New study shows that treating insomnia with cognitive behavioural therapy can prevent major depression in older adults

From newswise.com

Cognitive behavioural therapy to treat insomnia was more effective in preventing major depression as compared to sleep education therapy in adults over the age of 60 with insomnia 

Newswise — LOS ANGELES (Nov. 24, 2021) - University of California - A new study led by researchers at UCLA Health has found that cognitive behavioural therapy (CBT-I) prevented major depression, decreasing the likelihood of depression by over 50% as compared to sleep education therapy in adults over the age of 60 with insomnia.

Their findings, reported today in JAMA Psychiatry, could advance public health efforts to effectively treat insomnia and prevent major depression disorder (MDD) in older adults – a growing population that is projected to rise from about 54 million Americans aged 65 and older today to about 86 million in 2050. 

More than 10% of community dwelling adults older than 60 years will experience a major depression later in life in any given year. Late-life depression increases the risk of health conditions such as heart disease and high blood pressure, cognitive decline, and suicide particularly in men. Despite its prevalence in older adults, depression often goes undiagnosed and untreated. And, even among those who receive treatment, only about one-third get better or achieve remission.

“Given that older adults account for nearly 20% of the U.S. population and are the most vulnerable for health risks associated with depression, effective depression prevention is urgently needed,” said Dr. Michael Irwin, lead author of the study and the director of the Cousins Centre for Psychoneuroimmunology at the Semel Institute for Neuroscience, and a Professor of Psychiatry and Biobehavioural Sciences at the David Geffen School of Medicine at UCLA. “Insomnia more than doubles the risk for major depression. By targeting insomnia and effectively treating it with CBT-I, depression can be effectively prevented by over 50% in community dwelling older adults with insomnia.” 

Insomnia, a condition where people have difficulty falling and staying asleep, occurs in nearly 50% of adults 60 years of age or older and when it occurs, the risk of depression is more than doubled. Although various types of sleep medications are often used to treat insomnia, they provide only temporary relief and pose a risk for daytime side effects such as prolonged drowsiness or headache, and dependency. 

Accordingly, CBT-I is recommended as the first line of treatment for people with insomnia and has been highly effective in its treatment. This type of therapy typically centres around working with a therapist to help identify and change inaccurate or distorted thinking patterns, emotional responses, and behaviours.

But how well CBT-I works to prevent major depression from occurring in older adults with insomnia has been uncertain. Prior studies showed CBT-I has benefit in treating insomnia and depressive symptoms, but it was not known whether selectively targeting insomnia, a known risk for depression, would prevent it in older adults with insomnia but without depression.

To find out, the researchers enrolled 291 adults 60 years and older with insomnia but who had not experienced any depression for 12 months or longer, randomly assigning half the group to receive CBT-I by a trained psychologist, with the other half to receive sleep education therapy (SET) from a public health educator. SET includes education about sleep, healthy sleep habits and the impact of stress on sleep. Both groups received weekly 120-minute group sessions for two months and then underwent follow-up for three years.

Over the course of 36 months of follow up, participants completed monthly questionnaires to screen for symptoms of depression and/or from insomnia and were diagnostically interviewed every six months to determine whether an episode of clinical depression had occurred. 

Key findings showed that depression occurred in 25.9% of the older adults in the SET control group during follow-up, whereas depression occurred in only 12.2% in the CBT-I group, a 51% reduction in the risk of depression with CBT-I treatment.

Second, remission of insomnia that was continuously sustained during follow-up was more likely in the CBT-I group as compared to SET. Among those who received CBT-I and had sustained remission of insomnia, the likelihood of depression was reduced by 83%. Depression occurred in over 27% of the older adults in the SET group who did not have insomnia remission, whereas depression occurred in less than 5% of those in the CBT group who achieved insomnia remission.

These findings suggest that treatment with CBT-I provided significant benefit to prevent incident and recurrent major depressive disorder in older adults with insomnia and that it did so by treating insomnia, a known risk factor for depression.

“Our study was one of the largest selective prevention trials with the longest follow up to show that treatment of insomnia, a modifiable risk factor for depression, can robustly prevent the onset of a clinical episode of depression in older adults with insomnia who were not depressed at entry,” said Dr. Irwin. “We also showed that CBT-I produced sustained remission of insomnia. Treatment of insomnia, along with prevention of depression, taken together, could have huge public health implications in reducing health risks, suicide and cognitive decline in older adults.”

https://www.newswise.com/articles/new-study-shows-that-treating-insomnia-with-cognitive-behavioral-therapy-can-prevent-major-depression-in-older-adults

Females and insomnia: How hormones impact sleep at every stage of life

From medicalnewstoday.com

Insomnia is common in females due to a combination of biological and social factors. A sleep specialist can provide medication and non-medication options to support those with insomnia

Insomnia is a sleep disorder wherein a person has difficulty falling or staying asleep. It affects about 1 in 3 adults in the United States every year.

