Insomnia and sleep disorders

What is insomnia?

Causes of insomnia

Groups most at risk of insomnia

Consequences of insomnia

Remedies for insomnia (tips for sleeping)

References

What is insomnia?

Insomnia is difficulty falling asleep, staying asleep, or getting sufficient good-quality sleep. This lack of sleep affects your ability to function during the day, and can cause distress. An estimated 30% - 60% of adults are affected by insomnia at some time in their lives, with more women being affected than men. One in ten people in developed countries experience chronic insomnia. (6) Its incidence tends to increase with age.

Insomnia is not defined by getting a specific number of hours of sleep, because people vary in their sleep needs. Adults who get 7 - 8 hours of sleep every night tend to be the healthiest and longest-lived. However, depth and regularity of deep sleep is more important than the total time in bed.

Causes of insomnia

• Artificial light. Excessive light at night, especially light in the blue and ultra violet spectrum in the hours before you go to bed. Blue light mimics daylight, making your body think it is daytime. Daylight disrupts the natural production of melatonin. Sources of this kind of light include LED lights, fluorescent lights, all kinds of hand-held screens, bright unadjusted TVs, smart phones, laptop and desktop computers, and reading lamps with a harsh, bright white globe.
• Gut disorders. People who suffer from insomnia usually also have some kind of gut disorder, such as IBS, celiac disease, heartburn, bloating or indigestion. These gut disorders often start after a course of antibiotics. Gut bacteria help produce serotonin, which is converted to melatonin, and is necessary for a good night's sleep.
• Anxiety and chronic stress. (9) Worrying about the future. Life problems and fears relating to work, financial stress, relationships and social life, security etc. When I don't sleep well, it is usually because a thought is going round and round in my head - worry, anger, concern about something. The key to getting asleep is to drop it.
  Stress can cause adrenal exhaustion, which can keep you awake at 2am but make you sleepy at 7am when it is time to get up.
• Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, or obsessive compulsive disorder.
  Childhood trauma can cause sleep disorders - when a child is brought up in a crazy family or is abused in some way at an early age. Learned helplessness leads to a state of endless self-pity and entitlement. If you suffer from learned helplessness, low drive, low motivation, being scared all the time, or difficulty in relationships, then check the above link to depression and do the Adverse Childhood Events (ACE) test.
• Vitamin D deficiency. (15)
• Deficiency of a variety of minerals. Magnesium deficiency is the most important and common mineral deficiency causing insomnia. Zinc deficiency is also an indirect cause of insomnia, because zinc is used in so many pathways in the body.
• Not being sufficiently tired when you go to bed. Lack of exercise during the day.
• Eating and drinking (anything other than water) less than three hours before going to bed.
• Prostate problems disrupt toe sleep of many older men.
• Urinary incontinence can disrupt the sleep of both men and women. This can be healed.
• Circadian rhythm disturbances such as shift work, jet lag, not going to bed and rising at the same time every day (including weekends), and major changes to living and working patterns (new baby etc). Day and night no longer coincides with the body's internal concept of it, causing an inability to sleep at some times of the day and excessive sleepiness at other times.
• Salt deficiency. This is a common cause, and has a very simple cure - use more natural, unrefined salt. Be sure to use unprocessed sea salt or rock salt and NOT processed, refined table salt.
• Noisy partner. Loud snoring, periodic leg movements, shifting. Different requirements for temperature, open windows, fans, air conditioning, noise background, bed softness, sheets or other differences in individual sleep comfort.
• Sleep Apnoea.
• Restless leg syndrome. Creeping discomfort in the leg that is relieved by moving the leg or other body parts. Here is a tip to stop night time energy surges.
• Drugs and medicines. Many pharmaceutical and over the counter medications interfere with sleep. These include common medications for colds, asthma, blood pressure, depression, anxiety and schizophrenia, and particularly methylphenidate, MDMA, modafinil, and fluoroquinolone antibiotic drugs.
• Stimulants like caffeine and nicotine disrupt sleep. Do not take them in the hours before bedtime, and also limit your total daily intake.
• Alcohol. It is true that alcohol makes you drowsy, but a nightcap does NOT help get a good night's sleep. Alcohol is associated with sleep disruption and creates a sense of unrefreshed sleep in the morning. Alcohol actually prevents deep sleep, the most valuable kind of sleep.
• Sleep aids. Abuse of over-the counter or prescription sleep aids can cause dependency and further problems.
• Hormone shifts such as those that precede menstruation and those during menopause.
• Environment: excessive or unpleasant noise, light, air movement, uncomfortable room temperature (too hot or too cold).
• Under-methylation, also known as histadelia.
• Pain. Any painful injury or condition, especially back pain. A cycle can develop where movement puts pressure on the injured or painful area and wakes you up, and poor sleep makes the pain worse. Vitamin D can help in this situation. (15)
• Medical conditions such as chronic fatigue, angina, acid reflux (GERD), pyroluria, obstructive pulmonary disease (COPD), asthma, degenerative diseases such as Parkinson's disease and Alzheimer's disease, various neurological disorders, hyperthyroidism and rheumatoid arthritis.
• Coconut oil. Consumption of coconut oil keeps some people awake.
• High altitude (mountains).

