There are plenty of ways to improve the quality of your sleep — regular exercise, getting up at the same time each morning and having enough down time before bed are just a few. But what if you follow all the rules and still find it hard to sleep — or you have no difficulty falling asleep but still feel tired the next day?
Having difficulty sleeping now and again isn’t unusual, but if it’s a regular pattern that’s causing chronic sleep deprivation, you should see your doctor to try and find out why. There can be a number of different reasons why you are experiencing insomnia or disturbed sleep.
Insomnia and broken sleep can be linked to depression — although it’s not always clear which comes first. Depression itself is thought to disturb sleep by disrupting the body clock that keeps sleep on track, but chronic insomnia may also increase the risk of developing depression. Among people with insomnia, research shows that 40–60 percent show signs of depression. Typical sleep problems in depression include difficulty getting to sleep, difficulty staying asleep and waking up too early in the morning.
When we don’t sleep well for a night or two, it’s possible to become so anxious about getting to sleep the next night that the anxiety itself keeps us awake. Or if we wake up in the middle of the night and worry that we won’t be able to get back to sleep, again these anxious feelings can keep you awake. Accepting that waking is normal and learning to reframe your thinking helps lower sleep anxiety.
Instead of thinking “I won’t be able to function tomorrow unless I get back to sleep”, try “I’ve functioned on less sleep before and I’ll manage again tomorrow”. Relaxation exercises may help too. You can find out more about these in the Further Information section below. If sleep anxiety persists, see your doctor who can refer you to a sleep psychologist.
If someone has sleep apnoea it means that the airway from the mouth to the lungs collapses while they are sleeping, disrupting their sleep and reducing the oxygen supply to the body. Some people have hundreds of these sleep disruptions through the night, leaving them feeling tired and groggy the next day.
Often it’s not the person with sleep apnoea who’s the first to notice a problem but their partner as they may notice the person they sleep beside has a few brief pauses in breathing and snoring. These can last from a few seconds to a minute. After a minute the person may snore or gasp and wake up briefly as they struggle to breathe, according to Sleep Disorders Australia.
Sleep apnoea needs prompt treatment. Daytime fatigue caused by the condition can be dangerous. Research has shown that people with sleep apnoea are four times more likely to have a traffic accident.
They’re also more likely to have high blood pressure and heart disease. Untreated sleep apnoea can be accompanied by depression, personality changes or loss of memory and concentration. Anyone can have sleep apnoea, including children, but it’s more common in men after middle age. Around five percent of adults have the disorder.
Although it’s often linked to being overweight, sleep apnoea can also be caused by having a narrow airway.
Insomnia is more common in women than men and becomes more common just before and during menopause when symptoms like hot flushes and night sweats can disturb sleep. To fall asleep and stay asleep, our body temperature needs to drop. Anything that raises temperature — whether it’s a warm night, a heavy doona or a hot flush — can keep you awake.
If you wake up because it’s too hot, the best approach is to prepare strategies to help you cool down quickly and get back to sleep. You could try having a fan in the bedroom, using separate blankets rather than a single doona — so you can peel off a layer to lower the heat — or keeping a bowl of cold water and a face cloth close by.
Sleep apnoea may be another cause of sleep problems during this stage of life. Although sleep apnoea is more common in men, the risk of sleep apnoea increases in women at menopause.
Delayed Sleep Phase Syndrome
While we need our body temperature to drop before we feel sleepy, we also need our levels of the sleep hormone melatonin to rise. This helps us feel drowsy. But in some people the levels of melatonin don’t rise until much later in the night, making it difficult to fall asleep until after midnight or in the early hours of the morning.
This is called delayed sleep phase syndrome. It can be a problem for anyone who needs to be out of bed early to go to work or school — about seven percent of adolescents are believed to have this syndrome. The disorder, which can run in families, can be treated by a sleep specialist who can help the person to reset their ‘sleep clock ‘so they can go to sleep earlier.
