Many of us experience sleep difficulties at some point in our lives. In fact, at least one out of every five people may suffer from insomnia. “Insomnia” is a condition characterized by trouble sleeping- trouble falling asleep, trouble staying asleep, or trouble waking too early and not being able to get back to sleep. Many aspects of daily life can be harder to manage when we have not slept, including managing thoughts and emotions and maintaining our ability to focus. Not getting enough sleep increases our chances of feeling depressed or really stressed. When we are exhausted, everything seems more difficult. In fact, people who are exhausted from lack of sleep even have a higher likelihood of experiencing more pain symptoms!
Sleep difficulties usually include difficulties falling asleep, trouble staying asleep, or waking up too early.
Some of the common causes of sleep disruption are:
Stress or worry
Changes in sleeping patterns (e.g. jet lag, shift work)
Environmental factors such as a noisy, bright or uncomfortable bedroom
Difficult life events such as bereavement, divorce, job change, move, or other losses
Physical ill-health or pain
Going into a hospital, residential home, or hotel
Unwanted side-effects of medication
Street drugs such as amphetamines, ecstasy, or cocaine
Legal drugs such as alcohol, caffeine, or tobacco
Withdrawing from medicines or drugs
Emotional difficulties such as anxiety or depression
For most people, sleep difficulties are temporary and will pass with time. However, sleep disruption can last longer for some people and can start to affect areas of life including work, physical health, and relationships.
When we are experiencing sleep difficulties, we often may not be aware of how much actual sleep we are getting or think we need more sleep than we really do. We may find ourselves worrying about our sleep difficulties and this in turn can make the difficulties worse.
The amount of sleep we need to function properly varies from person to person. Some people may need 8 hours a night, while others may need more or less than this. The amount of sleep we need also changes with our age and lifestyle changes such as changes in our activity levels.
Bed Habits and Sleep Hygiene
When you have had sleep problems for a long time, you can develop common bad habits that can cause you to continue having sleep problems, or even make them worse.
"Sleep Hygiene" is a funny term that confuses some people, but it simply refers to having good sleep habits. A good sleep hygiene routine has been shown to help people with sleep problems to improve their sleep!
Below are some habits we all can get into and some tips for improving your sleep hygiene:
Problem: Not having a good routine
When we are children, it is very important to have a good bedtime routine to help us sleep well. We often lose sight of the importance of this routine as we get older, but it is still very important! Our bodies have internal clocks which rely on routine to help us to know what time of day it is. For example, regular mealtimes and bedtimes can be important factors to help us to sleep better.
Solution: Focus on routines for sleep, eating, and exercise
Creating a good routine of healthy sleep habits before bed, helps your body and mind to prepare for sleep and to produce lots of the sleep-inducing hormone melatonin. This routine should include doing relaxing activities that help you to wind down and preparing your bedroom for sleep.
In addition to having a bedtime routine, a morning routine may also help! In fact, research shows that having a consistent waking up time each day is an effective method for getting your body’s sleep rhythms on track.
A note on exercise: Exercising in the morning may help manage your sleep-wake cycle. Your "sleep-wake cycle" is your body’s ability to sleep at night and stay awake during the day. Exercising helps produce chemicals that controls this sleep-wake cycle. Be wary of exercising at night as this might keep you awake for longer. Talk to your medical provider before starting any exercise program.
It makes sense that, if you have had a bad night’s sleep and you are feeling tired, then you might want to sleep in the day to try and catch up. But this can really reduce the quality of your sleep that night. It can make falling asleep difficult, which can make you feel more tired, which can make you want more naps! This can become an unhealthy cycle.
Solution: Limit naps
You will find that it is easier to sleep if you increase your desire for sleep. This means limiting naps and not sleeping past your alarm clock. It could be hard to do this, especially if you are having difficulty sleeping at night. After a few sleepy days, you may find that you are better able to fall asleep and stay asleep.
Problem: Poor bedroom environment
It is important that your bedroom is a dark, quiet, relaxing, and comfortable place for you to sleep. Bright lights or ‘blue light’ from screens can impact negatively on your sleep, because they make your body think it is morning. Use warm ‘red spectrum’ lights instead.
Solution: Make your bedroom comfortable
Set yourself up for success by making your bedroom a place where you can easily fall asleep. This means making it very dark (or using an eye mask), having a comfortable bed, and limiting noises. Your mattress, bedding and the temperature of your bedroom are important too – make sure you are not too warm or too cold. If noise is keeping you awake, try ear plugs or a white noise machine. Ideally, a few hours before bed, you should make sure that your bedroom is organized and that the lighting is set. Also, avoid using devices such as computers and phones more than necessary in the hours leading up to bed, as their light can impact sleep. Many phones and computers have apps or setting that allow the device to adjust the screen lighting so it uses softer, more sleep-friendly light at night. You can also purchase blue-light filtering glasses to wear when using screens in the evening.
Problem: Negative associations with the bed and bedroom
After having had sleep problems for a while, you can start to see bedtime and your bed as an unpleasant place to be, because of the amount of time you have spent in bed not being able to sleep and feeling frustrated.
This means that when you are getting ready for bed, these negative associations can cause you to feel more stressed and anxious, which means that you will be less likely to sleep well. You might have started doing activities in bed other than sleeping like reading, scrolling through social media, or watching television. Spending a lot of time in bed not sleeping, causes you to associate your bed with being awake. This can again mean that you are less likely to sleep when you go to bed. Have you ever had the experience of doing some work in bed or paying bills in bed, and then having trouble sleeping because those activities got your mind racing? This is the reason we want to limit doing activities in bed that are not associated with sleep or relaxation.