Groups most at risk of insomnia

• Stressed people, worriers, and those with psychological and mental problems.
• People who are not busy enough, both physically and mentally. People who do not have full and meaningful days, and especially those who do little exercise and movement.
• Ageing - older people.
• Adolescents or young adult students.
• Pregnant women.
• Menopausal women.
• Travelers, especially long duration and those crossing time zones and suffering from jet lag.
• Shift workers with frequent changing of shifts.
• Those who live in insecure, noisy, polluted, crowded, night-bright conditions.
• Chronic alcoholics.
• Drug users - both pharmaceutical and recreational.

Consequences of insomnia

• Hormonal upsets causing weight gain, obesity and elevated cortisol. Ghrelin and leptin (the "hungry" and "satiated" hormones) are governed by sleep. Research (1, 2, 7, 8, 9) shows that a bad night's sleep or regularly not getting enough sleep upsets these two hormones. For most people, two nights with only 4 hours sleep can result in a hunger increase of nearly 25%, driving them towards sweet calorie-rich high-carbohydrate foods.
  
  A study (3) showed that just three nights of bad sleep decreased cells response to insulin by 30%. Volunteers had three normal nights of eight hours sleep, followed by three nights of four and a half hours sleep. This sleep upset, easy to get when travelling, over-working or with a sick family member, caused insulin resistance that eventually could lead to diabetes, cancer and numerous other diseases.
• Accumulation of metabolic waste toxins in the brain. Sleep is a brain-detox process. Increased risk of neurological problems like Alzheimer's disease (10, 11), with accumulation of B-amyloid after just one night of sleep deprivation. (12)
• Significant increase in all kinds of physical and mental health problems in the long-term. (13)
• Poor concentration that affects work and social life.
• Memory difficulties.
• Lack of coordination.
• Irritability and social difficulties.
• Accidents - increased risk.

Remedies for insomnia (tips for long deep sleep every night)

Deep youthful sleep is a skill to work on over your entire life.

• Light. Get plenty of bright sunlight in the morning. Go for a walk in the morning, try not to wear sunglasses in the morning and during the day. The warm infrared rays in sunlight penetrate your clothing and produce melatonin in your body. Get as much sunlight as you can during the day, especially early in the day. This sunlight greatly helps you to sleep well at night.
  
  At sunset start to get less light. Avoid bright light at night before you go to bed, especially blue or ultra violet light (often called bright white). This kind of light is typical of fluorescent lights, white LEDs, hand-held devices and computer screens. Gentle red or amber-coloured light at night will disrupt your sleep the least. Some people wear amber-coloured glasses that block blue light in the hours before bedtime to assist the natural production of melatonin. Blue or bright light in the evening and at night disrupts the Circadian rhythm, so important for the healthy functioning of many regular (time dependent) body systems.
  
  If you wake up during the night and read, watch TV, use a computer, or otherwise get white and blue light, you will sabotage your melatonin level. Research (4) shows that just a single pulse of white light in the middle of sleep at night causes a plunge in melatonin level and its production. This drop off in melatonin affects both sleep and health.
  
  Sleep in a completely dark room. Shut the curtains, and use blackout curtains if there are lights outside. There should be no lights on in your bedroom, obviously no TV, computer or hand held devices, and not even a bedside clock. Even little pinpoint LED lights on some devices can sabotage your sleep.
  
  If you wake up during the night try not to turn on any lights, but if you need a torch or bed light, the best colour is red. Red light disrupts your eyes and your sleep the least.
  
  Most computers and smart TVs have a night light setting, though it may not be turned on by default. For example in Microsoft Windows go to Settings and search for Night Light. Set it to turn on automatically at sunset. Your TV should also have a colour tone setting called "warm" that makes whites slightly pink, and the entire colour palette more red and less blue. You can also turn down the brightness level. If you do most of your TV watching at night, this is a highly beneficial adjustment to make.
  
