Why Can’t I Sleep at Night?

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Statistics indicate a third of the people suffer from insomnia. Sufferers ask:

  • Why can’t I fall asleep at night?
  • Why can’t I stay asleep at night?

On top of that, many people suffer from a lack of deep, restorative sleep and, consequently, wake up feeling tired most mornings.

Insomnia is most common in women, older people, shift workers, and people with psychiatric disorders.

One study of people in Los Angeles found that sleep disturbances had affected 52.1% of the adults either currently or in the past. The types of sleep disturbances found included:

  • Insomnia 42.5%
  • Nightmares 11.2%
  • Excessive sleep 7.1%
  • Sleep talking 5.3%
  • Sleepwalking 2.5%

The most prominent sleep disturbance is insomnia: having trouble getting to sleep or having trouble staying asleep.

What Exactly is Sleep?

Sleep comprises various states of the body that are characterized by changes in brain waves, heart rate, breathing, body temperature and other factors. It’s easy to understand that in sleep we normally lie down, close our eyes and become quiet. Our interactions with the “outside world” decrease and we often dream of imaginary events.

You go through several cycles of sleep each night from a light sleep, to deep sleep, to REM (rapid eye movement) sleep. The REM sleep state of associated with vivid dreams.

During deep sleep its harder for you to be awakened, you breathe more slowly and your heart rate becomes more regular. This is the state that promotes physical recovery and supports your immune system.

During REM sleep your brain becomes more active and your eyes make rapid movements. Your heart rate increases and breathing is less regular. This is that main time you dream. Scientists believe this is the time your brain combines information to try to make sense of it and moves it from your short term to long term memory.

Many people have a difficult time reaching a state called sleep. Somewhere along the transition to sleep they become “stuck” or while asleep they return to a more alert state and find it difficult to return to a sleep state.

A “sleep-onset spectrum” is often used to describe the stages from wakefulness to sleep. The progress of falling asleep is often divided into three stages:

  • Wakefulness
  • 1 Quiescence – When the body becomes inactive
  • 2 Dropping hand-held objects – When the muscles relax
  • 3 Auditory threshold increase – When you no longer respond to mild sounds such as someone softly calling your name
  • Sleep

Each of the three phases of the sleep-onset spectrum last different lengths of time for different people–and even vary from day to day for an individual. Some conditions that affect the transition time from wakefulness to sleep include life events, aging, and mental or physical illness.

The goal of those with insomnia should be to get through these three stages of the sleep onset spectrum quickly and “get to sleep.”

However, sleep researchers have noticed a ‘sleep-state misperception” in a number of people who suffer with insomnia. They sometimes claim they do not sleep at all some nights, but when their sleep state is measured it is found that they get much more sleep than they report.

What to do When You Can’t Sleep

Sleep scientists have developed a number of effective techniques to help people reach a sleep state.

  • Stimulus control therapy
    This involves associating the bed with sleep. Avoid reading or watching TV in bed. Get in bed only when you are sleepy. Get up at the same time every morning. And, no napping away from your bed.
  • Sleep restriction therapy
    Reduce your time in bed to sleep only. Get up when you wake up. Again, don’t stay in bed if you are not sleepy.
  • Relaxation training
    We are all tense during the day. Some people clench their teeth or make a fist. You may think and worry long and hard about the days activities. When you get in bed become aware of the ways your body is tense. Concentrate your mind on relaxing your muscles wherever you feel tension. This both directs your mind away from thinking about the day’s activities but also relaxes your body.
  • Cognitive therapy
    This involves gaining a healthy understands of sleep and insomnia. It helps you channel your mind away from thinking about your insomnia so you can get to sleep.
  • Sleep hygiene education
    This helps you see how your environment affects your sleep. This will include your diet, drugs you are taking (including stimulants like caffine), eating patterns (like eating late a night), the physical aspects of your bedroom (including light, noise and temperature), and understanding how sleep patterns may change as you age.
  • Cognitive-behavior therapy
    Any combination of the above techniques that may involve both behavioral and cognitive methods.

Personally, there are two techniques I use to fall asleep quickly.