Advanced Sleep Phase Syndrome
This is a similar problem — except that it causes the person to feel sleepy early in the evening, sometimes as early as six o’clock. This may lead them to wake up in the early hours of the morning and be unable to get back to sleep. Again, a sleep specialist can help reset their sleep clock to a more normal schedule.
Restless Legs Syndrome
Around two to five percent of people have restless legs syndrome (RLS). They may experience uncomfortable sensations in the legs and sometimes the arms. The sensations are often described as crawling, tingling, painful or prickly.
According to Sleep Disorders Australia, people with RLS describe an irresistible urge to move their legs when they feel these sensations. They can happen when the person has been sitting for a long while or when they go to bed, and symptoms tend to be worse in the evening. The sensations can make it hard for the person affected to fall asleep or stay asleep.
The cause isn’t clear, but RLS can happen in pregnancy or in people with low iron levels or those with some chronic diseases including diabetes, kidney disease, rheumatoid arthritis and Parkinson’s disease. It’s generally more common in older people. Self-help techniques and medicines may help treat the problem.
Periodic Limb Movements of Sleep
Periodic limb movements of sleep (PLMS) causes involuntary leg movements such as flexing the toe, bending the knee or hip twitching. This can disturb the sleep of the person with PLMS or any other person sharing their bed, though some people are not disturbed by this and do not consider it a problem. The cause of PLMS is unclear but it is more common as you age. Sometimes it can be treated by reducing alcohol, caffeine and smoking or by taking certain medicines.
Other causes of daytime fatigue
There are other causes of daytime fatigue that may not be related to a sleep disorder. If tiredness is a persistent problem for you, check with your doctor.Top of page
The Australasian Sleep Association http://www.sleep.org.au/
Newcastle Sleep Disorders Centre www.newcastle.edu.au
University of Maryland Medical Centre: Relaxation techniques for sleep disorders www.umm.edu/sleep/relax_tech.htmTop of page
Bartlett D Paisley L Desai A. Insomnia: diagnosis and management. Medicine Today. 2006; 7(8).
Berk M. Sleep and depression — theory and practice. Australian Family Physician. 2009; 38(5): 302–304.
beyondblue. Sleeping well. [online] Hawthorn West, VIC: beyond blue. 2006 [accessed 23 Aug 2010] Available from:http://www.beyondblue.org.au/index.aspx?link_id=89.586&tmp=FileDownload&fid=327
Division of Sleep Medicine at Harvard Medical School. Sleep and disease risk. [online] Boston, MA: President and Fellows of Harvard College. 2007 [accessed 19 Aug 2010] Available from: http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk
National Sleep Foundation. Sleep-wake cycle — its physiology and impact on health. [online] Washington DC: National Sleep Foundation. 2006 [accessed 19 Aug 2010] Available from: http://www.sleepfoundation.org/sites/default/files/SleepWakeCycle.pdf (PDF 2.6Mb)
Patlak M. Your guide to healthy sleep. Bethseda, MD: National Heart Lung Blood Institute. 2005.
Sleep Disorders Australia (SDA). Delayed Sleep Phase Syndrome. [online] Kent Town, SA: SDA South Australian branch. 2006 [accessed 23 Aug 2010] Available from: http://www.sleep.org.au/
Sleep Disorders Australia (SDA). Restless Legs and PLMS. [online] Kent Town, SA: SDA South Australian branch. 2006 [accessed 23 Aug 2010] Available from: http://www.sleep.org.au/
Sleep Disorders Australia (SDA). Sleep apnea. [online] Kent Town, SA: SDA South Australian branch. 2007 [accessed 23 Aug 2010] Available from: http://www.sleep.org.au/
Newcastle Sleep Disorders Centre. About sleep. [online] Newcastle, NSW: The University of Newcastle. C2008 [last updated 6 Apr 2006, accessed 23 Aug 2010] Available from: http://www.newcastle.edu.au/Top of page
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Last published 31 October 2010