For those who don't have a baby inside nudging them awake all night long, there are still lots of reasons why you might have trouble sleeping. Stress, excess stimulation, various types of physical discomfort, anxiety/depression, and age-related changes in the need for sleep can all be involved.
There are basically two types of insomnia: the kind where you can't fall asleep and the kind where you fall asleep just fine but awaken earlier than you'd like and then you can't fall back to sleep. The second kind in general is frequently associated with anxiety and depression, so getting those problems treated is very important as well as reducing those sources of stress that you can control. I've had several patients with longstanding insomnia that resolved after finally leaving a stressful job, for instance.
Physical discomfort can also awaken people during the night, including the need to urinate. It is considered abnormal if you have to get up more than twice a night to empty one's bladder. I often look at a patient's medications to see if they are using diuretics to manage high blood pressure. While diuretics are great medications for blood pressure, there are also lots of alternatives out there that may do just as good of a job without causing frequent urination. (Of course, your family/internal medicine doctor would need to be consulted regarding the best plan for your blood pressure management.) Caffeine and alcohol are also potent diuretics that should be avoided close to bedtime, and avoiding drinking fluids for two hours prior to bedtime can also help keep your bladder from becoming excessively full during the night.
Other medications that can be excessively stimulating for many patients are those used to treat nasal congestion caused by allergies or upper respiratory tract infections. Antihistamines in general are more sedating while decongestants are more stimulating. Neti pots are a good non-pharmaceutical alternative to managing chronic nasal congestion.
Other sources of physical pain and discomfort need to be addressed if they interfere with sleep, as lack of sleep tends to perpetuate pain syndromes. Many chronic pain patients can be managed well with certain antidepressants, anti-seizures medications, and other agents that reduce pain without leading to drug dependence.
One of the more serious issues of sleeplessness is sleep apnea. Common symptoms are snoring reported by one's sleeping partner along with periods of absent breathing followed by a sudden intake of breath. This can be associated with obesity, alcohol intake, certain medications, sleeping position (mostly back sleepers), and certain anatomic conditions of the neck and throat. Untreated, sleep apnea can be very hard on the heart and is associated with an increased risk for sudden cardiac death. Many local neurology practices offer sleep studies to help identify the extent of the condition and recommend treatment options, which may include a special breathing machine called CPAP.
As people age, many do not need as many hours of sleep at night as they might have in preceding years. If you awaken after 6 hours of sleep feeling refreshed and don't develop significant fatigue during the day thereafter, that may be all you require.
If daytime fatigue is a problem, there are a number of ways to help yourself get back to sleep including avoiding bright lights/computer screens/TV/suspenseful books, etc. Avoiding heavy meals close to bedtime is also important, particularly for those who tend to suffer with heartburn. Making sure your bedroom is dark, quiet and that the temperature is right around 70 degrees, and sticking to a regular sleep schedule all work toward good sleep hygiene. I like to use a white noisemaker myself to drown out random noises around my house. Warm milk, a light snack or herbal teas can be relaxing, or even a warm bath. Meditation techniques to control persistent worrisome thoughts are also very effective for many people. Daytime exercise (ending at least 4 hours before bedtime) is also associated with a variety of health benefits, including more sound sleep. Short naps in the daytime can be a wonderful way to refresh oneself, but long naps (more than 45 minutes) can interfere with nightime sleep. Short term sleeping medications are useful for acute insomnia, although in older patients, I worry about sedatives contributing to falls at night.
There are basically two types of insomnia: the kind where you can't fall asleep and the kind where you fall asleep just fine but awaken earlier than you'd like and then you can't fall back to sleep. The second kind in general is frequently associated with anxiety and depression, so getting those problems treated is very important as well as reducing those sources of stress that you can control. I've had several patients with longstanding insomnia that resolved after finally leaving a stressful job, for instance.
Physical discomfort can also awaken people during the night, including the need to urinate. It is considered abnormal if you have to get up more than twice a night to empty one's bladder. I often look at a patient's medications to see if they are using diuretics to manage high blood pressure. While diuretics are great medications for blood pressure, there are also lots of alternatives out there that may do just as good of a job without causing frequent urination. (Of course, your family/internal medicine doctor would need to be consulted regarding the best plan for your blood pressure management.) Caffeine and alcohol are also potent diuretics that should be avoided close to bedtime, and avoiding drinking fluids for two hours prior to bedtime can also help keep your bladder from becoming excessively full during the night.
Other medications that can be excessively stimulating for many patients are those used to treat nasal congestion caused by allergies or upper respiratory tract infections. Antihistamines in general are more sedating while decongestants are more stimulating. Neti pots are a good non-pharmaceutical alternative to managing chronic nasal congestion.
Other sources of physical pain and discomfort need to be addressed if they interfere with sleep, as lack of sleep tends to perpetuate pain syndromes. Many chronic pain patients can be managed well with certain antidepressants, anti-seizures medications, and other agents that reduce pain without leading to drug dependence.
One of the more serious issues of sleeplessness is sleep apnea. Common symptoms are snoring reported by one's sleeping partner along with periods of absent breathing followed by a sudden intake of breath. This can be associated with obesity, alcohol intake, certain medications, sleeping position (mostly back sleepers), and certain anatomic conditions of the neck and throat. Untreated, sleep apnea can be very hard on the heart and is associated with an increased risk for sudden cardiac death. Many local neurology practices offer sleep studies to help identify the extent of the condition and recommend treatment options, which may include a special breathing machine called CPAP.
As people age, many do not need as many hours of sleep at night as they might have in preceding years. If you awaken after 6 hours of sleep feeling refreshed and don't develop significant fatigue during the day thereafter, that may be all you require.
If daytime fatigue is a problem, there are a number of ways to help yourself get back to sleep including avoiding bright lights/computer screens/TV/suspenseful books, etc. Avoiding heavy meals close to bedtime is also important, particularly for those who tend to suffer with heartburn. Making sure your bedroom is dark, quiet and that the temperature is right around 70 degrees, and sticking to a regular sleep schedule all work toward good sleep hygiene. I like to use a white noisemaker myself to drown out random noises around my house. Warm milk, a light snack or herbal teas can be relaxing, or even a warm bath. Meditation techniques to control persistent worrisome thoughts are also very effective for many people. Daytime exercise (ending at least 4 hours before bedtime) is also associated with a variety of health benefits, including more sound sleep. Short naps in the daytime can be a wonderful way to refresh oneself, but long naps (more than 45 minutes) can interfere with nightime sleep. Short term sleeping medications are useful for acute insomnia, although in older patients, I worry about sedatives contributing to falls at night.
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