Most people have short-lived symptoms, but about 1 in 10 have chronic insomnia disorder. This is defined as experiencing distressing insomnia symptoms on at least 3 nights per week for at least 3 months.

Although insomnia can affect anyone, a 2020 meta-analysis suggests that females are 58% more likely to experience it than males. This can have important health consequences for females. Insomnia is associated with many health effects, including an increased risk of heart disease and stroke.

The female sex hormones oestrogen and progesterone are involved in a variety of processes that regulate sleep. Fluctuating levels during menstruation, pregnancy, and perimenopause can cause insomnia. Stress and mood disorders, such as anxiety and depression, can also increase the risk of insomnia in females.

“There are multiple factors — both biological and social — that account for higher rates of insomnia in women compared with men,” Dr. Jennifer L. Martin, Ph.D., told us.

Dr. Martin is a clinical psychologist and behavioural sleep medicine specialist at the University of California, Los Angeles and a spokesperson for the American Academy of Sleep Medicine (AASM).

Learn more about some of the reasons that females are more likely than males to experience insomnia, including the role that hormones play in regulating sleep, here.

Why do more females than males have insomnia?

Differences in sleep patterns emerge early in life. “Even in young children, there are differences in some aspects of sleep between boys and girls,” said Dr. Martin.

It is unclear exactly when differences begin. Some researchTrusted Source has found no major differences in sleep patterns between children of either sex assigned at birth. Other studies have noted differences in sleep quality among young adults.

Sleep is a dynamic process regulated by a variety of internal and external factors. These vary throughout a female’s life and can have profound impacts on sleep from childhood all the way to the postmenopausal phase of life.

The role of hormones in insomnia

The body uses hormones to quickly send messages throughout the body. Among other things, hormones are regulators of sexual function and reproduction.

They also perform a variety of other important roles, including the regulation of:

• growth and development
• metabolism
• mood
• sleep

Two of the main female sex hormones, oestrogen and progesterone, work heavily in the areas of the brain that regulate sleep. Studies suggest that these molecules have two primary sleep-related functions:

• Hypnotic effects: By regulating brain waves and sleep-wake cycles, oestrogen and progesterone can directly affect sleep patterns.
• Breathing effects: Progesterone, in particular, is a strong respiratory stimulant and supports airway function and breathing during sleep.

Oestrogen and progesterone levels change throughout the course of a female's lifeTrusted Source, including during puberty, menstruation, pregnancy, and perimenopause. Studies of insomnia in females often find that sleep problems tend to overlap with these events.

Sleep in pregnancy and postpartum

Pregnancy is a challenging time for quality sleep. Not only do hormone levels change, but substantial energy is needed to support a growing foetus.

Both the amount and quality of sleep generally declineTrusted Source over the course of pregnancy, with symptoms tending to peak in the third trimester. Some research suggests more than 3 in 4 peopleTrusted Source experience sleep problems during pregnancy, with most having difficulty falling or staying asleep.

Lack of sleep is also normal after the baby arrives. Caring for a newborn is around-the-clock work. However, for many new parents and caregivers, sleep problems can last for longer than they expected.

A 2015 studyTrusted Source involving 1,480 females found that 60% still experienced insomnia at 8 weeks postpartum and that 41% still had sleep problems 2 years after giving birth. Although depression is quite commonTrusted Source following birth and has been linked to insomnia, a diagnosis of depression could not explain the study’s findings.

The study authors suggest that these findings may be due to hormonal changes and changes in work and sleep schedules. They also note that pregnancy could be a trigger for longer-term chronic sleep problems.

Sleep during perimenopause

Around 40-60% of femalesTrusted Source experience poor sleep during perimenopause or menopause. Perimenopause is the period of physical changes that occur in the 4-8 years leading up to menopause. Rapid fluctuations in hormone levels are characteristic of this menopausal transition. Given their role in sleep maintenance, these changes may result in some level of insomnia.

“During menopause, many women also have trouble sleeping due to hot flashes,” Dr. Martin explained. “This tends to improve over time, but some women have trouble getting their sleep back on track after menopause.”

For some females, research suggestsTrusted Source that hormone therapy during menopause in those experiencing hot flashes can improve sleep quality. Other researchTrusted Source has found no link, suggesting that lifestyle and anxiety and depression diagnoses during this period may play more important roles in sleep.

