Women report poor sleep despite a good night's rest, while men overestimate their own sleep quality

From medicalxpress.com

by Torbjörn Åkerstedt, The Conversation

edited by Gaby Clark, reviewed by Andrew Zinin 

Disturbed sleep is a common problem—and one that has many serious consequences beyond feeling tired the next day. Research has linked insomnia and poor sleep to early mortality and diseases including diabetes and cardiovascular disease.

Women often report experiencing disturbed sleep more frequently than men. They also constitute the majority of patients in sleep clinics. Yet, strangely, some studies show worse objective sleep quality in men—a bit of a paradox.

To understand what might explain the paradox, my colleagues and I conducted a study that directly compared sleep quality ratings and objective sleep measures between men and women.

We found that women complained more of sleep problems—but slept objectively much better than men. We think this paradox can probably be explained by men overestimating their sleep quality because they are less able to perceive how often they wake up at night.

A total of 238 randomly selected women participated in the study, plus 238 men who were matched on age and BMI with the women to ensure similar participants were compared with each other.

Sleep was recorded in each participant's home using a recorder that measured brain waves (electroencephalography—EEG), muscle tension (electromyography—EMG) and eye movements (electrooculography—EOG). These devices tracked what stage of sleep a participant was in and for how long, how much time they spent awake and how quickly they fell asleep.

A researcher visited the participant's home in the evening, mounted the recording equipment and left. The participant went to bed and awoke at their usual time.

In the morning, the participant rated the degree of difficulty they had falling asleep, whether their sleep was restless, whether they woke up early, how often they thought they had woken up, how long it took them to fall asleep, how long they slept and their overall sleep quality.

The sleep recording was scored by a sleep technician based on visual inspection of the EEG, EOG and EMG recordings. The data was then analysed to understand the objective quality of each participant's sleep and its relation to gender and age.

Analyses were also adjusted for factors such as gender, age, alcohol consumption and smoking, which may affect sleep.

                                                                                                            Credit: CC0 Public Domain

Sleep quality

The results show that women subjectively reported significantly lower sleep quality than men. Yet women actually had considerably fewer night-time awakenings, less stage one (superficial) sleep and higher sleep efficiency (they spent more time asleep while in bed). Women also experienced more stage three (deep) sleep and slept longer (400 minutes versus 382 minutes for men).

The results suggest that women objectively had a good night's sleep, compared with men. The only variable that suggests worse sleep in women was that when they did wake up at night, they spent more time awake than men did—around nine minutes each time for women versus just under seven minutes each time for men.

It only takes around five minutes of being awake at night for a person to remember it the next morning. This may explain why women were better able to remember whether they had woken up the night before and estimate how many times they had. Men, on the other hand, grossly underestimated their number of awakenings (by 72% compared with women's 37%).

For other quantitative measures, like time to fall asleep, sleep duration and time awake, men and women were equally good at estimating their objective values. And they were relatively correct.

We took this further and found that men who woke up only for a short period during the night (around eight minutes or so each time they woke up) often didn't remember they had.

When this group of men was removed, no gender difference in subjective sleep quality remained. This suggests that men with short night-time awakenings report better sleep quality than would be expected from their objective sleep measures because they didn't remember they had woken up.

It's also noteworthy that men's objective sleep deteriorated faster with age than women's. This was particularly obvious for stage three sleep. While women older than 65 got around 80 minutes of stage three sleep each night, men had only 53 minutes. Among those between 30 and 50 years of age, the amount was similar for men and women (around 70 minutes).

Sleep and well-being

A key reason women may complain of having a worse night's sleep than they objectively had may therefore be the amount of time they spent awake when they woke up, making it easier for them to notice. Likewise, men may overestimate their sleep quality because they spend less time awake when they wake up, so they don't remember it happening.

Both findings would work toward reducing subjective sleep quality in women and increasing it in men. We assume, then, that the experience of awakenings has an important influence on subjective sleep quality.

As our study was conducted over only one night, it will be important for future research to investigate whether these findings remain when participants are studied over longer periods.

Future studies may also want to explore the reasons for poor sleep in men—especially since common sources of disturbed sleep, such as alcohol, smoking and BMI, were all adjusted for in our analysis. Researchers may also want to investigate why men's sleep becomes objectively worse as they get older.

