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Discover what causes sleepless nights and what you can do to help it.

Do you often find yourself lying awake at night not being able to sleep? Do you toss and turn endlessly, looking at the clock and worrying that you will not get enough rest? Or, maybe, you wake up too often at night, losing on quality of your sleep? If you experience sleep disturbances that affect your daily functioning you may be suffering from insomnia.

“Insomnia is the term applied collectively to complaints involving the chronic ability to obtain adequate sleep[…]Thus, insomnia is typically defined as taking longer than 30 minutes to fall asleep, awakenings during the night totalling more than 30 minutes of wakefulness, and less than 6.5 hours of total sleep.” ^[1]

Insomnia can describe short-term sleep disturbances that last less than 3 months, often caused by traumatic events, life changes, medication or drug withdrawals, or it can be chronic. Chronic insomnia is a long-term difficulty falling or staying asleep that occurs more than 3 nights a week and lasts for 3 or more months.^[2]

There are 3 types of insomnia :

• Sleep-onset insomnia, which describes difficulty falling asleep
• Sleep-maintenance insomnia- interrupted sleep characterized by periodic awakenings; difficulty staying asleep
• Early morning awakenings -waking up early with no ability to fall back asleep

Possible causes of insomnia are:

1. Depression and anxiety.

NHS^[3] has identified stress, anxiety and depression as top causes of insomnia. Stress and anxiety are closely linked to sleep disturbances as they result in a state of mental hyperarousal, meaning higher reactivity and lower relaxation levels. Certain anxiety treatment medications, like beta‐blockers, may also compromise your sleep. If taken too late in the evening, beta-blockers impair the body’s ability to produce melatonin.^[4]
“Melatonin, the hormone produced by the pineal gland at night, serves as a time cue to the biological clock and promotes sleep anticipation in the brain default mode network (DMN)”
It is worth remembering that the aforementioned hormone is produced in the absence of light therefore it is a good idea to dim your bedroom before you are about to get some shut-eye.

As for sleep problems related to depression, researchers found a strong link between the two as sleep disturbances could induce depression and vice versa. People who already suffer from insomnia could develop depression as a result of poor sleep quality that impairs the regulation of emotions. One study has found that “prior disordered sleep leads to emotion-regulation deficits and abundant data demonstrates that difficulties in emotion regulation are stable predictors of depressive episodes”^[5] On the flip side if you already suffer from depression you are also most likely to develop sleep problems. Sleep foundation ^[6] states that insomnia occurs in about 75% of adult patients with depression.^[6]There could be many reasons why individuals with depression suffer from insomnia. First of all, depression is linked to low serotonin levels and therefore, low melatonin as well. In some cases, depression may induce physical pain that prevents sleep. It also may cause fear of sleep due to distressing nightmares. Excessive thoughts that increase body alertness, or sleeping during a day resulting in irregular sleep patterns could be the reasons too.

Don’t give up if you experience any of these symptoms. Treatments such as cognitive behavioural therapy are widely available and could make a difference in your life.

2. Sleep apnoea.

Another potential cause of insomnia could be sleep apnoea ^[7] which is “a condition marked by abnormal breathing during sleep. People with sleep apnea have multiple extended pauses in breath when they sleep. These temporary breathing lapses cause lower-quality sleep and affect the body’s supply of oxygen, leading to potentially serious health consequences.”^[7] During periods of shallow, or interrupted breathing, the brain receives signals of a potential threat to an individual’s life and attempts to prevent suffocation by instigating insomnia. There are treatment options for people with sleep apnea. See your doctor or a sleep specialist to learn about them.

3. Caffeine.

Besides certain physical and mental health conditions that may induce insomnia, there are other factors, which we often overlook, that could be found the culprits. You may want to begin with re-evaluating your caffeine intake throughout the day as its stimulative properties may interrupt your sleep. Remember that coffee isn’t the only source of caffeine. It’s in chocolate( as caffeine is derived from cocoa beans), black and green tea, some sodas, weight loss pills and even some pain relievers. Get in the habit of reading labels to make sure you’re not doing yourself an injustice.

4. Alcohol.

Despite being known for its sedative effects (as alcohol is a Central Nervous System depressant), studies found links between alcohol consumption and compromised sleep. “Late afternoon (“happy hour”) drinking, as much as six hours before bedtime[…] disrupts sleep, even though alcohol is no longer in the brain at bedtime. This phenomenon suggests a relatively long-lasting change in sleep regulation.”^[8] Whilst it has been found that, depending on dosage, alcohol can have either hypnotic( aid sleep) or sleep-disturbing properties, it is certain that its hypnotic properties wear off very quickly. It means that, at low doses, alcohol can initially promote sleep however, that phase does not last and you end up with disturbed sleep after all.

5. Nicotine.

Nicotine, just like caffeine, is a stimulant and may cause insomnia. One study^[9] conducted by Dr Naresh M.Punjabi has indicated that smokers spend more time in light sleep and less time in a deep stage of sleep, which demonstrates a high risk of restorative sleep deprivation amongst smokers. The research included smoking and non-smoking individuals with no existing medical conditions and no regular medication usage, therefore, it could indicate that disturbances in sleep were directly associated with nicotine use. It has been suggested that those disturbances in the sleep pattern might be caused by nicotine withdrawals that smokers experience at night.

6. Psychological associations.

Unlike preceding examples, this one is purely psychological but may just as well affect your ability to fall asleep. If you spend a lot of time in your bedroom working, planning and scheduling, you might eventually associate that space with productivity rather than relaxation. Your brain will be tempted to stay active even when you want to fall asleep. Furthermore, it works both ways and your work performance could be disadvantaged too since you might be inclined to snooze when you’re not supposed to. To avoid this, designate one room/space, which is other than your bedroom, where all your work and planning will always be conducted. Leave the bedroom for what it is intended for and that is sleep.

7. Irregular sleep schedules.

A study^[10] conducted on university students in Taiwan concluded that people with irregular sleep schedules are likely to experience insufficient sleep. Moreover, it has been suggested that sleep quality also decreases the more irregular one’s sleep pattern is. You should try to go to bed at the same time each night. Practice meditation, listen to calm music or read a good book to help you wind down and fall asleep easier.

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Research references

1. http://apps.who.int/iris/bitstream/handle/10665/58229/WHO_MNH_PSF_93.2H.pdf;jsessionid=B01E0387305EE30D528B901A25B6E2EE?sequence=1
2. https://www.sleepfoundation.org/insomnia/types-of-insomnia
3. https://www.nhs.uk/conditions/insomnia/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057895/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190702/
6. https://www.sleepfoundation.org/mental-health/depression-and-sleep
7. https://www.sleepfoundation.org/sleep-apnea
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/
9. https://journal.chestnet.org/article/S0012-3692(15)49091-9/fulltext
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2718885/