Sleep problems

14 February 2017.

On average, a “normal” amount of sleep for an adult is considered to be around seven to nine hours a night [1]. Children and babies may sleep for much longer than this, whereas older adults may sleep less [1]. What’s important is whether you feel you get enough sleep, and whether your sleep is good quality.

People who have a menstrual cycle, or are taking hormonal medications, may notice that their sleep pattern is affected. Depending on the individual, this could be an inability to get to sleep, or stay asleep for very long (known as insomnia), or sleeping too much, especially during the day (known as hypersomnia). Some people may find it difficult to sleep just before and during menstruation, and then need to sleep for much longer than usual at the end of menstruation…

Insomnia:

If you have insomnia, you may [1]:

  • find it difficult to fall asleep
  • lie awake for long periods at night
  • wake up several times during the night
  • wake up early in the morning and not be able to get back to sleep
  • not feel refreshed when you get up
  • find it hard to nap during the day, despite feeling tired
  • feel tired and irritable during the day and have difficulty concentrating

Hypersomnia:

People with hypersomnia struggle to stay awake during the day and are usually compelled to take frequent long naps. These may be prolonged, or at inappropriate times – such as during a conversation or meal, or even while driving – and generally don’t provide any relief from the sleepiness [2].

Most people with hypersomnia also sleep for more than 10 hours a night and struggle to wake in the morning, as they feel very drowsy and confused upon waking (“sleep drunkenness”) but some people sleep for a regular amount of time and are able to wake relatively normally. The excessive sleepiness may have a negative impact on the person’s work, relationships and social life [2].

People with hypersomnia may also [2]:

Note– You have probably noticed how many of the symptoms associated with sleep problems are the same as those commonly experienced just before menstruation? So, if you frequently experience any of the above symptoms just before or during menstruation, it may well be because your sleep has been disrupted, rather than being directly caused by hormonal changes! Track your symptoms, together with your sleep pattern, to see if this is the case for you…

Associated symptoms: Anxiety; depression; difficulty concentrating; fatigue; irritability; and restlessness.


Note: If you think that you may have depression, or that your hormonal, or any other form of, medication is causing your sleep problems, please consult a doctor to discuss your treatment options.

Managing hormone-related sleep problems:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight a few of the key steps that are especially relevant for those suffering from sleep problems, below;

  1. Eat lots of fresh fruit and vegetables
  2. Eat lots of fibre (and drink water with it)
  3. Eat oily foods (mainly unsaturated fats)- However, fatty foods (especially those associated with meat) have been found to reduce sleep hours, so if you are experiencing insomnia, try to reduce your total fat intake, and opt for unsaturated fats, if possible [3].
  4. Reduce meat and dairy products
  5. Avoid sugary foods and drinks- there is a known association between poor sleep and reduced metabolic efficiency- e.g. glucose control in people with type 2 diabetes [4], and studies show that people with a higher BMI are at greater risk of disturbed sleep , as well as reduced glucose control [5-6]. So, a healthy low-sugar diet that does not exceed daily calorie intake guidelines (average man = 2,500 kJ, average woman = 2,000 kJ per day) is a critical step in improving sleep problems.
  6. Avoid caffeine and alcohol- especially near bed time- they are known to negatively effect sleep quality and duration [7].
  7. Take nutritional supplements (if required)

Exercise regularly– Regular exercise, particularly aerobic exercise, may help you combat stress and release tension. It also reduces the symptoms of hypersomnia, even in people with chronic depression [8].

Exercise has also been found to significantly improve mild-moderate depression [9] and so we highly recommend it as a cheap, accessible and empowering approach to managing your own health and well-being. Find out more about starting exercise and exercise for depression.


If improving your ‘sleep hygiene‘ doesn’t help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT) that’s specifically designed for people with insomnia (CBT-I) [1].

The aim of CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It’s an effective treatment for many people and can have long-lasting results [1].

CBT-I may include:

  • stimulus-control therapy – which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
  • sleep restriction therapy – limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
  • relaxation training – aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
  • paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it’s used if you have trouble getting to sleep, but not maintaining sleep
  • biofeedback – sensors connected to a machine are placed on your body to measure your body’s functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when you’re not relaxed

If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing sleep problems- please let us know– we can share them with others!


Further information:


Page last reviewed and updated: June 2018


References:

1. NHS. (2015) Insomnia. [ONLINE] Available at: http://www.nhs.uk/conditions/insomnia/pages/introduction.aspx. [Accessed 8 October 2017]

2. NHS. (2015) Hypersomnia. [ONLINE] Available at: http://www.nhs.uk/conditions/hypersomnia/Pages/Introduction.aspx?nobeta=true. [Accessed 8 October 2017]

3. Grandner, M. A., Kripke, D. F., Naidoo, N., & Langer, R. D. (2010). Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women. Sleep Medicine11(2), 180. http://doi.org/10.1016/j.sleep.2009.07.014

4. Knutson, K. L., Van Cauter, E., Zee, P., Liu, K., & Lauderdale, D. S. (2011). Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Sleep Study. Diabetes Care34(5), 1171–1176. http://doi.org/10.2337/dc10-1962

5. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. (2013) Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. Aug 13;62(7):569-76. doi: 10.1016/j.jacc.2013.05.045. Epub 2013 Jun 12. Review. PubMed PMID: 23770180; PubMed Central PMCID: PMC4461232

6. Petit, J.-M., Burlet-Godinot, S., Magistretti, P. J., & Allaman, I. (2015). Glycogen metabolism and the homeostatic regulation of sleep. Metabolic Brain Disease30(1), 263–279. http://doi.org/10.1007/s11011-014-9629-x

7. NHS. (2015) Insomnia- Self help. [ONLINE] Available at: http://www.nhs.uk/Conditions/Insomnia/Pages/Prevention.aspx. [Accessed 8 October 2017]

8. Rethorst CD, Greer TL, Toups MS, Bernstein I, Carmody TJ, Trivedi MH. (2015) IL-1β and BDNF are associated with improvement in hypersomnia but not insomnia following exercise in major depressive disorder. Transl Psychiatry. Aug 4;5:e611. doi: 10.1038/tp.2015.104. Review. PubMed PMID: 26241349; PubMed Central PMCID: PMC4564559

9. Mental Health Foundation (2013) Let’s Get Physical Booklet London pp. 14 [ONLINE] https://www.mentalhealth.org.uk/publications/lets-get-physical-booklet-2013


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