tag:theconversation.com,2011:/fr/topics/insomnia-6774/articlesInsomnia – The Conversation2024-03-14T08:30:05Ztag:theconversation.com,2011:article/2252982024-03-14T08:30:05Z2024-03-14T08:30:05ZWhy do we usually sleep at night? What happens when we don’t sleep? Expert insights into this essential part of our lives<p><em>Sleep is as essential to our health as food and water. It is important to a number of brain functions, including how nerve cells communicate with each other. We sleep for a third of our lives and there are many restorative processes going on during sleep that are needed to stay healthy.</em></p>
<p><em>Why do we usually sleep at night? What happens when we don’t sleep? On World Sleep Day, Nadine Dreyer asks a group of experts to tell us more about this essential part of our lives.</em></p>
<h2>Why do we need sleep and why do we sleep better at night?</h2>
<p>We sleep for a third of our lives, yet it is only when we cannot sleep or when we experience poor quality sleep that we really start noticing it. </p>
<p>During sleep, our muscle activity drops, our breathing slows down, and our heart rate and blood pressure decrease. At the same time our brain actively clears toxins, which cause neurodegenerative diseases.</p>
<p>It also consolidates memories, wiping out “useless” ones during deep sleep, known as <a href="https://www.sleepfoundation.org/stages-of-sleep/slow-wave-sleep#:%7E:text=During%20slow%2Dwave%20sleep%2C%20electrical,sleep%20in%20slow%2Dwave%20sleep.">slow wave sleep</a>. </p>
<p>All this allows us to start afresh the following day. </p>
<p>Our lives are organised around our sleep-wake schedule. As we’re a <a href="https://www.merriam-webster.com/dictionary/diurnal#:%7E:text=%3A%20of%2C%20relating%20to%2C%20or%20occurring%20in%20the%20daytime">diurnal</a> species, our master clock in the brain, which maintains many of our 24-hour rhythms, schedules our period of activity with daylight, and our period of rest with the night.</p>
<p>In some other animals, like rodents, evolutionary pressure has pushed those species to become nocturnal, which allows them to scurry and feed outside the view of their <a href="https://www.merriam-webster.com/dictionary/diurnal">diurnal</a> (daytime) or <a href="https://dictionary.cambridge.org/dictionary/english/crepuscular">crepuscular</a> (twilight) predators. </p>
<p>Not sleeping at the right time has been associated with poor health. Some of the side-effects are poorer cognitive performance, lower energy and worse mental health. </p>
<p>There’s also a higher risk of developing neurodegenerative diseases such as Alzheimer’s and a higher risk of developing high blood pressure and diabetes. </p>
<p>After a poor night’s sleep, we try to get on with our lives but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674220/">research</a> has shown this is not so easy. During the COVID-19 pandemic and the strictest lockdown, South Africans rated their sleep quality as poorer, with more insomnia symptoms. These were were both in turn associated with worse levels of depression and anxiety. </p>
<h2>What happens when we don’t sleep?</h2>
<p>Sleep is a state of vulnerability where a “rest and digest” state dominates over the “fight and flight” state when we are awake. </p>
<p>Our early sleep “scans” the environment before allowing us to dive into deeper stages of sleep. </p>
<p>When a rupture in this consolidated bout of sleep happens, we will start complaining “I haven’t slept enough” or “I slept really badly last night”. </p>
<p>Such ruptures include those induced by specific sleep disorders like sleep apnoea or insomnia.</p>
<p>Sleep apnoea leads to unconscious sleep interruptions due to upper airways obstruction and can lead to hypertension and increased risk of diabetes. </p>
<p>Research in rural Mpumalanga province in South Africa found one out of three older adults had <a href="https://jcsm.aasm.org/doi/10.5664/jcsm.9214">moderate to severe sleep apnoea</a> and this was associated with a higher risk of cardiovascular disease. Yet there is no treatment in the public health system for this common sleep disorder. </p>
<p>Certain situations disrupt sleep: parents tending to their young children, doctors being awake while on call, loud generator noises during night-time electricity cuts, mosquitoes, or worse, gunshots or sounds of violence waking us up from our slumber, signalling danger.</p>
<p>Sleep health inequity in South Africa is also driven by socioeconomic status. </p>
<p>A recent study on sleep in men and women living in the urban township of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10864334/">Khayelitsha</a> in South Africa’s Western Cape province showed that poor sleep quality was associated with fear of falling asleep in a violent environment. Sleep was disturbed by strange noises, fear of attacks and dreams about past traumatic experiences. </p>
<h2>Electronic devices make it difficult to sleep. Why?</h2>
<p>Even though our biology is meant to make us sleep at night, several societal, technological changes have progressively decreased our sleep opportunity. </p>
<p>Our sleep timing is controlled by our <a href="https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx">master circadian clock</a>. This clock is exquisitely sensitive to light, so exposure to bright light and blue light such as that emitted from electronic devices such as smartphones shifts our bedtime to a later time.</p>
<p>In our recently published study of <a href="https://www.sciencedirect.com/science/article/pii/S2352721823002668">adolescent sleep in Nigeria</a>, adolescents in urban areas slept less and sleep quality was worse. </p>
<p>Sleep duration was shorter, due to bedtimes being later but waking times in the morning similar to those of adolescents in rural areas. The use of electronic devices at night by urban Nigerian adolescents was associated with shorter sleep duration. </p>
<p>This is one example of a growing body of research that highlights the negative consequences of nocturnal tech use on sleep, even in African societies.</p>
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Read more:
<a href="https://theconversation.com/insomnia-how-chronic-sleep-problems-can-lead-to-a-spiralling-decline-in-mental-health-224131">Insomnia: how chronic sleep problems can lead to a spiralling decline in mental health</a>
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<h2>What are key habits to help people sleep better?</h2>
<p>The most important habit is to take sleep as seriously as a healthy diet and regular exercise. </p>
<p>We advise the following: </p>
<ul>
<li><p>Keep regular wake times and bedtimes. This helps us sleep at the best time with respect to our master clock’s rhythm. This in turn helps ensure a consolidated bout of sleep.</p></li>
<li><p>Aim for an average of 7 to 9 hours of sleep each night.</p></li>
<li><p>Avoid <a href="https://www.pnas.org/doi/full/10.1073/pnas.1418490112">watching screens</a> one hour before normal bedtime. If this is unavoidable, choose the lowest brightness and add the orange night screen setting. Rather read a book under a bedside light.</p></li>
<li><p>Get outdoor light during the day to strengthen the master clock’s circadian (near 24-hour) rhythm.</p></li>
<li><p>Do some form of physical activity once a day. This helps build sleep pressure and also strengthens the master clock’s rhythms.</p></li>
<li><p>Avoid alcohol before bedtime as this is associated with disrupted sleep.</p></li>
<li><p>Avoid caffeine and stimulants after noon.</p></li>
<li><p>Try to sleep in a quiet, cool and dark or dimly lit environment.</p></li>
</ul>
<p><em>For more information please visit <a href="https://sassh.org.za/">the South African Society for Sleep and Health</a>.</em></p><img src="https://counter.theconversation.com/content/225298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karine Scheuermaier receives funding from National Institutes of Health (Bethesda, MD, USA), South African Medical Research Council, South Africa's National Research Foundation, and the Wellcome Trust (London, UK). She is affiliated with the South African Society for Sleep and Health and the World Sleep Society.</span></em></p><p class="fine-print"><em><span>Dale Rae works for Sleep Science and is currently funded by the Wellcome Trust UK. She is affiliated to the South African Society for Sleep and Health, World Sleep Society and European Society for Sleep Research</span></em></p><p class="fine-print"><em><span>Gosia Lipinska receives funding from the Wellcome Trust and the National Research Foundation. She is affiliated with the South African Society for Sleep and Health and the World Sleep Society.</span></em></p><p class="fine-print"><em><span>Jonathan Davy receives funding from Wellcome Trust. He is affiliated with the South African Society for Sleep and Health and the Ergonomics Society of South Africa. </span></em></p><p class="fine-print"><em><span>Dr Joshua Davimes receives funding from the National Research Foundation. He is affiliated with the South African Society for Sleep and Health. </span></em></p><p class="fine-print"><em><span>Dr Nomathemba Chandiwana has received research funding from Unitaid, USAID, Shin Poong Pharm, Merck, ViiV Healthcare, Gilead Sciences, Johnson & Johnson and is currently receiving research support from the Bill and Melinda Gates Foundation,, Novo Nordisk and Merck</span></em></p><p class="fine-print"><em><span>Oluwatosin Olorunmoteni receives funding from the Obafemi Awolowo University, the Consortium for Advanced Research Training in Africa, Uppsala Monitoring Center, Norwegian Agency for Development Cooperation, the Wellcome Trust and the UK Foreign, Commonwealth & Development Office.
</span></em></p><p class="fine-print"><em><span>Alison Bentley and Francesco Xavier Gomez-Olive Casas do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sleep is an essential part of life. What happens when we don’t get enough sleep and how do we ensure that we do?Karine Scheuermaier, Associate Professor in Physiology, Chair of Science Committee, South African Society for Sleep and Health, Member of the World Sleep Society, University of the WitwatersrandAlison Bentley, Honorary Lecturer in Family Medicine, University of the WitwatersrandDale Rae, Director of Sleep Science and associate professor at the Faculty of Health Sciences, University of Cape TownFrancesco Xavier Gomez-Olive Casas, Research Manager at MRC/Wits Agincourt Research Unit, University of the WitwatersrandGosia Lipinska, Associate Professor, University of Cape TownJonathan Davy, Senior lecturer, Rhodes UniversityJoshua Davimes, Senior Lecturer in Anatomical Sciences, University of the WitwatersrandNomathemba Chandiwana, Principal Scientist at Ezintsha,, University of the WitwatersrandOluwatosin Olorunmoteni, Neurodevelopmental Paediatrician, Obafemi Awolowo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2241602024-03-05T19:10:46Z2024-03-05T19:10:46ZWhy do I need to get up during the night to wee? Is this normal?<figure><img src="https://images.theconversation.com/files/579470/original/file-20240304-50192-q3p70a.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5958%2C3972&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sleepless-man-suffering-insomnia-sleep-apnea-2314875487">Lysenko Andrii/Shutterstock</a></span></figcaption></figure><p>It can be normal to wake up once or even twice during the night to wee, especially as we get older. </p>
<p>One in three adults over 30 makes <a href="https://pubmed.ncbi.nlm.nih.gov/30085529">at least two</a> trips to the bathroom every night.</p>
<p>Waking up from sleep to urinate on a regular basis is called <a href="https://www.ncbi.nlm.nih.gov/books/NBK518987/">nocturia</a>. It’s one of the most commonly reported <a href="https://pubmed.ncbi.nlm.nih.gov/32249998/">bothersome urinary symptoms</a> (others include urgency and poor stream).</p>
<p>So what causes nocturia, and how can it affect wellbeing?</p>
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Read more:
<a href="https://theconversation.com/is-urine-sterile-do-urine-therapies-work-experts-debunk-common-pee-myths-191862">Is urine sterile? Do urine 'therapies' work? Experts debunk common pee myths</a>
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<h2>A range of causes</h2>
<p>Nocturia can be caused by a variety of <a href="https://www.health.gov.au/sites/default/files/nocturia-going-to-the-toilet-at-night_0.pdf">medical conditions</a>, such as heart or kidney problems, poorly controlled diabetes, bladder infections, an <a href="https://www.nature.com/articles/s41598-023-44916-8">overactive bladder</a>, or gastrointestinal issues. Other causes include pregnancy, <a href="https://onlinelibrary.wiley.com/doi/10.1002/nau.24839">medications</a> and consumption of alcohol or caffeine before bed. </p>
<p>While nocturia causes disrupted sleep, the reverse is true as well. Having broken sleep, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055528/">insomnia</a>, can also cause nocturia.</p>
<p>When we sleep, an antidiuretic hormone is released that slows down the rate at which our <a href="https://theconversation.com/is-urine-sterile-do-urine-therapies-work-experts-debunk-common-pee-myths-191862">kidneys produce urine</a>. If we lie awake at night, less of this hormone <a href="https://journals.physiology.org/doi/full/10.1152/ajprenal.00025.2023">is released</a>, meaning we continue to produce normal rates of urine. This can accelerate the rate at which we fill our bladder and need to get up during the night.</p>
<p>Stress, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153377/">anxiety</a> and watching television <a href="https://www.ncbi.nlm.nih.gov/books/NBK518987">late into the night</a> are common causes of insomnia.</p>
<figure class="align-center ">
<img alt="A person with their hands in front of their pelvic area in a bathroom." src="https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577527/original/file-20240223-18-azytla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sometimes we need to get up late at night to pee.</span>
<span class="attribution"><span class="source">Christian Moro</span></span>
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<h2>Effects of nocturia on daily functioning</h2>
<p>The recommended amount of sleep for adults is between <a href="https://www.nhlbi.nih.gov/health/sleep/how-much-sleep">seven and nine hours</a> per night. The more times you have to get up in the night to go to the bathroom, the more this impacts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602727/#:%7E:text=Nocturia%20is%2C%20however%2C%20an%20important,(QoL)%20and%20general%20health.">sleep quantity and quality</a>.</p>
<p>Decreased sleep can result in increased <a href="https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1251-5">tiredness</a> during the day, poor concentration, forgetfulness, changes in mood and impaired <a href="https://pubmed.ncbi.nlm.nih.gov/28425062/">work performance</a>.</p>
<p>If you’re missing out on quality sleep due to nighttime trips to the bathroom, this can affect your quality of life.</p>
<p>In more severe cases, nocturia has been compared to having a similar impact on <a href="https://www.racgp.org.au/getattachment/b43c05ba-e29e-47c3-b816-ec47ceeafe97/Nocturia-a-guide-to-assessment-and-management.aspx">quality of life</a> as diabetes, high blood pressure, chest pain, and some forms of arthritis. Also, frequent disruptions to quality and quantity of sleep can have longer-term health impacts.</p>
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Read more:
<a href="https://theconversation.com/why-do-i-need-to-pee-more-in-the-cold-184236">Why do I need to pee more in the cold?</a>
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<p>Nocturia not only upsets sleep, but also increases the risk of <a href="https://www.auajournals.org/doi/10.1097/JU.0000000000000459">falls</a> from moving around in the dark to go to the bathroom.</p>
<p>Further, it can affect sleep partners or others in the household who may be disturbed when you get out of bed.</p>
<h2>Can you have a ‘small bladder’?</h2>
<p>It’s a common misconception that your trips to the bathroom are correlated with the size of your bladder. It’s also unlikely your bladder is <a href="https://youtu.be/blVmyrBPves">smaller</a> relative to your other organs.</p>
<p>If you find you are having to wee more than your friends, this could be due to body size. A smaller person drinking the same amount of fluids as someone larger will simply need to go the bathroom more often.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/blVmyrBPves?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Can you have a small bladder?</span></figcaption>
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<p>If you find you are going to the bathroom quite a lot during the day and evening (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903463/">more than eight times</a> in 24 hours), this could be a symptom of an overactive bladder. This often presents as frequent and sudden urges to urinate.</p>
<p>If you are concerned about any lower urinary tract symptoms, it’s worth having a chat with your family GP.</p>
<p>There are some medications that can assist in the management of nocturia, and your doctor will also be able to help identify any underlying causes of needing to go to the toilet during the night. </p>
<h2>A happy and healthy bladder</h2>
<p>Here are some tips to maintain a happy and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206217/">healthy</a> bladder, and reduce the risk you’ll be up at night:</p>
<ul>
<li><p>make your <a href="https://theconversation.com/what-position-should-i-sleep-in-and-is-there-a-right-way-to-sleep-189873">sleep environment comfortable</a>, with a suitable mattress and sheets to suit the temperature</p></li>
<li><p>get to bed early, and limit <a href="https://www.ncbi.nlm.nih.gov/books/NBK518987/">screens</a>, or activites before bed</p></li>
<li><p>limit foods and drinks that irritate the bladder, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9811496/">coffee or alcohol</a>, especially before bedtime</p></li>
<li><p>sit in a <a href="https://theconversation.com/does-it-matter-if-you-sit-or-stand-to-pee-and-what-about-peeing-in-the-shower-206869">relaxed position</a> when urinating, and allow time for the bladder to completely empty</p></li>
<li><p>practice <a href="https://www.continence.org.au/about-continence/continence-health/pelvic-floor">pelvic floor muscle exercises</a></p></li>
<li><p>drink an adequate amount of fluids during the day, and avoid becoming <a href="https://www.health.gov.au/sites/default/files/nocturia-going-to-the-toilet-at-night_0.pdf">dehydrated</a></p></li>
<li><p>maintain a healthy lifestyle, eat <a href="https://journals.physiology.org/doi/full/10.1152/advan.00052.2023">nutritious foods</a> and do not do anything harmful to the body such as smoking or using illicit drugs</p></li>
<li><p>review your medications, as the time you take some <a href="https://www.health.gov.au/sites/default/files/nocturia-going-to-the-toilet-at-night_0.pdf">pharmaceuticals</a> may affect urine production or sleep</p></li>
<li><p>if you have <a href="https://pubmed.ncbi.nlm.nih.gov/28675633/">swollen legs</a>, raise them a few hours before bedtime to let the <a href="https://www.racgp.org.au/afp/2012/june/nocturia-a-guide-to-assessment-and-management">fluid drain</a>.</p></li>
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Read more:
<a href="https://theconversation.com/men-have-pelvic-floors-too-and-can-benefit-when-they-exercise-them-regularly-184451">Men have pelvic floors too – and can benefit when they exercise them regularly</a>
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<img src="https://counter.theconversation.com/content/224160/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Waking up regularly at night to go to the toilet is called nocturia – and it can have a variety of causes.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityCharlotte Phelps, Senior Teaching Fellow, Medical Program, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2220572024-03-01T13:33:37Z2024-03-01T13:33:37ZAltitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare<figure><img src="https://images.theconversation.com/files/577770/original/file-20240225-28-vk2tcl.jpg?ixlib=rb-1.1.0&rect=77%2C33%2C7271%2C4869&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Altitude sickness is rare at elevations of less than 8,200 feet but becomes much more common at higher altitudes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girls-having-fun-royalty-free-image/854544188?phrase=mountain+adventure+travel&adppopup=true">Maya Karkalicheva/Moment via Getty Images</a></span></figcaption></figure><p>Equipped with the latest gear and a thirst for adventure, mountaineers embrace the perils that come with conquering the world’s highest peaks. Yet, even those who tread more cautiously at high altitude are not immune from the health hazards waiting in the thin air above.</p>
<p>Altitude sickness, which most commonly refers to <a href="https://medlineplus.gov/ency/article/000133.htm">acute mountain sickness</a>, <a href="https://doi.org/10.1016/j.pcad.2010.02.003">presents a significant challenge</a> to those traveling to and adventuring in high-altitude destinations. Its symptoms can range from <a href="https://doi.org/10.1089/ham.2017.0164">mildly annoying to incapacitating</a> and, in some cases, may progress to more <a href="https://doi.org/10.1183/16000617.0096-2016">life-threatening illnesses</a>. </p>
<p>While <a href="https://doi.org/10.18111/9789284424023">interest in high-altitude tourism is rapidly growing</a>, general awareness and understanding about the hazards of visiting these locations <a href="https://doi.org/10.1089/ham.2022.0083">remains low</a>. The more travelers know, the better they can prepare for and enjoy their journey.</p>
<p>As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/36740">emergency physician specializing in high-altitude illnesses</a>, I work to improve health care in remote and mountainous locations around the world. I’m invested in finding ways to allow people from all backgrounds to experience the magic of the mountains in an enjoyable and meaningful way.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Researcher wearing cold-weather gear stands in front of a health clinic in the Himalayas." src="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The author in front of the Himalayan Rescue Association clinic in Nepal.</span>
<span class="attribution"><span class="source">Brian Strickland</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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</figure>
<h2>The science behind altitude sickness</h2>
<p>Altitude sickness is rare in locations lower than 8,200 feet (2,500 meters); however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">it becomes very common</a> when ascending above this elevation. In fact, it affects about <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">25% of visitors to the mountains of Colorado</a>, where I conduct most of my research. </p>
<p>The risk rapidly increases with higher ascents. Above 9,800 feet (3,000 meters), up to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">75% of travelers</a> may develop symptoms. Symptoms of altitude sickness are usually mild and consist of <a href="https://doi.org/10.1089/ham.2017.0164">headache, dizziness, nausea, fatigue and insomnia</a>. They usually <a href="https://doi.org/10.1016/j.rceng.2019.12.009">resolve after one to two days</a>, as long as travelers stop their ascent, and the symptoms quickly resolve with descent. </p>
<p>When travelers do not properly acclimatize, they can be susceptible to life-threatening altitude illnesses, such as <a href="https://doi.org/10.1016/j.resp.2007.05.002">high-altitude pulmonary edema</a> or <a href="https://doi.org/10.1089/1527029041352054">high-altitude cerebral edema</a>. These conditions are characterized by fluid accumulation within the tissues of the lungs and brain, respectively, and are the <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness#">most severe forms of altitude sickness</a>.</p>
<p>Altitude sickness symptoms are thought to be caused by <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">increased pressure surrounding the brain</a>, which results from the failure of the body to acclimatize to higher elevations. </p>
<p>As people enter into an environment with lower air pressure and, therefore, <a href="https://doi.org/10.1001/jamanetworkopen.2023.18036">lower oxygen content</a>, their <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">breathing rate increases</a> in order to compensate. This causes an increase in the amount of <a href="https://doi.org/10.1016/s1357-2725(03)00050-5">oxygen in the blood as well as decreased CO₂ levels</a>, which then increases blood pH. As a result, the <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">kidneys compensate</a> by removing a chemical called bicarbonate from the blood into the urine. This process makes people urinate more and helps correct the acid and alkaline content of the blood to a more normal level.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iv1vQPIdX_k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Tips for preventing or reducing the risk of altitude sickness.</span></figcaption>
</figure>
<h2>The importance of gradual ascent</h2>
<p>High-altitude medicine experts and other physicians <a href="https://doi.org/10.1016/s0140-6736(76)91677-9">have known for decades</a> that <a href="https://doi.org/10.1089/ham.2010.1006">taking time to slowly ascend is the best way</a> to prevent the development of altitude sickness. </p>
<p>This strategy gives the body time to complete its natural physiologic responses to the changes in air pressure and oxygen content. In fact, spending just <a href="https://doi.org/10.1089/ham.2010.1006">one night at a moderate elevation</a>, such as Denver, Colorado, which is at 5,280 feet (1,600 meters), has been shown to <a href="https://doi.org/10.7326/0003-4819-118-8-199304150-00003">significantly reduce the likelihood of developing symptoms</a>. </p>
<p>People who skip this step and travel directly to high elevations are <a href="https://doi.org/10.1093/jtm/taad011">up to four times more likely</a> to develop altitude sickness symptoms. When going to elevations greater than 11,000 feet, multiple days of acclimatization are necessary. Experts generally recommend ascending <a href="https://doi.org/10.1089/ham.2010.1006">no more than 1,500 feet per day</a> once the threshold of 8,200 feet of elevation has been crossed. </p>
<p>Workers at high altitude, such as <a href="https://doi.org/10.1089/ham.2020.0004">porters in the Nepali Himalaya</a>, are at <a href="https://doi.org/10.1016/j.wem.2018.06.002">particular risk of altitude-related illness</a>. These workers often do not adhere to acclimatization recommendations in order to maximize earnings during tourist seasons; as a result, they are more likely to experience <a href="https://www.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness#">severe forms of altitude sickness</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Five tents glow against the night sky with a tall mountain in the background." src="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adventure tourism is growing rapidly, but general awareness and education around altitude sickness and ways to prevent it remains low.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/milky-way-over-mitre-peak-view-from-concordia-camp-royalty-free-image/1936855402?phrase=mountain+adventure+travel&adppopup=true">Punnawit Suwuttananun/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Effective medications</h2>
<p>For more than 40 years, <a href="https://doi.org/10.1056/nejm196810172791601">a medicine called acetazolamide</a> has been used to <a href="https://medlineplus.gov/druginfo/meds/a682756.html">prevent the development of altitude sickness</a> and to treat its symptoms. Acetazolamide is <a href="https://www.ncbi.nlm.nih.gov/books/NBK557838/">commonly used as a diuretic</a> and for the <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma#">treatment of glaucoma</a>, a condition that causes increased pressure within the eye.</p>
<p>If started <a href="https://doi.org/10.1378/chest.09-2445">two days prior</a> to going up to a high elevation, acetazolamide can <a href="https://doi.org/10.1378/chest.09-2445">prevent symptoms of acute illness</a> by speeding up the acclimatization process. Nonetheless, it does not negate the recommendations to ascend slowly, and it is <a href="https://doi.org/10.1016/j.wem.2019.04.006">routinely recommended only</a> when people cannot slowly ascend or for people who have a history of severe altitude sickness symptoms even with slow ascent.</p>
<p>Other medications, including ibuprofen, have <a href="https://doi.org/10.1016/j.wem.2012.08.001">shown some effectiveness</a> in treating acute mountain sickness, although <a href="https://doi.org/10.1016/j.amjmed.2018.10.021">not as well as acetazolamide</a>. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/2028586/">steroid medication called dexamethasone</a> is effective in both treating and preventing symptoms, but it does not improve acclimatization. It is <a href="https://doi.org/10.1016/j.wem.2019.04.006">recommended only when acetazolamide is not effective</a> or cannot be taken. </p>
<p>Additionally, it is important to <a href="https://wwwnc.cdc.gov/travel/page/travel-to-high-altitudes#">avoid alcohol during the first few days at higher altitudes</a>, as it impairs the body’s ability to acclimatize.</p>
<h2>Unproven therapies and remedies are common</h2>
<p>As high-altitude tourism becomes increasingly popular, multiple commercial products and remedies have emerged. Most of them are not effective or provide no evidence to suggest they work as advertised. Other options have mixed evidence, making them difficult to recommend.</p>
<p>Medications such as <a href="https://doi.org/10.1089/ham.2007.1037">aspirin</a>, <a href="https://doi.org/10.1183/13993003.01355-2017">inhaled steroids</a> and <a href="https://doi.org/10.1089/ham.2011.0007">sildenafil</a> have been proposed as possible preventive agents for altitude sickness, but on the whole they have not been found to be effective.</p>
