaging in stimulating activities at nighttime in order to advance your biological clock.

You Aren't Sleepy until 3 or 4 in the morning
Delayed sleep phase syndrome is a sleep pattern opposite that of advanced sleep phase syndrome: You are unable to fall asleep until very late and have trouble waking up at the desired time in the morning. People with delayed sleep phase syndrome usually complain of trouble falling asleep at night and problems waking up in time for school or work. Exposure to bright light in the mornings, while limiting exposure to light in the late afternoon and evening hours, may help to reset your clock. Sleeping in on the weekends can make the problem worse because it reinforces the delayed sleep pattern.

You Stop Breathing During Your Sleep
Obstructive sleep apnea (OSA) is defined as repeated episodes of complete obstruction of the upper airway (apnea) or partial obstruction (hypopnea) during sleep, which causes you to stop breathing or have more shallow breathing during sleep. Although snoring and daytime sleepiness are the most common symptoms of obstructive sleep apnea, some people with OSA report having insomnia. Obstructive sleep apnea is a serious disease and should be treated. The gold standard for treating OSA remains CPAP, which is continuous positive airway pressure. Although not always the case, OSA often occurs in people who are overweight, so weight loss may reduce your likelihood for obstructive sleep apnea. People with OSA should avoid alcohol and sedatives before bedtime, as it may worsen the condition.

Another sleep disorder which causes a person to repeatedly stop breathing during sleep is called central sleep apnea and is due to a lack of respiratory effort. Central sleep apnea is a lot less common than obstructive sleep apnea and is often associated with heart failure or conditions that affect the nervous system. While obstructive sleep apnea is caused by a collapse in the upper airway, central sleep apnea is caused by the brain not sending the proper signals to the muscles that control breathing. People with central sleep apnea often report sleep maintenance insomnia, or difficulty staying asleep. Treatment for central sleep apnea includes treating the underlying medical cause, using supplemental oxygen or positive airway pressure devices during sleep, or taking medication.

You Feel Down in the Dumps or Worried a Lot

Insomnia is often related to depression or anxiety. People with depression may have early morning awakenings and spend more time lying in bed than is needed, thus causing a worsening of insomnia. Symptoms of depression include sadness, feelings of guilt, poor attention and concentration, decreased libido, increased crying, lack of desire to do things that are enjoyable and lack of pleasure when doing things that you used to enjoy. If you have depressive symptoms, it's important to discuss them with a healthcare professional in order to find the treatment that's right for you. Similarly, if you spend many hours during the day worrying or feeling nervous and stressed, then anxiety may be taking a toll on your life. Anxiety may cause trouble falling asleep, especially when it's difficult for you to relax and you experience racing thoughts or worries at bedtime. Effective treatment for insomnia (including that associated with anxiety and/or depression) includes cognitive behavioral therapy, which focuses on the behaviors and thought processes that are worsening your sleep.

There are many factors that can affect your sleep, so it's essential to figure out what's really causing your sleepless nights. If you're unsure what could be causing your insomnia, start by consulting with a sleep specialist who can help you figure out the source of your sleep problem and allow you to begin the process of getting a better night's sleep.

Stephanie A. Silberman, Ph.D., FAASM, is a Licensed Psychologist who is a Fellow of the American Academy of Sleep Medicine. She is active in professional organizations and legislative activities affecting psychology and sleep disorders. She is a consultant for various sleep laboratories and maintains a private practice in the Fort Lauderdale area. She has appeared on television news and in national magazines regarding sleep-related issues. Her recent book, The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need, is not only a self-help guide for people with insomnia, but also a useful reference tool for health-care professionals. Read her blog on Red Room or visit her website at http://www.sleeppsychology.com to learn more.


 

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