Our research illustrates how sleep quality doesn't just involve the physiological aspects of sleep. It also includes our own subjective experiences, which can affect our well-being and how rested we feel.

It also suggests that because many men overestimate their sleep quality, they may overlook any sleep problems they are experiencing. This could mean that some men aren't getting help for conditions that could be affecting their health and well-being.

https://medicalxpress.com/news/2026-06-women-poor-good-night-rest.html

Exposure to sunlight may be the key to better sleep: Research shows offices workers without windows sleep worse

From thestandard.com.hk

Many people think improving insomnia relies only on relaxing before bed or going to sleep earlier. However, family medicine physician Dr. Chan Yan-mei cites research showing that daytime light exposure is actually the key to regulating sleep. If people chronically lack natural light, their circadian rhythms can easily become disrupted, making it difficult to sleep well even if they go to bed early. Research shows that camping and moderate sun exposure help adjust sleep cycles – a simple, free sleep aid.

The Day-Night Hormonal Handover Mechanism

Chan explains that while most people think of melatonin for sleep, there is also cortisol, commonly known as the "stress hormone." She describes cortisol as the body's "day-shift doctor." It surges to its daily peak 30-45 minutes after waking, then slowly declines throughout the day, reaching its lowest point late at night. Melatonin is the opposite – the body's "night-shift doctor." It stays very low during the day, starts rising around 9 PM, and peaks between 2-4 AM.

Chan states that when this day-night hormonal handover goes smoothly, the body naturally produces sleepiness. If this rhythm is disrupted, you may toss and turn even when it's time to sleep. Therefore, insomnia is often not just a night-time problem but the result of a full-day circadian rhythm imbalance.

Office Workers with Windows Have Better Sleep Quality

In modern lifestyles, many office workers spend all day indoors, assuming the bright environment is sufficient. However, indoor light levels differ vastly from outdoor natural light. Typical office lighting is about 300-500 lux – roughly 0.5% of a sunny day's 50,000-100,000 lux. Many people think they work in a "bright place," but their body's internal clock isn't receiving strong enough light signals.

Chan cites a 2014 study from the University of Illinois and Northwestern University published in the Journal of Clinical Sleep Medicine. The controlled study of 49 office workers showed that those in offices with windows had significantly longer sleep duration and better overall sleep quality, while the windowless group showed the opposite.

Chan explains that the body's circadian rhythm needs light to calibrate. If daytime light exposure is insufficient, the brain may not correctly distinguish day from night, affecting melatonin secretion and sleep quality.

A 30-Minute Walk Outdoors: Natural Light Regulates Sleep

So how can office workers improve their sleep? Chan further cites a 2013 study from the University of Colorado published in Current Biology. In this experiment, participants went mountain camping for one week, exposed only to natural daylight during the day and no artificial light at night. After just one week, participants' "desired sleep time" shifted a full 2 hours earlier. Someone who normally felt sleepy at 11 PM began yawning at 9 PM. In 2017, the research team followed up on a more practical question: most people can't take a week off to camp. They found that even camping only during weekends (Saturday and Sunday) achieved 69% of the effect of a full week of camping.

Chan notes that for office workers, this means avoiding sleeping in and scrolling on your phone on weekend mornings. Instead, stepping outside for a 30-minute walk can shift your entire week's "desired sleep time" earlier. You don't truly need to camp – a "mini version" of the method yields most of the benefits.

Many think improving insomnia requires medication or supplements, but morning light exposure has been proven to enhance sleep quality. Chan cites a 2016 systematic review from the University of Amsterdam. The review analysed 53 studies with 1,154 participants and found that morning light therapy helps shorten the time to fall asleep and improves insomnia. The stronger the light intensity, the more pronounced the effect.

Additionally, a 2022 double-blind study from Inha University in Korea, published in Psychosomatic Medicine, experimented on 56 post-stroke insomnia patients. Using a 10,000 lux light therapy lamp for 30 minutes each morning for just 2 weeks significantly shortened their sleep onset latency and improved sleep efficiency.

Simple Anti-Insomnia Habit: Open the Curtains When You Wake Up

Chan also shares that she personally struggled with insomnia as a resident physician. Now, the first thing she does upon waking every day is open the curtains to let natural light in, helping her body quickly start up its circadian clock. She suggests that if you chronically have sleep problems, try starting with 10-30 minutes of morning sunlight. It might bring unexpected improvements to your sleep.

