Having Trouble Sleeping?

We've got expert shut-eye solutions to six surprising sleep wreckers that might be keeping you up at night.

From the WebMD Archives

Ah, the insomniac's plight: waking up with a hangover without having had a drop to drink. A poor night's sleep can have you starting your day feeling drained before your feet even hit the floor. Other mornings, you could swear you got a peaceful eight hours, yet your body tells a different story.

Too many of us are missing out on sweet dreams. Nearly one-third of Americans say they lie awake at least a few nights each week. Getting a poor night's sleep means more than just a bad day ahead. The quality of your sleep can harm your health long-term; sleep deprivation is linked to obesity and high blood pressure, poor concentration, and lack of energy for exercising, healthy eating, and leisure activities.

Why are we having a hard time catching the zzz's we need? Here are six surprising sleep wreckers that might be keeping you up at night.

Stress and Sleep

Who's stressed? Who isn't? Three in four U.S. adults say they felt moderate to high stress levels in the past month, according to a 2009 stress survey conducted by the American Psychological Association. Even teenagers find that school and family finances are stressing them out, with nearly half of teens polled saying their worries have gotten worse over the past year. The result? Many of us hit the sheets with our minds still churning, too wound up to sleep.

"No one sleeps well with worries," says Joyce Walsleban, RN, PhD, associate professor of medicine at NYU's School of Medicine. "They are too alerting. They will either keep you up or wake you up later on."

Stress hormones shoulder some of the blame. When you're stressed out, your adrenal glands release hormones, such as adrenaline and cortisol, which keep you amped up and struggling to snooze.

Completely eliminating stress and anxiety from your life isn't realistic. But learning how to place your worries up on a shelf for the night can help you manage them so they don't ruin your sleep. For starters, bar your work life -- a common cause of stress -- from your bedroom.

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"We see people using BlackBerries and laptops in bed, answering emails, and continuing to do the work they do all day long. For people who suffer from insomnia, that can perpetuate it," says Alon Avidan, MD, associate professor of neurology and associate director of UCLA's Sleep Disorders Program.

Walsleban suggests giving your body time -- an hour or so -- to unwind before slipping into bed. Take a bath, read a good book (try fiction!), and learn to practice deep breathing and relaxation exercises to calm nerves and encourage a peaceful night's sleep.

Depression and Sleep

Insomnia and depression tend to go hand in hand, and it can be difficult to figure out which came first. In fact, research suggests that people with insomnia have 10 times the risk of developing depression as people who sleep well. And people who are depressed commonly struggle with insomnia, showing symptoms such as difficulty falling asleep, staying asleep, or waking up feeling rested. The brain chemical serotonin, which affects mood, emotion, sleep, and appetite, according to Walsleban, is one likely reason the two conditions travel in tandem.

Ironically, Avidan warns, a common class of medication used to treat depression -- selective serotonin reuptake inhibitors -- sometimes causes sleep disorders, such as periodic limb movement disorder, which causes your legs to jerk while you sleep, or rapid eye movement (REM) sleep behavior disorder, in which people act out their dreams, punching, kicking, or jumping from bed while still asleep. Talk with your doctor about all possible medication side effects.

Caffeine and Sleep

Caffeine stays in the bloodstream much longer than most people realize, Avidan says, keeping you wired when you should be sleeping. Depending on your metabolism, it can take as long as eight to 14 hours to eliminate one-half of the total amount of caffeine you consume from your system.

A latte with two shots of espresso contains about 150 milligrams of caffeine. If you have that at 5 p.m., by the time you wake up at 7 in the morning, the level of caffeine in the body is still about 75 milligrams. One Red Bull contains 80 milligrams of caffeine, Avidan explains.

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If you can't sleep, say no to joe until sleep problems are under control, Avidan advises. If insomnia isn't a major problem, but you mysteriously can't sleep some nights, cut off your coffee or tea intake after breakfast. "Once you go beyond 10 a.m., it can be a problem," Avidan says about ingesting caffeine. Yet, most people become sleepy around 3 p.m. and use caffeine for a midday pick-me-up. That's a mistake, he says.

And don't forget that coffee and tea aren't the only things loaded with caffeine. "Chocolate is notorious for causing sleep problems and people don't recognize it," Avidan says. "People also have the notion that soda must have a dark color to be caffeinated. That's a myth."

Hormones and Sleep

Reproductive hormones shift when women are menstruating, pregnant, or entering menopause, and they mess with the brain chemicals that regulate sleep. The pain and discomfort that come with these shifts might also keep you up at night.

If you're menstruating and get cramps with your cycle, Walsleban suggests getting ahead of pain, which can be just enough to disrupt sleep but too subtle for you to be aware of it. Just one nonsteroidal anti-inflammatory pill, such as ibuprofen, or an aspirin at bedtime might do the trick. "It eases things up enough so you can sleep," Walsleban says.