<p><a href="https://doi.org/10.1093/qjmed/hcp026">Supplements and antioxidants have no proven benefit</a> in preventing or treating altitude sickness symptoms. Both normal and high-altitude exercise are popular ways to prepare for high elevations, especially among athletes. However, beyond <a href="https://doi.org/10.1097/jes.0b013e31825eaa33">certain pre-acclimatization strategies</a>, such as brief sojourns to high altitude, <a href="https://doi.org/10.1016/j.tmaid.2013.12.002">physical fitness and training is of little benefit</a>. </p>
<p><a href="https://missouripoisoncenter.org/canned-oxygen-is-it-good-for-you">Canned oxygen</a> has also exploded in popularity with travelers. While <a href="https://doi.org/10.1016/0140-6736(90)93240-p">continuously administered medical oxygen</a> in a health care setting can alleviate altitude sickness symptoms, portable oxygen cans <a href="https://doi.org/10.1016/j.wem.2019.04.006">contain very little oxygen gas</a>, casting doubt on their effectiveness.</p>
<p>Some high-altitude adventure travelers sleep in <a href="https://doi.org/10.2165/00007256-200131040-00002">specialized tents</a> that simulate increased elevation by lowering the quantity of available oxygen in ambient air. The lower oxygen levels within the tent are thought to accelerate the acclimatization process, but the tents aren’t able to decrease barometric pressure. This is an important part of the high-altitude environment that induces acclimatization. Without modifying ambient air pressure, these <a href="https://doi.org/10.1016/j.wem.2014.04.004">tents may take multiple weeks</a> to be effective. </p>
<p>Natural medicines, such as <a href="https://doi.org/10.1580/08-weme-br-247.1">gingko</a> and <a href="https://doi.org/10.1186/s40794-019-0095-7">coca leaves</a>, are touted as natural altitude sickness treatments, but few studies have been done on them. The modest benefits and significant side effects of these options makes their use <a href="https://doi.org/10.1016/j.wem.2019.04.006">difficult to recommend</a>. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/8469948/">Staying hydrated</a> is very important at high altitudes due to fluid losses from increased urination, dry air and increased physical exertion. <a href="https://doi.org/10.1186%2Fs12889-018-6252-5">Dehydration symptoms</a> can also mimic those of altitude sickness. But there is <a href="https://doi.org/10.1580/1080-6032(2006)17%5B215:AMSIOF%5D2.0.CO;2">little evidence that consuming excessive amounts of water</a> can prevent or treat altitude sickness.</p>
<p>The mountains have something for visitors of all interests and expertise and can offer truly life-changing experiences. While there are health risks associated with travel at higher elevations, these can be lessened by making basic preparations and taking time to slowly ascend.</p><img src="https://counter.theconversation.com/content/222057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Strickland does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether you’re ascending to high altitudes for casual travel or for adventure tourism, there are specific strategies to help you acclimate and reduce the likelihood of altitude sickness.Brian Strickland, Senior Instructor in Emergency Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2246162024-02-29T03:38:04Z2024-02-29T03:38:04ZWhy Barnaby Joyce’s TV diagnosis of insomnia plus sleep apnoea is such a big deal<p>The <a href="https://theconversation.com/view-from-the-hill-how-does-david-littleproud-handle-the-latest-barnaby-joyce-embarrassment-223289">health</a> of Nationals MP Barnaby Joyce is in the news again, this time with a diagnosis of a sleep disorder made <a href="https://www.afr.com/companies/media-and-marketing/barnaby-joyce-to-be-diagnosed-with-a-sleep-disorder-on-live-tv-20240223-p5f79q">while filming</a> a TV documentary.</p>
<p>Joyce’s diagnosis of insomnia plus sleep apnoea arose while filming <a href="https://www.sbs.com.au/whats-on/article/australias-sleep-revolution-with-dr-michael-mosley/nuyko305b">Australia’s Sleep Revolution with Dr Michael Mosley</a> in 2023. SBS has confirmed episode three, in which my Flinders University colleagues reveal his sleep disorder, is set to air on March 20.</p>
<p>I was not involved in the program and have no knowledge of Joyce’s <a href="https://www.theaustralian.com.au/weekend-australian-magazine/australias-sleep-crisis-has-flinders-university-cracked-the-code-to-a-better-nights-sleep/news-story/d3b82617af33fff82487da2534722733">ongoing health care</a>. But I was part of the research team that in 2017 <a href="https://doi.org/10.1016/j.smrv.2016.04.004">coined the term COMISA</a> (co-morbid insomnia and sleep apnoea), the official name of Joyce’s on-screen diagnosis. Since then, I’ve led research into this <a href="https://doi.org/10.1016/j.smrv.2019.01.004">common</a> sleep disorder.</p>
<p>Here’s why it’s so important to diagnose and treat it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/view-from-the-hill-how-does-david-littleproud-handle-the-latest-barnaby-joyce-embarrassment-223289">View from The Hill: How does David Littleproud handle the latest Barnaby Joyce embarrassment?</a>
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</em>
</p>
<hr>
<h2>What was Joyce’s diagnosis?</h2>
<p>People can be diagnosed separately with <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2">insomnia</a> or <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/obstructive-sleep-apnoea">sleep apnoea</a>.</p>
<p>Insomnia includes frequent difficulties falling asleep at the start of the night or difficulties staying asleep during the night. These can result in daytime fatigue, reduced energy, concentration difficulties and poor mood. Over time, insomnia can start to impact your <a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">mental health</a> and quality of life.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1720751088624672849"}"></div></p>
<p>Sleep apnoea (specifically, obstructive sleep apnoea) is when people experience repeated interruptions or pauses in breathing while they sleep. This reduces oxygen levels during sleep, and you can wake up multiple times at night. People with sleep apnoea may be aware of loud snoring, gasping for air when they wake up, or feeling exhausted the next morning. However, not all people have these symptoms, and sleep apnoea can go undiagnosed for years.</p>
<p>But in Joyce’s case, both insomnia and sleep apnoea occur at the same time.</p>
<p>We’ve known this could happen since <a href="https://doi.org/10.1126/science.181.4102.856">the 1970s</a>, with <a href="https://psycnet.apa.org/doi/10.1037/0022-006X.67.3.405">evidence growing</a> over <a href="https://doi.org/10.1378/chest.120.6.1923">subsequent decades</a>. Since then, sleep researchers and clinicians around the world have learned more about how <a href="https://doi.org/10.1016/j.smrv.2019.01.004">common</a> this is, its <a href="https://doi.org/10.1183/13993003.01958-2021">consequences</a> and how best to <a href="https://doi.org/10.1111/jsr.13847">treat it</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>How do you know if you have it?</h2>
<p>Many people <a href="https://doi.org/10.1016/j.sleep.2005.08.008">seek help</a> for their sleep problems because of fatigue, exhaustion, physical symptoms, or poor mood during the day.</p>
<p>If you think you have insomnia, a GP or sleep specialist can talk to you about your sleep pattern, and might ask you to complete <a href="https://www.sleepprimarycareresources.org.au/insomnia/assessment-questionnaires">brief questionnaires</a> about your sleep and daytime symptoms. You might also be asked to fill in a “sleep diary” for one to two weeks. These will allow a trained clinician to see if you have insomnia.</p>
<p>If you or your GP think you may have (or are at risk of having) sleep apnoea, you may be referred for a sleep study. This normally involves sleeping overnight in a sleep clinic where your sleep patterns and breathing are monitored. Alternatively, you might be set up with a recording device to monitor your sleep at home. A trained medical professional, such as a sleep and respiratory physician, will often make the diagnosis.</p>
<p><a href="https://doi.org/10.1016/j.smrv.2021.101519">Up to 50%</a> of people with sleep apnoea report symptoms of insomnia. About <a href="https://doi.org/10.1016/j.smrv.2021.101519">30–40%</a> of people with insomnia also have sleep apnoea. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-heres-what-you-need-to-know-about-sleep-apnoea-26402">Health Check: here's what you need to know about sleep apnoea</a>
</strong>
</em>
</p>
<hr>
<h2>What are the consequences?</h2>
<p>Insomnia and sleep apnoea (individually) are associated with reduced <a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">sleep quality</a>, <a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">mental health</a> and <a href="https://theconversation.com/health-check-heres-what-you-need-to-know-about-sleep-apnoea-26402">physical health</a>. </p>
<p>Importantly, people with both at the same also tend to <a href="https://doi.org/10.3390/brainsci9120371">experience</a> worse sleep, daytime function, mental health, physical health and quality of life, compared with people with no sleep disorder.</p>
<p>For instance, we know having both conditions comes with an <a href="https://doi.org/10.1111/jsr.13563">increased risk</a> of diseases of the heart.</p>
<p><a href="https://doi.org/10.2147/NSS.S379252">In</a> <a href="https://doi.org/10.1183/13993003.01958-2021">three</a> <a href="https://doi.org/10.1016/j.sleepe.2022.100043">studies</a>, we found people with both insomnia and sleep apnoea have about a 50–70% higher risk of dying early from any cause, compared with people with neither sleep condition. People with insomnia alone and sleep apnoea alone did not have an increased risk of dying early.</p>
<p>However, there are effective treatments to reduce these health consequences.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sleep-apnoea-can-be-scary-but-heres-what-happened-when-first-nations-people-had-a-say-in-their-own-care-214641">Sleep apnoea can be scary. But here's what happened when First Nations people had a say in their own care</a>
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</em>
</p>
<hr>
<h2>How is it treated?</h2>
<p>In general, it is best for people to access evidence-based treatments for both disorders. These treatments vary according to the patient and the severity of their condition.</p>
<p>For instance, wearing a <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/cpap-continuous-positive-airway-pressure">CPAP mask</a> while sleeping improves breathing during sleep and reduces many of the daytime consequences of obstructive sleep apnoea. However, other effective treatments may be recommended based on each person’s symptoms, such as weight management, avoiding sleeping on your back, <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/oral-appliances-to-treat-snoring-and-obstructive-sleep-apnoea-osa">oral devices</a> (which look a bit like a mouthguard), or surgery.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1722150602057118032"}"></div></p>
<p>The <a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">most effective</a> treatment for insomnia is cognitive behavioural therapy for insomnia, also known as <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti">CBTi</a>. About four to eight sessions often lead to improvements in sleep, daytime function and mental health that are maintained for many <a href="https://doi.org/10.1080/16506073.2021.2009019">years</a>. This can be delivered by trained therapists such as psychologists, nurses or GPs, as well as via <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti/referral-to-digital-cbti-programs">online</a> programs.</p>
<p>Last year, we drew together evidence from more than 1,000 people with both conditions. We found CBTi is an <a href="https://doi.org/10.1111/jsr.13847">effective treatment</a> for insomnia in people with treated and untreated sleep apnoea. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-snoring-is-waking-up-my-partner-apart-from-a-cpap-machine-what-are-the-options-188825">My snoring is waking up my partner. Apart from a CPAP machine, what are the options?</a>
</strong>
</em>
</p>
<hr>
<h2>New treatments and approaches</h2>
<p><a href="https://www.frontiersin.org/articles/10.3389/frsle.2024.1355468/abstract">We</a> and <a href="https://doi.org/10.1186/s13063-022-06753-4">other teams</a> internationally are developing and testing new ways of delivering CBTi.</p>
<p>Several groups are testing devices, which <a href="https://doi.org/10.1002%2Flio2.761">stimulate</a> the tongue muscles during sleep, to treat sleep apnoea in people with both disorders.</p>
<p>And we’re still working out the best order for patients to access treatments, and the best combination of treatments.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">How can I get some sleep? Which treatments actually work?</a>
</strong>
</em>
</p>
<hr>
<h2>The power of TV</h2>
<p>Joyce’s public diagnosis of both insomnia and sleep apnoea will no doubt raise awareness of what we suspect is an underdiagnosed condition. </p>
<p>Based on how common insomnia and sleep apnoea are in Australia, we estimate Joyce is one of about <a href="https://doi.org/10.1016/j.sleep.2021.03.023">5–10%</a> of Australian adults to have both at the same time.</p>
<p>The Conversation contacted Joyce’s spokesperson for comment but did not hear back before deadline.</p><img src="https://counter.theconversation.com/content/224616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Sweetman is a Senior Program Manager at the Australasian Sleep Association, the peak sleep health scientific and advocacy body in Australia and New Zealand, and has academic status at Flinders University. Alexander Sweetman reports previous research funding and/or consultancy work for; the National Health and Medical Research Council, The Hospital Research Foundation, Flinders University, Flinders Foundation, ResMed, Phillips, Cerebra, Re-Time, Sleep Review Mag, and Australian Doctor.</span></em></p>Having both conditions at the same time increases your risk of dying prematurely. But it can be treated. Here’s what’s involved.Alexander Sweetman, Research Fellow, College of Medicine and Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238952024-02-28T13:12:00Z2024-02-28T13:12:00ZSleep and circadian rhythm problems linked with poor mental health – new research<figure><img src="https://images.theconversation.com/files/577905/original/file-20240226-17-7n74le.jpg?ixlib=rb-1.1.0&rect=48%2C8%2C5435%2C3604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The more severe sleep and circadian disruptions are, the worse a person's mood may be.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-cant-sleep-night-because-her-172728239">Ground Picture/ Shutterstock</a></span></figcaption></figure><p>Every cell in the body has a circadian rhythm. This rhythm follows a near 24-hour cycle that is synchronised to day and night. These <a href="https://www.ncbi.nlm.nih.gov/books/NBK519507/#:%7E:text=The%20regulation%20of%20sleep%20is,light%20changes%20in%20our%20environment">circadian rhythms</a> are critical for health and wellbeing.</p>
<p>But our circadian rhythm can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142605/">become disrupted</a> when our lifestyle does not correspond with this natural day-and-night cycle – for example, if we work night shifts or experience jet lag. Factors such as ageing, genetics and certain medical conditions (such as <a href="https://pubmed.ncbi.nlm.nih.gov/37565922/">autoimmune diseases</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338075/">Alzheimer’s disease</a>) are also linked with long-term circadian rhythm disruptions.</p>
<p>Sleep and circadian rhythm disturbances can also predict the onset and relapse of certain <a href="https://cms.wellcome.org/sites/default/files/2022-07/MH-Sleep-Report-Wellcome-07.2022.pdf">mental health disorders</a> – including depression, anxiety, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505194/">bipolar disorder and schizophrenia</a>. The more severe the sleep and circadian disruptions are, the worse a person’s mood, risk of relapse and mental health treatment outcomes are.</p>
<p>But despite evidence showing this link, why it exists remains largely unknown. This is what research conducted by myself and my colleagues sought to understand.</p>
<p>We found that sleep and circadian rhythm disruptions appear to <a href="https://www.pnas.org/doi/10.1073/pnas.2214756121">trigger or worsen a range of mental disorders</a> – including bipolar disorder and depression. We also uncovered some of the specific biological mechanisms which may underpin this link.</p>
<p>Our review assessed all research published in the past ten years on different mental disorders – including depression, anxiety and psychosis. We mainly focused on adolescents and young adults. </p>
<p>We found that the majority of young people diagnosed with a mental health condition also had sleep problems – such as insomnia (trouble falling asleep and staying asleep), delayed sleep timing and worsened daytime alertness. We also found that one-third of people with bipolar disorder (and other mental disorders) had a disrupted circadian rhythm, where they go to sleep and wake up later than usual.</p>
<p>Our study also pinpointed some of the mechanisms that may explain the link between sleep problems and mental health disorders. Among these mechanisms are an increased vulnerability at the genetic or molecular level to circadian rhythm disruption. </p>
<p>We also found that some participants experienced changes in their brain activity caused by chemical signalling problems that can affect sleep and mood levels. Inappropriate light exposure (such as getting too little natural daylight or too much artificial light at night) and eating too late in the evening or at night may also trigger sleep and circadian rhythm problems. </p>
<figure class="align-center ">
<img alt="A young man uses his laptop at night while sitting on his bed." src="https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Getting too much artificial light at night may be one of the mechanisms behind circadian rhythm disruption.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-teen-front-laptop-computer-on-226752055">junpinzon/ Shutterstock</a></span>
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<p>Importantly, we showed that most studies to date have only looked at the effect of sleep on mood or the effects of circadian disruption on mood separately. Both were rarely studied in conjunction, as assessing sleep is far more common (and easier) than assessing circadian rhythms. This is one of the current key research limitations that needs to be addressed in future studies. </p>
<h2>Circadian misalignment</h2>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health">One in seven</a> ten to 19-year-olds experience a mental disorder worldwide. <a href="https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health">Depression and anxiety</a> are among the leading causes of illness and disability among adolescents, with suicide being the fourth leading cause of death among 15 to 29-year-olds. Moreover, not addressing adolescent mental disorders can cause these problems to extend into adulthood.</p>
<p>Adolescence is not only a particularly vulnerable time for developing mental disorders – it’s also a time when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136689/#:%7E:text=Indeed%2C%20insomnia%20during%20adolescence%20is,particular%20life%20period%20%5B17%5D">sleep and circadian rhythms change</a>. Adolescents often sleep later, due to a delay in their circadian rhythm caused by their development, but have to wake up early due to school. As a consequence, they often experience shorter sleep than needed, which can further <a href="https://www.nature.com/articles/s44159-022-00074-8#:%7E:text=A%20meta%2Danalytic%20review%20of,depression%2C%20negative%20affect%20and%20anxiety">worsen their mental health</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/investigating-insomnia-our-research-shows-how-chronic-sleep-problems-can-lead-to-a-spiralling-decline-in-mental-health-224131">Investigating insomnia: our research shows how chronic sleep problems can lead to a spiralling decline in mental health</a>
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<p>Our review highlights how important it is to pay attention to circadian rhythm disruptions in young people – especially when it comes to risk of certain mental health problems. Our review also highlights the need to consider sleep and circadian problems when someone experiences mental health problems. By addressing such problems, it may be possible to improve one’s mental health and quality of life.</p>
<h2>Sleep and circadian interventions</h2>
<p>At the moment, treatments for sleep problems (such as insomnia) involve <a href="https://academic.oup.com/sleep/article/43/9/zsaa034/5777024">cognitive behavioural therapy</a> and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00683-9/fulltext">sleep restriction</a>. These focus on improving sleep – while mental health problems due to circadian rhythm disruption are not directly addressed.</p>
<p>Our review highlighted treatments that may help improve mood and sleep quality and align circadian rhythms. This included timing medication intake, exposure to natural daylight (and reducing nighttime light) as well as eating and being physically active during the day. More research will be needed, however, to better understand the benefits of these treatments in real-world settings.</p><img src="https://counter.theconversation.com/content/223895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Chellappa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Depression, bipolar disorder and anxiety have all been linked to problems with sleep and a disrupted circadian rhythm.Sarah Chellappa, Associate Professor, Cognitive and Affective Neuroscience, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2241312024-02-26T17:24:36Z2024-02-26T17:24:36ZInsomnia: how chronic sleep problems can lead to a spiralling decline in mental health<figure><img src="https://images.theconversation.com/files/577722/original/file-20240224-24-su6ra5.jpg?ixlib=rb-1.1.0&rect=21%2C142%2C3629%2C2310&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/man-insomnia-cannot-sleep-hand-drawn-1965734296">APIMerah/Shutterstock</a></span></figcaption></figure><blockquote>
<p>I’ll often lie awake until three or four in the morning, before drifting off for just a few hours. Then comes the dreaded alarm clock. My mind and body are exhausted all the time – there’s always this knot of anxiety in my chest, doing away with any hope of a good night’s sleep.</p>
</blockquote>
<p>Simon* is a NHS mental health nurse who, like millions of people in the UK, suffers from insomnia: a sustained difficulty in initiating and maintaining sleep. His job is to support the recovery of people with severe mental illness, but his own sleep problems have had a profoundly negative impact on his mental health.</p>
<p>Most of us experience a bad night’s sleep from time to time, but can usually get back on track within a night or two. People suffering from insomnia, by contrast, have sleep problems that last for months or years at a time, taking a major toll on their health and wellbeing.</p>
<p>Around <a href="https://jcsm.aasm.org/doi/10.5664/jcsm.26929#:%7E:text=a%20cognitive%20system.-,CONCLUSION,%2C%20social%2C%20and%20physical%20domains.">a third</a> of people will experience insomnia at some point in their life, with women and older people more often affected. Nearly 40% of sufferers <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772563">fail to recover within five years</a>. People with insomnia have an increased risk of diabetes, high blood pressure and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1556407X22000182?via%3Dihub">cardiovascular disease</a>. Insomnia is also a major risk factor for <a href="https://onlinelibrary.wiley.com/doi/10.1111/jsr.13628">mental illness</a>, and often co-occurs with mood disorders such as depression and anxiety.</p>
<hr>
<p><em>Across the world, we’re seeing unprecedented levels of mental illness at all ages, from children to the very old – with huge costs to families, communities and economies. <a href="https://theconversation.com/uk/topics/tackling-the-mental-health-crisis-147216?utm_source=TCUK&utm_medium=ArticleTop&utm_campaign=MentalHealthSeries">In this series</a>, we investigate what’s causing this crisis, and report on the latest research to improve people’s mental health at all stages of life.</em></p>
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<p>Many different life events can increase your chances of sustained sleep deprivation. Both the financial burden and confinement arising from the COVID-19 pandemic were associated with <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14048-1">greater risk</a> of insomnia, which is in turn likely to have led to a <a href="https://www.sciencedirect.com/science/article/pii/S1389945721004196?via%3Dihub">rise in mental health problems</a>.</p>
<p>And yet, very little is known about why and how a prolonged absence of sleep gives rise to mental illness. Our team at the University of York has pioneered research into whether sleep deprivation <a href="https://www.sciencedirect.com/science/article/pii/S1364661321000577">disrupts the brain’s ability to suppress intrusive memories</a> and distressing thoughts – classic symptoms of psychiatric disturbance. </p>
<p>It has also led us to ask whether it might one day be possible to treat mental illness while patients are sleeping – for example, by using sounds to normalise irregular patterns of brain activity during rapid eye movement (REM) sleep.</p>
<h2>Why are some people so badly affected?</h2>
<blockquote>
<p>They put their hand over my face so I couldn’t breathe. Now I can’t wear anything that covers my mouth or nose for fear of reliving [that experience]. Mask wearing was a big problem for me during the pandemic – and it was always worse when I slept badly. Just the sight of other people wearing masks could bring it all back.</p>
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<p>Helen* is a domestic abuse survivor who suffers from post-traumatic stress disorder (PTSD), a debilitating condition characterised by flashbacks, nightmares and severe anxiety. She told us her symptoms would always get worse after a bad night’s sleep – a pattern reported by other PTSD sufferers we spoke to.</p>
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<a href="https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of woman in bed covering her face with her hands" src="https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577724/original/file-20240224-26-m8ngfp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/insomnia-concept-young-woman-sitting-her-625713866">Randoms/Shutterstock</a></span>
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<p>We can all sometimes encounter intrusive and unwanted thoughts, usually in response to reminders – for example, seeing a former partner and being reminded of an unpleasant breakup. While unsettling, these thoughts are infrequent, short-lived and, usually, quickly forgotten. This is in stark contrast to the highly lucid, distressing thoughts experienced by people with PTSD. Sufferers often engage in avoidant behaviour, such as not leaving home to reduce the likelihood of having to confront reminders of their trauma. </p>
<p>However, the symptoms of PTSD can also partly be explained by a breakdown of the brain mechanisms we rely on to push such intrusive thoughts out of conscious awareness. Because intrusive thoughts arise from unpleasant memories, another way people ward them off is by suppressing the offending content from their memory. But PTSD sufferers often <a href="https://journals.sagepub.com/doi/10.1177/0956797615569889">exhibit a deficit</a> in their ability to engage in this process of memory suppression, resulting in persistent unwanted patterns of thinking.</p>
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<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
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<p>And what if lack of sleep reduces our ability to suppress unwanted thoughts and memories? This could lead to a downward spiral of more persistent and frightening intrusive thoughts, severe anxiety, and chronic sleeplessness – culminating in psychiatric disturbance.</p>
<p>Although a <a href="https://www.nature.com/articles/nrn.2017.55">wealth of research</a> has shown that sleep deprivation leads to psychological instability, <a href="https://journals.sagepub.com/doi/10.1177/2167702620951511">our study</a> was the first study to examine how an inability to control intrusive thoughts might underpin this relationship. For this reason, we worked with young adults without a diagnosed mental health disorder, allowing us to determine how even healthy brain processes go awry when people do not get enough sleep.</p>
<h2>How sleep deprivation affects our brain</h2>
<p>Our group of young adults (aged 18–25) were asked to memorise face-image pairs, comprising a male or female face with a neutral expression next to a unique scene. They would memorise each pair over and over again, so that any face presented in isolation would serve as a powerful reminder of the scene it was paired with – in the same way a reminder of an unpleasant event in the real world can trigger a distressing thought.</p>
<p>The face-scene learning took place late in the evening – after which half the participants went to sleep in our laboratory, and the other half stayed awake for the entire night – watching movies, playing games and going for short walks outside. They could eat and drink, but psychological stimulants such as caffeine were strictly prohibited. We would wake anyone in this group who nodded off.</p>