Chan reminds that many people habitually sleep in until noon on weekends to catch up on rest, but this can further disrupt the circadian rhythm. She points out that rather than blindly extending sleep time, it's better to maintain a regular schedule and increase daytime sunlight exposure. Ideally, receiving natural light exposure daily is the simplest and most practical way to adjust your sleep cycle.

https://www.thestandard.com.hk/wellness/article/334234/Exposure-to-sunlight-may-be-the-key-to-better-sleep-Research-shows-offices-workers-without-windows-sleep-worse

Exhausted young people keep swiping screens until dawn

From e.vnexpress.net

Nguyen Nam's rented room in HCMC is pitch black at midnight, except for the faint blue light from his phone screen shining on his sleep-deprived face.

After a 10-hour shift, his back ached and a pain pulsed through his temples; he knew he needed sleep and wanted to go to bed, but kept scrolling on his phone until 3 a.m.

"At that point, my mind is completely blank. Nothing I watch stays with me," the 28-year-old programmer says.

Tran Mai, a 32-year-old fashion store owner in Tay Ninh Province, stays up late for a different reason. During the day, she focuses on work and family responsibilities, and the only time she has for herself is late at night.

"I'm afraid to close my eyes because I know tomorrow will arrive immediately," she says.

She spends hours switching between dance videos on TikTok, exposé posts on Facebook and personal confessions from strangers on Threads. She often stays awake until 3 a.m., sleeps poorly and wakes up at 7 a.m. feeling drained before the day even begins.

Nam scrolls through his phone late at night in his rented room in Ho Chi Minh City. Photo courtesy of Nam

A 2022 study published in Sleep Medicine Reviews, a peer-reviewed medical journal focusing on sleep research, found that more than 70% of adults aged 18 to 35 use mobile devices within 30 minutes of bedtime. Most respondents said they were aware that the habit negatively affects sleep quality.

Researchers refer to the phenomenon as bedtime procrastination, the intentional delay of sleep.

Vuong Nguyen Toan Thien, director of professional services at Lumos Psychological Counseling and Therapy Center, says the behaviour is not caused by laziness or a lack of discipline.

"This is an uphill battle between a brain that has run out of energy and psychologically manipulative algorithms designed by some of the world's top engineers."

From a neuroscience perspective, he says, the issue stems from competition between two systems in the brain: the prefrontal cortex, responsible for planning and self-control, and the habit-reward system associated with dopamine pathways.

During the day, the prefrontal cortex has enough energy to signal a stop and regulate behaviour. At night, after hours of stress and mental effort, its ability to do so weakens. Scrolling through social media before sleep then becomes habitual. Users no longer make conscious decisions as their brains switch from relying on thoughts to automatic responses.

The exhaustion also makes users more vulnerable to short-video platforms such as TikTok, Reels, and Shorts, which rely on a variable reward schedule, a mechanism similar to slot machines. Users do not know whether the next video will be entertaining or disappointing so the brain constantly releases dopamine, encouraging them to keep watching.

A 2023 study by Stanford University in the U.S. found that variable rewards are highly effective at sustaining repetitive behaviour, especially when people are tired and psychologically vulnerable.

The effects extend beyond fatigue. By the time users turn off their screens, their brains have been continuously stimulated by high-intensity content, while blue light suppresses the production of melatonin, the hormone that signals sleepiness. As a result, people may feel physically exhausted while remaining mentally alert, leading to restless sleep.

The following morning often brings brain fog, a condition marked by slower thinking, forgetfulness and reduced concentration.

According to a study by the University of Pennsylvania, sleeping fewer than six hours a night for 14 consecutive days can impair cognitive performance to a level comparable to staying awake for 24 hours straight. Researchers also found that people often fail to recognize the extent of their mental decline. Over time, chronic sleep deprivation increases the risk of depression, anxiety, and occupational burnout.

Thien says relying solely on willpower is unlikely to solve the problem in the long run. Instead, he recommends changing the environment to reduce triggers, starting with charging phones entirely outside the bedroom. When users must physically leave the bed to access their devices, most unconscious scrolling habits become easier to interrupt.