  Bright light therapy (BLT). If you are living at high latitudes and it is winter time, there is not much light to be had outside. In this case, BLT has been proved very effective. Use a BLT lamp which has full-spectrum light and a minimum of 100 lumen brightness. Get at least 30 minutes exposure to the lamp in the morning, preferably soon after you wake up. Do not use it in the evening or at night.
• Vitamin D. (15)
• Magnesium will help you to sleep, especially if you take it later in the day or before you go to bed.
• GHB (gamma-hydroxybutyrate).
• Be tired. Be physically and mentally tired when you go to bed. Those who have had a happy, busy day doing meaningful work sleep the best. It is also important to be physically tired, having done some exercise or fast walking or physical activities like cleaning out the garage during the day.
• Get to bed earlier. The later people get to bed, the less sleep they have. What time they regularly wake up in the morning makes little difference.
• Exercise for at least 30 minutes per day. Do not be inactive. Go for a long daily walk, work in a garden, or do a heavy clean of your home. The best time to exercise is mid to late afternoon. Excessive exercise, or exercise immediately before bed can actually cause insomnia.
• Worry. Let go of obsessive thoughts, worries, stresses and concerns. Lying in bed with the same thought going round and round is what keeps many people awake. Plan to deal with it in the morning. Get up earlier in the morning if you need to. Accept it, put it in perspective and then drop it, simply put it aside while you get on with the more important business of sleeping.
• Temperature. Sleep in a cool or natural temperature. The temperature in your bedroom should be cool and comfortable. Some research shows that 65F or 18C is the ideal sleep temperature, though I feel it depends on the individual and what climate you are adapted to. I personally hate air conditioners and find it easier to sleep on a hot night with no fan or air conditioner but just with the windows open. The most important thing to remember is not to artificially over-warm your bedroom.
• Do not eat anything at all for at least three hours before going to bed. No snacking. Avoid sweet foods during the afternoon and evening, especially dried fruit like raisins. (5)
• Your bed should be used only for sleep and sex. Don't bring up bad topics within a few hours before going to bed. Especially, do not argue, worry about or plan for the next day, watch TV, read, eat, work, or use phones or tech devices in bed.
• Sleep only as much as you need to feel rested. Try to keep to the same routine every day, including weekends. Do not oversleep, lie in or try to force yourself to sleep. Avoid taking long naps (+30 minutes, deep sleep) in the daytime unless you do it every day without exception, in which case it is a good habit.
• Make your sleep pattern a part of your regular daily routine. Animals instinctively go to sleep when the sun is at the same position each day. Humans have this instinct too, but many choose to ignore it. We sleep best during the night, when the sun is down, and wake up naturally early in the morning, just before sunrise. Try to keep to a regular daily routine, seven days a week. Under-sleeping on weekdays, and catching up on sleep over the weekend does NOT help insomnia.
• Get a pillow of the right height. If you always sleep on your back or your front you probably do not need a pillow. If you always sleep on your side, which is the best position in which to sleep provided other factors don't prevent you, then you need a pillow high enough and firm enough that your head is horizontal. In other words, your head should not be at an angle - up or down - when you sleep on your side.
• Sleep in a well ventilated room.
• Separate rooms. If you have a noisy or disruptive partner, or a partner who has different requirements for temperature, light, open windows, noise, mattress softness or whatever, then sleep in separate rooms if you can. It is a luxury and indulgence to have separate bedrooms and not everyone will be able to do this. Sleeping in separate rooms is far more common than most people will admit to, and is not an indication that you do not love, admire and respect each other.
• Probiotics. If you have gut ailments or have ever taken a course of antibiotics, then eat a gut biome-friendly diet and take probiotics. Some people have found that taking a probiotic such as a small spoonful of milk kefir before going to bed helps get a good night's sleep, even though this contradicts the advice not to eat anything before going to bed.
• Try to drink your last drink at least two hours before bed. Allow enough time for liquids to pass through before you retire, so you do not have to get up during the night to urinate.
• Do not drink caffeinated drinks like tea, coffee and cola later than lunchtime. Avoid night cap alcoholic drinks before bed.
• Do not take B vitamins or nutritional yeast in the evening, they will keep you awake.
• Zinc - ensure you are not deficient.
• Salt. Use sufficient natural, unrefined salt in your diet. Have a glass of water with a quarter teaspoon of unrefined sea salt or pink Himalayan salt a few hours before you go to bed. Be sure to use unprocessed, unrefined natural sea salt or rock salt. DO NOT USE processed, refined table salt. Salt is one of those nutrients that the mainstream media has taught us to fear, but nothing could be further from the truth. It is the type of salt you use that matters. Refined processed table salt is harmful and toxic. Unrefined natural salts are health giving. Use as much unrefined natural salt in your diet and cooking as your sense of taste requires.
• Taurine.
• GABA.
• Apple cider vinegar taken during the day helps you to sleep at night.
• Sleep on a firm mattress on a solid base. If you are used to a soft mattress, for the first few days of sleeping on a firm mattress you may feel muscle and spinal pain. Soft, sagging mattresses can do considerable harm to your posture and spinal alignment - see back pain.
• Ashwagandha. (14)
• Inclined Bed Therapy (IBT).
• Earth (ground) your body as much as possible. Earthing is especially effective if you are suffering from jet lag or sleep disruption.
• Do not smoke, especially in the evening.
• View remedies & comments contributed by visitors to Grow Youthful's Ailments & Remedies pages.

