Why no sleep? These are the keys to zzz's

If I was given a dollar every time someone told me they were a bad sleeper, I’d be hanging out with Richard Branson right now. It is a chronic health problem which has consequences that reach far beyond feeling a bit worn out and irritable. 

In 2017, the Sleep Health Foundation published research which estimated that “7.4 million Australians routinely missed out on adequate shut eye in the 2016-2017 financial year,” the report said.

“This lack of sleep had harmful effects on everyday function, and exacerbated health conditions from heart disease and stroke through to diabetes and depression in tens of thousands of Australians,” said Professor Dorothy Bruck, Chair of the Sleep Health Foundation. 

“On top of this, it claimed the lives of more than 3,000 people. The cost of sleep deprivation is utterly alarming and confirms we need to take urgent action to put sleep on the national agenda.”  

The report also said the nation’s sleep problem cost the country “$66 billion a year in health bills, lost productivity and wellbeing.”

If you experience sleep problems, chances are that your neighbour, your workmates and even your kids may battling with it too. 

The two main types of insomnia

1. Onset insomnia 

Insomnia is basically not being able to fall asleep. Ideally you would take 10 minutes to fall asleep each night. Taking only five minutes is too quick and 30-plus minutes is too long. 

2. Maintenance insomnia 

Waking during the night is also a problem. For some people getting up for a toilet run and falling straight back asleep is easy, but waking once and staying wide awake for one, two or three hours is terrible for you. 

If you wake multiple times a night, sometimes hourly, you are not getting into the deep sleep states you need for restorative sleep. Maintenance insomnia can also look like early waking. Often people wake at 4am and that’s it - their body thinks it’s time to get up and start the day. Forget falling back asleep. 

Cortisol and melatonin imbalance 

We know that chronic stress creates sleep problems and even acute, short bursts of stress cause short-lived disruptions to sleep for many people. 

Our bodies are designed to have high levels of cortisol throughout the day that taper off in the evening and remain low until the next morning. We are also supposed to have low levels of melatonin during the day which rise in the evening to get us ready for good quality sleep. 

Yet many people are so chronically stressed their cortisol stays high in the evening and can even be high during the night. That often looks like waking up between 1am and 3am. The aim is to manage stress so the body can naturally raise melatonin in the evening to help us get a deep and restful sleep. 

Nervous system 

We have two parts to our central nervous system. There is the parasympathetic system called ‘rest and digest’ mode and there is the sympathetic part called the ‘fight or flight’ response. 

When we are chronically stressed our nervous system thinks there’s danger we need to flee from - sabre tooth tiger, wooly mammoth, terrible boss, child who throws non-stop tantrums. 

Our sympathetic nervous system sets off a physiological sequence to prepare for a fight or flight. It’s doing what it was designed to do, but some of us go to bed in fight or flight mode and the rest and digest mode never gets a chance to kick in for a restful night’s sleep. 

Nutrient deficiency 

Could your insomnia be caused by a nutritional deficiency? Minerals and vitamins like magnesium, folate, and the B vitamins are really important for good sleep.

Magnesium is great for relaxing your nervous system, is a cofactor for making calming neurotransmitters and is a muscle relaxant. When it comes to magnesium you get a chicken-and-egg scenario. Often a person is stressed for a long time which depletes magnesium levels in the body. Low magnesium leads to insomnia and then the sleep deprivation itself adds to the chronic stress load that chews through whatever magnesium you have. On and on it goes. 

Your B vitamins are important for supporting a biochemical pathway called the methylation pathway and it plays a crucial role in the production of neurotransmitters. In order to make melatonin (your sleep hormone) you first have to make serotonin which gets converted to melatonin. Methylation ensures you can do that. It’s also involved in production of adrenaline for stress response and GABA for combatting anxiety. 

Vitamin B12 is a key cofactor in the methylation pathway too. It plays a role in the body’s biological rhythm to ensure your sleep-wake patterns are healthy ones. 

Sleep apnea 

This is a big one and it is often overlooked. It is not uncommon for sleep disturbance to be caused by sleep apnea. People with sleep apnea experience repeated obstruction of their upper airways while asleep and this in turn causes a complete stopping of or reduced airflow. 

As a result, they have a drop in oxygen and an increase of carbon dioxide occurs. This leads to activation of the fight/flight response and the result is fragmented sleep. Telltale signs are mouth breathing at night, and snoring and waking with a dry mouth in the morning.

Other medical issues

Insomnia can also be caused by a multitude of health conditions and it really is important to get these identified and addressed or managed. Common conditions that impact sleep quality include:

  • Chronic sinus congestion can make breathing through your mouth difficult and cause people to wake and not have a refreshing night’s sleep.
• Chronic musculoskeletal pain that keeps you up at night

• Joint disorders such as reactive or rheumatoid arthritis or ankylosing spondylitis

• Mood disorders such as bipolar disorder in manic phase

• Hyperthyroidism can cause insomnia

• Menopause can bring with it flushes, insomnia and flushes that wake you up! 

Other conditions associated with chronic insomnia include: 

• Cardiovascular disease

• Respiratory illnesses like asthma

• Gut disorders such as duodenal ulcer

• Chronic kidney disease

• Neurological conditions like Parkinson’s disease and chronic headaches or migraine 

The bottom line

Sleep is the cornerstone of a healthy life and it is a treatable condition. Yes, you can be a great sleeper.

I constantly counsel patients about the importance of guarding your sleep. Think of it as a precious thing to be nurtured and cared for. Be particular about your pre-bed routine, the time you go to sleep and the environment you sleep in. 

And importantly, if you don’t sleep well, get it investigated. You don’t have to be one of the 7.4 million grouchy Australians who don’t get enough sleep.

REFERENCES 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703169/

https://synapse.koreamed.org/search.php?where=aview&id=10.4162/nrp.2011.5.3.230&code=0161NRP&vmode=FULL

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128619/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763954/

https://www.sleephealthfoundation.org.au/news/media-releases/sleep-starved-aussies-run-up-66b-bill-report.html