He also recommends a digital curfew of 30 to 60 minutes before bedtime. Filling that time with activities such as reading printed books or listening to relaxing music can help reduce stimulation and prepare the body for sleep.

Maintaining a consistent wake-up time, including on weekends, and getting 15 to 30 minutes of morning sunlight can also help restore disrupted circadian rhythms, he says.

Thien says the distinction between entertainment and addiction is relatively clear. Healthy entertainment helps people relax and sleep easier. But when people finish watching content feeling guilty and regretful, physically drained yet unable to put down their devices, the behaviour has shifted from choice to loss of control.

Nam says he understands the distinction but has not found a way to stop. He continues scrolling late into the night despite knowing it comes at the expense of his sleep.

https://e.vnexpress.net/news/life/wellness/exhausted-young-people-keep-swiping-screens-until-dawn-5084919.html 

Study Finds Surprising Link Between Sleep & This Common Joint Issue

From mindbodygreen.com

By Zhané Slambee

Sleep rarely comes up in conversations about joint health. Most guidance focuses on weight management, exercise, and avoiding injury, and for good reason.

But a large new study suggests that what happens at night may matter more for your joints than previously understood.

Researchers analysed data from nearly 500,000 adults and found that short sleep, frequent insomnia, and night shift work were all independently linked to a higher risk of developing osteoarthritis (OA), a degenerative joint disease and needing joint replacement surgery. And many of those associations held even after accounting for body weight. 

                                                                          Image by Addictive Creatives / Stocksy

About the study

Osteoarthritis develops when the cartilage cushioning your joints breaks down over time. It's driven by a mix of factors: joint injury, metabolic changes, aging, and genetics. But researchers have been looking more closely at another possible contributor—disruptions to your body's internal clock, or circadian rhythm.

Cartilage goes through daily cycles of stress and recovery. During the day, it absorbs load and metabolic demand. At night, it recovers; rebuilding thickness and water content. 

The cells that make up cartilage (called chondrocytes, which is the only cell type found in cartilage) follow their own internal daily rhythm, which helps coordinate that repair process. In animal studies, disrupting the circadian clock led to cartilage breakdown similar to what's seen in OA. 

To see whether that pattern holds in people, researchers at Washington University used data from the UK Biobank, a large prospective study of approximately 500,000 adults in the United Kingdom recruited between 2006 and 2010. Participants (median age 58, 54% female) answered baseline questions about their sleep duration, how often they experienced trouble falling or staying asleep, and whether they worked shifts.

Researchers then tracked four outcomes over the following 8 to 13 years: knee OA, hip OA, total knee replacement, and total hip replacement.

Short sleep, insomnia, & night shifts all raised OA risk

People sleeping fewer than six hours a night had a 41% higher risk of knee OA and a 31% higher risk of needing a knee replacement compared with those sleeping seven hours. 

For the hip, the numbers were similar—39% higher risk of hip OA and 21% higher risk of hip replacement.

People who "usually" had trouble falling asleep or staying asleep had a 34% higher risk of knee OA and a 40% higher risk of knee replacement compared with those who "never or rarely" experienced those problems. 

Similar increases were seen for hip OA (30% higher risk) and hip replacement (24% higher risk).

Night shift workers, specifically those working through the hours of 12 a.m. to 6 a.m., had a 24% higher risk of knee OA and a 28% higher risk of knee replacement compared with people who didn't work shifts.

Night shift work was not significantly linked to hip OA or hip replacement, a pattern the researchers note is consistent with animal research: when the circadian clock gene BMAL1 (a key protein that helps regulate the body's internal clock) is knocked out in mice, cartilage in the knee breaks down, but not in the hip.

Why the associations held even after controlling for weight 

We've always thought that poor sleep raises OA risk mainly because it contributes to weight gain, which then puts more stress on your joints. But the data here tell a more complicated story.

After accounting for body weight, all of the associations weakened but didn't disappear. People sleeping fewer than six hours still had a 31% higher risk of knee OA and a 20% higher risk of knee replacement. Insomnia remained linked to all four endpoints. Night shift work remained linked to knee OA and knee replacement specifically.

The researchers also ran a separate analysis excluding anyone who already reported at least three months of knee or hip pain at the time of their sleep assessment. This was to rule out the possibility that people were sleeping poorly simply because they were already in pain.

The associations held there too.

