We all want to get a good night's sleep and wake up feeling refreshed. But, too often, it seems we're left staring at our ceilings at 3 am, wondering why our minds won't shut off, or we will get a full night's sleep but wake up still feeling exhausted. Several things could be causing these terrible periods of sleep; addressing the underlying cause and adopting positive sleep hygiene habits can help.
What Interferes with Getting a Night of Good Sleep?
We recently discussed the complex relationship between sleep and stress. Not only can stress result in poor sleep, but a lack of sleep or poor quality sleep can also negatively affect the body's stress response.
Caffeine and Alcohol
While most people have their cup of joe in the morning, it may be tempting to have one more shot of caffeine in the afternoon to help get through the day — especially if you're tired from a poor night's sleep. But a study in the Journal of Sleep Medicine found that caffeine intake even six hours before bedtime has significant disruptive effects on sleep, reducing sleep by more than one hour (1). The study suggests restricting caffeine consumption to no later than before 5:00 pm (1). However, if you have an early bedtime, you may want to restrict caffeine even earlier. (Don’t forget that chocolate has caffeine, so it may be best to avoid it after dinner.)
It is also interesting to note that specific genes affect how quickly you metabolize caffeine. Those that metabolize it quickly may get away with consuming more caffeine later in the day. However, for slow metabolizers, just a small amount can affect them up to nine hours later - and the more they consume, the longer it takes to clear their system.
Although alcohol provides sedative effects that can make you feel relaxed and sleepy, it's linked to reduced sleep quality and can exacerbate sleep apnea symptoms (2). The effects of alcohol on sleep vary by individual but, according to a 2018 study, low amounts of alcohol (less than two drinks per day for men and less than one drink for women) decreased sleep quality by 9.3%, while moderate amounts of alcohol (two servings for men and one serving for women) decreased sleep quality by 24% and high amounts (more than two drinks for men and one for women) decreased sleep quality by 39.2% (3).
While loud noises and sleeping in an unfamiliar place are obvious culprits for poor sleep, blue light is also a top offender. Sources of blue light include computer and phone screens and fluorescent and LED lighting. Harvard researchers found that blue light suppresses melatonin secretion twice as long and shifts circadian rhythms twice as much as green light (4). Harvard Medical School suggests the following for blue light protection at night (4):
Use dim red lights for night lights, which are less likely to suppress melatonin and shift circadian rhythm.
Avoid looking at a bright screen two to three hours before bed.
Night shift workers or those that use electronic devices at night should consider blue-blocking glasses or installing an app that filters the blue/green wavelength at night.
Bright light exposure during the day can boost sleep at night.
Medications like antidepressants, beta-blockers, and cholesterol-lowering drugs can cause insomnia, while amphetamines, appetite suppressants, and bronchodilators can have a stimulating effect that may make it hard to sleep (6).
Certain medical issues can also prevent you from getting a good night's sleep. Conditions that may affect sleep include (6):
Sleep apnea - a disorder where breathing starts and stops
Restless leg syndrome (RLS) - which causes an uncontrollable and uncomfortable urge to move the legs
Benign prostate hyperplasia - a common condition in older men that causes uncomfortable urinary symptoms
Irritable bowel syndrome (IBS) - a condition that causes cramping, bloating, constipation, diarrhea, and gas
Gastroesophageal reflux disease (GERD) - a condition where stomach acid flows back into the tube connecting the mouth and stomach
Congestive heart failure (CHF) - a condition where the heart muscle doesn't pump blood efficiently
Additionally, chronic pain disorders like joint pain, headaches, nerve impingements, muscle spasms, and fibromyalgia can affect sleep (6).
Hormones influence our mood, appetite and so much more, so it’s no surprise that hormones, or hormonal imbalances, can also affect sleep. Hormonal disorders that could affect sleep include (6):
Perimenopause, directly translating to “around menopause”. This is when the body begins to make less estrogen and progesterone.
Hyperthyroidism occurs when the thyroid gland makes too much of the hormone thyroxine. It can prolong sleep latency and reduce sleep efficiency and duration.