<p>Next morning, all participants were shown the faces only, in random order, with the following instructions. If the face was inside a green frame, the participant should allow the associated scene to come into their mind. A red frame meant they should engage in memory suppression to block out the scene – in the same way we sometimes purge unwanted thoughts from our conscious experience.</p>
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<a href="https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Explanation of face-image sleep and memory suppression experiment." src="https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577966/original/file-20240226-24-8ldt9l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sleep and memory suppression experiment.</span>
<span class="attribution"><a class="source" href="https://www.epoc-york.com/research">Scott Cairney/University of York</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>Our sleep-deprived participants reported having more “intrusions” (failed memory suppression attempts) than those who had slept normally. And only well-rested participants got better at suppressing the unwanted memories over time. This suggests that sleeplessness does long-term harm to our ability to suppress intrusive memories and, hence, unwanted thoughts.</p>
<p>What’s going wrong inside a sleep-deprived person’s brain? To address this question, we <a href="https://www.biorxiv.org/content/10.1101/2023.11.07.565941v1">repeated our study</a>, but this time with participants undergoing <a href="https://www.ndcn.ox.ac.uk/divisions/fmrib/what-is-fmri/introduction-to-fmri">functional magnetic resonance imaging</a> (fMRI) – a powerful neuroimaging technique that allows us to determine which brain regions are engaged during particular cognitive operations (in this case, keeping intrusive memories at bay).</p>
<p>Memory suppression <a href="https://www.sciencedirect.com/science/article/pii/S1364661314000746?via%3Dihub">relies on a brain region</a> known as the right <a href="https://en.wikipedia.org/wiki/Dorsolateral_prefrontal_cortex">dorsolateral prefrontal cortex</a> (rDLPFC). When a reminder triggers retrieval of an unwanted memory, the rDLPFC inhibits activity in the brain’s memory processing centre, the <a href="https://en.wikipedia.org/wiki/Hippocampus">hippocampus</a>, to push that memory out of the person’s mind.</p>
<p>Our fMRI study showed that, when participants were attempting to suppress unwanted memories, activity in rDLPFC was reduced after a night of sleep deprivation relative to a night of restful sleep. Moreover, activity in the hippocampus was stronger after sleep deprivation than restful sleep, suggesting that a breakdown of control by rDLPFC had allowed unsolicited memory operations to emerge with impunity, opening the door to intrusive patterns of thinking.</p>
<h2>Can better sleep improve our mental health?</h2>
<p>REM sleep, discovered by <a href="https://www.science.org/doi/10.1126/science.118.3062.273">Eugene Aserinsky and Nathaniel Kleitman</a> in 1953, is a unique stage of sleep characterised by rapid movement of the eyes and a high propensity for vivid dreaming.</p>
<p>As the brain enters REM sleep, it undergoes dramatic changes that are thought to play an important role in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890316/">regulating our mental health</a>. For example, levels of the neurotransmitter <a href="https://www.britannica.com/science/acetylcholine">acetylcholine</a>, which modulates the processing of disturbing memories, are markedly increased in REM sleep relative to other sleep stages, mirroring levels seen in wakefulness. Abnormalities of REM sleep are <a href="https://www.annualreviews.org/doi/10.1146/annurev-clinpsy-032813-153716">linked</a> to various psychiatric mood disorders including PTSD, and associated with the intense nightmares experienced following trauma.</p>
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Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
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<p>So, could the brain mechanisms that allow us to control intrusive memories be especially influenced by the amount of REM sleep we obtain over the course of a night? To investigate this, our fMRI study included <a href="https://pubmed.ncbi.nlm.nih.gov/31277862/">polysomnography</a> – a sleep monitoring technique that enabled us to identify when participants were in REM sleep, based on both their eye movement and discrete brainwave patterns.</p>
<p>Among our participants who slept, those who had more REM sleep showed stronger engagement of their rDLPFC when suppressing unwanted memories the next morning. This suggests REM sleep may indeed support mental health by restoring the brain systems that help to shield us from unwelcome thoughts.</p>
<h2>The emotional intensity of our memories</h2>
<p>When we think back to a traumatic or painful life event, we get a sense of the unpleasant feelings, such as sadness or anger, that accompanied the original experience. However, the intensity of these feelings is usually much reduced, allowing us to draw on past events without being consumed by negative emotions.</p>
<p>Suppressing unwanted thoughts has been shown to <a href="https://elifesciences.org/articles/71309">weaken the memories</a> that lead to them, meaning they are less likely to intrude into our consciousness in the future. This relates not only to the content of the memories (the “what, when and who”) but also <a href="https://www.jneurosci.org/content/37/27/6423.long">their emotional charge</a> – the intensity of the emotions we felt at the time. In other words, memory suppression helps us move on from prior adversity by gradually cleansing our memories of unpleasant experiences, and the negative emotions associated with them.</p>
<p>Conversely, failing to suppress an unwanted memory is likely to cause its emotional charge to linger, meaning that emotional responses to future reminders will remain more intense. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of exhausted man in bed, suffering with insomnia" src="https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577728/original/file-20240224-16-qbm7dc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/man-insomnia-cannot-sleep-hand-drawn-1819333274">APIMerah/Shutterstock</a></span>
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<p>We tested this by showing our participants scenes that were either emotionally negative (such as a car crash) or neutral (such as a forest). In the morning, after completing the memory retrieval and suppression task (with green and red-framed faces), participants were then asked to give intensity ratings for the negative and neutral scenes again.</p>
<p>Our findings were clear – and corroborated by further tests using an objective index of emotional arousal, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695635/#:%7E:text=The%20skin%20conductance%20response%20(SCR)%20is%20an%20indirect%20measure%20of,emotional%20valence%20(Bradley%20et%20al.)">skin conductance responses</a>. Among participants who had slept, emotional responses to the suppressed negative scenes became less intense over time. But among the sleep-deprived, emotional ratings for negative scenes remained elevated, regardless of whether the scenes were suppressed or not. This suggests that a breakdown of memory suppression mechanisms after sleep loss prevented participants from being able to “deal with” these negative emotions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">Insomnia and mental disorders are linked. But exactly how is still a mystery</a>
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</em>
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<p>In the context of psychiatric mood disorders that co-occur with chronic sleep disturbance, failure to suppress memories of emotionally disturbing events, together with an inability to reduce the unpleasant feelings embedded within those memories, could contribute to a strong tendency of mood-disordered individuals to focus on negative interpretations of the past.</p>
<p>Furthermore, anxiety arising from intrusive memories may also obstruct the sleep that is needed for recovery, leading to a vicious cycle of emotional dysregulation and sleeplessness.</p>
<h2>The importance of forgetting</h2>
<p>In the film Eternal Sunshine of the Spotless Mind (2004), the main characters have their memories of their turbulent relationship erased. Far from improving their quality of life, this leads to further complications, serving as a cautionary tale. </p>
<p>However, there are situations where aiding the forgetting process may help. For example, people who have experienced traumatic experiences can struggle to cope with unwanted memory intrusions. In these extreme cases, where the usual brain processes that allow for forgetting aren’t functioning properly, it could be beneficial to induce forgetting.</p>
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<p>Generally, forgetting is thought of as “bad”, with people worrying about forgetting where they put the car keys, or when their wedding anniversary is. But far from being a problem, this is how <a href="https://theconversation.com/why-forgetting-is-a-normal-function-of-memory-and-when-to-worry-223284">memory is supposed to work</a>. Sometimes, we want to just forget information that isn’t relevant to our daily lives, to prevent it from interfering with our goals. And sometimes, we want to forget embarrassing or emotionally scarring events.</p>
<p>Ultimately, the purpose of a functioning memory system is to make sensible and accurate decisions in the present, based on our past experience. The “adaptive” nature of forgetting allows us to get rid of irrelevant memories, making sure the memories that remain are as relevant to future decisions as possible. From this perspective, forgetting is as important as remembering. Simply put, forgetting is a feature of memory, not a bug.</p>
<p>While forgetting is a catch-all term we use for the loss of a memory, it isn’t a single process in the brain. Memories can be forgotten via active processes, such as memory suppression. But this can also happen via passive processes including “decay”, where the physical trace of a memory in the brain breaks down over time, or “interference”, where new memories that are similar to previous ones lead to confusion-impaired retrieval. For example, if you park your car in a new location in the supermarket you often visit, you might forget this new location because the usual place you park comes more readily to mind.</p>
<p>Forgetting is a complex phenomenon that unfolds over different timescales and via different processes, both while awake and asleep. While some memories can fragment, others are forgotten as a whole, so that all aspects of the memory are <a href="https://psycnet.apa.org/fulltext/2019-38883-001.html">no longer accessible</a>. </p>
<p>That forgetting is likely to occur during sleep has been underappreciated by psychologists, because research on sleep has largely focused on the role it plays in strengthening memories. But <a href="https://learnmem.cshlp.org/content/29/11/401.long">we</a> and <a href="https://www.jneurosci.org/content/37/3/464">other researchers</a> have recently reasoned that if forgetting is a fundamental part of a functioning memory system, then sleep should play as much of a role in forgetting as it does in retention.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of sleep-deprived man in bed, covering his head with pillows." src="https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577727/original/file-20240224-16-ist89m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/man-insomnia-cannot-sleep-hand-drawn-1936830988">APIMerah/Shutterstock</a></span>
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<p>Previous <a href="https://www.science.org/doi/10.1126/science.1179013?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">research</a>, including <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(18)30153-2">our own</a>, has shown that the presentation of specific sounds during sleep can boost memory. If you were to learn the location of a cat on a computer screen, and during learning we played a “meow” sound, the presentation of the same sound during sleep would lead to better location memory following sleep. This selective boosting of a specific memory during sleep is called “targeted memory reactivation”.</p>
<p>We have <a href="https://learnmem.cshlp.org/content/29/11/401.long">recently shown</a> that this technique can also be used to induce “selective forgetting”. We asked our participants to learn pairs of words or names before going to sleep. We used famous names, location and object words to allow participants to create vivid images in their minds for each pair, so they would be more likely to remember them after a night’s sleep.</p>
<p>But we also made sure the pairs overlapped by sharing one common word. When people learn these overlapping pairs, they compete against each other, and this competition can lead to <a href="https://psycnet.apa.org/record/1995-04358-001">forgetting</a> some of the words. We thought a similar forgetting effect might be seen by using targeted memory reactivation when participants were sleeping. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-forgetting-is-a-normal-function-of-memory-and-when-to-worry-223284">Why forgetting is a normal function of memory – and when to worry</a>
</strong>
</em>
</p>
<hr>
<p>We found the presentation of the word during sleep caused reactivation and strengthening for one pair, but this had a disruptive effect for the other pair. This suggests we could use targeted memory reactivation to selectively strengthen and weaken memories during sleep, presuming we can create interference between two memories. This could be beneficial in the case of people whose brain processes aren’t functioning properly, not allowing them to “healthily forget” disturbing and intrusive memories.</p>
<p>Although such a treatment is still a long way off, our work raises the possibility of using sound cues during sleep – in combination with psychological techniques such as cognitive behavioural therapy – to decrease the crippling emotional grip a particular memory has on a patient.</p>
<h2>Modifying REM sleep to improve mental health</h2>
<p>Given the strong link between REM sleep and mental health disorders, REM sleep may represent a powerful therapeutic target for treating and preventing various psychiatric conditions. By delivering sounds in synchrony with naturally occurring brain rhythms, it is possible to modify patterns of brain activity that are associated with memory processing in REM sleep.</p>
<p>In <a href="https://academic.oup.com/sleep/article/44/4/zsaa227/5960115">one study</a>, we used a computerised algorithm to track rapidly emerging patterns of brain activity in real time while people were asleep (based on polysomnography data). When the algorithm detects the emergence of a particular brain rhythm, it delivers short bursts of sound to increase the intensity of that brain rhythm (akin to pushing a swing as it reaches the highest point of its cycle).</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ORo-nbJ-F18?wmode=transparent&start=5" frameborder="0" allowfullscreen=""></iframe>
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<p>We have showed this technique can be used to modify distinct brain rhythms in REM sleep. In future, such auditory stimulation could potentially provide a means of renormalising aberrant patterns of brain activity in REM sleep to treat psychiatric disturbance. For example, by integrating this technology with devices that are already available for people to monitor their sleep at home, the playing of particular sounds while someone is sleeping could provide a simple and cost-effective therapy for reducing mood disturbance.</p>
<p>However, this is a long way from being a reality, and many studies would be required to evaluate the feasibility of such an approach before it could be used as a therapeutic tool.</p>
<h2>Targeting sleep in psychiatric hospitals</h2>
<blockquote>
<p>High-risk patients undergo routine observations, sometimes as regularly as every ten minutes, all night and every night. Torches are shone into their rooms – to check they’re breathing – and there’s a lot of noise as doors are open and closed. It has a terrible impact on their sleep.</p>
</blockquote>
<p>Heather* is a consultant forensic psychiatrist who works on a secure mental health ward in the North of England. She describes how the ward regime (in this case, routine welfare checks on high-risk individuals performed throughout the night) impact on patients’ sleep.</p>
<p>A number of people with severe mental illness receive treatment in secure inpatient units. Although the goal of these psychiatric hospitals is to provide a therapeutic setting to support the improvement of mental health, many features of the inpatient environment, such as noise at night or the ward regime, can worsen patients’ sleep disturbances – intensifying the symptoms of their illness, including low mood, impulsivity and aggression.</p>
<p>At the same time, chronic sleeplessness often reduces patients’ engagement with psychological therapies (due to them sleeping in the day or lacking motivation), lengthening their admission and recovery time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a man sitting up in bed, suffering with insomnia" src="https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577726/original/file-20240224-22-trso72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/man-insomnia-cannot-sleep-hand-drawn-1964955184">APIMerah/Shutterstock</a></span>
</figcaption>
</figure>
<p>In a recent international scoping review, we found that only a small number of non-pharmacological sleep interventions had been tested in psychiatric inpatient settings, despite <a href="https://www.medrxiv.org/content/10.1101/2023.03.03.23286483v1">clear evidence</a> that these improve both sleep and mental health outcomes.</p>
<p>New digital technologies can give a clear indication of patient welfare without the need for the noise and disruption Heather describes, providing an environment that is more conducive to healthy sleep. Future studies could test the potential for integrating these digital technologies with sleep-based therapies to speed up recovery times.</p>
<p>Achieving this goal is not only contingent on more research, but also on the capacity for carrying out scientific studies at scale. For example, all of the studies we have described were performed in tightly controlled laboratory environments, usually involving large and expensive pieces of equipment (for example, polysomnography systems). Though <a href="https://journals.sagepub.com/doi/10.1177/0956797619873344?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">recent efforts have shown promise</a> in the feasibility of moving these techniques into people’s homes, much more work needs to be done outside of the lab before digitised, sleep-focused interventions for mental illness become a reality.</p>
<p>We envisage a future in which sleep is a routine target for reducing or preventing symptoms of mental illness, both in psychiatric inpatient settings and in people’s homes. Although there is much work still to do, sleep research is at an exciting juncture between bench and bedside, and offers a viable solution to the growing global burden of mental illness.</p>
<p><em>*Some names in this article have been changed to protect the anonymity of the interviewees.</em></p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
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<li><p><em><a href="https://theconversation.com/the-brain-is-the-most-complicated-object-in-the-universe-this-is-the-story-of-scientists-quest-to-decode-it-and-read-peoples-minds-222458?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">The brain is the most complicated object in the universe. This is the story of scientists’ quest to decode it – and read people’s minds
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<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/224131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott Cairney has received funding from the Medical Research Council</span></em></p><p class="fine-print"><em><span>Aidan Horner receives funding from the Economic and Social Research Council and the Leverhulme Trust. </span></em></p>We envisage a future in which sleep is a routine target for reducing or preventing symptoms of mental illness, both in psychiatric settings and people’s homesScott Cairney, Associate Professor of Psychology, University of YorkAidan Horner, Associate Professor in Psychology and Neuroscience, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199552024-01-17T13:37:48Z2024-01-17T13:37:48ZWhat’s the best diet for healthy sleep? A nutritional epidemiologist explains what food choices will help you get more restful z’s<figure><img src="https://images.theconversation.com/files/569476/original/file-20240116-23-j8753f.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C2105%2C1409&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A balanced diet is one key factor in getting a restful night's sleep. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/freshly-woken-up-young-woman-enjoying-the-morning-royalty-free-image/1413633179?phrase=person+sleeping&searchscope=image%2Cfilm&adppopup=true">SimpleImages/Moment via Getty Images</a></span></figcaption></figure><p>You probably already know that how you eat before bed affects your sleep. Maybe you’ve found yourself still lying awake at 2 a.m. after enjoying a cup of coffee with dessert. But did you know that your eating choices throughout the day may also affect your sleep at night? </p>
<p>In fact, more and more evidence shows that <a href="https://doi.org/10.3390/nu12092830">overall dietary patterns</a> can <a href="https://doi.org/10.3390/nu14142998">affect sleep quality and contribute to insomnia</a>.</p>
<p>I am a <a href="https://sph.umich.edu/faculty-profiles/jansen-erica.html">nutritional epidemiologist</a>, and I’m <a href="https://scholar.google.com/citations?user=NwgRhPYAAAAJ&hl=en">trained to look at diets at the population level</a> and how they affect health. </p>
<p>In the U.S., a large percentage of the population suffers from <a href="https://www.gallup.com/analytics/390536/sleep-in-america-2022.aspx">poor sleep quality</a> and sleep disorders like <a href="https://www.nhlbi.nih.gov/health/insomnia#">insomnia</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK459252/#">obstructive sleep apnea</a>, a condition in which the upper airway becomes blocked and breathing stops during sleep. At the same time, most Americans eat far too much <a href="https://fns-prod.azureedge.us/sites/default/files/media/file/AverageHealthyEatingIndex-2020ScoresfortheUSPopulation.pdf">fatty and processed food, too little fiber and too few fruits and vegetables</a>. </p>
<p>Although it is difficult to determine whether these two trends are causally linked to one another, more and more <a href="https://doi.org/10.1146%2Fannurev-nutr-120420-021719">research points to linkages between sleep and diet</a> and offers hints at the biological underpinnings of these relationships.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Overhead view of colorful foods with high dietary fiber content arranged side by side on a countertop." src="https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569475/original/file-20240116-23-bh5k9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most Americans consume far too little fiber and too few fresh fruits and vegetables.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/group-of-food-with-high-content-of-dietary-fiber-royalty-free-image/1457889029?phrase=high+fiber+diet&searchscope=image%2Cfilm&adppopup=true">fcafotodigital/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>How diet and sleep quality can be intertwined</h2>
<p>My colleagues and I wanted to get a deeper understanding of the possible link between sleep and diet in Americans who are 18 and older. So we analyzed whether people who follow <a href="https://health.gov/our-work/nutrition-physical-activity/dietary-guidelines">the government’s Dietary Guidelines for Americans</a> get more hours of sleep.</p>
<p>Using a nationally representative dataset of surveys collected from 2011 to 2016, we found that people who did not adhere to dietary recommendations such as consuming enough servings of fruits, vegetables, legumes and whole grains <a href="https://doi.org/10.1016/j.appet.2020.104748">had shorter sleep duration</a>.</p>
<p>In a separate study, we followed more than 1,000 young adults ages 21 to 30 who were enrolled in a web-based dietary intervention study designed to help them increase their daily servings of fruits and vegetables. We found that those who increased their fruit and vegetable consumption over a three-month period reported better sleep quality and <a href="https://doi.org/10.1016/j.sleh.2021.02.005">reductions in insomnia symptoms</a>. </p>
<p>Research conducted outside the U.S. by my group and others also shows that healthier overall dietary patterns are associated with better sleep quality and fewer insomnia symptoms. These include the <a href="https://doi.org/10.3390/nu12092830">Mediterranean diet</a> – a diet rich in plant foods, olive oil and seafood, and low in red meat and added sugar – and <a href="https://doi.org/10.3390/nu15020419">anti-inflammatory diets</a>. These are <a href="https://doi.org/10.1016/j.appet.2021.105881">similar to the Mediterranean diet</a> but include additional emphasis on <a href="https://doi.org/10.1093/sleep/zsy158">certain components in the diet</a> like <a href="https://doi.org/10.3390%2Fmolecules25225243">flavonoids</a>, a group of compounds found in plants, which are shown to lower inflammatory biomakers in the blood.</p>
<h2>Parsing the foods and nutrients</h2>
<p>Within overall healthy diet patterns, there are numerous individual foods and nutrients that may be linked to quality of sleep, with varying degrees of evidence. </p>
<p>For example, studies have linked consumption of <a href="https://doi.org/10.5664/jcsm.3714">fatty fish</a>, <a href="https://doi.org/10.1016/j.advnut.2023.01.004">dairy</a>, <a href="https://doi.org/10.3389/fnut.2023.1079609">kiwi fruit</a>, <a href="https://doi.org/10.1097/mjt.0000000000000584">tart cherries</a> and <a href="https://doi.org/10.3390/nu15245115">other berries</a> such as strawberries and blueberries with better sleep. One of the common pathways through which these foods may affect sleep is by <a href="https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know">providing melatonin</a>, an important modulator of sleep and wake cycles in the brain.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Z7mNwDrr53c?wmode=transparent&start=82" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Walnuts and almonds, as well as fruits like kiwis and bananas, provide natural sources of melatonin.</span></figcaption>
</figure>
<p><a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">Fiber-rich foods</a> like beans and oatmeal and certain protein sources – especially those that are high in the amino acid tryptophan, such as poultry – are also associated with <a href="https://doi.org/10.1016/j.jand.2022.01.007">higher-quality sleep</a>. Individual nutrients that may be beneficial include <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703169/">magnesium</a>, <a href="https://doi.org/10.1016/j.tjnut.2023.11.030">vitamin D</a>, <a href="https://doi.org/10.1016/j.tjnut.2023.11.030">iron</a>, <a href="https://doi.org/10.1093/jn/nxz286">omega-3 fatty acids</a> and <a href="https://doi.org/10.1016/j.tjnut.2023.11.012">manganese</a>. Some foods like salmon are sources of multiple nutrients. </p>
<h2>Untangling the complexity</h2>
<p>One important caveat with a lot of the research on individual foods, as well as diet patterns, is that most studies cannot easily disentangle the direction of the relationships.</p>
<p>In other words, it’s hard to know whether the association is a result of diet affecting sleep, or sleep affecting diet. The reality is that it is likely a cyclical relationship, where a healthy diet promotes good sleep quality, which in turn helps to <a href="https://doi.org/10.1146/annurev-nutr-120420-021719">reinforce good dietary habits</a>. </p>
<p>With observational studies, there are also possible confounding factors, such as age and economic status, that may have important correlations with both sleep and diet.</p>
<h2>Foods to avoid for sleep health</h2>
<p>Aiming for higher intake of sleep-promoting foods isn’t necessarily enough to get better sleep. It’s also important to avoid certain foods that could be bad for sleep. Here are some of the main culprits:</p>
<ul>
<li><p>Saturated fats, such as that in burgers and fries and processed foods, could <a href="https://doi.org/10.5664/jcsm.5384">lead to less slow-wave sleep</a>, which is <a href="https://pubmed.ncbi.nlm.nih.gov/19998869/">considered the most restorative sleep</a>. </p></li>
<li><p>Refined carbohydrates, such as those in white bread and pasta, are metabolized quickly. If you eat these foods for dinner, they can result in <a href="https://doi.org/10.3389/fpubh.2022.931781">waking up from hunger</a>. </p></li>
<li><p><a href="https://doi.org/10.1016/j.alcohol.2014.07.019">Alcohol disrupts sleep quality</a>. Although the sedative effects of alcohol can initially make it easier to fall asleep, it disrupts sleep patterns by shortening the amount of <a href="https://www.webmd.com/sleep-disorders/sleep-101">REM, or rapid eye movement</a>, sleep in the first part of the night and leads to more night awakenings.</p></li>
<li><p>Caffeine consumed even six hours before bed can <a href="https://doi.org/10.5664/jcsm.3170">make it difficult to fall asleep</a> because it blocks the hormone adenosine, which promotes sleepiness. </p></li>
<li><p>The consistent overconsumption of calories can lead to weight gain, one of the <a href="https://doi.org/10.1016/j.smrv.2023.101838">strongest predictors of obstructive sleep apnea</a>. Having excess weight is a factor because it can put additional pressure on the diaphragm and lungs, and can also lead to a narrower airway if fat accumulates around the neck and throat.</p></li>
</ul>
