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Insomnia may be the primary problem, or it may be associated with other
Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.
Stress is a response to adverse and challenging circumstances and a response to daily life. It affects us emotionally, physically, and behaviorally. The right amount of stress can be a positive force that helps us to do our best and to keep alert and energetic. But too much can make us tense and anxious and can cause sleep problems.
Concerns about work, school, health, finances or family can keep your mind active at night making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
What you eat can affect your sleep. Spicy foods can contribute to painful heartburn. Big meals leave you uncomfortably full, and over time can contribute to obesity—a well-known risk factor for sleep apnea. Too much caffeine could keep you wide awake, even if you finish your coffee in the morning. “It takes six hours to clear half of the caffeine from your body. If you have enough caffeine, it’s still in your body at 4 in the morning,” . And though a glass of wine or two with dinner will make you feel relaxed or even sleepy, it won’t help you sleep. “You can fall asleep, but once you’re asleep you can’t sleep deeply,” .
nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
- Eating too much late in the evening
Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but the insomnia may persist after the medical condition improves.
Sleep and exercise complement each other. Working out regularly can help you sleep better, and conversely, you’re more likely to exercise if you get a good night’s rest.
Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or engaging in stimulating activities before bed.
Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
Most sleep experts recommend keeping your bedroom at a moderate 65 to 72 degrees at night, but many people like to cut energy costs by turning the thermostat down to the freeze zone during the winter, and switching the AC off during the summer, leading to a sweltering bedroom.
Both of these extremes hijack your trip to the land of Nod, however. Your body needs to cool slightly at night for the most refreshing sleep, which is impossible in an overly heated bedroom. A too-cold room, on the other hand, will wake you up.
Whether it’s coming from your bed partner’s reading lamp, the television, or outside your window, light exposure at bedtime impairs your quality of sleep. For some people, even the glow of a bedside alarm clock is enough to signal their brain that it’s time to wake up.
Mental health disorders.
Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
“Depression is a common compromiser of sleep, and it is much more common in women than in men,” Dr. Edelman says. Women who are depressed may sleep more than usual, but their sleep isn’t restful. Some of the antidepressants meant to counteract depression, particularly SSRIs, can also interfere with sleep.
Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
Untreated sleep apnea causes breathing to stop repeatedly during sleep, causing loud snoring and daytime tiredness, even with a full night’s sleep.
Sleep apnea can affect anyone, but most often older men who are overweight.
. “A woman who has a narrow jaw or a change in muscle tone can get apnea,” , Either of these anatomical issues can block oxygen from reaching your lungs (and subsequently the rest of your body) while you sleep. Snoring might not be your main symptom if you do have sleep apnea, but you will notice that you’re especially sleepy during the day
There are two types of sleep apnea, obstructive and central
In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.
Obstructive sleep apnea is a condition where there’s a blockage in the upper airways. This results in pauses in breathing throughout the night that may cause you to abruptly wake up, often with a choking sound. Snoring commonly occurs in this disorder
- Delayed sleep phase syndrome
Delayed sleep phase syndrome (DSPS) is a disorder in which a person’s sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime. The delayed sleep then causes difficulty in being able to wake up at the desired time.
For example, a person with DSPS may fall asleep after midnight instead of at 10 p.m. and then will have difficulty getting up in the morning for school or work.
Women are twice as likely as men to have restless legs syndrome (RLS)—a condition that causes a creepy, crawly feeling and uncontrollable movements in the legs at night. It’s often linked to hormonal changes early in life and during pregnancy, but RLS can continue as you get older. RLS isn’t just miserably uncomfortable—researchers at Harvard have linked this condition to an increased risk for heart disease and depression in women.
Chronic Medical conditions
Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson's disease and Alzheimer's disease.
Arthritis aches or any other kinds of pain do not make for restful slumber. Conversely, a lack of sleep can increase your pain. Researchers believe that a lack of sleep may activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain.
An overactive thyroid gland (hyperthyroidism) can cause sleep problems. The disorder overstimulates the nervous system, making it hard to fall asleep, and it may cause night sweats, leading to nighttime arousals. Feeling cold and sleepy is a hallmark of an underactive thyroid (hypothyroidism).
Because thyroid function affects every organ and system in the body, the symptoms can be wide-ranging and sometimes difficult to decipher. Checking thyroid function requires only a simple blood test, so if you notice a variety of unexplained symptoms, ask your doctor for a thyroid test.
People with kidney disease have kidneys that are damaged to the extent that they can no longer filter fluids, remove wastes, and keep electrolytes in balance as efficiently as they did when healthy. Kidney disease can cause waste products to build up in the blood and can result in insomnia or symptoms of restless legs syndrome. Although researchers aren’t sure why, kidney dialysis or transplant does not always return sleep to normal.
- Musculoskeletal disorders
Arthritis pain can make it hard for people to fall asleep and to resettle when they shift positions. In addition, treatment with steroids frequently causes insomnia. You may find it helpful to take aspirin or a nonsteroidal anti-inflammatory drug (NSAID) just before bedtime to relieve pain and swelling in your joints during the night.
People with fibromyalgia—a condition characterized by painful ligaments and tendons—are likely to wake in the morning still feeling fatigued and as stiff and achy as a person with arthritis. Researchers who analyzed the sleep of fibromyalgia sufferers have found that at least half have abnormal deep sleep, in which slow brain waves are mixed with waves usually associated with relaxed wakefulness, a pattern called alpha-delta sleep.
Tips for Better Sleep
Good sleep habits (sometimes referred to as “sleep hygiene”) can help you get a good night’s sleep.
Some habits that can improve your sleep health:
Be consistent. Go to bed at the same time each night and get up at the same time each morning,* including on the weekends
- Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature
- Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
- Avoid large meals, caffeine, and alcohol before bedtime
Get some exercise. Being physically active during the day can help you fall asleep more easily at* night.
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