Hypothyroidism occurs when the thyroid gland does not make enough thyroxine.
Elevated cortisol, the hormone associated with stress, can cause anxiousness before bed.
Melatonin deficiency - Many factors that cause poor sleep also cause low melatonin levels at night.
Autonomic dysfunction develops when the nerves of the autonomic nervous system (ANS) are damaged.
Cognitive/Mental Health Problems
Sleep problems are not uncommon in patients with mental health problems, and the two have a bidirectional relationship (7). Around 75% of people with depression have insomnia, and growing evidence points to poor sleep worsening — or sometimes inducing — depressive symptoms (7).
A survey that looked at Korean adults found those with insomnia were at a greater risk of anxiety and depression than adults without insomnia. Of the adults with insomnia, 52.4% had neither anxiety nor depression, 21.7% had anxiety, 7.2% had depression, and 18.6% had both anxiety and depression. The group with both anxiety and depression had worse scores on the sleep-related scales than all the other groups (8).
Worries and anxiety disorders are strongly linked to sleeping problems, with worry and fear creating a state of hyperarousal that can cause insomnia (7). Additionally, sleep problems can be an added source of concern and create anticipatory anxiety at bedtime that makes sleep difficult (7).
People who have PTSD may also find sleep difficult, and research has found that at least 90% of U.S. Veterans with recent combat-related PTSD have insomnia symptoms (7).
A Hope for Better Sleep - and the Accompanying Benefits
There’s typically a cause behind those never-ending sleepless nights and diagnosing the cause is the first step to treating the symptoms. It is also very important to adopt good sleep hygiene habits. We can help you discover whether an underlying condition is a contributing factor. If so, treating the cause may help improve your sleep. Whether you experience poor sleep due to an underlying condition, or simply need help creating and implementing a plan for better sleep habits, or learning to deal with stress, it is our privilege to partner with you to find underlying causes and develop a personalized plan, so you can consistently enjoy a good night's sleep.
Dr. Erik Lundquist is Board Certified in Family Medicine with ABFM and he is sub-specialized with the American Board of Integrative Medicine (ABoIM). He has also has received a certification from the American Board of Integrative and Holistic Medicine (ABIHM).
Dr. Lundquist has a special interest in Integrative and Holistic medicine. He is currently the founder and medical director for the Temecula Center for Integrative Medicine specializing in all aspects of Functional Medicine. He is a member of the American Holistic Medical Association as well as the Institute of Functional Medicine. He specializes in endocrine disorders, especially thyroid and adrenal dysfunction, chronic fatigue, migraine headaches, cardiometabolic disorders, and chronic pain.
Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013 Nov 15;9(11):1195-200. doi: 10.5664/jcsm.3170. PMID: 24235903; PMCID: PMC3805807.
Alcohol and Sleep. Sleep Foundation. (2022, March 11). Retrieved from https://www.sleepfoundation.org/nutrition/alcohol-and-sleep
Pietilä J, Helander E, Korhonen I, Myllymäki T, Kujala UM, Lindholm H. Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study. JMIR Ment Health. 2018 Mar 16;5(1):e23. doi: 10.2196/mental.9519. PMID: 29549064; PMCID: PMC5878366.
Blue light has a dark side. Harvard Health Publishing, Harvard Medical School. (2020, July 7). Retrieved from https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side
FDA adds Boxed Warning for risks of serious injuries caused by sleepwalking with certain prescription insomnia medications. U.S. Food & Drug Administration. (2019, April 30). Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-risk-serious-injuries-caused-sleepwalking-certain-prescription-insomnia.
Lunquist E. Sleep and Stress: What’s the Connection? Metagenics Institute. 2002.
Mental Health and Sleep. Sleep Foundation. (2022, April 15). Retrieved from https://www.sleepfoundation.org/mental-health
Oh CM, Kim HY, Na HK, Cho KH, Chu MK. The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia: A Population-Based Study. Front Neurol. 2019;10:849. Published 2019 Aug 13. doi:10.3389/fneur.2019.00849