Why you can’t sleep & what’s keeping you awake

Somewhere along the way we have all been told that 7 hours sleep is optimal; however, this is the absolute minimum an adult should be getting. 9 hours may be a better number for many people who wish to have optimum health and energy levels. Teenagers (aged 14-17) need between 8 and 10 hours – do we know any junior or leaving cert student getting this?

So why is enough sleep so important?

• Your immune system needs adequate sleeping hours in order to function well. Those who are worried about any viral infections, flu, colds and pneumonia should pay as much attention to their hours of slumber as they do their hand washing. Studies¹ have shown that those who get less rest have a depressed immune system compared to those getting enough shuteye. One of the reasons is because when you sleep your body produces and releases proteins called cytokines; these are chemical messengers that immune cells use to signal each other. If you don't get enough sleep your immune system will not function as well as it could and when a virus or bug gets inside you, your immune system may be too slow to act.
• REM or Rapid Eye Movement is the part of your sleep when dreaming happens and it is the first part of your sleep sequence that will suffer if you are not sleeping well or going to bed too late. REM can be compared to a mental systems-reboot for your mind, as this is the stage of sleep when all your mental tasks, deeds, thoughts and emotions are processed. It's when your brain has a good think about everything and when your thoughts are allowed a good airing in the privacy of your slumber. Chronic sleep problems and ongoing supressed REM have been linked to anxiety, depression and poor concentration. One study² in the Netherlands found that participants who got adequate REM sleep were better able to deal with fear and distress than those who did not get enough REM. Another study³ found that REM sleep improved the ability to solve puzzles.
• Getting less than 8 hours sleep has been linked to an increased risk of injury, and this risk increases as you get older. It doesn't matter if you are an athlete, school child or pensioner: you are more likely to hurt yourself, as well as being more prone to inflammation and pain.
• You will overeat.⁴ Two hormones, ghrelin and leptin, are affected by sleep and this can affect hunger and appetite. Less than 8 hours sleep can increase your levels of ghrelin, which causes hunger. Not only that, but your levels of a lipid called endocannabinoid increases too, which makes you want cakes, fatty foods and sugar. A lack of sleep has been linked to an excess of 300 calories a day; so, if you want to make healthier food choices or lose weight, go to bed on time!

What can be keeping you awake?

There are many reasons why sleep quality can be impaired and they may be mechanical, physical or emotional.

• Overheating in bed can disturb your sleep. The ideal temperature for a bedroom is between 16 and 18°C. This is because when your body is cool and rested, it triggers the production of melatonin, the sleep hormone. During the evening, your body temperature naturally drops, and as morning approaches it rises again, getting ready for the day. This is all part of the shutdown and repair process. If you are waking up in a bog of sweat then your bedroom may be too hot or you may need to ditch that high TOG duvet.
• Hormonal imbalances, in particular during menopausal transition, can really play havoc with the body's thermostat and ability to regulate temperature. Falling oestrogen levels can cause hot flushes, which can be mild but can also be a feeling of intense heat that can roll up through the body suddenly from the toes to head, causing redness, flushing and sweating. This can last a few seconds or up to ten minutes. This can alternate with periods of a drop in temperature, so it may be really hard to choose a duvet for this scenario!
• 50% of men over fifty have an enlarged prostate, and this increases to 95% of men of eighty. Most of the time this is caused by a condition known as Benign Prostatic Hyperplasia or BPH, where normal ageing processes like falling testosterone and a bit of inflammation cause the prostate gland to swell and block the urethra (the pee pipe). This makes it really hard to empty the bladder. Urinary flow becomes a thin dribble, stopping and starting, and this makes it hard to empty the bladder completely. Many men who have BPH have to get up repeatedly during the night to wee, and this does affect sleep.
• Chronic stress (stress that is ongoing and long-term) has been linked to many health conditions like heart disease and inflammation. It's unsurprising that it is linked to anxiety, depression, poor concentration, weight gain, digestive problems, headaches, heart disease and sleep problems.
• Alcohol, caffeine and smoking have all been proven to cause sleeping issues. Here are all the lovely things that alcohol can do: it acts like a diuretic, making you pee more (this can make you dehydrated); it is hard on the digestive system and can cause diarrhoea and acid reflux; too much of it puts a burden on your liver, which is already busy processing your hormones, making immune cells and cleaning your blood. Alcohol also widens the blood vessels, causing more overheating and temperature fluctuations. Both nicotine and caffeine are stimulants, so may well keep you awake by disturbing production of melatonin. Smoking will also add breathing problems to the mix, whether it's a blocked nose or a cough.