<p>Interestingly, our group has recently shown that toxicants in food or food packaging, <a href="https://doi.org/10.1186/s12889-021-12014-x">like pesticides</a>, <a href="https://doi.org/10.1016/j.envres.2020.110216">mercury</a> and <a href="https://doi.org/10.1007/s11356-023-26833-5">phthalates</a> – chemicals used to manufacture plastics – can affect sleep. Since toxicants can be found in both healthy and unhealthy foods, this research suggests that some foods can contain a mix of components that are both beneficial and harmful for sleep.</p>
<h2>Timing of meals and gender considerations</h2>
<p>The timing and consistency of eating, known as “chrononutrition” in the sleep research field, also very likely help to explain associations between healthy diets and good sleep. </p>
<p>In the U.S., eating at conventional meal times as opposed to random snacking <a href="https://doi.org/10.1017/S136898001000296X">has been associated with better sleep</a>. In addition, late-night eating is typically associated with unhealthier food intake – such as processed snacks – and could <a href="https://doi.org/10.1017/s0007114521003597">cause more fragmented sleep</a>.</p>
<p>A final and very interesting piece of this puzzle is that associations between diet and sleep often differ by gender. For example, it appears that the associations between healthy diet patterns and insomnia symptoms <a href="https://doi.org/10.1016/j.sleh.2021.02.005">could be stronger among women</a>. One reason for this could be gender differences in sleep. In particular, <a href="https://doi.org/10.3389%2Ffpsyt.2020.577429">women are more likely than men to suffer from insomnia</a>.</p>
<h2>Keys to a good night’s sleep</h2>
<p>Overall, there is not one magic food or drink that will improve your sleep. It’s better to focus on overall healthy dietary patterns throughout the day, with a higher proportion of calories consumed earlier in the day. </p>
<p>And, in addition to avoiding caffeine, alcohol and heavy meals in the two to three hours before bed, the last few hours of the day should include other <a href="https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/">good sleep hygiene practices</a>. </p>
<p>These include disengaging from technology, reducing light exposure and creating a comfortable and relaxing environment for sleep. Moreover, allowing enough time to sleep and maintaining a consistent bedtime and wake time is essential.</p><img src="https://counter.theconversation.com/content/219955/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erica Jansen receives funding from the National Heart Lung Blood Institute (NHBLI) through a K01 award (K01HL151673). </span></em></p>A growing body of research is finding a robust link between diet and sleep quality. But it’s not just the usual suspects like caffeine and alcohol that can get in the way of restful sleep.Erica Jansen, Assistant Professor of Nutritional Sciences, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172682023-11-09T04:38:08Z2023-11-09T04:38:08ZWhy The Conversation lifted the (eye) mask on insomnia<figure><img src="https://images.theconversation.com/files/558256/original/file-20231108-21-nr1728.jpg?ixlib=rb-1.1.0&rect=5%2C5%2C992%2C992&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/statue-gold-sleep-mask-gypsum-david-1909455499">Shutterstock</a></span></figcaption></figure><p>Insomnia is an ancient preoccupation and modern obsession. Its effect on our mental health and wellbeing <a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">can be dramatic</a>.</p>
<p>In Australia, the financial cost of poor sleep is an estimated <a href="https://treasury.gov.au/sites/default/files/2019-03/360985-Sleep-Health-Foundation-and-Australasian-Sleep-Association.pdf">A$26 billion a year</a>, mainly through lost productivity or accidents.</p>
<p>The pursuit of sleep is also a <a href="https://www.alliedmarketresearch.com/insomnia-market">multibillion-dollar</a> global business which is still getting bigger. Think sleep apps, sleep therapy, sleep influencers, sleeping pills, medicinal cannabis, and on it goes. </p>
<p>That’s why The Conversation commissioned a <a href="https://theconversation.com/au/topics/insomnia-series-144018">six-part series</a> to explore insomnia. We hear from sleep researchers, psychologists, a historian and a sociologist. Each has a unique take on sleep, the lack of it, and what it’s costing us.</p>
<h2>How we became obsessed with sleep</h2>
<p>The series begins with a <a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">short history</a> of insomnia, charting its rise as nations industrialised. Philippa Martyr, a historian from the University of Western Australia, writes that’s when things we now associate with insomnia became part of people’s lives – artificial lighting and clocks, more ambient noise, changes in diet and housing. So our sleep habits shifted as a result of this new way of living and working. </p>
<p>Sleeping pills followed, as did our obsession with caffeine. Now we go to bed with handheld devices – with their bright lights and constant dopamine hits that stimulate us and stop us sleeping.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>Insomnia in the movies, and why it’s a problem</h2>
<p>Next, we look at how fictional portrayals of insomnia in the movies can be misleading. Most movies tend either to minimise or, more commonly, to exaggerate symptoms. Psychological thrillers are among the biggest offenders.</p>
<p>Insomnia is rarely depicted as a treatable illness, <a href="https://theconversation.com/whats-insomnia-like-for-most-people-who-cant-sleep-youd-never-know-from-the-movies-211823">write</a> Aaron Schokman and Nick Glozier from the University of Sydney.</p>
<p>Why are they concerned? These portrayals have implications for the estimated <a href="https://www.sleep.theclinics.com/article/S1556-407X(22)00022-4/fulltext">one in three</a> of us with at least one insomnia symptom. These portrayals can perpetuate stereotypes about insomnia and who’s at risk, making it harder for people to seek care.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1720751088624672849"}"></div></p>
<h2>How dangerous is insomnia really?</h2>
<p>Insomnia has been linked to developing conditions such as dementia, obesity, diabetes and high blood pressure. No wonder people are concerned about their lack of sleep and its impacts. This concern, in turn, can worsen sleep.</p>
<p>But how bad is insomnia on your body, really? Leon Lack and Nicole Lovato from Flinders University <a href="https://theconversation.com/how-dangerous-is-insomnia-how-fear-of-what-its-doing-to-your-body-can-wreck-your-sleep-212248">show</a> how the evidence is less robust than we might think. Yet the scary headlines continue, making people worry even more. </p>
<p>Even if people don’t have insomnia to start with, all this unnecessary worry may lead them to develop it.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1714756257427370360"}"></div></p>
<h2>How about mental disorders?</h2>
<p>The evidence for insomnia’s link with mental disorders is much stronger, which we explore in the <a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">next article</a> in the series.</p>
<p>As Ben Bullock from Swinburne University of Technology writes, the relationship between insomnia and mental disorders is complex. It’s not just a case of “which comes first, the insomnia or the mental disorder?” Insomnia and mental disorders are interrelated in ways we don’t fully understand.</p>
<p>And treating one often treats the other.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1715193491888701464"}"></div></p>
<h2>Which treatments actually work?</h2>
<p>Next, we look at treatments for insomnia – what works, what doesn’t, and what we might expect.</p>
<p>It turns out the most effective treatment isn’t a sleeping pill, <a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">write</a> Alexander Sweetman and Nicole Grivell from Flinders University, and Jen Walsh from the University of Western Australia.</p>
<p>It’s a type of psychological therapy known as cognitive behavioural therapy for insomnia, or CBTi. About <a href="https://connect.h1.co/prime/reports/b/11/4/">70-80%</a> of people with insomnia sleep better after CBTi, with improvements lasting <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079218301965?via%3Dihub">at least a year</a>.</p>
<p>If that doesn’t work, there are sleeping pills, and newer drug therapies on the horizon.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1721830842761126336"}"></div></p>
<h2>There’s an app for that</h2>
<p>Insomnia is not just a personal issue that affects an individual’s health and wellbeing. It’s a public health issue, affecting public safety. It’s a socioeconomic issue, as poorer sleep is linked to a lower education and income. And, increasingly, it’s a commercial issue, <a href="https://theconversation.com/how-apps-and-influencers-are-changing-the-way-we-sleep-for-better-or-for-worse-211749">writes</a> Deborah Lupton from the University of New South Wales, in the final article in the series.</p>
<p>The global insomnia market is expected to reach <a href="https://www.alliedmarketresearch.com/insomnia-market">US$6.3 billion</a> by 2030, driven by increased diagnoses and therapy, as well as sleep aids, including sleep apps.</p>
<p>But not all sleep apps are accurate or useful. And fixating on the sleep data these apps generate won’t necessarily help you sleep. </p>
<p>Then there are social media “sleep influencers” who share their take on sleep and how to get more of it. Can any of this help us?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1717783446972404007"}"></div></p>
<h2>If you can’t sleep</h2>
<p>We hope the series helps pull back the (eye) mask on insomnia – what it is, what it is not, and how to access treatment. But the series is also a reminder that not everyone can buy the latest technologies or can change their environment or lifestyle to help them sleep.</p>
<p>As Lupton <a href="https://theconversation.com/how-apps-and-influencers-are-changing-the-way-we-sleep-for-better-or-for-worse-211749">concludes</a>, a good night’s sleep shouldn’t be the preserve of the privileged.</p><img src="https://counter.theconversation.com/content/217268/count.gif" alt="The Conversation" width="1" height="1" />
How did you sleep last night? Our six-part series looks at why so many of us have insomnia, and what it’s costing us.Anna Evangeli, Deputy Health Editor, The Conversation Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117492023-10-27T01:24:05Z2023-10-27T01:24:05ZHow apps and influencers are changing the way we sleep, for better or for worse<figure><img src="https://images.theconversation.com/files/554430/original/file-20231017-21-7t15ti.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-woman-watching-bad-online-content-1074562523">Shutterstock</a></span></figcaption></figure><p><em>This is the final article in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>Insomnia is not just a personal issue that affects an individual’s health and wellbeing. It’s a <a href="https://treasury.gov.au/sites/default/files/2019-03/360985-Sleep-Health-Foundation-and-Australasian-Sleep-Association.pdf">public health</a> issue, affecting public safety. It’s a <a href="https://academic.oup.com/eurpub/article/33/2/242/7049369?login=false">socioeconomic</a> issue, as poorer sleep is linked to a <a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-040119-094412">lower education and income</a>. And, increasingly, it’s a commercial issue.</p>
<p>The global insomnia market is expected to reach <a href="https://www.alliedmarketresearch.com/insomnia-market">US$6.3 billion by 2030</a>, driven by increased diagnoses <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.12820">and</a> therapy, as well as sleep aids, including <a href="https://www.openpr.com/news/3228602/sleep-tech-devices-market-2023-driving-factors-forecast">sleep apps</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>There’s an app for that</h2>
<p>There are <a href="https://www.jstor.org/stable/27213628">numerous</a> <a href="https://www.nature.com/articles/s41746-020-0244-4">digital devices and apps</a> to help people sleep better. You can buy wearable devices, such as smartwatches and smart rings or wristbands, to digitally monitor your sleep. You can download apps that record how long you sleep and where you can log your tiredness and concentration levels. </p>
<p>Some devices are designed to promote sleep, by generating <a href="https://theconversation.com/what-is-brown-noise-can-this-latest-tiktok-trend-really-help-you-sleep-188528">white or brown noise</a> or other peaceful sounds. You can also buy “smart” <a href="https://thegadgetflow.com/blog/smart-pillows/">pillows</a>, <a href="https://www.sleepfoundation.org/best-mattress/best-smart-mattress">mattresses</a> and a range of <a href="https://sleepspace.com/smart-lights-improve-perceived-sleep-quality/">smart light-fittings and lightbulbs</a> to help track and improve sleep.</p>
<p>Such technologies operate to “digitise” sleep as part of “<a href="https://www.amazon.com.au/Quantified-Self-Deborah-Lupton/dp/150950060X">the quantified self</a>”. They render sleep practices and bodily responses into data you can review. So these devices are promoted as offering scientific insights into how to control the disruption to people’s lives caused by poor sleep.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CqpQFLMAp-x","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>You can listen to “<a href="https://www.theguardian.com/lifeandstyle/2019/feb/08/rise-of-sleep-story-apps-talking-books-that-send-you-to-sleep">sleep stories</a>” – bedtime stories, music or guided meditations meant to help you sleep. Then there are the sleep <a href="https://blog.feedspot.com/insomnia_blogs/">blogs</a>, <a href="https://www.timeout.com/things-to-do/best-sleep-podcasts">podcasts</a> and social media content on <a href="https://www.tiktok.com/tag/insomnia?lang=en0">TikTok</a>, <a href="https://www.youtube.com/watch?v=i9sR_T76H34">YouTube</a> and <a href="https://www.instagram.com/p/CqpQFLMAp-x/">Instagram</a>. </p>
<p>Where there is social media content, there are social media “influencers” sharing their take on sleep and how to get more of it. These “<a href="https://influencers.feedspot.com/sleep_instagram_influencers/">sleep influencers</a>” have accumulated large numbers of followers. Some have <a href="https://www.bbc.com/news/technology-66524539">profited</a>, including those who live-stream themselves sleeping or invite audiences to try to wake them up – for a price.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1693353491161325720"}"></div></p>
<h2>Sharing and connecting can help</h2>
<p>There may be benefits to joining online communities of people who can’t sleep, whether that’s in an online forum such as <a href="https://www.reddit.com/r/sleep/?rdt=60835">Reddit</a> or a specially designed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861843/">sleep improvement program</a>.</p>
<p>Sharing and connection can ease the loneliness we know <a href="https://academic.oup.com/sleep/article/34/11/1519/2454670?login=false">can impact</a> sleep. And technology can facilitate this connection when no-one else is around.</p>
<p>We know social media communities provide much-needed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156131/">support</a> for health problems more generally. They allow people to share personal experiences with others who understand, and to swap tips for the best health practitioners and therapies. </p>
<p>So online sharing, support and feelings of <a href="https://www.psychologytoday.com/au/blog/the-science-of-fandom/202303/can-social-media-and-online-communities-be-good-for-us">belonging</a> can alleviate the stresses and unhappiness that may prevent people from finding a good night’s sleep.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">Social media, activism, trucker caps: the fascinating story behind long COVID</a>
</strong>
</em>
</p>
<hr>
<h2>What is this fixation costing us?</h2>
<p>But there are some problems with digitising sleep. A <a href="https://www.theguardian.com/commentisfree/2023/may/09/obsession-sleep-harm-drivers-legal-sleep-limit">focus</a> on sleep can create a <a href="https://theconversation.com/is-tracking-your-sleep-a-good-idea-190231">vicious cycle</a> in which worrying about a lack of sleep <a href="https://www.sciencedirect.com/science/article/abs/pii/S0005796717301638">can itself</a><a href="https://www.bps.org.uk/research-digest/misbelieving-youve-got-sleep-problems-can-be-more-harmful-actual-lack-sleep"> worsen sleep</a>. </p>
<p>Using sleep-tracking apps and wearable devices can encourage people to become <a href="https://theconversation.com/is-tracking-your-sleep-a-good-idea-190231">overly fixated</a> on the metrics these technologies gather. </p>
<p>The data generated by digital devices are not necessarily <a href="https://www.nature.com/articles/s41746-020-0244-4">accurate or useful</a>, particularly for groups such as <a href="https://mhealth.jmir.org/2021/6/e26462">older people</a>. Some young people say they feel <a href="https://journals.sagepub.com/doi/abs/10.1177/10949968221142806">worse</a> after using a sleep app. </p>
<p>There are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157780/">data privacy issues</a>. Some digital developers do not adequately protect the very personal information smart sleep devices or apps generate.</p>
<p>Then, there’s the fact using digital devices before bedtime <a href="https://www.sleepfoundation.org/how-sleep-works/how-electronics-affect-sleep">is itself</a> linked to <a href="https://www.sciencedirect.com/science/article/pii/S2352721823000347">sleep problems</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-sleep-trackers-accurate-heres-what-researchers-currently-know-152500">Are sleep trackers accurate? Here's what researchers currently know</a>
</strong>
</em>
</p>
<hr>
<h2>Are we missing the bigger issue?</h2>
<p>Other critics argue this intense focus on sleep ignores that sleeping well is impossible for some people, however hard they try or whatever expensive devices they buy. </p>
<p>People living in poor housing or in noisy environments have little choice over the conditions in which they seek good sleep. </p>
<p>Factors such as people’s income and education levels <a href="https://www.mdpi.com/2254-9625/12/8/80">affect</a> their sleep, just as they do for <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjop.12645">other health issues</a>. And <a href="https://www.sciencedirect.com/science/article/pii/S2352721823000864">multiple socioeconomic factors</a> (for instance, gender, ethnicity and economic hardship) can combine, making it even more likely to have poor sleep.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Plane flying low over houses" src="https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People living in poor housing or in noisy environments have little choice over their sleep environment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/heathrow-airport-london-9-september-british-114954946">Steve Heap/Shutterstock</a></span>
</figcaption>
</figure>
<p>Sleep quality is therefore just as much as a <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjop.12645">socioeconomic</a> as a biological issue. Yet, much of the advice offered to people about how to improve their sleep focuses on individual responsibility to make changes. It assumes everyone can buy the latest technologies or can change their environment or lifestyle to find better “sleep health”. </p>
<p>Until “<a href="https://www.mdpi.com/2624-5175/5/1/13">sleep health inequalities</a>” are improved, it is unlikely digital devices or apps can fix sleep difficulties at the population level. A good night’s sleep should not be the preserve of the privileged.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211749/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton receives funding from the Australian Research Council.</span></em></p>Fixating on sleep can make your sleep worse. But some people crave the connection online sleep communities provide.Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2129642023-10-25T19:09:58Z2023-10-25T19:09:58ZHow can I get some sleep? Which treatments actually work?<figure><img src="https://images.theconversation.com/files/549731/original/file-20230922-15-vh7iga.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-surrounded-by-different-pills-on-2132651521">Shutterstock</a></span></figcaption></figure><p><em>This article is the next in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>Do you have difficulty falling asleep? Do you stay awake for a long time at night? Do these sleep problems make you feel fatigued, strung-out, or exhausted during the day? Has this been happening for months?</p>
<p>If so, you’re not alone. About <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">12-15%</a> of Australian adults have chronic insomnia.</p>
<p>You might have tried breathing exercises, calming music, white noise, going to bed in a dark and quiet bedroom, eating different foods in the evening, maintaining a regular sleep pattern, or reducing caffeine. But after three to four weeks of what seems like progress, your insomnia returns. What next?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>What not to do</h2>
<p>These probably won’t help:</p>
<ul>
<li><p><strong>spending more time in bed</strong> often results in more time spent <em>awake</em> in bed, which can make <a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">insomnia patterns worse</a></p></li>
<li><p><strong>drinking coffee and taking naps</strong> might help get you through the day. But <a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">caffeine</a> stays in the system for many hours, and can disrupt our sleep if you drink too much of it, especially after about 2pm. If naps last for more than 30 minutes, or occur after about 4pm, this can reduce your “sleep debt”, and can make it <a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">more difficult</a> to fall asleep in the evening</p></li>
<li><p><strong>drinking alcohol</strong> might help you fall asleep quicker, but <a href="https://journals.sagepub.com/doi/10.1300/J465v26n01_01">can cause</a> more frequent awakenings, change how long you sleep, change the time spent in different “stages” of sleep, and reduce the overall quality of sleep. Therefore, it is not recommended as a sleep aid.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">Why do I fall asleep on the sofa but am wide awake when I get to bed?</a>
</strong>
</em>
</p>
<hr>
<h2>What to do next?</h2>
<p>If your symptoms have lasted more than one or two months, it is likely your insomnia requires targeted treatments that focus on sleep patterns and behaviours.</p>
<p>So, the next stage is a type of non-drug therapy known as cognitive behavioural therapy for insomnia (or <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti">CBTi</a> for short). This is a four to eight week treatment that’s been shown to be <a href="https://doi.org/10.1016/j.smrv.2022.101687">more effective</a> than sleeping pills. </p>
<p>It involves education about sleep, and offers psychological and behavioural treatments that address the underlying causes of long-term insomnia.</p>
<p>You can do this one-on-one, in a small group with health professionals trained in CBTi, or via self-guided <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti/referral-to-digital-cbti-programs">online programs</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Counsellor or psychologist putting hand on shoulder of woman in group therapy" src="https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can do this therapy in a group, one-on-one or online.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/men-women-sitting-circle-during-group-1316330951">Shutterstock</a></span>
</figcaption>
</figure>
<p>Some GPs are trained to offer CBTi, but it’s more usual for specialist <a href="https://psychology.org.au/find-a-psychologist">sleep psychologists</a> to offer it. Your GP can refer you to one. There are some Medicare rebates to subsidise the cost of treatment. But many psychologists will also charge a gap fee above the Medicare subsidy, making access to CBTi a challenge for some. </p>
<p><a href="https://doi.org/10.12703%2Fr%2F11-4">About 70-80%</a> of people with insomnia sleep better after CBTi, with improvements lasting <a href="https://doi.org/10.1016/j.smrv.2019.08.002">at least a year</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-makes-a-good-psychologist-or-psychiatrist-and-how-do-you-find-one-you-like-120981">What makes a good psychologist or psychiatrist and how do you find one you like?</a>
</strong>
</em>
</p>
<hr>
<h2>What if that doesn’t work?</h2>
<p>If CBTi doesn’t work for you, your GP might be able to refer you to a specialist sleep doctor to see if other sleep disorders, such as <a href="https://doi.org/10.1016/j.smrv.2016.04.004">obstructive sleep apnoea</a>, are contributing to your insomnia. </p>
<p>It can also be important to manage any mental health problems such as <a href="https://doi.org/10.5694/mja2.51200">depression and anxiety</a>, as well as physical symptoms such as pain that can also disrupt sleep. </p>
<p>Some lifestyle and work factors, such as shift-work, might also require management by a specialist sleep doctor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<h2>What about sleeping pills?</h2>
<p>Sleeping pills are <a href="https://www.sleepprimarycareresources.org.au/insomnia/pharmacological-therapy">not the recommended</a> first-line way to manage insomnia. However, they do have a role in providing short-term, rapid relief from insomnia symptoms or when CBTi is not accessible or successful.</p>
<p>Traditionally, medications such as benzodiazepines (for example, temazepam) and benzodiazepine receptor agonists (for example, zolpidem) have been used to help people sleep.</p>
<p>However, these can have <a href="https://doi.org/10.1136/bmj.38623.768588.47">side-effects</a> including a risk of falls, being impaired the next day, as well as tolerance and dependence. </p>
<p>Melatonin – either prescribed or available from pharmacies for people aged 55 and over – is also often used to manage insomnia. But the <a href="https://doi.org/10.1016/j.smrv.2022.101692">evidence suggests</a> it has limited benefits.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-reasons-why-you-should-avoid-sleeping-pills-10054">Some reasons why you should avoid sleeping pills </a>
</strong>
</em>
</p>
<hr>
<h2>Are there new treatments? How about medicinal cannabis?</h2>
<p>Two newer drugs, known as “orexin receptor antagonists”, are available in Australia (suvorexant and lemborexant).</p>
<p>These block the wake-promoting pathways in the brain. <a href="https://doi.org/10.4088/PCC.22nr03385">Early data suggests</a> they are effective in improving sleep, and have lower risk of potential side-effects, tolerance and dependence compared with earlier medicines.</p>
<p>However, we don’t know if they work or are safe over the long term.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dropper bottles of medicinal cannabis oil" src="https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medicinal cannabis may be one option in the future. But trials so far have been mixed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/macro-detail-dropper-cbd-oil-cannabis-725041309">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1093/sleep/zsab149">Medicinal cannabis</a> <a href="https://doi.org/10.1111/jsr.13793">has only in recent years</a> <a href="https://doi.org/10.1093/sleepadvances/zpac029.048">been studied</a> as a treatment for <a href="https://doi.org/10.1093/sleepadvances/zpac029.005">insomnia</a>.</p>
<p>In an Australian survey, <a href="https://doi.org/10.2147/nss.s390583">more than half</a> of people using medicinal cannabis said they used it to treat insomnia. There are reports of <a href="https://doi.org/10.1371/journal.pone.0272241">significant benefit</a>. </p>
<p>But of the four most robust studies so far, <a href="https://doi.org/10.1093/sleep/zsab149">only one</a> (led by one of us, Jen Walsh) has demonstrated an improvement in insomnia after two weeks of treatment.</p>
<p>So we need to learn more about which cannabinoids – for example, delta-9-tetrahydrocannabinol, cannabidiol or cannabinol – and which doses may be beneficial. We also need to learn who can benefit most, and whether these are safe and effective over the long term.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516">1 in 10 women with endometriosis report using cannabis to ease their pain</a>
</strong>
</em>
</p>
<hr>
<h2>What now?</h2>
<p>If you’ve had trouble sleeping for a short time (under about a month) and nothing you try is working, there may be underlying reasons for your insomnia, which when treated, can provide some relief. Your GP can help identify and manage these.</p>
<p>Your GP can also help you access other treatments if your insomnia is more long term. This may involve non-drug therapies and/or referral to other services or doctors.</p>
<hr>
<p><em>For more information about insomnia and how it’s treated, see the Sleep Health Foundation’s <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2">online resource</a>.</em></p><img src="https://counter.theconversation.com/content/212964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Sweetman is a Senior Program Manager at the Australasian Sleep Association, the peak sleep health scientific and advocacy body in Australia and New Zealand, and has academic status at Flinders University. Dr Sweetman reports previous research funding and/or consultancy work for; the National Health and Medical Research Council, The Hospital Research Foundation, Flinders University, Flinders Foundation, ResMed, Philips, Cerebra, Re-Time, and Australian Doctor.</span></em></p><p class="fine-print"><em><span>Jen Walsh is affiliated with the Centre for Sleep Science at The University of Western Australia and the West Australian Sleep Disorders Research Institute at Sir Charles Gairdner Hospital. She is a director of the Australian Sleep Association (ASA), and a member of the Australia and New Zealand Sleep Science Association (ANZSSA) and Sleep Health Foundation (SHF).
