Sleep apnea. A number of medical conditions interfere with sleep. One is sleep apnea, where the person experiences interruptions of breathing during the night. Sleep apnea normally happens to heavy snorers, who are usually, but not always, overweight. Sleep apnea is typically observed when loud snoring is interrupted by about 10 seconds or more of silence as breathing stops and then starts again — often with a loud snort or gasp — which may wake you. (Some people think they woke to go to the bathroom, when actually it was sleep apnea.) This pattern may repeat many times an hour throughout the night. If you have a bed partner, he or she would probably notice the signs of sleep apnea first. You could also spend a night in a sleep lab for an official diagnosis. It’s worth checking out, because sleep apnea is associated with serious health problems, including diabetes and heart disease.
Other medical conditions. Gastroesophageal reflux disease (GERD) is commonly known as heartburn. When people with GERD lie down, acid from the stomach can leak back into the esophagus, causing pain and, sometimes, severe damage. Other people have periodic limb movements or restless legs syndrome, in which jumping of the legs makes sleep difficult. (Sometimes it’s even more difficult for the bed partner!) Older men may develop a benign enlargement of the prostate, which can cause more frequent urges to urinate, waking them several times a night. These conditions are treatable and should be checked out by a physician.
Many other diseases, including heart, kidney, liver, nerve, and thyroid problems, can cause insomnia. Many prescription and over-the-counter drugs can cause insomnia in some people. Check the labels on the drugs you take or ask your pharmacist if you suspect a drug may be causing or contributing to your sleep difficulties.
Pain, whether from neuropathy, headache, arthritis, or some other source, can make it hard to get to sleep.
Stress and anxiety. What’s happening in your life — money problems, job hassles, family stress, worrying about the world situation, or whatever — can leave you too worked up to relax and sleep. “Emotional arousal, frustration, and worry are incompatible with sleep,” says Dr. Kuo. “Relaxation, not distress, is a necessary condition for sleep.” Even if the cause of the stress is long-term, relaxation techniques could help you to calm down enough at night to sleep.
If you lie there at bedtime with a rapid heartbeat, worrying about bad things that could happen, or have trouble falling or staying asleep, you may have an anxiety disorder. Anxiety disorders are highly treatable.
Conditioned insomnia. Another big cause of sleep problems is trying to sleep when conditions aren’t right for it. Some people spend too much time in bed; others don’t get enough activity during the day. Some think they should sleep more than their bodies really want. Dr. Buda says, “You can’t get more sleep than you need each night. When your body is rested, it just won’t sleep.”
Once people get into a pattern of struggling to sleep, they can have insomnia for years, just out of habit. The key is to start applying good sleep practices like the ones outlined later in this article. To determine whether you might have conditioned insomnia, ask yourself if you sleep better away from home. If you do, you could be conditioned to associate your own bed with insomnia.
Eliminating the struggle
Nothing bad happens when you miss one or two nights of sleep, as long as you’re careful about driving the next day. It’s chronic insomnia that causes problems. So if you regularly have problems falling asleep, don’t lie in bed tossing and turning. Sleep specialist Richard Bootzin, PhD, Professor of Psychology and Psychiatry at the University of Arizona, says that if you’re not asleep in 10 minutes, you should get up and go to another room. Dr. Kuo says it’s not the length of time that matters but that you should get up if you feel it’s taking too long to get to sleep or you’re getting frustrated. Then do something relaxing or soothing for at least 10 minutes, preferably out of bed. Don’t go back to bed until you’re really tired. If you still can’t sleep as quickly as you’d like, get up and try relaxing again. But if you’re comfortably relaxed in bed, Dr. Kuo says it’s OK to stay there, even if you’re not asleep. The idea is to associate your bed with relaxation, comfort, and getting to sleep easily, not with frustration and wakefulness.