All causes of disturbed sleep could be classified into three main categories: environmental, physiological and psychological.
Environmental reasons for your nighttime wakings:
Your sleeping conditions disturb your sleep - look for the cause in your bedroom
1. Is your mattress comfortable? Do you wake up because you may have pain in your shoulder or hips, or back? Your mattress is either too hard for your body or have deteriorated, creating uneven surface to sleep on. Mattresses last on average 7 years, invest in one of good quality that suits your body weight and your type of physical activity. In my own case, being quite light in bodyweight I needed a soft mattress, but having a lot of muscle, I also needed a slighter harder mattress to support the muscle. It took me some time to find a mattress that answered this dilemma.
2. Not enough darkness in the room: even small cracks of light (maybe you have light coming from the top of your curtains?) will affect your melatonin production making your sleep light with frequent wakeful moments. Blackout curtains are your best solution, if this is not an option, get a good quality face mask.
3. How quiet is your bedroom? Do you get street noise? Do you have pets that move during the night? Is your partner snoring? Recent research shows that having a pet dog or cat is associated with poor sleep quality.. So close the door of your bedroom for your pets; and as for the other types of noise, look into a variety of earplugs on the market. I swear by Boots wax earplugs.
4. Perhaps one of the most important conditions for sound sleep is the temperature of your bedroom. Previously it was considered that the temperature around 21 degrees Celsius was ideal, however, newer research shows that 19 is where the body finds it most relaxing and therapeutic. If your room ambiance is too warm, it may negatively impact your REM (dreaming) phases of sleep.
In one study it was shown that sleeping at 19 degrees Celsius temperature can also add a benefit to one’s metabolism - by increasing the amount of brown fat. Brown fat is the most metabolically active fat (as compared to inflammatory white and beige fat tissue). The participants in this study slept for a month at 24 degrees Celsius, another month - at 19 degrees and then again at 24 degrees and at 27 degrees. At the end of each month, the men underwent the evaluations of their energy expenditure, muscle and fat biopsies. After sleeping at 19 degrees, the participants had a 42% increase in brown fat volume and a 10% increase in fat metabolic activity, including better insulin sensitivity. These changes returned to practically baseline, when the participants slept at 24 and 27 degrees Celsius.
Physiological reasons for your nighttime wakings:
How is your breathing? Do you snore? Do you suffer from sleep apnea? Sleep apnea is becoming more common, according to the UK’s Sleep Apnoea Trust, approximately 13% of men and 6% of women in the UK are affected by the condition. Sleep apnea is when breathing is not constant, repeatedly stopping and starting during your sleep. Some people find themselves woken up in anxiety as they gasp for air.
There’s significant research that have consistently found a strong independent association between the presence and severity of obstructive sleep apnea (OSA) and insulin resistance / glucose intolerance. If you suffer from sleep apnea, you should have a glucose monitoring test - Hba1c to rule out insulin resistance.
Nighttime wakings due to the need for the toilet? Are you drinking enough during the day? There is a common misconception that toilet breaks are a body necessity which happens to most of us. There is no scientific evidence for this. In my practice, most people have inadequate hydration levels during the day. Closer to the evening, there’s a stronger urge to replenish lost hydration, thus your consumption of liquids increases. Not only you are drinking more water, caffeinated and herbal teas are also your favourites. For adequate hydration, follow Andrew Huberman, Ph.D., neuroscientist’s advice. He advocates that for adequate water intake we should aim to drink 227 ml of water at every hour for the first 10 hours of our day. Adequate water consumption will also help you train your bladder to contain more liquid during the day, which will help you sleep without the need for the toilet during the night. Refrain from drinking teas and herbal drinks within 2 hours of sleep.
Blue light disruptions - yes, you have heard this before, but why exactly do bluelight devices cause nighttime wakings? Digital devices, such as laptops, iPads, mobile phones and even Kindle disrupts your biological clock that is responsible for the sleep-wake cycle. Our sleep-wake cycle is regulated by the central clock system - SCN - suprachiasmatic nucleus. Taking the information from the environment, such as temperature of the air and the amount of light, the SCN determines cortisol & melatonin production. After 8:30 pm the SCN regulates the body to produce little cortisol (the hormone of energy & stress), and start producing the hormone melatonin which acts as a switch for the body to initiate sleep. In the early 2000s researchers working on our circadian rhythms discovered a protein in the SCN that is most sensitive to blue light. They called it "melanopsin". It is this blue light emitted from digital devices that is able to reduce the amount of nocturnal melatonin. Our brain ends up sending ‘a wrong’ signal to the body that it is daylight - the need to produce cortisol to stay energetic. As a result, your sleep is delayed, but provided you are sufficiently physically tired you may fall asleep easily, only to have fitful sleep with wakeful moments.
Your age matters. Older people are reported to have poorer sleep quality. It is unsubstantiated though that as we age we require fewer hours of sleep. A 75-year old needs the same 7,5 - 9 hours of sleep as a 30-year old does. The National Institute of Aging points out that insomnia is the most common sleep problem in adults age 60 and older. However, the human body has the same physiological need for good night’s sleep during old age. Many people have inadequate quantity and quality of sleep throughout their lives, thus in ageing, where there might be additional health concerns, several medications and other factors, sleep quality may suffer even further.
There are indeed a few factors that affect our sleep in old age independently of our lifestyle habits, such as the production of melatonin. Our bodies do not produce the same amount of melatonin in older age, compared to when we are younger. This plays a significant role in difficulty falling asleep and also staying asleep, as well as having a disruption in circadian rhythms.
Most significant problems with sleep in old age seem to stem from the loss of deep sleep that affects people 60 years and over.
Matthew Walker and his team investigated the causal effect of memory loss associated with decrease in slow-wave (deep sleep) in the elderly. Walker and his team posed a question of the direction in the causal relationship between deep-sleep and cognitive decline in the older population. As well as looking at the role of the glial cells for helping the brain detoxify during the night, I wrote about this in my previous blog, Walker’s team correlated their study findings with those conducted by Dr Maiken Nedergaard at the University of Rochester. Walker found that the buildup of amyloid plaques, the characteristic of Alzheimer’s disease, increases dramatically when sleep is insufficient; the buildup occurs especially in the deep-sleep generating regions, attacking and degrading them. The loss of deep-NREM sleep exacerbates the buildup, creating a vicious cycle - more amyloid, less deep sleep and vice versa.
Psychological reasons for your nighttime wakings:
Ever heard the term ‘body noise’? Coined by Andrew Weil, MD, Clinical Professor of medicine, Director for Integrative Medicine at the University of Arizona, body noise refers to a range of biomedical and psychological factors that contribute to sleeplessness. These include stressful events, depression and anxiety, restless leg syndrome, body aches and pains, chronic muscle tension, excessive worry. As well as body noise interfering with sleep, we may have what is called ‘mind noise’ - these are sleep-impeding thoughts and feelings that are rooted in misguided beliefs. For example, anxiety about not being able to sleep will exacerbate any poorly formed sleep habits.
More about body and mind noise interfering with your sleep quality in my next post.
Any questions, I’m always happy to answer, don’t be shy - reach out!