Jen Walsh has received research funding (past) from the NHMRC, Sir Charles Gairdner Hospital research advisory committee, Australia and New Zealand College of Anaesthetists (ANZCA), Oventus Pty Ltd, Nyxoah Pty Ltd, Zelira Therapeutics Ltd and Incannex Healthcare Ltd. She is currently receiving research funding from CHC Helicopter Australia and Chevron Australia Pty Ltd. She also receives consultancy fees from Invicta Medical and Melius Consulting.
Jen Walsh was the first author of a medicinal cannabis trial mentioned in this article.</span></em></p><p class="fine-print"><em><span>Nicole Grivell is involved in the Australasian Sleep Association as a co-chair of the Primary Care Council and as a member of the Conference Committee.
She currently has PhD funding from Flinders University and an NHMRC-funded Partnership Grant. She has previously received PhD funding from the Flinders Foundation in the form of a Nick Antic Sleep Research PhD Scholarship. </span></em></p>You’ve tried everything to get some sleep, but nothing’s working. Here’s what not to do, and what works.Alexander Sweetman, Research Fellow, College of Medicine and Public Health, Flinders UniversityJen Walsh, Director of the Centre for Sleep Science, The University of Western AustraliaNicole Grivell, Research Coordinator and final year PhD Candidate at FHMRI Sleep Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2121062023-10-19T19:03:26Z2023-10-19T19:03:26ZInsomnia and mental disorders are linked. But exactly how is still a mystery<figure><img src="https://images.theconversation.com/files/546862/original/file-20230907-15-5fhfee.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C4985%2C2979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/psychologist-consulting-mental-problem-solving-brainstorm-2087426509">Shutterstock</a></span></figcaption></figure><p><em>This article is the next in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>The 2004 movie <a href="https://www.imdb.com/title/tt0361862/">The Machinist</a> gives us a striking depiction, albeit a fictional one, of the psychological effects of chronic insomnia.</p>
<p>When people don’t have enough sleep, <a href="https://doi.org/10.1007/s11910-017-0799-x">their</a> memory and concentration are impaired in the short term. They are also less able to regulate their emotions.</p>
<p>If sleeping difficulties continue, longer-term psychological effects <a href="https://doi.org/10.1111/jsr.13930">can include</a> anxiety, depression, mania and psychosis. Indeed, Christian Bale’s character in The Machinist has increasingly vivid visual hallucinations and paranoid delusions as his insomnia deepens.</p>
<p>The relationship between insomnia and mental disorders is complex. It’s not just a case of “which comes first, the insomnia or the mental disorder?” Insomnia and mental disorders are interrelated in ways we don’t yet fully understand.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>What is insomnia? Is it a mental disorder?</h2>
<p>Insomnia is, by far, the most common disorder of sleep. <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">An estimated 12-15%</a> of Australian adults at any one time meet criteria for insomnia.</p>
<p>People with insomnia have frequent and ongoing difficulties in falling and staying asleep, and/or going back to sleep after early waking. Insomnia not only affects people’s quality of sleep, but how they function the next day.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1678293771539161089"}"></div></p>
<p>Many of the factors that trigger insomnia and help maintain its negative long-term effects are psychological or behavioural. These include:</p>
<ul>
<li><p>psychosocial stressors (such as money, work or family problems)</p></li>
<li><p>attentional bias and worry about sleep (the more we think and worry about sleep, the worse it gets)</p></li>
<li><p>poor sleep habits (such as irregular sleep and wake times).</p></li>
</ul>
<p>Insomnia is not a mental disorder in the same way that, say, depression and anxiety are mental disorders. Insomnia is a recognised <a href="https://aasm.org/clinical-resources/international-classification-sleep-disorders/">sleep disorder</a> that nonetheless has close links to a wide variety of mental disorders.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-insomnia-like-for-most-people-who-cant-sleep-youd-never-know-from-the-movies-211823">What's insomnia like for most people who can't sleep? You'd never know from the movies</a>
</strong>
</em>
</p>
<hr>
<h2>Many people have both insomnia and a mental disorder</h2>
<p><a href="https://doi.org/10.1016/S0022-3956(02)00052-3">Around half</a> of all people diagnosed with insomnia also have an associated mental disorder. The most common ones associated with insomnia are depression, anxiety, bipolar disorder, post-traumatic stress disorder, and substance-related disorders.</p>
<p>We don’t (yet) know why we see such high levels of mental disorders in people with insomnia. But there are several leading theories, including:</p>
<ul>
<li><p>a <a href="https://doi.org/10.1038/s41588-018-0333-3">shared genetic risk</a> for insomnia and a mental disorder. In other words, some people’s genes may predispose them to both conditions</p></li>
<li><p>a <a href="https://doi.org/10.1038/nrn.2017.55">shared neurobiological</a> response. How the brain responds to sleep loss may be connected to how systems in the brain control cognition, emotion and reward. Disturbances of these brain functions are implicated in a range of mental disorders</p></li>
<li><p><a href="https://doi.org/10.3389/fpsyt.2020.00071">inflammation</a> and/or dysfunction of the immune system may underlie both insomnia and mental disorders.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-dangerous-is-insomnia-how-fear-of-what-its-doing-to-your-body-can-wreck-your-sleep-212248">How dangerous is insomnia? How fear of what it's doing to your body can wreck your sleep</a>
</strong>
</em>
</p>
<hr>
<h2>Which comes first?</h2>
<p>Further complicating the picture <a href="https://doi.org/10.1016/S2215-0366(20)30136-X">is evidence</a> showing insomnia can occur <em>before</em> someone develops a mental disorder, or <em>afterwards</em>. Researchers call this a “bidirectional” relationship.</p>
<p>We can’t say one causes the other. We can only say there is a clear link between them.</p>
<p>This link means diagnosis and treatment of one <a href="https://doi.org/10.1016/j.smrv.2021.101556">can have implications</a> for diagnosis and treatment of the other. For instance, if you don’t adequately treat insomnia, this can worsen symptoms of someone’s mental disorder, <a href="https://doi.org/10.31887/DCNS.2008.10.4/plfranzen">increasing</a> both the severity and risk of relapse.</p>
<p>A type of talking therapy known as cognitive behavioural therapy for insomnia (<a href="https://doi.org/10.1016/j.sleep.2017.03.017">CBTi</a>) aims to change the unhelpful thoughts, feelings, emotions and behaviours that contribute to insomnia. And, in many cases, successful treatment of insomnia with CBTi <a href="https://doi.org/10.1016/j.smrv.2022.101597">can also treat</a> someone’s mental disorder (and vice versa).</p>
<p>CBTi is particularly <a href="https://doi.org/10.1016/j.smrv.2022.101597">effective</a> at treating insomnia plus depression, substance use or post-traumatic stress disorder. But it is less effective at treating insomnia plus psychosis or bipolar disorder.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man having counselling or therapy, with therapist filling in questionnaire on clipboard" src="https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546880/original/file-20230907-25-hikaoh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fixing the sleep problem can often resolve the mental disorder (and vice versa).</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-patient-having-consultation-doctor-psychiatrist-731147215">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Filling the gaps</h2>
<p>There’s much we don’t know about the link between insomnia and mental disorders. Last year an international panel of experts <a href="https://wellcome.org/reports/sleep-circadian-rhythms-and-mental-health-advances-gaps-challenges-and-opportunities">outlined</a> the research needed to plug the knowledge gaps. Recommendations included:</p>
<ul>
<li><p>longer-term studies starting in childhood and adolescence that collect data on sleep and mental health using wearable or smartphone technologies. The aim is to provide more objective measurement of insomnia and mental health in these younger age groups, and to intervene early if needed</p></li>
<li><p>more studies involving people from <a href="https://doi.org/10.1038/466029a">diverse</a> social and cultural backgrounds. Sleep practices are often <a href="https://doi.org/10.3390/ijerph18042005">culturally-determined</a>. So researching diverse populations would provide a more comprehensive picture of insomnia and mental disorders</p></li>
<li><p>a greater recognition of people’s daytime behaviours and environmental exposures, and their contribution to insomnia and poorer mental health. This <a href="https://doi.org/10.3390/ijerph18126626">includes</a>, eating fast food, having disrupted sleep routines (for example, shift work) and using technology excessively.</p></li>
</ul>
<p>Results of this research will have profound implications for accurate diagnosis of both insomnia and mental disorders, and their treatment. The aim is to reduce <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/rise-and-try-to-shine-the-social-and-economic-costs-of-sleep-disorders">the burden</a> when these conditions occur together, both for <a href="https://www.health.gov.au/resources/publications/national-preventive-health-strategy-2021-2030">individuals and society</a> more broadly.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. <a href="https://www.sleephealthfoundation.org.au/sleep-categories/mental-health-sleep">Free information</a> about insomnia and mental health is available from the Sleep Health Foundation.</em></p><img src="https://counter.theconversation.com/content/212106/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Bullock receives funding from Australian Rotary Health and the Barbara Dicker Brain Sciences Foundation. He is a member of the Sleep Health Foundation.</span></em></p>Insomnia and mental disorders are inter-related in a way we’ve yet to fully understand. But treating one can often help the other.Ben Bullock, Senior Lecturer, Psychology, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2122482023-10-18T19:07:01Z2023-10-18T19:07:01ZHow dangerous is insomnia? How fear of what it’s doing to your body can wreck your sleep<figure><img src="https://images.theconversation.com/files/551962/original/file-20231004-15-pl3k0k.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-who-sees-smartphone-1656037894">Shutterstock</a></span></figcaption></figure><p><em>This article is the next in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>I (Leon) have recently seen several patients who were concerned their insomnia symptoms would increase their risk for dementia. They were in their 70s and were awakening two or three times a night, which they took to be insomnia. But they were not impaired in the daytime in a way typical of insomnia.</p>
<p>Their brief awakenings are normal for most people and <a href="https://theconversation.com/broken-sleep-its-a-rollercoaster-ride-1792">completely harmless</a>. Brief awakenings emerge from the periodic phases of light sleep that occur naturally between the four or five 90-minute deep sleep cycles. If you’re unaware of this “rollercoaster” of 90-minute cycles, you might think such awakenings are a sign of disease. In fact, they are perfectly normal and experienced more as people age when sleep naturally becomes lighter and shorter – <a href="https://theconversation.com/mondays-medical-myth-you-need-eight-hours-of-continuous-sleep-each-night-5643">with no ill effect</a>.</p>
<p>Therefore, I reassured them their sleep patters were normal and they did not have insomnia. This requires daytime impairments – fatigue, cognitive problems, mild depression, irritability, distress or anxiety – in addition to night time symptoms. </p>
<p>I trust they were reassured, and so they avoided the type of fear and worry that would have triggered a cascade of events leading to insomnia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/broken-sleep-its-a-rollercoaster-ride-1792">Broken sleep? It's a rollercoaster ride</a>
</strong>
</em>
</p>
<hr>
<h2>Is it really insomnia?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C561&q=45&auto=format&w=1000&fit=clip"><img alt="Older Asian woman awake in bed, alarm clock at about 3.30am" src="https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C561&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551954/original/file-20231004-29-dliczq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Reading about the health risks of insomnia can keep you up at night.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/60s-70s-asian-senior-woman-having-1180245385">Shutterstock</a></span>
</figcaption>
</figure>
<p>So where did my patients get the notion their sleep symptoms could lead to dementia? Let’s pick apart this tsunami of alarming information.</p>
<p>It usually starts with very <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1623-0">large surveys</a> that find a statistically significant relationship between measures of sleep problems and subsequently developing dementia. </p>
<p>First, most of these studies ask participants to report how long they typically sleep. Those reporting less than six hours a night show a small but statistically elevated risk of developing dementia.</p>
<p>These studies do not say if people have clinical insomnia diagnosed by a health professional. Instead they rely solely on participants guessing how long they’ve slept, which <a href="https://academic.oup.com/sleep/article/25/5/559/2750164?login=false">can be inaccurate</a>.</p>
<p>The studies would have also included many people without insomnia who are not allowing themselves adequate opportunity for sleep. Perhaps they’d been in the habit of socialising or playing computer games late at night.</p>
<p>In other words, we don’t know what proportion of these short-sleepers are simply over-estimating their sleep problems, or restricting their sleep and experiencing chronic sleep loss rather than insomnia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-it-possible-to-catch-up-on-sleep-we-asked-five-experts-98699">Is it possible to catch up on sleep? We asked five experts</a>
</strong>
</em>
</p>
<hr>
<h2>What do the numbers really mean?</h2>
<p>A second problem is with interpreting the meaning of “statistically significant”. This only means the results were unlikely to be due to pure chance. If a single study shows a 20% increased risk of a physical health problem associated with insomnia, how worried should we be? This single finding does not necessarily mean it’s worth considering in our everyday lives.</p>
<p>Studies relating insomnia to health risks are also typically inconsistent. For example, although some studies have found small increases in dementia risk with having insomnia, a very <a href="https://mentalhealth.bmj.com/content/ebmental/26/1/e300719.full.pdf">large UK study</a> did not find any relationship between the amount of sleep or sleeping difficulties and dementia risk.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/study-links-insomnia-with-increased-heart-failure-risk-12659">Study links insomnia with increased heart failure risk</a>
</strong>
</em>
</p>
<hr>
<h2>What’s the context?</h2>
<p>A third problem is communicating a balanced perspective to the public about the potential dangers of insomnia. Some in the mainstream media, with the help of the researcher’s institution, will report on studies showing a statistically significant increase in the risk of a frightening disease, such as dementia. </p>
<p>But <a href="https://theconversation.com/essays-on-health-reporting-medical-news-is-too-important-to-mess-up-68920">not all media reports</a> ask about how clinically meaningful the risk is, whether there are alternative explanations, or how this result compares with what other researchers have found. So the public is left with no context to temper the scary, “increased risk” narrative. This narrative is then shared on social media, amplifying the scary finding.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man on laptop, at desk, at home" src="https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551960/original/file-20231004-27-rbqhx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scary headlines about the health impacts of insomnia don’t always reflect the actual risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-working-laptop-home-old-1212903190">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-reporting-medical-news-is-too-important-to-mess-up-68920">Essays on health: reporting medical news is too important to mess up</a>
</strong>
</em>
</p>
<hr>
<h2>Obesity, diabetes, high blood pressure</h2>
<p>We’ve used dementia as one example of how fears about potential risks to physical health from insomnia arise and are magnified. But we could have used a potential increased risk of obesity, diabetes or high blood pressure. All have been associated with shorter sleep, but researchers are debating whether these links are real, meaningful or related to insomnia.</p>
<p>When we looked at the impact of sleep problems on life expectancy, we found <a href="https://pubmed.ncbi.nlm.nih.gov/30529432/">no evidence</a> sleep symptoms alone shorten your life. Only when daytime symptoms such as fatigue, memory problems and distress are included is there a <a href="https://www.nature.com/articles/s41598-023-36016-4">small increased risk</a> of dying prematurely. However, it’s difficult to know if that excess mortality can be explained by undiagnosed heart, kidney, liver or brain disease causing those daytime symptoms.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-picking-your-nose-really-increase-your-risk-of-dementia-193463">Does picking your nose really increase your risk of dementia?</a>
</strong>
</em>
</p>
<hr>
<h2>We should be talking about mental health</h2>
<p>However, there is stronger evidence of increased <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental health</a> problems, especially depression, with insomnia.</p>
<p>The typical daytime impairments of fatigue, distress, cognitive impairments and irritability certainly lower the quality of life. Life becomes more of a challenge and less enjoyable. Over time, this can trigger <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">hopelessness and depression</a> in some people. This is enough reason to seek help to improve sleep and quality of life. </p>
<p>People with these problems should seek help from a health practitioner. The good news is there is an effective, long-term, non-drug treatment with no side effects – cognitive behavioural therapy for insomnia <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-13-40">or CBTi</a>. Even better, successful CBTi also <a href="https://www.sciencedirect.com/science/article/abs/pii/S1389945720303828">decreases</a> symptoms of depression and other mental distress.</p>
<p>What is not helpful is unnecessary fear triggered by reports suggesting serious physical health dangers of insomnia. This fear is only likely to increase insomnia rather than mitigate it.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/212248/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leon Lack received funding from the National Health and Medical Research Council (Australia) and the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Nicole Lovato receives funding from the National Health and Medical Research Council, the Australian Research Council and the Hospital Research Foundation. </span></em></p>Many studies showing an impact of insomnia on the body are flawed or not meaningful in everyday life. But they can lead to scary headlines.Leon Lack, Emeritus Professor of Psychology, Adelaide Institute for Sleep Health, Flinders UniversityNicole Lovato, Associate Professor, Adelaide Institute for Sleep Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118232023-10-10T19:04:39Z2023-10-10T19:04:39ZWhat’s insomnia like for most people who can’t sleep? You’d never know from the movies<figure><img src="https://images.theconversation.com/files/547965/original/file-20230913-15-x9hiii.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-watching-movie-on-tv-2280957353">Shutterstock</a></span></figcaption></figure><p><em>This article is part of The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>Hollywood appears fascinated by sleep’s impact on the mind and body.
