Wired and wide awake ... why we can't sleep

Wired and wide awake ... why we can't sleep Photo: iStockphoto

Why are so many of us having trouble getting a good night's sleep? Let us count the ways: firstly we are over-caffeinated, we are over-wired and we're overworked.

Being over-caffeinated (coffee, soft drinks, energy drinks, snacks) and over-medicated (prescription and over-the-counter drugs, including alcohol), is wreaking havoc with slumber patterns.

Then being over-wired (video games, web browsing, social media, texting) and overstressed (money, work, relationships, overloaded schedules), is making us too restless to doze off when we should.

Plus we're overworked (longer hours, night shifts incompatible with our biological clocks) and overweight (perhaps a chicken-or-egg deal, as different studies have found that one leads to the other).

And then there's societal pressure, what US sleep expert Dr Mark Mahowald calls "the pervasive, erroneous attitude that sleep is not a biological imperative, that it is negotiable. We have raised sleep deprivation to a badge of honour."

Mahowald is director of the Minnesota Regional Sleep Disorders Center, chief of the Department of Neurology at Hennepin County Medical Center and professor of neurology at the University of Minnesota Medical School.

The effects might outnumber the causes, and are hardly as benign as many of us might think. "Any degree of sleep deprivation will impair performance: behind the wheel, in the classroom or workplace," Mahowald said.

The lowdown:

- Insomnia victims have trouble falling or staying asleep in a setting with adequate conditions for sleep; this becomes chronic insomnia if it lasts more than three weeks. Sleep deprivation is caused by behavioural or situational factors that curtail or mitigate the ability to get enough sleep time.

- Most adults need seven to nine hours of sleep a night. The amount a person needs is genetically determined, Mahowald said. "Some people might need four hours on the short end, up to 10 on the high end. We have absolutely no control over this."

- Anyone who uses an alarm clock "is by definition sleep-deprived," Mahowald said, "because if the brain had received the amount of sleep it wanted, you would have woken up before the alarm went off."

- Larks and owls: "Some people are early to bed, early to rise; others late to bed, late to rise. We have very little control over that," Mahowald said. "So you see a lot of problems when an owl marries a lark and each one thinks the other is being stubborn."

- With sleep deprivation, some glucose metabolism problems might predispose one to diabetes. And if so, a consequence could be heart disease and stroke.

- With insomnia, there is no evidence of long-term physical problems or links to other diseases. But insomnia results in poorer quality of life and work absences and can lead to depression.

- There is some evidence that severe sleep apnea can lead to hypertension, heart problems and a higher risk of strokes.

At different stages of our lives, we're plagued by unique stresses. The good snoozing news: Solutions that go well beyond counting sheep are at hand.


Late teens

- Common stress sources: schoolwork and social pressures.

- This is the stage of circadian rhythm shifts: The ability to fall asleep shifts to later in the night just as the need for sleep increases. This age group has a hard time getting out of bed early and an even harder time attending early-morning classes. That leads to poor attention, concentration and irritability.

- Technology's bite: Young people who are on Facebook or video games late into the night have trouble winding down for bed.

- Caffeine is a huge factor, not only in beverages and "nutritional supplements" but everything from sweets to potato chips, and now inhaled caffeine.

- Obstructive sleep apnea is on the rise among teens, and might be related to the rise in teen obesity.


40-ish

- Common stress sources: work, finances, parenthood.

- Increased work and family obligations abound: Think 5am swimming practices, more early-morning and late-evening meetings at work.

- As many of us age, our biological clocks shift so that we go to sleep earlier and get up earlier. Sleep needs don't change, although sleep might be lighter and more fragmented.

- Many people in this age range who suffer from insomnia are reluctant to seek treatment because they want to avoid sleeping medications. People are increasingly turning to over-the-counter nonprescription agents that have some effect.

- In middle years the risk for intrinsic sleep disorders, including obstructive sleep apnea, increases. Restless-limb syndrome often starts.


70-ish

- Common stress sources: health-related issues and finances.

- Contrary to previous conventional wisdom, aging does not cause poor sleep. It appears that most people experiencing sleep deterioration have another underlying medical cause.

- Pain is an issue for this group. Partly as a result, there's heightened concern with those 70 or older taking a lot of medication.

- Good news, of a sort: We used to see insomnia related to retirement in this age group, but more people are continuing to work later in life.


SOLUTIONS

- Improving sleep hygiene - avoiding late eating and drinking, keeping the room cool and dark, winding down before bedtime - can improve or resolve transient or acute insomnia but probably not chronic insomnia.

- For chronic insomnia, cognitive behavioural therapy is equally as or more effective than medications. Medication often is useful for acute insomnia.

- Naps can help - except when they don't. "We discourage napping when anyone has problems falling or staying asleep at night, which might be an untreated sleep disorder," said Dr Michael Schmitz, who runs the Behavioural Sleep Medicine Program at Abbott Northwestern Hospital in Minneapolis.

"We encourage power naps, 30 minutes or less, when people can't stay awake or will have late-night events."

- See your doctor if: You have had difficulty falling and staying asleep for more than a week. Or if you snore, have frequent awakenings and are reporting sleepiness during the day. Anyone with apnea symptoms should seek treatment.

SHNS