Dr. Martin added that the benefits and risks of hormone replacement therapy are different for each female. “A detailed discussion between a woman and her doctor [is] needed to make an informed choice.”

Stress, depression, anxiety, and sleep

Stress and mood disorders are important factors that can also contribute to insomnia in females.

“There are also differences in how daily life differs for men and women, and these factors may impact sleep,” Dr. Martin said. “For example, even today, women still have more responsibilities related to childcare and household tasks than men. This is true even if women are working outside the home.”

She also explained that females are at increased risk of mood disorders that can affect sleep, such as anxiety and depression.

According to data from the Substance Abuse and Mental Health Services Administration, the prevalence of depression is over 50% higherTrusted Source in females than in males. Females are also nearly twice as likelyTrusted Source as males to have an anxiety disorder. These differences may be due to both biological factors and external psychological stressors.

Stress, depression, and anxiety are significant drivers of insomnia in transgender women as well. In fact, almost 80%Trusted Source report significant sleep issues.

How can females get better sleep?

Dr. Martin emphasized the importance of prioritising healthy sleep habits.

“Find a bedtime and rise time that work for you and stick to [them],” she said. “Most people know the basics, like limiting caffeine and alcohol and having a comfortable sleep environment. If you haven’t checked these things off yet, see if you can do one small improvement in one of these areas.”

People who have made these changes and haven’t seen any improvement within 3 months may have chronic insomnia. “This is the time to reach out to your doctor or a sleep specialist for help. Some people with insomnia also have other sleep disorders, so getting an evaluation from a specialist can be very helpful,” explained Dr. Martin.

The AASM  has information about how to find a sleep specialist on its website.

“There are effective, safe non-medication treatments out there,” Dr. Martin noted. The recommended first-line treatment is called cognitive behavioural therapy for insomnia (CBT-I).

CBT-I involves exploring examining how thoughts, feelings, and behaviours contribute to symptoms of insomnia. It provides participants with healthy strategies to relax and establish good sleep habits. A person can seek CBT-I from a trained healthcare professional or through a digital app.

One 2020 studyTrusted Source found that the use of a digital CBT-I program improved sleep and reduced the use of both prescription and non-prescription sleep medications.

For some people, treatment for insomnia may also require medication.

Studies also suggest that yoga and PilatesTrusted Source Trusted Sourcecan support sleep health and improve symptoms of insomnia.

The takeaway

Insomnia is common among females and may come and go throughout different phases of life, including pregnancy and menopause. A combination of biological and social factors increases the risk of insomnia in this group. These factors include hormonal changes and short-term or chronic stressors.

Developing healthy sleep habits can help some females. However, people who have been sleeping poorly — particularly if the symptoms have lasted for longer than 3 months — should consider connecting with a healthcare professional.

Chronic insomnia may require support from a sleep specialist, who can provide both medication and non-medication treatment as needed.

https://www.medicalnewstoday.com/articles/women-hormones-and-insomnia

How to Fall Asleep Faster Even Though Life Is Stressful Right Now

From self.com

Time to assess your sleep habits 

Anyone who has wearily dragged themselves to bed, gotten under the covers, and discovered that they can’t sleep knows that figuring out how to fall asleep faster is an elaborate affair. As you toss, turn, scroll through Instagram, and keep calculating how many hours of sleep you’ll have if you crash right now, the desire to fall asleep faster becomes another stressor keeping you awake. You might be wondering if there’s a better way to drift off. Well, you’ve come to the right place. Below, you’ll see an exploration of why good sleep is so important, plus a list of expert-approved techniques to help accelerate your journey into dreamland.

It’s reasonable to want to fall asleep faster—sleep is really important

If you’re reading this article, it’s safe to assume that no one needs to sell you on the virtues of a good night’s sleep. But since sleep is vital to our survival and well-being, just like food and water, let’s go through a quick recap anyway.

The average adult between the ages of 18 and 64 needs between seven and nine hours of sleep each night, according to National Sleep Foundation guidelines published in 2015. There’s research to suggest that getting enough quality sleep can remove toxins in your brain that build up from, you know, being awake all day, the National Institute of Neurological Disorders and Stroke (NINDS) explains. Getting quality sleep also helps you consolidate memories, restores your brain’s ability to concentrate, and rebuilds your muscles, among plenty of other benefits. There’s also significant evidence that a consistent lack of sleep can wreak all kinds of havoc on your health, including increased risk of high blood pressure, depression, and diabetes, the NINDS explains.