Blockbuster movies featuring someone living with insomnia include <a href="https://www.imdb.com/title/tt0108160/">Sleepless in Seattle</a> (1993), <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> (1999) and <a href="https://www.imdb.com/title/tt0278504/?ref_=fn_al_tt_1">Insomnia</a> (2002). </p>
<p>But how well do these and other portrayals compare with what it’s really like to live with insomnia?</p>
<p>As we’ll see, most movies tend to either minimise or exaggerate symptoms. Insomnia is rarely depicted as a treatable illness. And these portrayals have implications for the estimated <a href="https://www.sleep.theclinics.com/article/S1556-407X(22)00022-4/fulltext">one in three</a> of us with at least one insomnia symptom.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>Back in the real world</h2>
<p>Insomnia is a common <a href="https://doi.org/10.1378/chest.14-0970">sleep disorder</a> where a person struggles to fall asleep, stay asleep, or wakes up too early – despite having adequate opportunity for sleep. </p>
<p><a href="https://doi.org/10.1111/j.1753-6405.2012.00845.x">Around 5%</a> of adults experience significant insomnia to the degree that it causes distress or impairs daily life.</p>
<p>It’s a common misconception that insomnia is only a night-time issue. <a href="https://www.healthdirect.gov.au/insomnia">Insomnia</a> can impact your ability to stay awake and alert during the day. It can also affect your <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental health</a>.</p>
<p>At work, you might be more prone to accidents, more forgetful, or make poorer decisions. At home, you might be irritable or short with your friends and family.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1678293771539161089"}"></div></p>
<p>So what is it like living with insomnia? Apart from the effects of poor sleep quality, many people experience <a href="https://doi.org/10.1016/j.smrv.2021.101583">anxiety or dread</a> about the night ahead from the moment they wake up. From early in the day, people plan how they can improve their sleep that night.</p>
<p><a href="https://doi.org/10.1016/j.smrv.2016.01.003">A review</a> found
people living with insomnia felt their sleep concerns were often trivialised or misunderstood by health-care professionals, and stigmatised by others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-memoir-of-sleeplessness-posits-making-peace-with-our-ruptured-nights-but-risks-becoming-an-exhausting-read-209496">A memoir of sleeplessness posits making peace with our ruptured nights – but risks becoming an exhausting read</a>
</strong>
</em>
</p>
<hr>
<h2>Movies can minimise symptoms …</h2>
<p>Nicholas Galitzine’s character in the recent romcom <a href="https://www.imdb.com/title/tt10172266/?ref_=fn_al_tt_1">Red, White and Royal Blue</a> (2023) has insomnia. We’re briefly told he struggles to fall asleep at night. However, we never see any meaningful impact on his life or depiction of the difficulty living with insomnia entails.</p>
<p>That said, minimising the impact of insomnia can have benefits. It shows insomnia is an invisible illness, doesn’t have obvious visual symptoms and anyone can have it. </p>
<p>But this can perpetuate the expectation someone with insomnia should be able to function unencumbered. Or it can fuel the misconception having insomnia may be beneficial, as in <a href="https://www.imdb.com/title/tt0050543/?ref_=fn_al_tt_1">Insomnia Is Good for You</a> (1957).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gay-guys-can-do-missionary-how-red-white-and-royal-blue-brings-queer-intimacy-to-mainstream-audiences-211663">'Gay guys can do missionary?' - how Red, White & Royal Blue brings queer intimacy to mainstream audiences</a>
</strong>
</em>
</p>
<hr>
<h2>… or exaggerate symptoms</h2>
<p>But most Hollywood portrayals of insomnia tend to depict the most extreme cases. These usually feature insomnia as a symptom of another condition rather than a disorder itself, as is commonly experienced.</p>
<p>These movies tend to be psychological thrillers. Here, insomnia is often used as an enigma to keep the audience guessing about which events are real or figments of a character’s imagination.</p>
<p>Take <a href="https://www.imdb.com/title/tt0361862/?ref_=fn_al_tt_1">The Machinist</a> (2004), for example. The main character is emaciated, ostracised and plagued by paranoia, hallucinations and delusions. It’s only towards the end of the movie we learn his insomnia may be the result of a <a href="https://doi.org/10.9740/mhc.n101819">psychiatric disorder</a>, such as post-traumatic stress disorder.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/-R4rQMImHwE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In The Machinist, the main character has paranoia, hallucinations and delusions.</span></figcaption>
</figure>
<p>Hollywood’s focus on extreme cases of insomnia is a recurring pattern (for instance, <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> 1999, <a href="https://www.imdb.com/title/tt0434165/?ref_=fn_al_tt_3">Lucid</a> 2005).</p>
<p>It’s understandable why Hollywood latches onto these extreme portrayals – to entertain us. Yet these portrayals of insomnia as something more severe or threatening, like psychosis, can increase anxiety or stigma among people living with insomnia.</p>
<p>While it’s true other medical conditions including <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental illnesses</a> can lead to insomnia, insomnia often exists on its own. Insomnia is often <a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">caused by</a> more mundane things like too much stress, lifestyle and habits, or longer daylight hours at higher latitudes (such as in <a href="https://www.imdb.com/title/tt0278504/?ref_=fn_al_tt_1">Insomnia</a>, 2002).</p>
<p>Something these exaggerated portrayals do well is highlight the impact sleep deprivation can have on safety, albeit extremely dramatised. Regardless of profession, <a href="https://doi.org/10.1037/xge0000717">not getting enough sleep</a> at night can substantially impact cognitive function, increasing the chance of making a mistake.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/emIHzg4VH8A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In Insomnia, one character has insomnia because of extended daylight hours.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<h2>Movies rarely depict treatment</h2>
<p>It is rare to see insomnia depicted as a health condition requiring medical care. Very few characters struggling with insomnia seek or receive help for it. </p>
<p>An exception is the narrator in <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> (1999). But he has to pretend to have other illnesses to receive therapy, again suggesting insomnia is not a legitimate condition.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/BdJKm16Co6M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The narrator in Fight Club pretends to have other illnesses to receive therapy for insomnia.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">Explainer: what is insomnia and what can you do about it?</a>
</strong>
</em>
</p>
<hr>
<h2>Why does accurate representation matter?</h2>
<p>Many people only learn about the symptoms and impact of sleep disorders through pop culture and film. These portrayals can affect how others think about these disorders and can impact how people living with these disorders think about themselves.</p>
<p>Uniform and stereotypical portrayals of insomnia can also impact people’s <a href="https://doi.org/10.1080/15402002.2011.620671">likelihood of seeking help</a>.</p>
<p>Most of these films show young or middle-aged men experiencing insomnia. Yet women are <a href="https://doi.org/10.1093/sleep/29.1.85">more likely</a> to have insomnia than men. Insomnia is also <a href="https://doi.org/10.1016/j.jsmc.2022.03.003">more common</a> in older adults, people with a lower socioeconomic background and those living alone. People at higher risk of developing insomnia might not recognise their risk or symptoms if their experience doesn’t match what they’ve seen.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hallucinations-in-the-movies-tend-to-be-about-chaos-violence-and-mental-distress-but-they-can-be-positive-too-204547">Hallucinations in the movies tend to be about chaos, violence and mental distress. But they can be positive too</a>
</strong>
</em>
</p>
<hr>
<h2>We can do better</h2>
<p>While the reality of living with insomnia may not be particularly cinematic, filmmakers can surely do better than using it as a convenient plot point. </p>
<p>There are a number of main characters living with different health conditions across pop culture. For instance, the movie <a href="https://www.imdb.com/title/tt4034228/">Manchester by the Sea</a> (2016) features someone with <a href="https://www.rcpsych.ac.uk/news-and-features/blogs/detail/cultural-blog/2017/07/08/manchester-by-the-sea">prolonged grief disorder</a> and the TV series <a href="https://www.imdb.com/title/tt6315640/?ref_=nv_sr_srsg_0_tt_8_nm_0_q_Atypical">Atypical</a> (2017-2021) features someone’s experience living with autism.</p>
<p>But if you’re looking for an accurate portrayal of insomnia, Hollywood still has some way to go. It’s about time insomnia is depicted in a way that accurately reflects people’s experiences.</p><img src="https://counter.theconversation.com/content/211823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aaron Schokman is a member of the Sleep Health Foundation’s Consumer Reference Council </span></em></p><p class="fine-print"><em><span>Nick Glozier has received funding from the Australian Research Council and NHRMC for sleep health research, consults to organisations that provide digital and pharmacological insomnia treatments, and has IP in a sleep app.</span></em></p>Most movies tend to minimise or exaggerate insomnia symptoms. Insomnia is also rarely depicted as an illness that can be treated.Aaron Schokman, PhD Candidate, University of SydneyNick Glozier, Professor of Psychological Medicine, BMRI & Disciplne of Psychiatry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117292023-10-09T19:19:19Z2023-10-09T19:19:19ZA short history of insomnia and how we became obsessed with sleep<figure><img src="https://images.theconversation.com/files/544431/original/file-20230824-23-3k83z1.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/statue-gold-sleep-mask-gypsum-david-1909455499">Shutterstock</a></span></figcaption></figure><p><em>This article is the first in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>French author Marie Darrieussecq writes in her 2023 memoir <a href="https://www.textpublishing.com.au/books/sleepless-a-memoir-of-insomnia">Sleepless</a>:</p>
<blockquote>
<p>The world is divided into those who can sleep and those who can’t. </p>
</blockquote>
<p>It’s a big call. But insomnia is <a href="https://pubmed.ncbi.nlm.nih.gov/29916377/">a well-recorded</a> preoccupation in history. It <a href="https://doi.org/10.5664/jcsm.26929">includes</a> difficulty falling asleep, or staying asleep, and comes with daytime distress and anxiety. </p>
<p>There are <a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">many, varied reasons</a> why people have insomnia. These include biological changes <a href="https://pubmed.ncbi.nlm.nih.gov/32469116/">as we age</a> or because of <a href="https://journals.healio.com/doi/10.3928/00485713-20191106-04">our hormones</a>, physical or mental health issues, the medicines we take, as well as how and where we live and work.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">Explainer: what is insomnia and what can you do about it?</a>
</strong>
</em>
</p>
<hr>
<h2>Insomnia is a form of torture</h2>
<p>Sleep deprivation is literally a <a href="https://www.psychologytoday.com/au/blog/dreaming-in-the-digital-age/201412/why-sleep-deprivation-is-torture">form of torture</a>. Roman consul Marcus Atilius Regulus is allegedly the first person in recorded history to <a href="https://alextardiff.wordpress.com/2010/02/26/marcus-atilius-regulus-a-historiography-and-transformation-from-roman-history-to-legend/">die of insomnia</a>.</p>
<p>In about 256 BCE he was handed over to Rome’s enemies, the Carthaginians, who apparently tortured him to death. They did this by amputating his eyelids and forcing him to stare at the Sun.</p>
<p>As horrible as this sounds, the legend doesn’t stand up. There are <a href="https://www.cambridge.org/core/journals/harvard-theological-review/article/convicts-gibbet-and-the-victors-car-the-triumphal-death-of-marcus-atilius-regulus-and-the-background-of-col-215/A24256342370590EF069DBDDEB796E9F#">no reliable accounts</a> of how Regulus died. But even though sleep-deprivation torture may not have killed Regulus, it continues to be used <a href="https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=3927&context=mlr">in many countries</a> today.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Regulus Returning to Carthage" src="https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=629&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=629&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=629&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Legend has it that Roman consul Regulus died of insomnia. But the evidence doesn’t stack up.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Lens,_Cornelis_-_Regulus_Returning_to_Carthage_-_1791.jpg">Andries Cornelis Lens/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>One of the best early descriptions of insomnia is by English clergyman Robert Burton in his book <a href="https://www.bl.uk/collection-items/burtons-anatomy-of-melancholy-1628">The Anatomy of Melancholy</a> (1628). </p>
<p>Burton knew insomnia was both a <a href="https://royalsocietypublishing.org/doi/10.1098/rsfs.2019.0087">cause and a symptom of depression</a>. He also recommended avoiding eating cabbage, which “<a href="https://royalsocietypublishing.org/doi/10.1098/rsfs.2019.0087">causeth troublesome dreams</a>” and not going to bed straight after eating the evening meal. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">Explainer: what's the link between insomnia and mental illness?</a>
</strong>
</em>
</p>
<hr>
<h2>Then came industrialisation</h2>
<p>But we need to look at industrialisation – when a country moves from mostly farming to mostly manufacturing using machinery – for clues to the level of insomnia we see in Western nations today. </p>
<p>In countries without industrialisation, insomnia is quite rare. Only <a href="https://pubmed.ncbi.nlm.nih.gov/29916377/">around 1-2%</a> of the population will experience it. Compare this with modern United Kingdom, where the estimated insomnia rates are <a href="https://doi.org/10.1111/1467-9566.12820">10-48%</a>, depending on the study. A 2021 report said <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">14.8% of Australians</a> had symptoms meeting criteria for chronic (long-term) insomnia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Powerloom weaving in 1835" src="https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The shift to working in factories using machines also shifted our sleep habits.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Powerloom_weaving_in_1835.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>As Western countries modernised, things we now associate with insomnia became part of people’s lives. These include <a href="https://doi.org/10.1093/sleep/zsac104">artificial lighting</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/16793001/">clocks</a>. There was also more <a href="https://academic.oup.com/sleep/article/40/2/zsw055/2662183">ambient noise</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/31828298/">changes in diet</a> and <a href="http://dx.doi.org/10.1136/oem.2003.011379">housing</a>. So our <a href="https://theconversation.com/did-we-used-to-have-two-sleeps-rather-than-one-should-we-again-57806">sleep habits shifted</a> as a result of this new way of living and working.</p>
<p>At around the same time, the Enlightenment era of flourishing new sciences in the late 18th century gave us the term “<a href="https://royalsocietypublishing.org/doi/10.1098/rsfs.2019.0074">insomnia</a>” and where there is “insomnia”, there must be “insomniacs”. So “insomniacs” became a diagnostic term for people struggling with sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-we-used-to-have-two-sleeps-rather-than-one-should-we-again-57806">Did we used to have two sleeps rather than one? Should we again?</a>
</strong>
</em>
</p>
<hr>
<h2>The 19th and 20th centuries</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hospital ward for insomniacs (1910),G.E. Studdy" src="https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=868&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=868&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=868&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1090&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1090&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1090&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This 1910 cartoon plays on our long-held quest for sleep.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/egb89yd4/images?id=dwsz6qh9">Wellcome Collection</a></span>
</figcaption>
</figure>
<p>Medical cures for insomnia began to spread – some of them probably effective. </p>
<p>For example, in the 19th century Grimault & Co’s “<a href="https://www.pointshistory.com/post/a-sovereign-remedy-grimault-co-s-asthma-cigarette-empire">Indian Cigarettes</a>” were advertised in <a href="https://trove.nla.gov.au/newspaper/article/63619299?searchTerm=insomnia%20grimault">Australia</a>. They contained cannabis.</p>
<p>The 19th century was also the birthplace of modern medical ideas about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610616/">anxiety</a>, which we now know can <a href="https://www.sleepfoundation.org/mental-health/anxiety-and-sleep">cause</a> insomnia.</p>
<p>Romanian philosopher Emil Cioran (1911-1995) had <a href="https://partiallyexaminedlife.com/2020/08/14/the-influence-of-insomnia-on-the-life-and-work-of-emil-cioran/">chronic insomnia</a>. His 1934 book <a href="https://press.uchicago.edu/ucp/books/book/chicago/O/bo3620043.html">On the Heights of Despair</a> (the title speaks for itself) describes the loneliness and isolation of insomnia – the feeling of being cut off from the rest of humanity. </p>
<p>So many famous modern writers and artists had insomnia that it’s now <a href="https://digitalcommons.uri.edu/cgi/viewcontent.cgi?article=1324&context=oa_diss">almost a cliche</a>. <a href="https://www.washingtonexaminer.com/weekly-standard/victor-hugo-alas">Victor Hugo</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29982086/">Franz Kafka</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26459675/">Marcel Proust</a> and <a href="https://archive.nytimes.com/opinionator.blogs.nytimes.com/2010/02/25/a-thousand-and-one-sleepless-nights/#:%7E:text=In%20Ernest%20Hemingway's%20short%20story,bed%20with%20the%20lights%20out.">Ernest Hemingway</a> all struggled with sleeplessness. </p>
<p>In Hemingway’s short story <a href="https://muse.jhu.edu/article/440974/summary">Now I Lay Me</a>, his soldier narrator and alter ego says:</p>
<blockquote>
<p>I myself did not want to sleep because I had been living for a long time with the knowledge that if I ever shut my eyes in the dark and let myself go, my soul would go out of my body.</p>
</blockquote>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bottle for Veronal crystals" src="https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=826&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=826&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=826&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1038&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1038&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1038&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Veronal was one of a range of new drugs that promised easy sleep.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/zyxns96e/images?id=wkj5h9yz">Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>It’s also no coincidence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/">the first barbiturate drugs</a> were discovered in this era. Barbital, <a href="https://www.drugfoundation.org.nz/matters-of-substance/archive/august-2016/veronal-who-remembers-veronal/">marketed as Veronal</a>, was just <a href="https://doi.org/10.1002/dta.301">one of a range of new drugs</a> that promised easy sleep to those who struggled. </p>
<p>These drugs made people relaxed and sleepy by switching on the <a href="https://doi.org/10.1111/epi.12025">body’s gamma-aminobutyric acid (GABA) system</a>. This part of our nervous system works to inhibit processes in the body that would otherwise keep us awake. But these drugs can inhibit these processes too much. Suicides and accidental deaths by sleeping pill overdose became <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760168/">sadly common</a> in the following decades.</p>
<p>The famous home encyclopedia <a href="https://books.google.com.au/books/about/Enquire_Within_Upon_Everything.html?id=cW5FAQAAMAAJ&redir_esc=y">Enquire Within Upon Everything</a> provided a scientific-sounding cure for insomnia:</p>
<blockquote>
<p>Nervous persons, who are troubled with wakefulness and excitability, usually have a strong tendency of blood on the brain, with cold extremities. The pressure of the blood on the brain keeps it in a stimulated or wakeful state […] rise and chafe the body and extremities with a brush or towel, or rub smartly with the hands to promote circulation, and withdraw the excessive amount of blood from the brain, and they will fall asleep in a few moments. A cold bath, or a sponge bath and rubbing […] will aid in equalising circulation and promoting sleep.</p>
</blockquote>
<p>Now, “<a href="https://www.sleepfoundation.org/sleep-hygiene">sleep hygiene</a>” means something different to taking a cold bath. It’s the process of quieting your body and mind before bedtime.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<h2>Which brings us to today</h2>
<p>In the 21st century, Western living has added two new sleep disturbers to the mix. We drink huge amounts of <a href="https://doi.org/10.1016/j.envpol.2019.113343">caffeine</a>. We also go to bed with handheld devices – with their <a href="https://amerisleep.com/blog/future-of-sleep/">bright lights</a> and <a href="https://doi.org/10.1016/j.isci.2021.102497">constant dopamine hits</a> that stimulate us and stop us sleeping.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1679239587393306624"}"></div></p>
<p>Our problems with insomnia show no signs of going away. This is partly because our economy is increasingly organised around sleep-depriving work. In the United States, production workers are the <a href="https://www.sleepadvisor.org/sleep-deprivation-by-profession/">most likely to</a> have sleep disorders, possibly because of shift work. In the United Kingdom, professional soccer players are <a href="https://www.spectator.co.uk/article/the-premier-leagues-sleeping-pill-problem/">over-using sleeping drugs</a> to help them wind down after the adrenaline rush of a game.</p>
<p>In Australia, the financial cost of poor sleep is an estimated <a href="https://treasury.gov.au/sites/default/files/2019-03/360985-Sleep-Health-Foundation-and-Australasian-Sleep-Association.pdf">A$26 billion a year</a>, mainly through lost productivity or accidents. This means there’s a good financial incentive to address the problem.</p>
<p>And if the global <a href="https://www.alliedmarketresearch.com/insomnia-market">insomnia market</a> is anything to go by, insomnia is big business and getting bigger. This is projected to reach US$6.3 billion by 2030, largely driven by increased diagnoses and therapy, as well as the use of sleep aids, such as <a href="https://theconversation.com/is-tracking-your-sleep-a-good-idea-190231">sleep apps</a>.</p><img src="https://counter.theconversation.com/content/211729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippa Martyr does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Insomnia is torture, literally, and getting enough sleep a modern obsession. Here’s why.Philippa Martyr, Lecturer, Pharmacology, Women's Health, School of Biomedical Sciences, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2131452023-09-25T01:41:27Z2023-09-25T01:41:27ZDo blue-light glasses really work? Can they reduce eye strain or help me sleep?<figure><img src="https://images.theconversation.com/files/549203/original/file-20230919-25-ucj5dq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-womans-eyes-stress-blue-blocking-1391138681">Shutterstock</a></span></figcaption></figure><p>Blue-light glasses are said to <a href="https://www.baxterblue.com.au/collections/blue-light-glasses">reduce eye strain</a> when using <a href="https://www.blockbluelight.com.au/collections/computer-glasses">computers</a>, improve your <a href="https://www.ocushield.com/products/anti-blue-light-glasses">sleep</a> and protect your eye health. You can buy them yourself or your optometrist can prescribe them.</p>
<p>But <a href="https://mivision.com.au/2019/03/debate-continues-over-blue-blocking-lenses/">do they work</a>? Or could they do you harm?</p>
<p>We <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013244.pub2/full">reviewed</a> the evidence. Here’s what we found.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-will-i-damage-my-eyes-if-i-dont-wear-sunglasses-68582">Health Check: will I damage my eyes if I don't wear sunglasses?</a>
</strong>
</em>
</p>
<hr>
<h2>What are they?</h2>
<p>Blue-light glasses, blue light-filtering lenses or blue-blocking lenses are different terms used to describe lenses that reduce the amount of short-wavelength visible (blue) light reaching the eyes. </p>
<p>Most of these lenses prescribed by an optometrist decrease blue light transmission by <a href="https://onlinelibrary.wiley.com/doi/10.1111/opo.12615">10-25%</a>. Standard (clear) lenses do not filter blue light.</p>
<p>A wide variety of lens products are available. A filter can be added to prescription or non-prescription lenses. They are widely marketed and are becoming <a href="https://onlinelibrary.wiley.com/doi/10.1111/opo.12615">increasingly popular</a>.</p>
<p>There’s often an added cost, which depends on the specific product. So, is the extra expense worth it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-eye-disorders-may-have-influenced-the-work-of-famous-painters-92830">How eye disorders may have influenced the work of famous painters</a>
</strong>
</em>
</p>
<hr>
<h2>Blue light is all around us</h2>
<p>Outdoors, sunlight is the main source of blue light. Indoors, light sources – such as light-emitting diodes (LEDs) and the screens of digital devices – emit varying degrees of blue light. </p>
<p>The amount of blue light emitted from artificial light sources is much lower than from the Sun. Nevertheless, artificial light sources are all around us, at home and at work, and we can spend a lot of our time inside.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Blue light-filtering lenses block some blue light from screens from reaching the eye" src="https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549210/original/file-20230920-16-tsb23b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Screens emit blue light. The lenses are designed to reduce the amount of blue light that reaches the eye.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/blue-light-blocking-ray-filter-lens-2286229107">Shutterstock</a></span>
</figcaption>
</figure>
<p>Our research team at the University of Melbourne, along with collaborators from Monash University and City, University London, sought to see if the best available evidence supports using blue light-filtering glasses, or if they could do you any harm. So we conducted a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013244.pub2/full">systematic review</a> to bring together and evaluate all the relevant studies. </p>
<p>We included all randomised controlled trials (clinical studies designed to test the effects of interventions) that evaluated blue light-filtering lenses in adults. We identified 17 eligible trials from six countries, involving a total of 619 adults.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-my-treatment-work-how-major-medical-reviews-can-be-gold-standard-evidence-yet-flawed-205014">Does my treatment work? How major medical reviews can be 'gold standard' evidence, yet flawed</a>
</strong>
</em>
</p>
<hr>
<h2>Do they reduce eye strain?</h2>
<p>We found no benefit of using blue light-filtering lenses, over standard (clear) lenses, to reduce eye strain with computer use. </p>
<p>This conclusion was based on consistent findings from three studies that evaluated effects on eye strain over time periods ranging from two hours to five days.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/screentime-can-make-you-feel-sick-here-are-ways-to-manage-cybersickness-163851">Screentime can make you feel sick – here are ways to manage cybersickness</a>
</strong>
</em>
</p>
<hr>
<h2>Do they help you sleep?</h2>
<p>Possible effects on sleep were uncertain. Six studies evaluated whether wearing blue-light filtering lenses before bedtime could improve sleep quality, and the findings were mixed. </p>
<p>These studies involved people with a diverse range of medical conditions, including insomnia and bipolar disorder. Healthy adults were not included in the studies. So we do not yet know whether these lenses affect sleep quality in the general population.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1678293771539161089"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/booting-up-or-powering-down-how-e-readers-affect-your-sleep-36145">Booting up or powering down: how e-readers affect your sleep</a>
</strong>
</em>
</p>
<hr>
<h2>Do they boost your eye health?</h2>