References

1. Spiegel K., et al. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. Journal of Clinical Endocrinology & Metabolism 89, no. 11. November 2004. 5762-71.

2. Taheri S., Lin L., Austin D., Young T., Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Medicine 1, no. 3. December 2004.

3. Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Ann Intern Med. 2012 Oct 16;157(8):549-57. doi: 10.7326/0003-4819-157-8-201210160-00005.

4. Ben-Shlomo R, Kyriacou CP. Light pulses administered during the circadian dark phase alter expression of cell cycle associated transcripts in mouse brain. Cancer Genet Cytogenet. Feb 2010; 197(1):65-70.

5. R. Pamplona. Mitochondrial DNA Damage and Animal Longevity: Insights from Comparative Studies. Journal of Aging Research, 2011. DOI: 10.4061/2011/807108.

6. Roth T, Roehrs T. Insomnia: epidemiology, characteristics, and consequences. Clin Cornerstone. 2003;5(3):5-15.

7. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004 Dec;1(3):e62. Epub 2004 Dec 7.

8. Taheri S. The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child. 2006 Nov;91(11):881-4.

9. Al Khatib HK, Harding SV, Darzi J, Pot GK. The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr. 2017 May;71(5):614-624. doi: 10.1038/ejcn.2016.201. Epub 2016 Nov 2.

10. Erik S. Musiek, Meghana Bhimasani, Margaret A. Zangrilli, John C. Morris, David M. Holtzman, Yo-ElS, Ju. Circadian Rest-Activity Pattern Changes in Aging and Preclinical Alzheimer Disease. JAMA Neurol. Published online 29 January 2018. doi:10.1001/jamaneurol.2017.4719.

11. Kate E. Sprecher, Rebecca L. Koscik, Cynthia M. Carlsson, Henrik Zetterberg, Kaj Blennow, Ozioma C. Okonkwo, Mark A. Sager, Sanjay Asthana, Sterling C. Johnson, Ruth M. Benca, Barbara B. Bendlin. Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults. Neurology. 2017 Aug 1; 89(5): 445-453. doi: 10.1212/WNL.4171. PMCID: PMC5539733. PMID: 28679595.

12. Ehsan Shokri-Kojori, Gene-Jack Wang, Corinde E. Wiers, Sukru B. Demiral, Min Guo, Sung Won Kim, Elsa Lindgren, Veronica Ramirez, Amna Zehra, Clara Freeman, Gregg Miller, Peter Manza, Tansha Srivastava, Susan De Santi, Dardo Tomasi, Helene Benveniste, Nora D. Volkow. B-Amyloid accumulation in the human brain after one night of sleep deprivation. PNAS, 24 April 2018. 115 (17) 4483-4488.

13. Severine Sabia, Aline Dugravot, Damien Leger, Celine Ben Hassen, Mika Kivimaki, Archana Singh-Manoux. Association of sleep duration at age 50, 60, and 70 years with risk of multimorbidity in the UK: 25-year follow-up of the Whitehall II cohort study. Published 18 October 2022, PLOS Medicine.

14. Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar D. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. Cureus. 2019 Sep 28;11(9).

15. Huang W, Shah S, Long Q, Crankshaw AK, Tangpricha V. Improvement of pain, sleep, and quality of life in chronic pain patients with vitamin D supplementation. Clin J Pain. 2013 Apr;29(4):341-7. doi: 10.1097/AJP.0b013e318255655d. PMID: 22699141.