How do you get to sleep and improve your sleep quality?

• It's as important to have a regular sleep routine as it is to get the hours at rest. This is due to something called circadian rhythm, which is your 24-hour body clock. Interestingly, this will change slightly as you get older, which is why teenagers like to stay up late and an older person may do better with an earlier bedtime. You may notice that you feel tired around the same time every day and maybe full of beans at other times. This is worth paying attention to, as it gives you a clue about your own body clock. The hypothalamus (the most primitive part of the brain- our lizard brain) controls the circadian rhythm and keeps the body on a cycle of tasks: repair, sleep, digestion and many other jobs are all lined up for specific times over the course of the day. The hypothalamus uses daylight and darkness to regulate itself, so spending time outside in the bright light during the morning hours and then dimming lights in the hour or so before bed are good measures to take, if at all possible. This rhythm and routine are essential to respect if you want to function as well as you can. Going to bed and waking up at the same time every day will make the hours that you sleep more productive and will help you establish a sleep routine. For those who have to work unsociable hours, trying to keep as regular a routine as possible in your sleeping and eating habits may mitigate some of the negative effects.
• Keeping all electronic devices, TVs and whatnot out of your bedroom is good sleep hygiene. The blue light that phones and tablets emit inhibit the sleep hormone melatonin, and this can cause insomnia. I would argue that binge watching Netflix is addictive and sometimes you just have to make hard decisions!
• Identifying health issues like BPH, hormonal imbalances or anxiety that may be affecting your ability to sleep well may really positively impact your life and health. Talk to your GP about your concerns and ask for a diagnosis. Your local chemist and health food store stock many effective, natural remedies, and are excellent places to ask for advice on herbal medicine, food supplements as well as lifestyle changes.
• Take B vitamins and/or a magnesium supplement - both are good food supplements that will support the nervous system during stressful periods. Magnesium is a mineral that is needed for over 300 biochemical reactions in the body: we need heaps of it! It has a role to play in nerve and muscle function and energy production, and it helps keep our bones, glucose levels and immune system healthy. It can be recommended to both help maintain energy and to aid sleep. B vitamins are essential for the health of the nervous system as well as many other complex and essential functions. Because they are water-soluble, they are not stored the way fat-soluble nutrients like vitamin D are. If the diet or digestive system are poor, or if there are extra demands on the mind and body, it may be necessary to increase the intake of B vitamins to avoid running low. Foods that are rich in these vital nutrients include green leafy vegetables, wholegrains, beans, meat, dairy and eggs.
• Take a natural sleep remedy – Dormeasan Sleep is a fresh herb tincture that is made of Valerian and Hops. This is a non-addictive and fast-acting remedy, which has a strong taste and smell due to the volatile components that contribute to its effect. (Cats like the smell for some reason: not me!). I use it when I am travelling, as my routine gets out of sorts. I find that I still wake if a dog is barking or my husband snores, but that I can get back to sleep really quickly. I never feel drowsy in the morning after it, although I do get quite vivid dreams – apparently it helps with the REM phase of sleep, so you dream more as your brain catches up on its processing duties. Don't take Valerian and Hops if you are on Warfarin, are pregnant or breastfeeding, or if you are already taking a sleep medication.

¹ https://www.sciencedaily.com/releases/2017/01/170127113010.htm
² https://nin.nl/rem-sleep-silences-siren-brain/
³ https://www.sciencedaily.com/releases/2009/06/090608182421.htm
⁴ https://www.sleepfoundation.org/articles/connection-between-sleep-and-overeating