It's also common for women in their late 30s and early 40s to have a hard time sleeping. According to Walsleban, this is sometimes an early sign of perimenopause. In the early phases of menopause, hormones fluctuate, occasionally causing hot flashes, sweating, and even anxiety -- all of which can prevent you from dozing off or can wake you up. Both perimenopausal and menopausal women can help reduce their symptoms by maintaining a cool bedroom temperature (mid-60s is good), sleeping in loose, comfortable clothing, and staying healthy with good eating and exercise habits.

Alcohol and Sleep

Although a few glasses of wine might knock you out, as alcohol is metabolized in the body (a rate of one glass of wine per hour is typical), levels of alcohol begin to fall, and its sleep-inducing effect wears off. That's when you wake up.

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In fact, alcohol disrupts your ability to doze in a number of ways, according to Avidan. During the first stages of sleep a number of things are altered: Alcohol shortens the time it takes to fall asleep, it reduces REM sleep (which, research shows, stimulates regions of the brain necessary for learning and good cognitive function), and it increases non-REM sleep, which is a lighter slumber. As the alcohol begins to withdraw from your body later in the night, sleep becomes more shallow and disrupted, REM sleep increases (all at once, rather than slowly, over the course of the night), and with it, so do dreams and/or nightmares. This all adds up to a poor night's rest.

Alcohol can also rob you of needed slumber by swelling mucus membranes, blocking airways. People breathe more heavily, making it difficult to pass oxygen to the lungs. That's particularly dangerous for people with sleep apnea, a condition causing brief interruptions in breathing.

Red wine with dinner is fine if you don't have trouble sleeping, Avidan says. Just be sure to drink three to four hours before bedtime so your body has enough time to metabolize the alcohol and your sleep is not disrupted. That's the average time needed for three glasses of wine to clear your system.

For people with sleep apnea or a history of insomnia, he recommends not drinking until sleep problems are under control.

Eating and Sleep

Food and sleep don't make good bedmates. Either eating too much or too little at bedtime can interrupt sleep.

A heavy meal before you go to bed is a bad idea because it can cause reflux, Avidan says. Lying down brings acid from the stomach back up into the esophagus, which can trigger heartburn, pain, or coughing -- not a recipe for restful sleep.

Try eating dinner early in the evening, say around 6 p.m. or 7 p.m. If you're hungry later, opt for a light snack to tide you over. "You want to have finished your dinner at least four hours before bedtime," according to Walsleban.

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Walsleban also recommends elevating the head of your bed with a brick or block of wood to combat the effects of reflux. Gravity helps hold stomach acids down where they belong, making it easier to get sleep. But don't try this trick with pillows, she warns. "Pillows just cause more grief because they slip and you roll off of them. You kink your neck and stomach, putting you into a worse position," she says.

Tried everything and still feel the burn at bedtime? Check with your doctor to find out if you have an undiagnosed case of GERD, or gastroesophageal reflux disorder, a condition that causes food or liquid to leak backward from the stomach into the esophagus.

Healthy Bedtime Snacks

Although eating too close to bedtime can disrupt sleep, eating too little can wreck sleep too. Walsleban says she commonly sees this among women who are trying to lose weight. "They'll eat very little during the day and have a salad at night, and then they don't sleep well. So if you had a light meal at dinner time, you might need a snack before going off to sleep." Small portions of crackers and cheese, fruit, cereal, or yogurt are all good choices an hour or so before bed.

A few lifestyle tweaks should go a long way toward peaceful slumber and a happier outlook. But if sleep still eludes you, talk to your doctor about what might be standing between you and a restful night of sleep. Sweet dreams!

Be a Sleep Sleuth

Be on the lookout for other things that can disturb sleep. These include:

Medications, vitamins, or supplements -- with an agitating effect, such as respiratory inhalers used to treat asthma, blood pressure medications, and oral contraceptives.

Undiagnosed or low-level chronic pain.

An old, uncomfortable mattress -- be sure to replace your mattress every eight to 10 years.

Pets in bed -- that thrash throughout the night or that cause your allergies to flare up.

A restless, snoring, or otherwise disruptive bed partner -- who might have his or her own sleep issues.

A sleep disorder -- always rule out that possibility.

WebMD Magazine - Feature Reviewed by Michael J. Breus, PhD on January 04, 2011

Sources

SOURCES:

National Sleep Foundation: "2009 Sleep in America Poll, Highlights and Key Findings."

American Psychological Association: "APA Survey Raises Concern about Parent Perceptions of Children's Stress."

Joyce Walsleban, RN, PhD, associate professor of medicine at NYU's School of Medicine.

Alon Avidan, MD, MPH, associate professor of neurology, UCLA; associate director of UCLA's Sleep Disorders Program.

Taylor DJ, Sleep, 2005; vol 28: pp 1457-1464.

March of Dimes: "Caffeine, What You Need to Know."

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