Solution: Use your bed for sleep and intimacy only
Try limiting the time you spend on your phone (or cutting it out completely), watching TV, reading, or talking with a sleep partner. Instead, go to sleep when you are already tired. If you find that you are not tired, spend time doing other activities in a different space until you are ready to fall asleep. Your bed should be for sleep and sexual activity only- doing other activities in bed can negatively impact your sleep.
Problem: Using substances
Sometimes when people have difficulty sleeping they start using substances to self-medicate their sleeping problems. For example, you might find yourself having a few glasses of wine before going to bed or drinking caffeine to help keep you awake during the day. Using substances like alcohol, drugs, caffeine, or nicotine can actually keep sleeping difficulties going.
Solution: Reduce or eliminate your use of substances
- Limit the amount of caffeine that you consume. Caffeine can disrupt the signals in your body that tells you when you are sleepy. Experts believe adults should keep caffeine consumption below 400-mg per day (about 4 cups of coffee). It is important to pay attention to your body because some people may be more sensitive than others. Talk with your doctor if you are concerned about the amount of caffeine that you are drinking.
- Avoid alcohol use at night. Alcohol can be deceiving. While it can make you fall asleep quickly, alcohol hurst sleep much more than it helps! Alcohol interferes with your body’s ability to get restful sleep and makes it difficult to stay asleep throughout the night. Alcohol temporarily reduces some stress hormones in our body, which can lead to feeling relaxed and may make it easier to fall asleep. However, a few hours later, as our bodies process the alcohol in our systems, we get a rebounding spike of these stress hormones that often leads to waking up and having difficulty getting back to sleep. This hormone-related sleep disruption leads to fatigue and can disrupt our sleep cycles. Also, alcohol can negatively impact sleep quality, making our sleep more restless and less restorative for our bodies and our minds. And these factors are only some of the reasons to avoid alcohol- they do not include the other negative health effects that overuse of alcohol can cause. In sum, alcohol is best avoided if you are having sleep problems. Cut out moderate to heavy alcohol use before bedtime.
- Avoid nicotine before bed. Nicotine causes your body to become more awake. This may make it more difficult for you to fall asleep when you want to.
Hunger, thirst, and bathroom use: Set your body up to sleep well
Increasing your desire to sleep will not be helpful if you are unable to sleep consistently due to your stomach is rumbling or having keep running to the bathroom during the night!
- Don’t go to sleep hungry. This may cause you to wake up during the night. Getting up to eat may then make it harder to fall back asleep.
- Don’t drink excessive liquids before sleep. Having to use the restroom during the night will also interfere with your ability to get uninterrupted sleep. Like being hungry, this may impact your ability to fall asleep again.
Sometimes nightmares can contribute to sleep problems, especially after a stressful or scary event. Nightmares are common reasons for nighttime awakening, and they can often make it difficult to fall asleep after you wake up because your body is on high alert and you may feel panicky. There are a few strategies that can help make nightmares more manageable, but this is often not a problem that resolves quickly. If you find nightmares are an ongoing problem, talk with a medical or mental health provider about treatment options.
Solution: Focus on your sleep routine
Several factors have been shown to make nightmares more manageable. These include:
- Develop a consistent, pleasant, relaxing bedtime routine and stick with it. Make your time leading up to bed as pleasant, relaxing, and safe as you can.
- Talk about or write about the nightmare. Nightmares can be our mind’s way of processing difficult events. If we talk about the events, write about them, think about how the event has impacted us, or even rewrite alternative story lines that are not as disturbing, this allows us to process the event so that nightmares will, eventually, be less problematic. It is important to know that speaking about an event, writing about it, and hearing someone else talk about the event all use different parts of our brain, which is a great tool for processing a difficult event so that it has less power over us. If you find yourself thinking about events frequently even though you don’t want to, and/or you find yourself feeling very upset, please seek the support of a provider who can help you figure out a good treatment option for you.
- Seek help from medical and/or mental health providers. Having nightmares for a short time after a scary or stressful experience is common, and these usually resolve within a few weeks to a few months. If you find yourself feeling very upset by the incident or of nightmares are not improving as time passes, seek the support of providers who can help you understand the symptoms and find a good treatment plan. Nightmares can be a symptom of PTSD or other mental health reactions to stress, and seeking support early can make a big difference in helping you get back to doing the things you enjoy doing.
Problem: Worrying about your sleep
Sleep problems can cause you to become very anxious about sleep. For example, you may worry about how you will cope the next day if you have another night of not sleeping well. However, the more you worry about sleeping, the more anxious you will become, and the less likely you will be able to sleep.
Solution: Manage Bedtime Worries
If you find your mind is racing and your worries are keeping you awake, try keeping a journal beside your bed and writing down your worries. Trying to ignore or suppress worries only makes them worse, whereas writing them down on paper gets them out of your head. Then you could try a relaxation technique to help you let go of any residual anxiety or tension you are feeling.
Taking a Closer Look at Sleep
There may be several factors that are contributing to your sleep difficulties, and some may be things that you are not even aware of.
Read through the questions to help you identify these factors:
Am I going to bed at the same time each night & getting up at the same time each morning?
Do I get less sleep, or poorer quality sleep, when I have had an alcoholic drink or too many caffeinated drinks during the day?
Am I taking any medication or drugs that might affect my sleep?
Is my bedroom a comfortable environment for sleeping in?
Do I find it more difficult to sleep at night when I have had a nap during the day?
Am I spending too much time in bed not sleeping?
Do I really need as much sleep as I think I do?
Are my worries keeping me awake?
If you are experiencing difficulties sleeping, you may find support talking with a therapist. There are research-supported treatments that may help you learn skills to fall asleep and stay asleep. Talk with your doctor or clinician about Cognitive Behavioral Therapy for Insomnia (CBT-I). Reach out to your doctor if you are interested in learning more about medications that might assist you in sleeping better.