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Reasons Why You're Not Sleeping and What to Do About It

by Nancy Stedman
December 22, 2016 | Health

This article appeared originally on Next Avenue.

Did you get a full eight hours of sleep last night? What about the night before? If you're like most people, probably not. And lack of sleep can have pretty immediate adverse health effects, not to mention making it hard to focus at work or think about anything else besides getting back in bed.

If it’s been years since you slept like a baby, you’re not alone: An estimated 25 to 30 percent of American adults suffer from insomnia. Here are six reasons you might be having trouble reaching, or staying in, the Land of Nod and what you can do about it:

1. You’re stressed

Stress keeps you revved up and interferes with the biological processes that would normally help you fall asleep at the end of the day. Cognitive behavioral therapy for insomnia, or CBT-I, a branch of cognitive behavioral therapy targeted to those with sleep issues, is especially helpful for tense people and is the first-line treatment for most sleep disorders.

“This is a regimented program, with five to six sessions,” said Joseph Andrew Berkowski, a neurologist at the University of Michigan.

A sleep psychologist trained in CBT-I may, for instance, ask you to keep a sleep diary, recommend avoiding naps, train you to get out of bed when you can’t sleep and help you change thoughts that may make it hard to nod off.

“This is by far the most effective long-term therapy for people with chronic insomnia, those with sleep problems on a night-to-night basis,” Berkowski says.

However, there’s a scarcity of CBT-I practitioners in the U.S. — most are clustered at major academic and VA medical centers. But recently, research has validated the efficacy of CBT-I done remotely by computer. In the November, 2016 issue of JAMA Psychiatry, an analysis of SHUTi ($135), a six-week online course, found that the treatment helped participants fall asleep more quickly and stay asleep longer both shortly after the program and a year later. A London-based program called Sleepio ($300) has also received some validation in studies.

2. You get up at different times during the week

“If you have a consistent routine, your sleep will be of higher quality and you’ll feel better in the day," Berkowski said. But many people with regular jobs sleep late on weekends to make up for what they miss during the week, resulting in insomnia when they go back to work.

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Erratic sleep schedules can also happen when people retire and no longer adhere to a rigid timetable, said Karl Doghramji, medical director of the Jefferson Sleep Disorders Center at Thomas Jefferson University.

The solution is to wake up at the same hour each day. “The time you go to bed is not as important as the time you wake up, because that’s when the body’s clock starts,” Berkowski noted.

3. You have sleep apnea

If you snore loudly and wake up a lot, you may have sleep apnea. In this condition, you stop breathing several times during the night, depriving your body of oxygen.

Obstructive sleep apnea (OSA), the most common form, happens when there’s an obstruction in the back of your throat, such as collapsed soft tissue, that interferes with air flow. OSA is a serious condition associated with daytime fatigue, high blood pressure and heart disease.

“Fortunately, sleep apnea is one of the easiest sleep conditions to treat,” Berkowski says. The most effective way is with a machine called Continuous Positive Airflow Pressure, or CPAP, that blows air down your throat while you’re sleeping.

4. You’re depressed

Depression—defined by the Mayo Clinic as “persistent feeling of sadness and loss of interest" —is one of the most common causes of insomnia.

“Most often people wake up early in the morning, though some depressed people may also have trouble falling asleep,” Doghramji said. He added that depression can be successfully treated with antidepressants and talk therapy.

5. You take over-the-counter sleep medications

“In general, over-the-counter drugs, those with ‘PM’ in the name, contain antihistamines, which are engineered to treat allergies, not insomnia,” Berkowski said. “They can make you feel drowsy the next day and usually stop working after being taken a few days in a row.”

If you really feel the need for a sleep medication, he says, you’re better off with newer prescription drugs like Lunesta that are tailored to sleep problems and won’t leave you foggy the day after.

“They can be effective for months, but then they will probably stop working, too,” Berkowski said. Prescription drugs work better when used occasionally rather than on a continuing basis.

For chronic insomnia, you’re better off with CBT-I. “It has a longer effect than medications,” Doghramji said.

6. You don’t turn off your electronic screens

Too much exposure to the blue light of electronic screens can shift your natural circadian rhythm and depress levels of melatonin, a hormone that helps regulate sleep.

The Harvard Health Letter recommends:

-Avoid spending time on your cell phone, computer or iPad beginning two to three hours before bed.

-If you work overnight or must use electronic devices close to bedtime, consider installing an app, like Twilight, that filters the blue/green wavelength on your phone or tablet.

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