Your body has a natural 24-hour cycle, called a circadian rhythm, that dictates when you start to feel tired. Your circadian rhythm actually governs a bunch of processes in your body, including your metabolism and various hormone fluctuations. Still, it’s best known as the internal mechanism that clues you into sleepiness and wakefulness. A host of external and internal factors influence your circadian rhythm, including light and temperature, according to the National Institute of General Medical Sciences (NIGMS).

As it gets dark, your internal clock sends a message to your brain, where your pineal gland releases melatonin, a significant player in your ongoing rest quest, the NINDS says. “Melatonin is a hormone that is in charge of signalling for sleep," Dianne Augelli, M.D., a fellow of the American Academy of Sleep Medicine and an assistant professor of Medicine at Weill Medical College of Cornell University, tells SELF. “Basically, it’s sending a signal to the brain: ‘Hey, it’s time for sleep,’” she explains.

The good news is that, by tweaking your environment, you might be able to help your body realize what your brain already knows: that you want to fall asleep faster.

Better sleep hygiene can help you fall asleep faster (and stay asleep longer).

You might imagine sleep hygiene as the rest-related equivalent of regular showers or brushing your teeth. And, in truth, it sort of is. Sleep hygiene is a set of behaviours and practices that facilitate healthy and productive sleep, the Centres for Disease Control and Prevention (CDC) says. Naturally, people tend to start really caring about sleep hygiene when they start having sleep issues, Donald Greenblatt, M.D., director of the University of Rochester Medicine Sleep Centre, tells SELF. Once you start assessing your habits, you might discover why you’re having trouble sleeping each night.

Here are 12 sleep hygiene best practices you can adopt to fall asleep faster:

1. Commit to a consistent bedtime and wake time.

It might be tempting to stuff your sleep into any gaps of time you have, which can include sleeping later and longer whenever possible, but that’s counterproductive. Instead, aim for a sleep schedule, the Mayo Clinic says. That helps get you in the routine of getting enough sleep. And here’s a biggie: Your weekend routine shouldn’t deviate from your weekday schedule very much, the CDC explains. It might be tough to pull off, but it’s worth a try.

2. Limit the time you spend napping.

Naps are so delicious—they’re an afternoon treat that can help you get through the rest of the day. But if you’re finding that you’re more awake at night than you’d like, it might be time to let them go. Or, if you’re committed to naps, make sure that they don’t exceed 30 minutes each day, and consider moving them so they don’t happen too late in the afternoon, the Mayo Clinic suggests.

3. Do something soothing if you can’t fall asleep.

When sleep doesn’t come quickly, it’s natural to move around in bed to bide your time, but does this really help? Nope. More often than not, tossing and turning leads to frustration that works against falling asleep faster. Instead of huffing and puffing, try getting out of bed and leaving your bedroom for about 20 minutes to do something relaxing, the Mayo Clinic suggests. Read, listen to soothing music, or engage in another calming habit until you’re feeling more tired, then climb back into bed and give it another try.

4. Don’t fall asleep with the TV on.

Remember, as the sun goes down, your pineal gland begins to pump melatonin into your bloodstream. When you keep lights on, even from your favourite TV show, it can interfere with this melatonin signalling and make it a little more challenging to fall asleep quickly, SELF previously reported. And even if you do knock out, there’s also some evidence that the variances in TV light throughout the night can keep you from getting quality sleep.

5. Eliminate other sources of light too.

Since you’re turning off the television before you get into bed, it might be worth it to look around your space and see where you can eliminate other sources of light. Perhaps you can get curtains that block street light, or put your phone in another room if you tend to scroll through Instagram in bed, the Mayo Clinic suggests. “If we have [too much] light at the wrong time, it can tell your body to wake up and stay awake," Dr. Augelli explains. “So we have to be careful about the timing of our light consumption.” If you can’t control the amount of light in your room, think about getting an eye mask to block out light.

6. Consider the sound quality in your room.

Much like light can keep you awake, sounds—like from your TV or your loud neighbours—can keep you up longer than you’d like. If ambient sounds are an issue, consider trying to use a fan or white noise machine to help alleviate that. The consistent whir of a sound machine can help soften the impact of other erratic noise that could keep you awake, the CDC suggests.

7. Regulate the temperature in your room.

Light gets a lot of credit for encouraging your circadian rhythm to do its job, but temperature also plays a role. As SELF previously reported, a room that’s between 60 and 67 degrees Fahrenheit tends to be most people’s sleepy-time sweet spot. If you can’t regulate the temperature in your room (hello, old New York City apartment), consider switching up your bedding, sleeping with lighter (or heavier) pyjamas, or a host of other things to get your ideal sleep temperature.