Why knees may be especially vulnerable

Across all three sleep factors (duration, insomnia, and shift work) the signal was strongest and most consistent for the knee. The researchers offer a few explanations.

The knee may depend more heavily on a functioning circadian clock than the hip does, partly because of differences in how the two joints are structured and how hip OA tends to develop (often through issues like hip dysplasia or impingement).

Weight also plays a bigger role in knee OA than hip OA, and disrupted sleep likely influences the knee partly through that pathway.

One other pattern stood out: among night shift workers whose jobs rarely or never required heavy physical labour, the risk increases were even larger; 43% higher knee OA risk and 40% higher knee replacement risk.

The researchers suggest that circadian disruption may have the biggest impact on people who don't already have elevated OA risk from physical wear on the job.

Sleep habits worth building for your joint health long-term

Circadian rhythms and sleep can be improved through lifestyle changes and sleep hygiene. This points to new potential ways to reduce OA risk before joint pain ever develops. Here are strategies worth considering:

Keep a consistent sleep schedule: Seven hours appears to be the protective threshold in this data. Going to bed and waking at the same time every day helps anchor your body's internal clock.

Get morning light exposure: Light is one of the most powerful cues for setting your circadian rhythm. Getting outside in the first hour after waking helps your body clock stay on track.

Limit artificial light at night: Dimming screens and lights in the hours before bed supports your body's natural melatonin production and helps protect your sleep timing.

Address insomnia early: Frequent insomnia was linked to risk increases comparable to (and in some cases greater than) sleeping fewer than six hours.

If you work night shifts, minimize circadian disruption where you can: Changing your schedule may not be an option, but strategies like timed light exposure, strategic napping, and keeping a consistent routine on days off can help reduce the mismatch between your internal clock and your work hours.

The takeaway

This large prospective study found that sleeping fewer than six hours, experiencing frequent insomnia, and working night shifts were all linked to higher osteoarthritis risk (particularly at the knee) even after accounting for body weight.

The findings suggest that sleep quality and circadian health may be modifiable risk factors for OA, alongside the more commonly discussed pillars of exercise and weight management.

https://www.mindbodygreen.com/articles/poor-sleep-could-be-quietly-raising-your-osteoarthritis-risk-study-finds 

Using cannabis for sleep isn’t harmless – a neurologist explains how it can trap people in a cycle of dependency

From theconversation.com

For millions of people, cannabis has become the unofficial prescription for lost sleep. But what feels like a solution may be quietly making the problem worse.

Consider these two cases:

She is 15 and has been lying in bed for the past hour. It is past midnight, and her brain will not quiet down. Her school bus comes at 6:20 a.m. She is getting anxious, knowing that she needs to wake up in six hours. She did all the right things: turned off her phone at 10 p.m., tried melatonin. So tonight she tries something a friend recommended: a cannabis gummy. Within 20 minutes, she’s asleep.

He is 34, a veteran who did two tours and has struggled with sleep since coming home. It takes him two hours to fall asleep, and when he does, he is jolted awake by relentless nightmares. He hasn’t slept more than three hours a night in months, and it’s catching up with him. His buddy swears that cannabis helped him, and with a six-month waiting list for a sleep consultation at the Veteran’s Affairs medical center and a cannabis dispensary six blocks away that’s open until 10 p.m., the decision doesn’t feel complicated.

Both will tell you cannabis works for their specific needs. They are not entirely wrong. But no one has told them what is actually happening inside the brain when the lights go out. It’s complex, and for them – as for many others – ultimately it’s a trap.

As a neurologist specializing in sleep and brain performance, I write this not as someone opposed to cannabis but as someone who regularly sees patients whose sleep has quietly unravelled after months or years of use, especially teenagers and veterans.

I believe the public deserves a more complete picture than they currently have due to the limited research that’s available.

Why the teenage brain is especially vulnerable

From the early teens through the mid-20s, the brain is actively under construction, clearing out weak or redundant connections and reinforcing the circuits responsible for judgment, emotional regulation and stress response.

Tetrahydrocannabinol, or THC, the psychoactive component of cannabis, interferes with this process directly by acting on the endocannabinoid system, one of the primary regulatory networks guiding it.