<p>We did not find any clinical evidence to support using blue-light filtering lenses to protect the macula (the region of the retina that controls high-detailed, central vision). </p>
<p>None of the studies evaluated this.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/macular-diseases-cause-blindness-and-treatment-costs-millions-here-is-how-to-look-after-yours-196796">Macular diseases cause blindness and treatment costs millions. Here is how to look after yours</a>
</strong>
</em>
</p>
<hr>
<h2>Could they do harm? How about causing headaches?</h2>
<p>We could not draw clear conclusions on whether there might be harms from wearing blue light-filtering lenses, compared with standard (non blue-light filtering) lenses. </p>
<p>Some studies described how study participants had headaches, lowered mood and discomfort from wearing the glasses. However, people using glasses with standard lenses reported similar effects.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-causes-headaches-42254">Health Check: what causes headaches?</a>
</strong>
</em>
</p>
<hr>
<h2>What about other benefits or harms?</h2>
<p>There are some important general considerations when interpreting our findings. </p>
<p>First, most of the studies were for a relatively short period of time, which limited our ability to consider longer-term effects on vision, sleep quality and eye health. </p>
<p>Second, the review evaluated effects in adults. We don’t yet know if the effects are different for children.</p>
<p>Finally, we could not draw conclusions about the possible effects of blue light-filtering lenses on many vision and eye health measures, including colour vision, as the studies did not evaluate these.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-are-people-colour-blind-107599">Curious Kids: why are people colour blind?</a>
</strong>
</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>Overall, based on relatively limited published clinical data, our review does not support using blue-light filtering lenses to reduce eye strain with digital device use. It is unclear whether these lenses affect vision quality or sleep, and no conclusions can be drawn about any potential effects on the health of the retina. </p>
<p>High-quality research is needed to answer these questions, as well as whether the effectiveness and safety of these lenses varies in people of different ages and health status.</p>
<p>If you have eye strain, or other eye or vision concerns, discuss this with your optometrist. They can perform a thorough examination of your eye health and vision, and discuss any relevant treatment options.</p><img src="https://counter.theconversation.com/content/213145/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the past three years, Laura Downie's research laboratory at the University of Melbourne has received funding from Alcon Laboratories, Azura Ophthalmics, CooperVision and Novartis for clinical research studies unrelated to this article. She is affiliated with the Tear Film and Ocular Surface Society, as a global ambassador.</span></em></p>They’re heavily promoted. Your optometrist may even prescribe them. But when we looked at the evidence, this is what we found.Laura Downie, Associate Professor in Optometry and Vision Sciences, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2094962023-09-12T04:39:12Z2023-09-12T04:39:12ZA memoir of sleeplessness posits making peace with our ruptured nights – but risks becoming an exhausting read<figure><img src="https://images.theconversation.com/files/544944/original/file-20230828-188700-5uoiq9.jpg?ixlib=rb-1.1.0&rect=59%2C47%2C7880%2C4261&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Annie Spratt/unsplash</span></span></figcaption></figure><p>My relationship with sleep is fraught. For me, the journey towards sleep is a precarious one, relying on a shifting portfolio of mental states, and an irritating need for silence.</p>
<p>When I finally sink into oblivion, my rest can be shattered by the sound of my partner breathing, or a hoon tearing down the road at the top of our driveway. Once broken, sleep lies around me in sharp, little pieces, jabbing with the promise of a difficult day ahead.</p>
<hr>
<p><em>Review: Sleepless: A Memoir of Insomnia – Marie Darrieussecq (Text Publishing)</em></p>
<hr>
<p>When did this start? Was it the heated anxiety of menopause, the interrupted nights of early motherhood, the wide-awake longing for home after moving halfway round the world? When did sleep become so elusive? </p>
<p>I became sensitive to noise in London. I was a music journalist in the 1990s, but sometimes even <em>I</em> needed to sleep and this could be hard with paper-thin walls and drunken neighbours. But did the trouble start even earlier, in adolescence or childhood, I wonder, remembering the volatility in my first home. Did I ever sleep like a baby, even when I was one? </p>
<p>In her new book, <a href="https://www.textpublishing.com.au/books/sleepless-a-memoir-of-insomnia">Sleepless: A Memoir of Insomnia</a>, French writer Marie Darrieussecq embarks on a similar investigation into her own struggle with sleep. Through a hybrid of personal narrative and meditative essays, Darrieussecq contemplates the curse of insomnia with unusual scope. But while she writes like a dream, her work is thrown out of joint by its ambitious scale. Her exhaustive project risks becoming an exhausting read.</p>
<p>Beginning with a tour of literary perspectives and a brief history of barbiturates, Darrieussecq examines the connection between creativity and hyper-vigilance. </p>
<p>Proust and Kafka lead the canon here, and the stories of addiction to <a href="https://en.wikipedia.org/wiki/Barbital">Veronal</a> (a powerful barbiturate) and accidental overdose are both fascinating and shocking. But the references rush in thick and fast, and I struggle to keep pace. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">How do I stop my mind racing and get some sleep?</a>
</strong>
</em>
</p>
<hr>
<h2>A global industry</h2>
<p>The hunt for sleep has become a global industry. Psychologists, doctors, yoga teachers, meditation and breath-work practitioners ply us with sleep apps, mindfulness routines, prescription drugs and natural remedies. Columns and articles clog up the media with tips on How To Sleep, recycling age-old advice in jazzed-up terminology. </p>
<p>At least we have something to occupy us in the small hours.</p>
<p>Herbal teas and melatonin help me drift off, but when I wake up at 2am or 3am, resignation and a book work best. According to my London herbalist, the trick is to break the pattern. With this in mind, he once prescribed me <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621465/">datura</a> a potentially deadly narcotic. Entranced, I left his basement practice with strict instructions and a tiny dark glass bottle. I felt like Alice in Wonderland. It worked, but only for a while. </p>
<p>Perhaps my own struggles with sleep are why no matter how much I appreciate the scholarship of Darrieussecq’s impressive project, I’m most interested in her personal quest. Her desperate encounters with pharmacology, alcohol, and eventually a somnologist (sleep psychiatrist) are the ones that resonate. The love and torture of childbirth and breastfeeding, the problem of the study-bedroom, the relentlessness of the 4.04am waking hour, all have me bristling with recognition and relief. </p>
<p>I Google one of the alluring sleep aids she describes, I’m curious about the sleep test, a polysomnographic examination which involves being fitted with a network of electrodes by a sleep technician, and I’m moved by her account of her addiction to sleeping pills. But these personal vignettes are brief. She opens up pockets of her life, only to shut them back down again, leaving me intrigued and a little dissatisfied.</p>
<p>I want to know more about her childhood, about being born in the years after her brother who did not survive. I wonder if her mother was unable to sleep, due to grief and fear of losing another baby. There doesn’t seem to be an endpoint to this story, which I don’t mind at all because that’s the whole point with insomnia. But I would like to know what happened in the beginning. </p>
<p>A trained psychoanalyst, Darrieussecq is understandably careful. When she walls off her narrative, it’s with a firmness you might expect from someone whose work depends on boundaries. As a qualified psychotherapist myself, I appreciate and respect her need for containment. But as a reader, I prefer it when she’s visible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">Explainer: what's the link between insomnia and mental illness?</a>
</strong>
</em>
</p>
<hr>
<h2>Eluding the page</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=923&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=923&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=923&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1160&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1160&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542725/original/file-20230815-18-ckj7p6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1160&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Dancing on and off the page, appearing, disappearing, and re-emerging throughout her book, Darrieussecq spins a heady web. Intoxicating and disorientating, her style works perfectly when she writes about the spiralling anxiety of insomnia, and the dizzy voids of sleeplessness. It lets her capture the internal cacophony, the sense of isolation and the tide of dread that destabilises those of us who battle for sleep. </p>
<p>Elsewhere this fragmented approach threatens to collapse the insomniac’s voice into a guidebook to sleeplessness. Depending on what you want from a memoir, maybe this doesn’t matter. Darrieussecq’s writing is faultless, however you look at it. But the question of structure is worth considering.</p>
<p>Memoirs have enjoyed increasing popularity for the last 20 years or so, and there are many ways to write one. Essentially, a good memoir takes us out of ourselves while inviting valuable connection with the author. When countered with intellectual ideas and reflections, memoir can offer valuable, wider context for personal stories, but achieving this balance is a delicate act. </p>
<p>With this in mind, the strongest sections of Sleepless are when Darrieussecq positions herself within a manageable network of references, and keeps herself clearly in the picture. </p>
<p>She does this when investigating the ruptured sleep of the homeless, politicising insomnia, but personalising the narrative with recollections of restless nights in hotels. And again, when she considers the impact of social inequity and modern technologies on our ability – as well as our basic human right – to sleep, while charting her adventures in Southern Cameroon. She had gone there to solve her writer’s block, to finish a novel about a woman who follows her lover into the Congo, but the inspiration she found in the forest was marred by sleeplessness.</p>
<p>These personal snippets add a necessary touch of individualism to this impressive enquiry. Engaging, brave and funny, they render Darrieussecq’s dazzling treatise into something more relatable. </p>
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<strong>
Read more:
<a href="https://theconversation.com/having-trouble-sleeping-heres-the-science-on-3-traditional-bedtime-remedies-150360">Having trouble sleeping? Here's the science on 3 traditional bedtime remedies</a>
</strong>
</em>
</p>
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<h2>Insomnia vs creativity</h2>
<p>On finishing Darrieussecq’s book, I return to the beginning, to where she writes of the hunt for the killer of sleep, and states a brutal truth: <em>Nothing prevents the insomniac from not sleeping</em>. There is a mythological quality to these words that bears little relationship to the more familiar grind and drudgery of not sleeping. But Sleepless is an attempt to coax something meaningful from long, empty wide-awake nights. </p>
<p>So, how do you make sense of insomnia? How do you reconcile yourself to lying awake night after night, within the threat of tomorrow’s awful haze? Despite her tiring search, Darrieussecq claims no answers, but by the end of her book, she’s stopped fighting for sleep. </p>
<p>Instead, she settles on changing her perspective of insomnia altogether. Turning back to Kafka and Virginia Woolf, she weaves in the rhythms of nature, drawing on the cycles of plants and planets, animals and trees to reimagine a new relationship with shadows. In this way, she hopes to “find insomnia without fatigue”, and to try and find a way of remembering “nights as a dimension of days”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544950/original/file-20230828-27248-5uxzn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Should insomniacs try to remember nights as a dimension of days?</span>
<span class="attribution"><span class="source">Photo by Arzu Sendag on Unsplash</span></span>
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<p>It’s a beautiful move, and typical of the psychoanalytic mind which enjoys finding new angles on questions far more than contriving neat answers. So while I don’t feel I’ve got a better grasp on who my narrator is, when I finish her book, I am refreshed. I have a different way of relating to the night.</p>
<p>This morning, I woke at 3am. My mind was quietly busy, rustling away in the pre-dawn hours with songs of work and murmuring concerns about unfinished tasks. So I rose and settled by the fire with my books, returning to bed two hours later with a hot water bottle, looking forward to the task that prodded me awake.</p>
<p>We may not be able to cure our insomnia, but, heeding the final chapter of Darrieussecq’s book we might be able to make peace with it. Consenting to a creative impulse at an unsociable hour might sound impractical, but I’ve had a productive day. And who knows, I may even sleep tonight.</p><img src="https://counter.theconversation.com/content/209496/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liz Evans does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The hunt for sleep has become a global industry, with apps, drugs, self-help remedies. In a new book, author Marie Darrieussecq contemplates the curse of insomnia.Liz Evans, Writer, Author, Journalist, Associate Lecturer in English & Writing:, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104492023-08-28T12:01:46Z2023-08-28T12:01:46ZShort naps can improve memory, increase productivity, reduce stress and promote a healthier heart<figure><img src="https://images.theconversation.com/files/542889/original/file-20230815-21-42kbnn.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5190%2C3457&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Short naps at the right time of day can benefit alertness and overall health in myriad ways.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-man-asleep-royalty-free-image/1352026356?phrase=Nap&adppopup=true">Tara Moore/Digital Vision via Getty Images</a></span></figcaption></figure><p>Napping during the day is an ancient custom that is practiced worldwide. </p>
<p>While some people view napping as a luxurious indulgence, others see it as a way to maintain alertness and well-being. But napping can come with drawbacks as well as benefits. </p>
<p>As an <a href="https://health.tamu.edu/experts/steven-bender.html">orofacial pain specialist</a>, I have extensive education in sleep medicine and how sleep impacts wellness, due mostly to the relationship between sleep and painful conditions such as headaches and facial pain. My training involved all aspects of sleep, especially sleep breathing disorders, insomnia and sleep-related movement disorders. </p>
<p>As such, I’m aware of the complex nature of napping, and why a short nap – that is, a nap during the daytime that lasts from 20 to 30 minutes – may be beneficial in myriad ways. </p>
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<figcaption><span class="caption">While napping is generally a good habit for many people, there are some caveats to consider.</span></figcaption>
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<h2>An abundance of health benefits</h2>
<p>Research shows that there are many benefits to napping. Short naps can <a href="https://doi.org/10.1016/j.smrv.2022.101666">boost mental functioning and memory</a>, as well as <a href="https://www.apa.org/monitor/2016/07-08/naps">improve alertness, attention and reaction time</a>. </p>
<p>Short naps are also linked to <a href="https://www.media.mit.edu/articles/that-moment-when-you-re-nodding-off-is-a-sweet-spot-for-creativity/">increased productivity and creativity</a>. Because napping seems to improve creative thinking, some companies have attempted to harness this by introducing <a href="https://www.yahoo.com/now/nap-job-10-companies-100300632.html">napping rooms into the workplace</a>. </p>
<p>What’s more, it appears the brain uses nap time to process information gathered throughout the day, which appears to <a href="https://doi.org/10.1111/jsr.12728">enhance problem-solving abilities</a>. One small study revealed that people who took short naps were less frustrated and impulsive, which <a href="http://dx.doi.org/10.1016/j.paid.2015.06.013">resulted in better focus and efficiency</a> when performing work-related tasks. Napping may even lead to an improved ability <a href="https://doi.org/10.1007%2Fs40675-020-00193-9">to learn new motor skills</a>, such as a golf swing or the playing of a musical instrument. This is because these memories or skills become consolidated in the brain during sleep, whether at night or while napping.</p>
<p>Napping can also reduce stress. One study found that naps of approximately 20 minutes <a href="https://doi.org/10.5114/biolsport.2021.103569">improved the overall mood of participants</a>. However, longer naps lasting more than 30 minutes are not typically associated with improved mood and <a href="https://vitalrecord.tamhsc.edu/asked-grumpy-nap/">increased feelings of well-being</a>. </p>
<p>Short naps may also be associated with a <a href="http://dx.doi.org/10.1016/j.smrv.2016.09.002">reduced risk of cardiovascular diseases</a>. If we are awake more than we should be, we tend to have a buildup of the “fight or flight” chemicals in our bodies. Studies show that more consistent sleep <a href="https://doi.org/10.1007/s11906-018-0874-y">will help lower these chemicals</a>, resulting in a normalization of blood pressure and heart rates. Napping <a href="https://doi.org/10.1007/s11906-018-0874-y">appears to help this process</a> for some people. </p>
<p>But just as in nighttime sleep, some people may have trouble drifting off for a nap, especially when they have limited time. Progressive muscle relaxation techniques have been shown to be <a href="https://doi.org/10.1111/jsr.13574">beneficial for both nighttime sleep and napping</a>. Other nonspecific relaxation techniques, like listening to relaxing music, appear to also be beneficial for falling asleep. Interestingly, many people overestimate their time awake when trying to sleep and underestimate <a href="https://psycnet.apa.org/doi/10.1037/a0025730">the time they actually spent sleeping</a>. </p>
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<figcaption><span class="caption">Make sure the nap is short.</span></figcaption>
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<h2>Napping can have drawbacks</h2>
<p>One condition associated with napping longer than 30 minutes is <a href="https://www.sleepfoundation.org/how-sleep-works/sleep-inertia">sleep inertia</a> – the grogginess and disorientation that people sometime experience after waking from a longer nap. </p>
<p>Usually, the longer the nap, the more sleep inertia there is to overcome. This can impair cognitive function from several minutes up to half an hour. In many cases, these effects can be <a href="https://doi.org/10.2147/NSS.S188911">minimized by consuming caffeine</a> directly after the nap. </p>
<p>But it is important to note that <a href="https://theconversation.com/can-coffee-or-a-nap-make-up-for-sleep-deprivation-a-psychologist-explains-why-theres-no-substitute-for-shut-eye-206847">caffeine is not a substitute for sleep</a>. Caffeine acts to temporarily block the action of a chemical known as adenosine, a sleep-promoting agent that builds up during waking hours. If you are habitually dependent on caffeine consumption to keep you awake and alert, it may suggest that there is an underlying sleep disorder such as <a href="https://www.nhlbi.nih.gov/health/insomnia#">insomnia</a> or <a href="https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631#">sleep apnea</a>, in which a person temporarily stops breathing during sleep. </p>
<p>Long or late afternoon naps can also interfere with nighttime sleep, either by leading to difficulties falling asleep or staying asleep during the night. This disruption of the regular <a href="https://www.sciencedirect.com/topics/neuroscience/sleep-waking-cycle#">sleep-wake cycle</a> can result in <a href="https://my.clevelandclinic.org/health/diseases/23970-sleep-deprivation">overall sleep deprivation</a>, which <a href="http://dx.doi.org/10.1016/j.smrv.2016.09.002">can have numerous negative health effects</a>. </p>
<p>What’s more, for those age 60 and up, longer naps – beyond 30 minutes – <a href="https://doi.org/10.1016/j.smrv.2022.101682">may increase the risk for cardiovascular problems</a>. Researchers found that older adults taking naps for more than one hour per day have a higher incidence of increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels, sometimes known as metabolic syndrome. </p>
<p>The reason for this phenomenon is mostly unknown. Older individuals tend to nap more frequently than younger adults partly due to <a href="http://dx.doi.org/10.1016/j.smrv.2016.09.002">more disturbed sleep during the night</a>. This could be related to more pain or other health factors that will interfere with sleep, sleep altering medications and altered sleep rhythms seen with aging. </p>
<h2>Best practices</h2>
<p>So, to maximize benefits while reducing risks, here are some tips: Keep naps short to avoid sleep inertia and nighttime sleep disruptions. Nap in the early afternoon, as that aligns with a decrease in energy levels after lunch and with <a href="https://www.health.harvard.edu/staying-healthy/is-your-daily-nap-doing-more-harm-than-good#">the body’s natural circadian dip</a>, which is an increase in sleepiness similar to what occurs at dusk. Avoid late afternoon naps, finish naps at least four to six hours before bedtime, and create the right environment by napping in a quiet, comfortable and dimly lit space. </p>
<p>If you’re struggling with daytime sleepiness, it’s best to address the root cause rather than relying solely on napping. Reducing caffeine consumption, maintaining a regular sleep schedule and getting adequate nighttime sleep are essential steps to reduce daytime sleepiness. </p>
<p>Ultimately, napping should complement a healthy sleep routine, not serve as a <a href="https://theconversation.com/can-coffee-or-a-nap-make-up-for-sleep-deprivation-a-psychologist-explains-why-theres-no-substitute-for-shut-eye-206847">substitute for sufficient nighttime rest</a>. A balanced approach to napping can contribute to a more energized, focused and resilient life.</p><img src="https://counter.theconversation.com/content/210449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Bender does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Naps can be rejuvenating and beneficial to attentiveness and overall health, but the length of naps and the time of day are key.Steven Bender, Clinical Associate Professor, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2044362023-08-25T12:27:42Z2023-08-25T12:27:42ZScreen time is contributing to chronic sleep deprivation in tweens and teens – a pediatric sleep expert explains how critical sleep is to kids’ mental health<figure><img src="https://images.theconversation.com/files/544646/original/file-20230824-2188-dbvyvh.jpg?ixlib=rb-1.1.0&rect=45%2C36%2C5961%2C3971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When teens can’t sleep, they often scroll online well into the night, which only exacerbates the problem.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenager-sending-email-from-smart-phone-in-her-bed-royalty-free-image/537460890?phrase=teens+screens&adppopup=true">ljubaphoto/E+ via Getty Images</a></span></figcaption></figure><p>With the start of a new school year comes the inevitable battle to get kids back into a healthy bedtime routine. In many cases, this likely means resetting boundaries on screen use, especially late in the evenings. But imposing and enforcing those rules can be easier said than done.</p>
<p>A growing body of research is finding strong <a href="https://doi.org/10.1016/j.smrv.2020.101414">links between sleep, mental health and screen time</a> in teens and tweens – the term for pre-adolescent children around the ages of 10 to 12. Amid an <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7219a1.htm">unprecedented mental health crisis</a> in which some <a href="https://www.cdc.gov/healthyyouth/mental-health/index.htm">42% of adolescents</a> in the U.S. are suffering from mental health issues, teens are also <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">getting too little sleep</a>. </p>
<p>And it is a vicious cycle: Both a lack of sleep and the heightened activity involved in the consumption of social media and video games before bedtime can exacerbate or even trigger anxiety and depression that warrant intervention.</p>
<p>I am the lead physician of the sleep center at Seattle Children’s Hospital, where I <a href="https://www.seattlechildrens.org/directory/maida-lynn-chen/">study various pediatric sleep disorders</a>. Our team of physicians and providers routinely observe firsthand the negative effects of excessive screen time, and particularly social media, both of which affect not only sleep, but also the <a href="https://doi.org/10.1016/C2017-0-04667-0">physical and mental health</a> of our patients. </p>
<h2>Relationship between mental health and poor sleep</h2>
<p>Research has long shown a clear relationship between mental health and sleep: Poor sleep can lead to poor mental health and vice versa. People with <a href="https://doi.org/10.1016%2Fj.chc.2020.09.003">depression and anxiety commonly have</a> <a href="https://www.nhlbi.nih.gov/health/insomnia">insomnia</a>, a condition in which people have trouble falling or staying asleep, or both, or getting refreshing sleep. That ongoing sleep deprivation further worsens the very depression and anxiety that caused the insomnia in the first place. </p>
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<figcaption><span class="caption">A teen’s health, growth and emotional stability are linked to the quality and quantity of sleep.</span></figcaption>
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<p>What’s more, insomnia and poor-quality sleep may also <a href="https://doi.org/10.1016%2Fj.chc.2020.09.003">blunt the benefits of therapy and medication</a>. At its worst, chronic sleep deprivation increases the risk of suicide. One study found that <a href="https://doi.org/10.1007/s10964-014-0170-3">just one hour less sleep</a> during the week was associated with “significantly greater odds of feeling hopeless, seriously considering suicide, suicide attempts and substance use.” </p>
<p>And what do young people do when lying in bed awake, frustrated and unable to sleep? You guessed it – far too often, <a href="https://doi.org/10.1016/j.envint.2018.11.069">they get on their smart devices</a>. </p>
<p>Studies across the world in over 120,000 youth ages 6 to 18 who engage in any sort of social media have repeatedly shown <a href="https://doi.org/10.1001%2Fjamapediatrics.2016.2341">worsened quality and decreased quantity of sleep</a>. This is happening across the globe, not just in the U.S. </p>
<h2>The strong pull of screens and social media</h2>
<p>Although social media has some benefits, I believe research makes it clear that there are significantly <a href="https://doi.org/10.1503%2Fcmaj.190434">more downsides to social media consumption</a> than upsides. </p>
<p>For one, scrolling social media requires being awake, and hence, displaces sleep.</p>
<p>Second, the <a href="https://doi.org/10.1111/bjop.12351">light emitted from most hand-held devices</a>, even with a night filter, a blue light filter or both, is enough to decrease <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/melatonin-for-sleep-does-it-work">levels of melatonin</a>, the primary hormone that signals the onset of sleep. </p>
<p>When melatonin release is inhibited by staring at a lit device near bedtime, <a href="https://doi.org/10.1073%2Fpnas.1418490112">falling asleep becomes more challenging</a>. For some people, melatonin supplements can help with inducing sleep. However, supplements cannot overcome the highly stimulating powers of internet content and light. </p>
<p>Third, and perhaps most problematic, is the content that young people are consuming. Taking in fast-paced imagery like that found on TikTok or video games <a href="https://doi.org/10.1111/j.1365-2869.2012.01060.x">before bedtime is disruptive</a> because the brain and body are highly stimulated by these exposures, and require time to settle back into a state that is conducive to sleep. </p>
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<figcaption><span class="caption">Teens are often ‘night owls,’ which adds to sleep deprivation.</span></figcaption>
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<p>But it’s not just the speed of the imagery flitting by. Media content can disrupt both nondream and dream sleep. Have you ever fallen asleep watching a disturbing thriller or a horror movie and had scenes from that movie <a href="https://www.courierpostonline.com/story/life/2019/02/06/perchance-dream-how-binge-watching-social-media-affect-your-dreams-sleep/2796568002/#">enter your dreams</a>? And it’s not just dreams that are affected – the brain also <a href="https://doi.org/10.5935%2F1984-0063.20180046">may not sustain deep nondream sleep</a> since it is still processing those fast-paced images. These intrusions in your sleep can be very disruptive to overall quality and quantity of sleep. </p>