8. Exercise during the day (but not too close to bedtime).

Engaging in a little more exercise during the day could help you ease into sleep, the CDC says. Experts aren’t exactly sure about the physiological mechanism, but according to Johns Hopkins Medicine, exercising during the day does increase deep sleep. Be mindful, however, that doing a physical activity too close to bedtime might keep you awake. This is because aerobic exercise can cause you to release endorphins (which make your brain more active) and raise your core body temperature, Johns Hopkins Medicine says.

9. Incorporate some bedtime stretching.

Yes, vigorous exercise before bed might keep you up, but consider grabbing your yoga mat and doing some gentle exercises to help you relax before bed. Why? Static stretching encourages deep breathing, which encourages your relaxation response, SELF previously reported. Looking for a few ideas? We have a 5-minute bedtime stretching routine you can try tonight.

10. Limit night-time cocktails and caffeine.

If the pandemic has brought a new fondness of nightcaps and quarantine cocktails into your life, they might be working against you. Yes, alcohol does relax you, but it can diminish the quality of sleep, and keep you from staying asleep, the CDC says. And, depending on your system, you might want to make sure you time your afternoon coffee so that it doesn’t keep you awake at night. As SELF previously reported, the Food and Drug Administration (FDA) says it takes four to six hours for half the caffeine you’ve consumed to leave your body. This means that after about five hours, you still have another half of your ingested caffeine to metabolize, which can definitely keep you up.

11. Don’t use your phone to “doom scroll” (or do anything else).

We’ve already discussed how light from your phone can interfere with melatonin production, but we haven’t addressed how scrolling through your phone, reading new coronavirus updates, checking email, or chatting with your friend in Hong Kong can keep your mind active. If you find that racing thoughts or mindless phone use is to blame, consider keeping your phone out of arm's reach and switching it out for a good book before bed.

12. Come up with a nightly routine that eases you into bedtime.

Depending on what keeps you up at night, this might be an excellent opportunity to intentionally relax before bed. You can try meditation, journaling, or reading, the Mayo Clinic says. But the important thing is to find a mindful and relaxing activity that works for you. Overall, a bedtime routine helps “signal to your brain that it’s time to go to sleep,” Carl Bazil, MD, Ph.D., director of the Division of Epilepsy and Sleep at Columbia University, previously told SELF.

When should you see a doctor about your sleep routine?

There’s a difference between wanting to learn how to fall asleep faster and dealing with sleeping patterns that involve truly being unable to fall asleep (or waking up for 20 to 30 minutes regularly during the night). And, let’s be completely honest, there are so many stressors and factors that could be keeping you up right now. In fact, the Mayo Clinic says, at some point, most adults will experience a short-term bout of insomnia. But if you are having trouble falling or staying asleep and it lasts more than a month, it might be time to work with your doctor to see if there are underlying factors, like medication or health conditions at play, the Mayo Clinic says. If it’s been less time than that but your sleeping pattern is severely impacting your quality of life—making it hard for you to carry out normal functions—it could also be time to see your doctor.

Your provider might conduct a physical exam (to identify possible underlying conditions), according to the Mayo Clinic. They might also have you keep a sleep journal, fill out a questionnaire to assess your sleepiness and wakefulness, and potentially connect you with a specialist or sleep centre for further evaluation, the Mayo Clinic explains. Whether or not you’re dealing with insomnia, it’s important to pay attention to your sleep quality. Restful sleep makes it a little easier to deal with the challenges and curveballs that come with being alive and staying healthy right now. 

https://www.self.com/story/how-to-fall-asleep-faster

What Causes Insomnia? 8 Reasons You Can’t Sleep at Night

From self.com

The tossing and turning might be signalling a deeper problem 

We’ve all been there: You can’t fall asleep, you get worried about not being able to fall asleep, and the vicious cycle begins. If you’re wondering what causes insomnia, the answer isn’t always simple, but all that tossing and turning often boils down to some type of stress.

From time to time, it’s common to struggle to fall asleep, battle frequent wake-ups throughout the night, or notice your mind starts running far too early in the morning. In fact, insomnia is the most common sleep complaint, affecting over one in three adults at any time, per the American Academy of Sleep Medicine (AASM). 

But chronic insomnia usually isn’t a standalone issue. Rather, it’s an actual sleep disorder—and a possible sign of an underlying problem with your lifestyle, environment, or overall health.

“In my practice, sleep and insomnia are so important we often call this the ‘canary in the coal mine,’" Alex Dimitriu, M.D., a sleep physician double-board-certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine in California, tells SELF. “If sleep is off for some time, there is usually something deeper worth looking into.”