A 2021 brain imaging study of 799 teenagers found that cannabis use was associated with dose-dependent thinning of the cerebral cortex – meaning the more cannabis a teenager used, the thinner their prefrontal cortex became. The prefrontal cortex is the region of the brain responsible for judgment, decision-making and impulse control. Thinning of the cortex in this region has been associated with increased impulsivity, poorer decision-making and reduced inhibitory control.

Another seldom-discussed factor is how puberty affects sleep. Hormonal changes and brain maturation in adolescence shift the internal biological clock, known as the circadian rhythm, toward a later sleep schedule.

And teenagers are far from alone. A 2025 study found that more than 1 in 5 young adults in the U.S. turn to cannabis or alcohol to fall asleep. For teenagers who are already sleep-deprived and facing early school start times, cannabis can become its own nightly fix.

Teenagers’ developing brains are particularly vulnerable to harms from cannabis use. Fiordaliso/Moment via Getty Images

What cannabis is doing while you sleep

Sleep is not passive. It is well-organized, purposeful and foundational to our physical and brain health.

Every night, the brain cycles through distinct stages, each serving a specific function. All sleep stages matter, but the one that matters most is REM sleep, the dreaming stage. This is when the brain processes the emotional weight of the day, locks in learning and resets the brain circuits that govern mood, judgment and resilience.

THC has a sedative effect at low doses but is stimulating at high doses. Cannabis also contains other cannabinoids – plant-derived compounds such as CBD and CBN that interact with a system in the body that produces its own cannabinoids and contributes to the sedative effects of cannabis.

Here is where it gets complicated.

THC does help people fall asleep faster, but that effect fades quickly as the body adapts to regular use. The same gummy that once helped someone fall asleep quickly does less. They need more to get the same effect.

In addition, falling asleep quicker is not the same as sleeping well. A 2025 review of the research to date found that cannabis does not consistently improve sleep overall, including how long people stay asleep or how restful that sleep is.

In a separate study, chronic daily users spent significantly more time awake during the night and got less restful sleep compared with nonusers; another study found that using cannabis close to bedtime had similar effects.

In other words, the subjective sense of sleeping better does not match what the brain recordings show.

When relief becomes reliance

At this point many people are using cannabis not because it is working well, but because stopping feels worse.

Even when chronic cannabis users have the willpower to stop, they often face brutal withdrawal symptoms that are more severe than what drove them to cannabis in the first place. Sleep disturbance, including insomnia and disturbing dreams, is described as a common manifestation of cannabis withdrawal. In addition, two-thirds of users report other symptoms such as anxiety, depressed mood, restlessness, irritability, decreased appetite or a combination of these symptoms that often persist for weeks after stopping use.

The discomfort of withdrawal drives many people to keep using it.

This is the trap – it’s quiet and insidious, which makes it harder to see.

Cannabis works just enough to feel like a solution. Night after night it dulls the problem without fixing it, until stopping feels unthinkable. When someone finally tries to quit, their sleep falls apart. So they go back. The original reason they could not sleep has not been identified or treated, and it hasn’t gone away.

Trying to quit cannabis use can bring about severe withdrawal and other symptoms. Jamie Grill/Tetra Images via Getty Images

Veterans and the need for long-term recovery

The developing brain is one kind of vulnerability. The traumatized brain is another.

Post-traumatic stress disorder affects an estimated 12% to 23% of post-9/11 veterans, compared with 6% to 8% of the general population. Sleep disturbances affect 70% to 90% of military personnel with PTSD. People with PTSD commonly have nightmares that are visceral, relentless and exhausting. They might be jolted awake with a pounding heart, multiple times a night, for years.

As a result, many veterans turn to cannabis to help them sleep. It’s understandable, especially when it can take weeks or months to get an appointment with a mental health practitioner.

But the data on outcomes for veterans is sobering. Those with cannabis use disorder – meaning cannabis use they struggle to control despite negative consequences, which affects roughly 1 in 4 veterans who use cannabis nonmedically – have higher rates of depression, anxiety and suicidal ideation and respond much more poorly to evidence-based PTSD treatments.
And then there is withdrawal. When a veteran tries to stop, the same symptoms that cannabis seemed to quiet come roaring back in potentially dangerous ways – rebound insomnia and nightmares, worsening depression and, in some cases, thoughts of suicide.

Because these withdrawal symptoms so closely mirror PTSD itself, many veterans interpret the return of symptoms as their condition worsening, not as withdrawal, so they go back to cannabis. And the cycle continues.