  • Normally as part of my before-bedtime routine I brush my teeth with an electric toothbrush. While brushing I do 60 knee-bends, counting them to brush all areas of my teeth equally. At the end of the two-minute brushing cycle I am breathing heavily. As I get into bed my breathing becomes softer and I continue to relax, drifting to sleep.Of course, you should be healthy enough to do this exercise. And, this is not a full ‘workout” which could stimulate your body to a high level of alertness. It merely sets the stage for a fairly rapid relaxation.
  • Another technique I use is progressive relaxation. Here, I concentrate on various muscle groups to detect any tension and produce relaxation. I start from the top of my head to my feet, progressing from noticing the muscles in my forehead, eyelids, jaw, tongue, lips, neck, shoulders, upper arms, lower arms and hands, and so on.Again, this stops you from thinking and worrying about the day’s events and promotes relaxation the drifts to sleep.

Insomnia – causes, symptoms, diagnosis, treatment & pathology

This video discusses the definition of insomnia, as well as the diagnostic criteria and signs and symptoms.

Assess the Quality of Your Sleep

You can assess the quality of your sleep by answering these questions based on the Pittsburgh Sleep Quality Index. They will point out the extent of sleep disturbance and which aspect of sleep is the biggest problem?

Does it take more than 30 minutes for you to get to sleep?
Do you wake up in the middle of the night or too early in the morning?
Do you have to use the bathroom at night when you should be sleeping?
What is your total sleep time?
Do you have trouble breathing at night?
Do you cough or snore loudly at night?
Do you feel too cold or too hot?
Do you have bad dreams?
Do you have pain?

Though much of this is subjective, if you think you suffer with insomnia it would be worth while to actually measure how much sleep you actually get.

Measuring Your Sleep Time and Quality

Fitbit Measurement of Sleep Time

Most people who are truly concerned about getting good sleep will want to measure the time they spend sleeping as well as the quality of their sleep.

Fortunately, there are several consumer-oriented fitness trackers that record how well you sleep. They can measure when you start becoming quiescent as you drift into sleep. They can also record the deepness of your sleep by noting your heart rate.

Your time spent sleeping is simply calculated by taking the total time the fitness tracker monitors you in sleep mode minus the restless time when you are not quiescent. By noting your movement and heart rate the fitness tracker can detect the sleep stage you are in.

This chart shows the sleep time for days that the fitness tracker was worn at night.

Fitbit Stages of Sleep

By measuring the time spent in the various states of sleep, you will get a better idea of exactly how well you sleep.

During a normal sleep session you will cycle through the stages of sleep several times. Usually these cycles last around 90 minutes each.

Once you know how long and how well you sleep, you will be able to use one or more of the techniques described above to help you sleep even better.

Getting a fitness tracker to measure your sleep is the key to knowing where you stand and how to improve.

Try the Fitbit Fitness Tracker

Fitbit Charge 2 Heart Rate + Fitness Wristband, Black, Large (US Version)

  • PurePulse continuous, automatic wrist-based heart rate tracking to better measure calorie burn all day
  • Maximize your workouts using simplified heart rate zones (Fat Burn, Cardio and Peak)
  • See call, text & calendar notifications on the OLED display; Automatically track how long and how well you sleep and wake with a silent vibrating alarm
  • Get a better understanding of your fitness level and see how you can improve over time with a personalized Cardio Fitness Score; Use Connected GPS during run mode to see real-time stats like pace and distance on your wrist
  • Track all-day activity like steps, distance, calories burned, floors climbed and active minutes;Find moments of calm throughout your day with personalized guided breathing sessions based on your heart rate, Like all heart rate tracking technologies, accuracy is affected by physiology, location of device, and different movements.
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  • Operating temperature: 14 degree to 113 degree fahrenheit, Maximum operating altitude: 30,000 feet
Make every beat count with Fitbit Charge 2—the heart rate and fitness wristband built for all-day, workouts and beyond. PurePulse continuous heart rate makes it easy to maximize workouts, better track calorie burn and get a snapshot of your cardio fitness level, while all-day activity and auto sleep tracking, lets you see how your whole routine adds up. Record your workouts with multi-sport modes to see real-time workout stats on screen, or rely on SmartTrack to automatically record select

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References

Psychological And Behavioral Treatment Of Insomnia:Update Of The Recent Evidence (1998-2004) published in the journal Sleep

Prevalence of sleep disorders in the Los Angeles metropolitan area. published in the American Journal of Psychiatry

The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research published in the journal Psychiatry Research

Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. published in the Journal of the American Medical Association

Issues of Validity in Actigraphic Sleep Assessment published in the journal Sleep

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