While many of us are tempted to adjust to this lack of sleep with more coffee and naps, it’s important to take insomnia seriously. Over time, poor sleep can contribute to a slew of issues, ranging from chronic health conditions like diabetes and heart disease to serious accidents and injuries, per the Cleveland Clinic. Just how much sleep you need can vary, but most of us function best between seven to nine hours of shut-eye each night.

If you’ve been lying in your bed wide awake, keep reading to learn what could be causing your insomnia, when to bring up your sleep issues with a doctor, and what types of treatment can help get you snoozing soundly again.

What are the symptoms of insomnia?

First, a quick primer on what this sleep disorder actually does to your body and mind. Potential symptoms of insomnia may include:

• Struggling to fall asleep
• Waking up in the middle of the night or too early in the morning
• Feeling tired, sleepy or foggy during the day
• Having problems paying attention, concentrating, or remembering
• Moodiness, irritability, or depression
• Impulsive or aggressive behaviour
• Lower energy, motivation, or performance at work or school
• Being more prone to mistakes and accidents
• Feeling frustrated or worried about poor sleep

Are there different types of insomnia?

Experiencing short-term disturbed sleep is more common than chronic insomnia, per the U.S. National Library of Medicine. In this case, you may experience symptoms for days, weeks, or sometimes a couple of months due to a particularly stressful period at work or a traumatic life event, like losing a family member or going through a painful breakup.

Chronic insomnia, on the other hand, means you have trouble falling and staying asleep at least three times a week for three months or longer. It can also be triggered by things like never-ending stress, difficult emotions you haven’t worked through, or constant travel that’s throwing your schedule out of whack. However, this type of insomnia can present as a side effect to a deeper issue as well, like an underlying health condition, medication plan, or substance use.

What causes insomnia?

Let’s dive deeper into the most common reasons you may be missing out on sleep:

1. You’re anxious about falling asleep.

“In some ways, insomnia is like an anxiety disorder about not getting enough sleep," Jason Ong, Ph.D., director of behavioural sleep medicine at SleepCharge by Nox Health and adjunct associate professor of sleep medicine at Northwestern Feinberg School of Medicine, tells SELF. “Anxiety about sleep and the attempts to try and make sleep happen actually perpetuate the problem by inadvertently disrupting your body’s regulation of sleep.”

A common response is to try to fix the issue by trying harder to fall asleep. However, moves like hopping in bed when you believe you should be sleepy (but aren’t) just turn up the pressure. In turn, you tend to feel even more restless and awake.

2. You have an off-kilter sleep schedule.

If you’re a jetsetter travelling across time zones for work, for example, or a shift worker trying to sleep during the day, disturbed sleep could follow. The root of the problem is known as circadian misalignment, or trying to sleep at times that don’t match your internal body clock, which regulates your sleep-wake cycle, says Dr. Ong.

3. You’re stressed to the max.

An overwhelming work schedule, looming debt, caregiving, the loss of a loved one—any number of stressful life events could trigger insomnia. That’s because chronic stress flicks on your fight-or-flight response, Ash Nadkarni, M.D., an associate psychiatrist at Brigham and Women's Hospital and an instructor at Harvard Medical School, tells SELF. This cues a flood of stress hormones like adrenaline and cortisol into your bloodstream. When your stress doesn’t subside and that “on” switch gets stuck, these hormones keep surging through your body at night to keep you alert, blocking your ability to relax and ease into sleep.

4. You have a mental health condition.

Insomnia is a symptom of many psychiatric disorders, including depression, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder, and post-traumatic stress disorder (PTSD), per the National Alliance on Mental Illness (NAMI). While the relationship is complicated and more research is needed, researchers hypothesize the link is due to changes like a heightened stress response, issues with neurotransmitters or chemical messengers like serotonin, norepinephrine, and dopamine, plus associated problems with the internal body clock and sleep cycle, says Dr. Nadkarni.

5. Or you have another underlying health condition.

This brings us back to that “canary in the coal mine” comment: Insomnia may stem from numerous health problems including other sleep disorders like restless legs syndrome, narcolepsy, or sleep apnoea, chronic pain due to conditions like arthritis or headaches, cancer, gastrointestinal disorders such as heartburn or GERD, hormone fluctuations during your period or due to thyroid disease, or even neurological disorders like Parkinson’s disease, per the Cleveland Clinic. 

6. You’re taking medications or drugs that keep you up.

Insomnia can also be an unwanted side effect of certain medications or drugs. Stimulants, for example, cause a release of certain neurotransmitters, which in turn may disrupt your ability to fall and stay asleep, says Dr. Nadkarni. Others cause a change or reduction in sleep quality.

