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Sleepless nights

Have you had a sleepless night? It can be a common, one-off occurrence – especially when you are worried about something, you are in an unfamiliar bed or you are feeling unwell.

In this blog post, Dr Lindsay Browning explores what can cause a sleepless night. She reveals its impact on your health and how to try to reduce the occurrence of sleepless nights, with good bedtime habits, as well as a recommendation of what to do if it starts happening more and more often.

What can cause a sleepless night?

A lot of different things can cause a sleepless night. Sometimes, people don’t get enough sleep because they are not prioritising it, but others struggle to fall asleep or don’t get good quality sleep due to anxieties and pressures of the day causing frequent night-time awakenings.

However, sleepless nights may not only be due to psychological reasons, but physical discomfort too. In a 2021 sleep study they asked what was keeping people up at night and these were the top ten reasons:

Top 10 sleep disturbances

Being too hot – 55%
Anxiety – 36%
Needing the toilet – 30%
Partner snoring – 23%
Your phone – 20%
Depression – 17%
The light (street lights or brighter mornings) – 16%
Being too cold – 16%
A headache – 15%
Pain – 14%

It’s interesting to see that being too hot came out as the top reason that people struggle to sleep. This could be because when we go to sleep our body temperature naturally drops, but when we are too hot, our body temperature struggles to fall, and, in turn, it is making it hard to sleep.

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It is also worth noting that anxiety was the second most commonly reported cause of poor sleep. Often, people find that their mind won’t “switch off” at night and, instead, is full of things like worries and to-do lists. If people don’t make time during the day to think about what is on their minds, then once they lie down in bed, in the silence of the night, this can be the first chance they have had to “think”. With this opportunity, their mind can become filled with anxious thoughts, stopping them from being able to sleep.

Is sleep that important?

Sleep, although not always a top priority for people, is vital for our longevity. When we sleep, our brains physically repair our bodies and regulate important hormones, which control the functioning of our bodies during the day.

Does a sleepless night or two matter?

In the short run, a lack of quality sleep can negatively affect concentration, memory and leave us feeling groggy. Partly, this is due to not having enough sleep, but also due to the sleep cycles becoming fragmented. Sleep is made up of three main parts: REM sleep (the part where we have our most vivid dreams), light sleep and deep sleep. These happen in sleep cycles throughout the night – typically starting as light sleep, deep sleep, back to light sleep and then dreaming sleep, then the cycle repeats again.

Each sleep cycle is approximately 90-110 minutes long. As much as “deep sleep” might sound like it is the most important part of sleep, that isn’t really true. We need all the different parts of our sleep to be healthy as they provide different functions. Deep sleep is the part of sleep where we are hardest to wake, and if we wake from deep sleep we may experience a groggy feeling called “sleep inertia”. This is why a 50-minute nap may leave us feeling worse when we wake than a shorter 20-minute nap, because we have woken from this deeper part of sleep.

Dreaming/REM sleep is vital for helping us to process our emotions and make sense of what’s going on in our lives. If you are depressed or having a particularly difficult time in your life you might find that your dreaming sleep is not functioning to help you process the painful emotions you are going through. Similarly, deeper sleep is associated with muscle repair and hormone regulation.

If we don’t get the right amount of sleep, or the right kind of sleep in the long term, then our bodies may not be properly repaired during the night. For example, as we sleep our brains physically wash away the build-up of amyloid plaques which can cause Alzheimer’s disease and when we don’t get enough sleep our brain doesn’t have the time to do this physical spring cleaning of our brain and we are more likely to develop dementia. Also, if we don’t get enough sleep then our brain doesn’t regulate the hormones that control our hunger drive (ghrelin and leptin), which can lead to weight gain and obesity.

People who get too little sleep (fewer than 7 hours per night), or too much sleep (more than 9 hours per night) have been shown to have increased all-cause mortality risk, i.e. you are more likely to die earlier due to any reason, compared to people sleeping between 7-9 hours.

For all of these reasons and more, regular sleepless nights and interrupted sleep is not good for us.

How can we reduce sleepless nights?

1. Have a regular bedtime and wake time

Keeping a regular wake up and bed time seven days per week will help you sleep better. When you keep a regular sleep schedule your body develops a robust circadian rhythm, which helps you to sleep at the right time at night. If you go to bed early and wake up early on weekdays, but stay up late and have a lie-in on the weekend, you are giving yourself weekend “jet-lag” – making it much harder to go to sleep early on a Sunday night ready for another early start on Monday morning!

2. Increase your exercise levels

As well as being essential for overall health, people who exercise regularly are more likely to have better sleep. Also, some studies suggest that increasing exercise can increase your need for “deep sleep” at night. Deep sleep helps you to feel refreshed when you wake up and helps with sleep continuity.

Some people may prefer exercising early in the morning, whereas others may prefer to exercise after work, depending on their chronotype and personal preferences. Early chronotypes (larks) often feel more able to exercise before work, whereas late chronotypes (owls) may feel much more ready to exercise later on in the day. Try to avoid vigorous exercise within 90 minutes of bedtime as that can affect sleep in some people, as you may be in a heightened state of physiological arousal with an elevated heart rate and an increased body temperature.

3. Stop your caffeine intake at 2pm

Caffeine has an average half life of about 5-7 hours. That means that around 5-7 hours after your cup of coffee, half of the caffeine may still be in your system! Caffeine is not only found in tea and coffee, but also in chocolate and in soft drinks, such as cola and energy drinks, including the sugar-free variety. Caffeine intolerance is very greatly between people and for some people they metabolised caffeine more quickly and may they may find that caffeine does not affect their sleep as much as for somebody else. I typically recommend that people who are having difficulty sleeping try to avoid caffeine after around 2pm.

4. Have a warm bath before bed

Having a relaxing warm bath before bed may not only help you to wind down after a busy day, but also the temperature of the bath may help you sleep. When you go to sleep, your body temperature naturally decreases.

If you have a warm bath, then you increase blood flow to the surface of the skin as well as artificially raising your body temperature. When you come out of the warm bath, your body temperature will naturally start to drop, enhanced by the increased blood flow at your skin surface, mimicking the drop in temperature that happens as you fall asleep, helping you to feel sleepier.

5. Don’t lie in bed for long periods if you can’t sleep

If you can’t sleep, then lying still in bed for long periods trying to force sleep is one of the worst things you can do. The longer you lie in bed trying to force yourself to sleep and clock watching, paradoxically, the more anxious you are likely to get about not sleeping. Instead, you may want to get out of bed for a little while to do something else such as reading a book or doing a jigsaw, returning to bed when you feel sleepy.