What actually works, and why it’s so hard to get

Cognitive behavioural therapy for insomnia, or CBT-I, is considered the first-line treatment for persistent insomnia. Research shows that it outperforms every sleep medication, cannabis included.

This therapy works by modifying sleep habits, regulating sleep-wake schedules, reducing arousal and reframing unhelpful beliefs about sleep. A form of treatment known as image rehearsal therapy, in which patients rewrite the storyline of a recurring nightmare and mentally rehearse the new version while awake, has been shown to be effective for veterans with trauma-related nightmares. But trained CBT-I providers are scarce, wait times are long, and most primary care settings do not offer it.

In other words, the people most vulnerable to the sleep-related harms of cannabis use are the least likely to have access to treatments that address the underlying problem, and the most likely to get caught in a negative cycle.

For those already caught in that cycle, quitting abruptly rarely works and often makes things worse. Research shows that CBT-I can reduce both insomnia and cannabis use at the same time – treating the root problem so cannabis no longer feels necessary.

Sleep is the foundation on which memory, mood, judgment and recovery are built.

The 15-year-old who cannot fall asleep and the veteran who wakes gasping at 3 a.m. both deserve evidence-based information about what is happening in their brains, and real access to care that treats the root cause.

https://theconversation.com/using-cannabis-for-sleep-isnt-harmless-a-neurologist-explains-how-it-can-trap-people-in-a-cycle-of-dependency-280904 

Middle insomnia: what it is and how to beat it

From saga.co.uk

By Patsy Westcott

Waking repeatedly in the night and being unable to sleep again is the form of insomnia most suffered by older people. But there are ways to boost your chance of a better night’s sleep 

It’s 3am and you’re awake. You turn over, plump up the pillow, adjust the duvet and try a different position. You take a sip of water, realise you need the loo, tell yourself it can wait, then decide it can’t, and drag yourself to the bathroom. By the time you get back into bed, you’re wide awake and thoroughly fed up. However hard you try, sleep won’t come. 

If this sounds familiar, you’re not alone. Doctors call it middle insomnia, or sleep-maintenance insomnia, and it’s especially common in older people.

How common is middle insomnia?

“Sleep efficiency is undoubtedly more challenging as we get older,” says consultant neurologist Professor Guy Leschziner, professor of neurology and sleep medicine at Guy’s and St Thomas’ Hospitals.

Around half of older people report difficulty dropping off or staying asleep. Of these, sleep-maintenance insomnia, defined as multiple awakenings or prolonged wakefulness in the middle of the night, affects 50 to 70%.

“Typically, people report waking at 2, 3 or 4am and being unable to fall asleep again for hours,” says psychologist and sleep expert Dr Lindsay Browning of Trouble Sleeping.

Why are older people more affected?

“There are several destabilising influences on sleep that come with age,” says Prof Leschziner, author of The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep.

“They include weakening of the brain circuitry that controls when we fall asleep, when we wake up and how stable sleep is, together with changes in the secretion of the sleep hormone, melatonin.

“Melatonin is the main chemical signal to the brain that it’s time to go to sleep and stay asleep. With age, its nocturnal peak is much lower, making it harder to maintain sleep,” he explains.

What physical changes can cause middle insomnia?

Certain physical aspects of getting older play a role too. They include: 

• Bladder weakness or irritability
• Joint and back pain or stiffness
• Menopausal symptoms such as night sweats or anxiety
• Medications, such as blood pressure-lowering beta blockers and calcium channel blockers, antihistamines, steroids and some antidepressants  

Medical conditions can also be culprits according to Prof Leschziner. Common offenders include:

• Obstructive sleep apnoea (OSA), in which breathing repeatedly stops and starts during sleep
• Periodic limb movement disorder (PLMD), which causes repetitive, uncontrollable jerking or twitching of the limbs
• Restless legs syndrome (RLS) a neurological condition that creates an irresistible urge to move the legs

“People with these conditions often feel as though they haven’t had any sleep,” says Prof Leschziner. In fact, this can be a trick of the brain, making you feel as though you haven’t slept a wink when you may actually have been drifting in and out of sleep.

What should you do if you’re affected?

Both experts agree that it’s best to not to lie there tossing and turning as this strengthens the association between bed and wakefulness.