Common culprits include:

• Stimulants like caffeine and nicotine
• Some medications used to treat depression, ADHD, high blood pressure, or Parkinson’s disease
• Alcohol or other sedatives
• Some asthma medications such as theophylline
• Decongestants and allergy and cold medications that contain pseudoephedrine
• Some steroids like prednisone
• Drugs such as marijuana, LSD, and ecstasy

7. You’ve got some sleep-disrupting habits.

Poor sleep hygiene—or habits that wreck your ability to doze off—can also contribute to insomnia. Staying in bed for long periods of time (hello, revenge bedtime procrastination) or taking naps, for instance, often sets you up for more sleep disturbances at night, says Dr. Ong. If you’re not getting enough exercise, working late, going to bed at different times each night, or using your phone or watching TV in bed, you could also be making good sleep harder to come by, according to the U.S. National Library of Medicine.

8. Blame your sleep space.

While it’s typically not the root cause for insomnia, issues with your sleeping environment could also make it harder to get a good night’s rest, says Dr. Nadkarni. Think: bright street lights illuminating your bedroom, noisy neighbours, a snoring sleeping partner, or a mattress or comforter that traps too much heat.

When should you see a doctor about insomnia?

“Anyone that consistently gets less than six hours of sleep per night or experiences significant next-day symptoms of fatigue, low mood, or sleepiness, should consider speaking with a doctor,” says Dr. Dimitriu. 

Generally, if it’s been a few weeks and your lack of sleep is really interfering with your day-to-day life and ability to function, it’s a good idea to seek professional help, Dr. Ong agrees.

Start by reaching out to a primary care doctor. Since insomnia can be caused by so many different health issues, they can help identify whether it’s necessary to refer you to a sleep specialist or psychiatrist, says Dr. Nadkarni.

What does insomnia treatment look like?

Treatment for insomnia typically includes addressing the underlying cause, making lifestyle changes to improve sleep hygiene, going to therapy, and/or taking medication.

If you have disturbed sleep, step one is to improve your sleep habits. A few quick tips:

• Go to bed and get up at the same time every day, even on weekends.
• Exercise more during the day, ideally outside if you can.
• Avoid large meals, too many fluids, and stressful discussions before bed.
• Limit naps and don’t snooze in the late afternoon.
• Cut down on alcohol and nicotine intake, and avoid “nightcaps.”
• Keep your bedroom dark, quiet, and cool—ideally between 60°F to 67°F for a peaceful snooze.
• Create a wind-down routine before bed with relaxing self-care activities like a long bath or meditation. 
• Schedule a digital curfew at least 30 minutes before bedtime.
• If you can’t stop intrusive thoughts, try writing out your worries.
• If it’s been about 20 to 40 minutes and you can’t fall asleep, get out of bed and go do something relaxing—like reading a book—until you’re sleepy.

For chronic insomnia, the first-line treatment is cognitive behaviour therapy for insomnia (CBT-I), which lasts for about five to eight sessions with a licensed therapist in person or virtually. “This is a specific type of psychotherapy that uses cognitive and behavioural strategies based on the science of sleep to help patients regain their ability to regulate sleep,” says Dr. Ong. The key is to target anxiety and behavioural problems surrounding sleep issues with stress-reduction practices, relaxation, and healthy sleep habits. 

If CBT-I is unavailable to you or simply not working fast enough, you can also try sleep medications like zolpidem (Ambien) or eszopiclone (Lunesta), provided that your doctor recommends them for your situation, says Dr. Ong. Keep in mind it’s important to take these under close medical supervision, as they do come with risks such as dizziness, brain fog, and possible dependence.

Bottom line: Whether your insomnia is short-lived or long-lasting, you shouldn’t have to just deal with it. With the proper help, you can have better sleep and start living well again.

https://www.self.com/story/insomnia-causes

The Ultimate Guide To Insomnia And The Ways It Can Be Treated

From californianewstimes.com

The chances are all of us have experienced trouble sleeping at some point in our lives. Whether that’s the act of actually falling asleep or waking up throughout the night, or not being able to get enough of it, poor quality sleep can significantly disrupt our daily lives by making us lethargic and unwell, and even impacting our reaction and decision-making abilities. While we tend to be able to get ourselves back on track and catch up on sleep or reset our body clocks, there are some people that struggle with sleep to the point it becomes a clinical problem. Insomniacs are people that regularly have problems sleeping and can find it a bit harder to correct those problems without a bit of help and effort. If these problems last for less than three months, this is referred to as short term insomnia. After that, it’s categorised as long-term insomnia and may need professional intervention.

