If you can never summon the sandman fast enough, listen up. A medical reason might be behind your lack of rest, and once you determine it, you’ll be able to sleep longer and better.
“While urinary incontinence does affect women more often than men, millions of both men and women deal with some type of bladder control issue at some point in their lives and many suffer from symptoms that significantly impact their quality of sleep,” says Adam Ramin, MD, urologic surgeon and medical director of Urology Cancer Specialists in Los Angeles. “And the truth is, if you suffer from urinary incontinence, it doesn’t have to be a condition that puts you in adult diapers for the rest of your life or prevent you from ever having a good night’s sleep again.” Dr. Ramin says diet and lifestyle changes can help with bladder control, including reducing your intake of caffeine. “Caffeine stimulates bladder function and is also considered a diuretic,” Dr. Ramin continues. “Though it can be much easier said than done, limiting or eliminating caffeine altogether has been known to be successful in diminishing and resolving issues of urinary incontinence.”
“As many sufferers know, it’s tough to stop that runaway migraine train once it gets moving, let alone try to get a good night’s sleep,” says Vernon Williams, MD, neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Kerlan-Jobe Orthopedic Clinic in Los Angeles. But if you can’t sleep, staying up might just make it worse. “Not getting enough sleep, and sometimes getting too much, can trigger a migraine,” he adds. Dr. Williams suggests staying hydrated, eating a balanced and nutritious diet, and staying active to help reduce the onset of migraines.
“Numerous studies have shown magnesium’s effectiveness in boosting mood, lowering anxiety, and reducing stress levels as well as helping with deeper more restful sleep,” says Carolyn Dean, MD, a general practitioner based in Kihei, Hawaii and a medical advisory board member with the Nutritional Magnesium Association. Most Americans aren’t getting enough magnesium, so it could be one of the reasons why you can’t sleep. “Magnesium deficiency causes muscle tension, nerve irritability, adrenal surges, decreased production of serotonin, and muscle cramps. All of these symptoms and conditions interfere with sleep,” she says, calling magnesium a safe and important treatment for insomnia. However, not all forms of magnesium are easily absorbed by the body. “Magnesium citrate powder is a highly absorbable form that can be mixed with hot or cold water and sipped at work or at home throughout the day,”
Circadian rhythm delay
Everything from alertness to body temperature fluctuates based on where our bodies in our 24-hour biological clock called circadian rhythm, explains Michael Howell, MD, CEO of Sleep Performance Institute in Edina, Minnesota. “Our circadian rhythms are primarily determined by when we are exposed to light, and our modern culture’s affinity to light in the evening (computer, tablet, television, and phone screens) activates a cell layer in our retina sending a signal that delays our circadian rhythm. That means that it could be 10 p.m., but the brain will think the sun is still out, so it won’t be ready to fall asleep—no matter how tired you actually are.” Another problem could be a circadian rhythm delay, which is probably what’s happening when the alarm clock goes off, but you’re not ready to wake up yet. “If you have trouble falling asleep at night but can sleep in easily in the morning, you probably have a delay in your circadian rhythm. This problem is solved with bright light (sunlight or a 10,000 lux light box used first thing in the morning) along with low dose (0.5mg) of melatonin about three to four hours before bedtime.”
Dr. Howell says numerous medications can cause difficulty falling asleep. The most common ones include: steroids such as prednisone; antidepressants such as bupropion and venlafaxine; stimulants such as methylphenidate and modafinil, adrenal, thyroid replacement medications, beta agonists and theophylline used for asthma. “Some over-the-counter medications, such as some pain medications, allergy, and cold medications, and weight-loss products, contain caffeine and other stimulants that can disrupt sleep,” reports the Mayo Clinic. Dr. Howell suggests you talk to your doctor about the medication if you can’t sleep, and consider if the benefits you are receiving from the medication outweigh the consequences of poor sleep.
Chronic obstructive pulmonary disease, or COPD, (an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory asthma, and some forms of bronchiectasis) can make it harder to get a good night’s sleep. In fact, many COPD patients also suffer from insomnia, obstructive sleep apnea, and depression,” says Fredric Jaffe, associate professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University. Medications used to treat COPD, including bronchodilators and steroids, can cause sleep difficulties, too. If you can’t sleep and have COPD, Dr. Jaffe suggests having a solid bedtime routine and minimizing distractions in the bedroom. “Discuss with your pulmonologist if your COPD treatment is optimized and if any of the medications prescribed are impacting your sleep problems,” he advises.
Houtan Chaboki, MD, a facial plastic surgeon in Washington D.C., sees many patients with a deviated septum who can’t sleep or have chronic sinus conditions that contribute to poor sleeping. “Ideally, one should be breathing through their nose during sleep. For anyone who has nasal congestion, they cannot breathe through the nose and may snore, too. Patients with a deviated septum have worse symptoms during sleep due to gravity,” Dr. Chaboki says. “Deviated nasal symptoms can occur naturally from genetics, or occur after injury. Patients may try allergy medication, but often need nasal surgery such as septoplasty or rhinoplasty for adequate nasal relief and better sleep.”
Depression and anxiety
An often-missed indicator of depression is a change in sleep patterns. “Many people who are depressed experience trouble falling asleep or staying asleep during the night. If sleeplessness is accompanied by other symptoms such as mood changes, disinterest in previously enjoyable activities, unexpected weight gain or loss, or thoughts of suicide, one should seek mental health evaluation by a doctor or therapist,” says Ameshia Arthur, a licensed clinical social worker with Arthur LCSW Sacramento, California. Also, says Arthur, generalized anxiety disorder (GAD) may be causing your sleep troubles. “Common indicators of GAD are restlessness and difficulty sleeping. If sleeplessness is accompanied by excessive worry, muscle soreness, and irritability, one should seek mental health evaluation by a doctor or therapist,”
Menopause introduces hormonal, physical, and psychological changes for women. “From peri-menopause (or transition phase) to post-menopause, women report the most sleeping problems,” reports the National Sleep Foundation (NSF). “These include hot flashes, mood disorders, insomnia, and sleep-disordered breathing. Sleep problems are often accompanied by depression and anxiety.” Treatment with estrogen (estrogen replacement therapy, ERT) or with estrogen and progesterone (hormone replacement therapy, HRT) has been found to help relieve menopausal symptoms, reports the NSF.
Restless leg syndrome
Sleep-related movement disorders, like restless leg syndrome, can impact sleep substantially. The condition is associated with symptoms ranging from “tingling, stinging, or creepy-crawly sensations before bedtime” to “periodic limb movement disorder, an involuntary rhythmic movement of the legs,” reports the Washington Post. If you think you have it, discuss treatment options with a doctor.
By Erica Lamberg