“If you feel like you have been awake for about 20 minutes or more, it can help to leave the bedroom and go somewhere else,” says Dr Browning.

Prof Leschziner suggests sitting in dim lighting and doing something fairly unstimulating until you feel sleepy again. Dr Browning, meanwhile, recommends doing something “pleasant and engaging” to take your mind off not sleeping.

As she explains: “The aim is not to make yourself sleepier. It’s to take your mind off the fact you’re awake. This can reduce the link between bed, wakefulness and frustration, so that when you return to bed, sleep is more likely to follow naturally.”

Getty

Distracting and/or calming activities could include:

• Reading
• Watching TV
• Listening to the radio
• Creative activities such as puzzles, word searches or colouring books
• Humming a favourite tune to calm the brain and vagus nerve  

And what shouldn’t you do?

One of the biggest mistakes is checking the time. “Calculating how much longer it is until morning, and how annoyed you are that you’ve woken up can increase anxiety, making it harder to go back to sleep,” says Dr Browning.

She recommends setting an alarm for the latest time you need to wake up. “If you wake in the middle of the night, ask yourself: ‘Has my alarm gone off yet?’ If it hasn’t, it’s not morning, and you can try to go back to sleep.’

Another thing to avoid is scrolling on your phone. This can make it harder to get back to sleep because it strengthens that connection between being in bed and being awake and mentally switched on, and secondly, because the content of what you scroll may leave you feeling alert, agitated or distracted.

Instead, she suggests trying a calming breathing exercise or what experts call cognitive shuffling: mentally listing random, unrelated words or objects to gently distract the brain.

Should you have a snack?

Having something to eat in the middle of the night is not a good idea either, as it can train your body to wake up expecting food at that time. Instead try a light snack before bed, such as a piece of wholemeal toast with nut butter or a glass of warm milk.

And while we’re on food and drink, bear in mind that eating late in the evening, as well as caffeine and alcohol, are well-known sleep disruptors.

Are there any treatments?

According to the British Geriatrics Society, it’s best to steer clear of sleeping pills if you can. Older people are more susceptible to their sedating effects, which can lead to daytime drowsiness and a higher risk of falls and serious injury.

The good news is there are plenty of non-pill options and, even if you have struggled with insomnia for decades, you can still improve your sleeping habits.

“Long-standing insomnia is often maintained by unhelpful behaviours and anxiety about sleep itself, and this can be changed,” says Dr Browning.

CBT-I (cognitive behavioural therapy for insomnia) uses a range of techniques to tackle the habits and thought patterns that keep insomnia going – such as going to bed earlier to compensate for sleep loss or worrying about how you will function the next day – as well as so-called sleep restriction or sleep compression.

These techniques involve working out how long you usually spend asleep then strictly limiting the time you spend in bed to that time. It sounds counter-intuitive to deliberately restrict your sleep to treat insomnia, but over time it creates mild sleep deprivation. “Eventually, the sleep pressure that builds up as a result stabilises your sleep pattern, enabling you to gradually increase the amount of time you spend asleep in bed,” explains Prof Leschziner.

The Sleepio app, which uses CBT-I, is recommended by NICE (National Institute for Health and Care Excellence) and is thought to be especially beneficial for over 65s.

What matters, both experts agree, is not to accept broken nights as something you have to put up with. Once you understand what lies behind them, small changes to your routine can make a real difference and help you back to more restful nights.

Types of insomnia

• Short-term (acute) insomnia: lasts for less than three months and is often triggered by stressful events, jet lag or changes in the environment, such as a heatwave or extreme cold.
• Long-term (chronic) insomnia: lasts for three months or more and is often linked to underlying medical, psychological or lifestyle factors.
• Sleep-onset insomnia: difficulty dropping off at the beginning of the night. This is the kind most common in younger adults
• Sleep-maintenance (middle) insomnia: frequent awakenings during the night, or waking in the middle of the night and struggling to drop off again. This is the one most commonly suffered by older people
• Insomnia with early morning awakening: when you wake up very early in the morning, e.g. 5am.

If poor sleep is causing anxiety, frustration or daytime fatigue, speak to your GP or a sleep professional. 

https://www.saga.co.uk/magazine/health-and-wellbeing/middle-insomnia-what-it-is-and-do-you-have-it