Insomnia Symptoms
To discern whether you’re suffering from insomnia or not, first we need to take a look at the general symptoms of this sleep disorder. There are many ways to figure out if you’re struggling with acute, transient or chronic insomnia. If you find it hard to go to sleep, wake up throughout the night and find it hard to get back to sleep, then this could be a sign of some form of insomnia. Of course, stressful situations and anxiety can disturb sleep until that stress is gone, and so shouldn’t really be much of a concern if things go back to normal once you’ve stopped worrying. If you also feel tired after waking up, you may be having disturbed sleep throughout the night that you can’t remember, resulting in your body not completing the correct sleep cycles and getting enough rest. Irritability and a lack of concentration is also a sign of getting a lack of rest.

Possible Causes Of Insomnia Today

There is a myriad of different things that are known to cause insomnia, or at least exacerbate ongoing sleeping problems. As mentioned earlier, stress, anxiety and depression are huge contributors to this problem and should be taken into consideration. Not only that, but excessive noise where you’re trying to sleep, badly regulated room temperature, discomfort in bed, are all external influences on your ability to sleep properly. Excessive use of recreational drugs, alcohol and drinking caffeine too close to bedtime can also affect your body’s ability to sleep and should be used with great caution. If these things are causing you problems with sleep, not to mention recreational drugs being illegal, you probably shouldn’t be using them. On top of all of this, imbalances in our brain chemistry, such as melatonin deficiency, can keep us awake too.

What Is Melatonin?
This hormone is present in all of our brains. It’s stored and secreted by the pineal gland when our brains detect a switch from a light to dark environment and appears to aid us in relaxing and ultimately falling asleep. Simply put, it’s our brains way of telling the body that it’s night time and therefore time to get some sleep. If the place is too light, it can impact the melatonin production in the brain, making it more difficult to get to sleep. Excessive alcohol consumption has a negative impact on the production of this hormone too, so it’s important for you to learn more about the relationship between melatonin and alcohol if you find that you drink too much and struggle with sleep. For those that do struggle with their melatonin regulation, there are actually supplements that you can take to help maintain healthy levels. It’s important to speak to a medical professional first though, before you start taking any supplement.

How Much Sleep Do We Need?
While everyone is different and it’s difficult to truly define exactly how much sleep we need, it’s generally agreed that adults need between 7 and 9 hours of quality sleep per day to feel refreshed and rejuvenated, ready for the next day. Children actually need much more sleep due to their developing, growing bodies and it’s said that they need anywhere between 9 to 13 hours, and toddlers and babies even need 12 to 17 hours, explaining the frequency of nap requirements they have. The reasons that more sleep is needed, the younger we are, is due to the fact that when we’re asleep, our bodies spend time building and repairing tissue, organs, and bones. This accounts for why sleep is required after sustaining an injury and why these injuries, depending on severity, can feel much better after a good night’s sleep.

The Benefits Of Quality Sleep
As well as repairing and growing our bodies, sleep is generally very healthy for the mind too. There are many things that poor quality sleep is linked to and improving our sleeping habits can help to offset these problems. Bad sleep is often linked to obesity as certain hormones that help to regulate body weight need to be produced during rest. A lack of sleep also reduced our ability to be motivated to exercise, and actually a desire to eat more calories due to low energy levels. Getting regular, quality rest also boosts concentration levels and our general desire to be productive. Tiredness can make us just want to rest more throughout the day and can even cause our minds to wander away from important tasks. Bad quality sleep also increases the risk of heart disease and stroke as well as other chronic illnesses such as type 2 diabetes and even mental health disorders such as depression and anxiety. To reduce the risks of all of these problems, we highly recommend getting some good, undisturbed sleep, as well as going to bed at roughly the same time every night to set your body’s internal clock. You’ll also find that by doing this, you’ll wake up at the same time every morning without the need for an alarm either. This will show that you’re getting good quality sleep and enough of it too.

Sorting Your Sleeping Pattern
Getting good quality sleep may be much easier said than done. Although it’s something that is easily achievable with a bit of dedication and commitment. First of all, set yourself a good time to go to bed every night and stick to it. Even if you’re finding you’re not always tired at that time, eventually, as you also wake up at the same time every day, your body will begin to feel tired at the right time. Also try to switch off at least one hour before you get into bed. This means turning off screens and choosing a relaxing activity such as reading or having a hot bath with some scented candles. You may actually find that spending a night socialising with friends with no screens on and dimmed lights makes you feel much sleepier than if you were sat watching TV or playing video games for the same amount of time. This is due to the higher levels of blue light or short-wavelength enriched light emitted from these devices, which also includes your smartphone. This blue light hinders melatonin production keeping you from feeling tired.

https://californianewstimes.com/the-ultimate-guide-to-insomnia-and-the-ways-it-can-be-treated/596138/