Why some of us can’t sleep well

You’d be hard pressed to find anyone who hasn’t experienced the odd bad night’s sleep. But for a third of us, according to the Sleep Health Foundation, insomnia is more than a rare occurrence. It’s an ongoing, and sometimes relentless issue that can cause frustration, distress, anxiety and, of course, exhaustion.

What’s worse, struggling to sleep can feel even more frustrating when your partner can slumber blissfully through the night. So why do some of us experience insomnia and others don’t?

Causes of insomnia

“There are a few different categories or reasons why some people have insomnia,” reveals Professor Dorothy Bruck, chair of the Sleep Health Foundation. “The first big one is physiological insomnia.”

According to Dorothy, that’s when someone has a heightened arousal or a sensitive adrenal system and can find it hard to unwind during the day. They may experience ongoing stress because they are always ready with a fight or flight response. “Physiological insomnia can be genetic – we sometimes see it running in families.”

Then you have insomnia that is very much related to environmental issues. “What we call poor sleep hygiene,” explains Dorothy. “People might stay in bed too long and then wonder why they can’t sleep, they might have non-routine wake and sleep times, they might be consuming stimulants such as caffeine or cigarettes – and stimulants affect people very differently, so while one person can have a cup of coffee in the afternoon and sleep, someone else might not be able to drink any, or just one in the morning.”

A third big group of insomniacs have an underlying sleep disorder that stops them from sleeping, says Dorothy. “A common one here is obstructive sleep apnoea – especially amongst older people. There’s a general belief it’s mainly men that get it, but amongst post-menopausal women it’s just as common as it is in men of similar age. Other sleep disorders include periodic limb movement and restless leg syndrome.”

Some people experience a worsening of their insomnia as they get older and others can experience chronic insomnia for the first time. According to Dorothy, one physiological reason for this is that the amount of melatonin that your body produces can decrease as you age, however there are often behavioural components too. “It’s generally an interaction of environmental and physiological issues,” says Dorothy.

“A lot of people who come to me don’t realise that as you get older you need a bit less sleep,” says Dorothy of her practise as a sleep psychologist. So they might aim for eight hours but only get six or seven and that might be enough.

“Comorbid health conditions can also be an issue in older age. When people have heart burn, or pain or even certain medications that don’t support sleep, it can make it more difficult.”

Treatments for insomnia

“Treatment programs that adopt behavioural and cognitive strategies – so changing the behaviours and thoughts people have around sleep – are very effective. Research shows that two thirds of people who undergo these programs experience really significant gains within just four to six weeks,” reports Dorothy.

“People often get more stressed about sleep than they need to. Once they get educated about what to expect and what may be happening – such as the fact that often people are dropping in and out of light sleep when they think they’re awake – and what’s helpful, such as just resting, they learn strategies and also get less anxious about it.”

Of course, insomnia can be chronic and debilitating and Dorothy acknowledges that medication for a short period can provide some relief to help get you through a tough period of stress, pain or grief.

“Our concerns are that sleep medication can start to become less effective over time, so people need a higher dose to get the same effect, and that if people continue to take medication they can lose confidence in their own sleep ability or lose their ability to self soothe,” says Dorothy. “We also know that the big family of sleeping tablets – benzodiazepines – can cause falls amongst the older population, as you can wake feeling groggy.”

So what about other sleep supplements? “Herbal supplements like valerian and chamomile tea can be effective if the problem is related to an inability to relax,” says Dorothy.

“Some people find magnesium useful but it’s only effective if you have a deficiency, so you could talk to your doctor about that. Regarding melatonin, I think it has disappointed a lot of people as it’s only mildly sleep-inducing and it’s primarily of benefit if you have low levels of melatonin.”

Dorothy says she would always encourage people down the path of reading about sleep tips and exploring behavioural change programs, as she’s seen so much success with them. “We’ve got a lot of great information and links on the Sleep Health Foundation’s Insomnia page.”

Dorothy’s tips to help reduce insomnia

• Try restricting your time in bed to a little less than you think you need, so that your body learns to consolidate the sleep you get.
• Keep your morning wake up time consistent and try going to bed a bit later.
• If you’re trying herbal supplements and medications such as valerian or chamomile, make sure you take them every night for two weeks – they take time to build up and be effective.
• Have a wind-down routine, away from screens and anything too stimulating or upsetting, for an hour or so before bed.
• A warm shower is a great way to start unwinding.
• Keep the lights dimmer throughout the evening and make sure you get outside in the daylight. The higher the circadian rhythm you get during the day from sunlight and activity, the greater drop you’ll get at night.
• The blue light of screens will suppress melatonin. There are free programs you can download on your computer, such as f.lux, which makes the screen slightly orange rather than blue in the evening. On some electronic tablets you can switch to night mode, which makes the screen dimmer and more orangey. You can turn down the brightness too and if you read on an iPad at night, opt for a black background with white writing.
• Many people don’t realise how long caffeine might be affecting them. Some people can’t sleep if they have any, or can only have one cup in the morning, so experiment with this a bit.
• Exercise is great, as long as it’s not super vigorous just before bed.

Australian Pensioners Insurance Agency Pty Limited ABN 14 099 650 996 is an authorised representative of AAI Limited ABN 48 005 297 807, the product issuer. Limits, exclusions and conditions apply. Read the Product Disclosure Statement before buying this insurance. Go to apia.com.au for a copy. The Target Market Determination is also available. This advice has been prepared without taking into account your particular objectives, financial situations or needs, so you should consider whether it is appropriate for you before acting on it.

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