<p>Worst of all, social media can contribute to FOMO – short for the fear of missing out. This can occur when a teen becomes enmeshed with an influencer or role model through posts, reels and stories, all of which are cultivated to reflect unrealistic perfection, not reality.</p>
<p>In addition, research has found a clear link between <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">social media consumption and poor body image</a> in kids and teens, as well as overall <a href="https://doi.org/10.1016/j.smrv.2020.101414">worse mental health and worsened sleep problems</a>. </p>
<p>These issues are troubling enough that in May 2023, <a href="https://www.hhs.gov/about/news/2023/05/23/surgeon-general-issues-new-advisory-about-effects-social-media-use-has-youth-mental-health.html">the surgeon general issued a statement</a> <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">warning of the dangers of social media</a> and encouraging caregivers, teachers and policymakers to work together to create a safer online environment. </p>
<h2>A state of chronic sleep deprivation</h2>
<p>Making <a href="https://theconversation.com/how-much-sleep-do-you-really-need-156819">sleep a high priority</a> is a cornerstone of overall health and mental health, and it is also key to staying alert and attentive during the school day.</p>
<p>Multiple <a href="https://publications.aap.org/aapnews/news/6630/AAP-endorses-new-recommendations-on-sleep-times">professional medical</a> and <a href="https://www.thensf.org/how-many-hours-of-sleep-do-you-really-need/">scientific organizations</a> have recommended that teens sleep eight to 10 hours per night. But only 1 in 5 high schoolers <a href="https://edition.cnn.com/2022/06/07/health/teen-sleep-deprivation-wellness/index.html">come close to that</a>. </p>
<p>Some of this is due to <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">school start times</a> that don’t align with the natural rhythms of most teens, so they don’t fall asleep early enough on weekdays. </p>
<p>Teens who don’t get enough sleep <a href="https://doi.org/10.1016/j.pcl.2011.03.002">may suffer from weak academic performance</a>, a lack of organizational skills and mediocre decision-making. Teens don’t have fully formed frontal lobes, the part of the brain that controls impulse and judgment. Sleep deprivation <a href="https://doi.org/10.1016/j.dcn.2018.03.012">further impairs those behaviors</a>. This, in turn, may lead to poor decisions regarding <a href="https://doi.org/10.1111%2Facer.12618">drug and alcohol use</a>, <a href="https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a1.htm">driving under the influence</a>, <a href="https://doi.org/10.1037%2Fhea0000753">sexual promiscuity</a>, fighting or the <a href="https://doi.org/10.1111/josh.12044">use of weapons</a>, and more. And these behaviors can start <a href="https://doi.org/10.1093/sleep/zsw004">in middle school</a>, if not earlier.</p>
<p>In addition, sleep deprivation is directly linked with <a href="https://doi.org/10.1161%2FCIRCULATIONAHA.108.766410">high blood pressure</a>, <a href="https://www.sleepfoundation.org/sleep-deprivation/how-sleep-deprivation-affects-your-heart">heart attacks</a> and the <a href="https://www.sleepfoundation.org/physical-health/lack-of-sleep-and-diabetes">development of diabetes</a> in adulthood. Lack of adequate sleep is also linked with <a href="https://doi.org/10.2147%2FAHMT.S219594">childhood and adolescent obesity</a>. Undesired weight gain occurs with sleep deprivation though a series of complex mechanisms, including <a href="https://www.sleepfoundation.org/physical-health/obesity-and-sleep">shifts in metabolism</a>, a more <a href="https://doi.org/10.1186%2Fs12966-016-0428-0">sedentary lifestyle and poor dietary</a> choices. </p>
<h2>A way forward</h2>
<p>So what can be done to pry teens and tweens away from their screens? Keeping goals realistic is key, and sometimes it is helpful to start by focusing on just one goal.</p>
<p>Parents need to prioritize sleep for the entire household and model good screen time habits. Caregivers too often <a href="https://www.pewresearch.org/internet/2018/08/22/how-teens-and-parents-navigate-screen-time-and-device-distractions/">send mixed messages</a> around screen time use, given their own bad habits.</p>
<p>Ultimately, parents and caregivers need to recognize the warning signs of <a href="https://parentingscience.com/signs-of-sleep-deprivation/">sleep deprivation</a> and <a href="https://www.stanfordchildrens.org/en/topic/default?id=overview-of-mood-disorders-in-children-and-adolescents-90-P01634">progressive mood</a> and <a href="https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Anxiety_Disorder_Resource_Center/Your_Adolescent_Anxiety_and_Avoidant_Disorders.aspx">anxiety disorders</a>. Seek professional help for disordered sleep, troubled mental health or both, keeping in mind that finding <a href="https://theconversation.com/as-the-mental-health-crisis-in-children-and-teens-worsens-the-dire-shortage-of-mental-health-providers-is-preventing-young-people-from-getting-the-help-they-need-207476">mental health professionals can take time</a>. </p>
<p>When it comes to digital media, the American Academy of Pediatrics recommends avoiding screens for <a href="https://publications.aap.org/pediatrics/article/138/5/e20162592/60321/Media-Use-in-School-Aged-Children-and-Adolescents">at least an hour before going to bed</a> and not sleeping with devices in the bedroom. </p>
<p>For older kids who have homework to do online, avoiding screen use right before bedtime can feel next to impossible. What’s more, this rule tends to lead to <a href="https://www.parents.com/parenting/better-parenting/teenagers/teen-talk/how-strict-parents-can-actually-make-their-teens-more-rebellious/">covert use of electronic devices</a>.</p>
<p>So if one hour before bedtime is too stringent, then start by avoiding media for even 15 or 30 minutes prior to going to sleep. Or if some media is needed as a compromise, try watching something passive, like TV, rather than engaging in social media apps like Snapchat. </p>
<p>Remember that not everything has to be done all at once – incremental changes can make a big difference over time.</p><img src="https://counter.theconversation.com/content/204436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maida Lynn Chen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exposure to screens before bedtime can contribute to chronic sleep deprivation, which raises the risk for anxiety, depression and even suicidal thoughts.Maida Lynn Chen, Professor of Pediatrics, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083712023-08-11T01:23:56Z2023-08-11T01:23:56ZWhy do I fall asleep on the sofa but am wide awake when I get to bed?<figure><img src="https://images.theconversation.com/files/539895/original/file-20230728-20-xahusw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lazy-man-watching-television-night-alone-1332746786">Shutterstock</a></span></figcaption></figure><p>After a long day, you flop onto the sofa and find yourself dozing off while watching TV. The room is nice and warm, the sofa is comfortable, and the background noise of the TV lulls you to sleep. </p>
<p>Then a loved one nudges you awake and reminds you to go sleep – in bed. But when you get there, you find to your frustration that you’re wide awake.</p>
<p>Why does sleep come so easily on the sofa but not always in bed?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1684313058519179264"}"></div></p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">How do I stop my mind racing and get some sleep?</a>
</strong>
</em>
</p>
<hr>
<h2>Why is it so easy to fall asleep on the sofa?</h2>
<p><a href="https://www.sleepfoundation.org/circadian-rhythm/sleep-drive-and-your-body-clock#:%7E:text=Sleep%2Fwake%20homeostasis%20balances%20our,that%20it's%20time%20to%20sleep.">Sleep pressure</a> is one reason why you fall asleep on the sofa. This refers to the strength of the biological drive for sleep. The longer you’ve been awake, the greater the sleep pressure.</p>
<p>Your body clock or <a href="https://www.thensf.org/what-is-a-circadian-rhythm/">circadian rhythm</a> is another factor. This tells you to be awake during the day and to sleep at night. </p>
<p>Your environment will also impact how likely it is you fall asleep. You might have just <a href="https://theconversation.com/health-check-food-comas-or-why-eating-sometimes-makes-you-sleepy-44355">eaten a meal</a>, your very comfortable sofa is in a warm room, with dim lighting and maybe a TV program in the background. For many people, this environment is perfect for falling asleep. </p>
<p>So by the end of the day, sleep pressure is strong, your circadian rhythm is telling you it’s time for sleep <em>and</em> your environment is cosy and comfortable.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-food-comas-or-why-eating-sometimes-makes-you-sleepy-44355">Health Check: 'food comas', or why eating sometimes makes you sleepy</a>
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</em>
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<hr>
<h2>What happens after a nap on the sofa?</h2>
<p>If you’ve had a nap on the sofa before heading to bed, your sleep pressure is likely much lower than it was before your nap. Instead of having more than 16 hours of wakefulness behind you, you’ve just woken up and therefore have less sleep pressure. This can make it much harder to fall asleep in bed. </p>
<p>If you just fell asleep on the sofa for five minutes, you might not have too much trouble getting to sleep in bed. This is because a nap that short is unlikely to reduce your sleep pressure very much. But if you were asleep for an hour, it might be a different story.</p>
<p>Your sleep cycles might also be working against you. Most sleep cycles are about <a href="https://www.researchgate.net/profile/Mary-Carskadon/publication/287231408_Normal_Human_Sleep_An_Overview_Principles_and_Practice_of_Sleep_Medicine_MH_Kryger_Ed/links/5db0c338299bf111d4c026c5/Normal-Human-Sleep-An-Overview-Principles-and-Practice-of-Sleep-Medicine-MH-Kryger-Ed.pdf">90 minutes long</a>. They start with light sleep, progress to deep sleep, and then end with light sleep again. If you wake up during deep sleep, you’re probably going to feel groggy – and it might be easy to get back to sleep when you go to bed. But if you wake up during light sleep it could be harder to fall asleep again in bed. </p>
<p>The activities you might do when you get up from the sofa – like turning on bright lights or brushing your teeth – can also make you feel more alert and make it harder to sleep when you get to bed.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young woman brushing teeth in bathroom mirror, holding glass of water" src="https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539904/original/file-20230728-29-ffb4ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Brushing your teeth in a brightly lit bathroom? That may not help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-woman-brushing-teeth-looking-1962557119">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-naps-good-for-us-72268">Health Check: are naps good for us?</a>
</strong>
</em>
</p>
<hr>
<h2>Why can’t I fall asleep in my own bed?</h2>
<p>There are other reasons why falling asleep in your bed could be challenging. Many people experience anxiety about falling asleep. They <a href="https://pubmed.ncbi.nlm.nih.gov/24005330/">worry</a> about getting enough sleep or falling asleep fast enough. </p>
<p>In such cases, getting into bed can be associated with feelings of stress and apprehension, which make it even harder to sleep. It might be easier to fall asleep on the couch, where there is less stress involved. </p>
<p>It might also be harder to fall asleep in bed because of poor <a href="https://www.sleepfoundation.org/sleep-hygiene">sleep hygiene</a>. This refers to your pre-sleep behaviours and sleep environment. </p>
<p>Good sleep hygiene, or healthy sleep habits, includes having a regular routine before bed, a dark, quiet room to sleep in, and not using your mobile phone in bed. For many people who don’t have good sleep hygiene, their behaviours before bed and their bedroom environment might not be conducive to sleep.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phubbing-snubbing-your-loved-ones-for-your-phone-can-do-more-damage-than-you-realise-194039">'Phubbing': snubbing your loved ones for your phone can do more damage than you realise</a>
</strong>
</em>
</p>
<hr>
<h2>How can I make it easier to fall asleep in bed?</h2>
<p>First, make sure your room is dark, quiet and comfortable. In winter this might mean putting a heater on 20 minutes before you go to bed or taking a heat pack to bed with you. In summer, you might consider air conditioning or a fan to make your bedroom comfortable for sleeping. </p>
<p>If you find it easy to fall asleep with the TV on, you might like to play “<a href="https://www.youtube.com/watch?v=2iL1Ce1PZFM&t=1s">white noise</a>” in your bedroom as you fall asleep. Some evidence suggests this may make it <a href="https://www.sciencedirect.com/science/article/pii/S1087079220301283#abs0010">easier to fall asleep</a> by masking other disruptive noises. </p>
<p>Your behaviour before bed also impacts how easy it is to fall asleep. Making sure you follow the same bedtime routine every night (including going to bed at the same time) can help. </p>
<p>Also, even though it’s hard, try not to look at your phone while you’re in bed. Scrolling on your phone before bed can make it <a href="https://ieeexplore.ieee.org/document/8329667">harder to sleep</a> due to both exposure to blue light and the potentially stressful or alerting effect of the content you interact with. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-brown-noise-can-this-latest-tiktok-trend-really-help-you-sleep-188528">What is brown noise? Can this latest TikTok trend really help you sleep?</a>
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</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>The best way to make it easier to fall asleep in your bed is to avoid falling asleep on the sofa in the first place.</p>
<p>This will ensure all the sleep pressure you build up during the day will be directed towards a deep sleep in your bed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-we-wake-around-3am-and-dwell-on-our-fears-and-shortcomings-169635">Why do we wake around 3am and dwell on our fears and shortcomings?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/208371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wake up! It’s time for bed. Here’s how to make sure you can actually fall asleep when you get there.Madeline Sprajcer, Lecturer in Psychology, CQUniversity AustraliaSally Ferguson, Director, Appleton Institute, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2106952023-08-02T19:59:46Z2023-08-02T19:59:46ZCounting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits<p>Sleep may seem straightforward – everyone does it, after all. But as many of us know, getting enough sleep is not necessarily a simple task, despite what you might read in the media.</p>
<p>How to sleep “properly” is a favourite topic of self-help articles, with <a href="https://www.mirror.co.uk/news/health/expert-advice-good-nights-sleep-27900333">headlines</a> such as “Expert advice to get a good night’s sleep whatever your age” promising the answer to your nocturnal awakenings.</p>
<p>Older people are commonly the audience of these messages. <a href="https://doi.org/10.1093/geront/gnad058">Our analysis</a> of articles published in the New Zealand media between 2018 and 2021 found sleep is presented as inevitably declining with age.</p>
<p>At the same time, sleep is portrayed as a cure for everything: a good night’s sleep is depicted as a way to maintain productivity, ward off illness and dementia, and ultimately live longer. </p>
<p>But most of these articles are aimed at the individual and what they can do to improve their sleep. Often missing is any reference to the external factors that can contribute to poor sleep.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540623/original/file-20230802-36293-2r0ssq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Personal habits – like staring at screens in bed – are often blamed for poor sleep patterns.</span>
<span class="attribution"><span class="source">Getty Images</span></span>
</figcaption>
</figure>
<h2>Personal choice and sleep</h2>
<p>A key message in many of the articles we examined is that sleep is a simple matter of making the right choices. So, if you’re not getting enough sleep it’s probably your own fault. </p>
<p>People are lectured about poor “<a href="https://www.cci.health.wa.gov.au/%7E/media/CCI/Mental-Health-Professionals/Sleep/Sleep---Information-Sheets/Sleep-Information-Sheet---04---Sleep-Hygiene.pdf">sleep hygiene</a>” – staying up too late looking at their phone, having too many cups of coffee, or not getting enough exercise during the day.</p>
<p>And it’s true, drinking too much caffeine or staring at a screen into the small hours might interfere with sleep. It’s also true that good sleep is important for good health.</p>
<p>But things are a bit more complicated than this. As anyone who has struggled to maintain good sleep knows, simple tips don’t always overcome the complex situations that contribute to these struggles.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sleep-deprivation-benefited-our-ancestors-yet-harms-us-now-but-staying-fit-may-help-us-cope-208541">Sleep deprivation benefited our ancestors, yet harms us now — but staying fit may help us cope</a>
</strong>
</em>
</p>
<hr>
<h2>Awake to other factors</h2>
<p>Good sleep is not just a matter of “making the right choices”. Internationally, there’s a growing body of research showing sleep is affected by much more than individual behaviour: it’s often shaped by a person’s <a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-040119-094412">social and economic circumstances</a>.</p>
<p>New Zealand research is adding to this pool of knowledge. <a href="https://www.sciencedirect.com/science/article/pii/S235272181600019X?via=ihub">One study</a>, based on survey results from just over 4,000 people, found insufficient sleep was more common among Māori than non-Māori, partly due to higher rates of night work.</p>
<p>International <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524484/">research</a> has also found women are more likely to experience insomnia due to their caregiving roles. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">How do I stop my mind racing and get some sleep?</a>
</strong>
</em>
</p>
<hr>
<p>One US study found unpaid caregivers for children or parents (or both) reported shorter sleep quantity and poorer sleep quality than paid caregivers or people without such roles. A <a href="https://journals.sagepub.com/doi/10.1177/1471301220915071">survey</a> of 526 carers in New Zealand showed two-thirds reported mild or severe sleep disturbance.</p>
<p>We also know lack of sleep is <a href="https://www.cdc.gov/sleep/about_sleep/chronic_disease.html">linked to serious disease</a>, including diabetes and heart disease. Sleep duration and quality have been identified as predictors of levels of haemoglobin A1c, an important marker of blood sugar control. </p>
<p>And hypertension, stroke, coronary heart disease and irregular heartbeats have been found to be more common among those with disordered sleep than those without sleep abnormalities.</p>
<p>Failure to acknowledge the social context of poor sleep means sleep messages in the media ignore the fundamental causes in favour of the illusion of a quick fix. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540069/original/file-20230731-16223-ossxn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Caregivers, who are predominantly women, have reported worse sleep.</span>
<span class="attribution"><span class="source">Alistair Berg/Getty Images</span></span>
</figcaption>
</figure>
<h2>The commodification of sleep</h2>
<p>Sleep is also increasingly characterised as a commodity, with a growing market for products – such as sleep trackers – that claim to help improve sleep quality. </p>
<p>Sleep trackers promise to measure and enhance sleep performance. However, their reliability may be limited – <a href="https://mhealth.jmir.org/2021/6/e26462">one study found</a> the tested tracker did not accurately detect sleep, particularly in older adults who had greater levels of nighttime movement.</p>
<p>Framing public health problems as matters of personal choice is common. Alcohol and fast-food consumption, for example, are regularly presented as <a href="https://journals.sagepub.com/doi/full/10.1177/1745691619896252">matters of individual responsibility</a> and poor personal choices. The <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.737">role of marketing</a> and access to healthy food gets a lot less attention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-much-sleep-do-we-need-29759">Explainer: how much sleep do we need?</a>
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</em>
</p>
<hr>
<p>Of course, simple tips for getting good sleep may be useful for some people. But ignoring the underlying social and economic factors that shape the possibilities for good sleep will not address the problem. </p>
<p>Health promotion messages that focus on individual behaviour miss <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12112">the structural barriers to better health</a>, including poverty, low levels of education, high rates of incarceration, substandard or crowded housing and racism. </p>
<p>We need to move beyond messages of individual behaviour change and start talking about inequities that contribute to the problem of who gets a decent night’s sleep and who doesn’t.</p><img src="https://counter.theconversation.com/content/210695/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Self-help articles and books usually point to the things we can do personally to get a good night’s sleep. But the wider social and economic causes of insomnia deserve more attention.Mary Breheny, Associate Professor of Health Psychology, Te Herenga Waka — Victoria University of WellingtonRosie Gibson, Senior lecturer, School of Psychology, Massey University, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079042023-07-10T04:44:46Z2023-07-10T04:44:46ZHow do I stop my mind racing and get some sleep?<figure><img src="https://images.theconversation.com/files/534972/original/file-20230630-23-skd86y.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-man-bed-suffering-insomnia-sleep-1106545967">Shutterstock</a></span></figcaption></figure><p>Martin turns off the light to fall asleep, but his mind quickly springs into action. Racing thoughts about work deadlines, his overdue car service, and his father’s recent surgery occupy his mind.</p>
<p>As he struggles to fall asleep, the hours start to creep by. He becomes frustrated about how he will cope tomorrow. This is a pattern Martin has struggled with for many years.</p>
<p>But what’s going on when your mind is racing at night? And how do you make it stop?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-we-wake-around-3am-and-dwell-on-our-fears-and-shortcomings-169635">Why do we wake around 3am and dwell on our fears and shortcomings?</a>
</strong>
</em>
</p>
<hr>
<h2>It can happen to anyone</h2>
<p>In bed, with no other visual or sound cues to occupy the mind, many people start to have racing thoughts that keep them awake. This can happen at the start of the night, or when they awake in the night.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1637766179396767748"}"></div></p>
<p>The good news is there are effective ways to reduce these racing thoughts, and to help get some sleep. To do this, let’s take a step back and talk about insomnia.</p>
<h2>What is insomnia?</h2>
<p>If you are like Martin, you’re not alone. Right now, up to six in every ten people have regular <a href="https://www.sleepprimarycareresources.org.au/insomnia/epidemiology">insomnia symptoms</a>. One in ten have had these symptoms for months or years. </p>
<p>Insomnia includes trouble falling asleep at the start of the night, waking up during the night, and feelings of daytime fatigue, concentration difficulties, lethargy or poor mood. </p>
<p>Just like Martin, many people with insomnia find as soon as they get into bed, they feel alert and wide awake. So what’s going on?</p>
<p>The more time we spend in bed doing things other than sleep, the more our brain and body start to learn that bed is a place for these non-sleep activities.</p>
<p>These activities don’t just include worrying. They can be using a mobile phone, watching TV, eating, working, arguing, smoking or playing with pets.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phubbing-snubbing-your-loved-ones-for-your-phone-can-do-more-damage-than-you-realise-194039">'Phubbing': snubbing your loved ones for your phone can do more damage than you realise</a>
</strong>
</em>
</p>
<hr>
<p>Gradually, our brains can learn that bed is a place for these other activities instead of rest and sleep. Over time the simple act of getting into bed can become a trigger to feel more alert and awake. This is called “<a href="https://www.med.upenn.edu/cbti/assets/user-content/documents/ppsmmodelsofinsomnia20115theditionproof.pdf">conditioned insomnia</a>”. </p>
<p>Here are six ways to spend less time awake in bed with racing thoughts.</p>
<h2>1. Re-learn to associate bed with sleep</h2>
<p><a href="https://www.sleepprimarycareresources.org.au/insomnia/bbti/insomnia-stimulus-control-therapy">Stimulus control therapy</a> can <a href="https://www.med.upenn.edu/cbti/assets/user-content/documents/Bootzin%201972.pdf">help</a> re-build the relationship between bed and sleep.</p>
<p>Follow these simple steps every night of the week: </p>
<ul>
<li><p>only use your bed for sleep and intimacy. All other activities should occur out of bed, preferably in another room</p></li>
<li><p>only go to bed if you are feeling sleepy (when your eyes are heavy and you could easily fall asleep). If you are not feeling sleepy, delay getting into bed. Use this time to do something relaxing in another room</p></li>
<li><p>if you are still awake after about 15 minutes in bed, get out of bed and go to another room. Do something else relaxing until you are feeling sleepy again, such as reading a book, listening to the radio, catching up on some chores or doing a crossword puzzle. Avoid anything too stimulating such as work or computer gaming</p></li>
<li><p>repeat the above two steps until you are asleep within about 15 minutes. This can take several cycles of getting in and out of bed. But during this time, you body’s natural need for sleep will increase, and you will eventually fall asleep within 15 minutes of getting into bed</p></li>
<li><p>get out of bed at the same time each morning, no matter how much you slept the night before </p></li>
<li><p>avoid long daytime naps, which can make it harder to fall asleep that night.</p></li>
</ul>
<p>Over several nights, this therapy builds the relationship between bed and sleep, and reduces the relationship between bed and feeling alert and having racing thoughts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C666&q=45&auto=format&w=1000&fit=clip"><img alt="Young woman sitting in bed, hand in face, in the dark" src="https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C666&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534746/original/file-20230629-19-8p4hop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you’re still awake after about 15 minutes in bed, get up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-young-asian-woman-sitting-bed-1841485552">Shutterstock</a></span>
</figcaption>
</figure>
<h2>2. Distract yourself with fond thoughts</h2>
<p>Negative thoughts in bed or worrying about the consequences of losing sleep can make us feel more alert, worried, and make it more difficult to sleep. </p>
<p>So try something called “<a href="https://doi.org/10.1016/j.beth.2012.07.004">cognitive re-focusing</a>”. Try to replay a fond memory, movie, or TV show in your mind, to distract yourself from these negative thoughts. </p>
<p>Ideally, this will be a memory you can recall very clearly, and one that causes neutral or slightly positive feelings. Memories that are overly positive or negative might cause an increase in alertness and mental activity.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-food-comas-or-why-eating-sometimes-makes-you-sleepy-44355">Health Check: 'food comas', or why eating sometimes makes you sleepy</a>
</strong>
</em>
</p>
<hr>
<h2>3. Relax into sleep</h2>
<p><a href="https://www.sleepprimarycareresources.org.au/insomnia/bbti/insomnia-relaxation-techniques">Relaxation therapy</a> for insomnia aims to <a href="https://www.sciencedirect.com/science/article/abs/pii/B9780123815224000043">reduce alertness</a> and improve sleep.</p>
<p>One way is to progressively tense and relax muscle groups throughout your body, known as <a href="https://youtu.be/pyxvL1O2duk">guided progressive muscle relaxation therapy</a>.</p>
<p>You could also try breathing exercises, soothing music, visual imagery or other <a href="https://www.sleephealthfoundation.org.au/cognitive-behavioural-therapy-for-insomnia-cbt-i.html">relaxation exercises</a> that feel right for you.</p>
<p>Part of relaxing into sleep is avoiding doing work in the late evening or screen-based activities right before bed. Give yourself a “buffer zone”, to allow yourself time to start relaxing before getting into bed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drip-drip-drip-why-is-my-leaking-tap-keeping-me-awake-at-night-194733">Drip, drip, drip. Why is my leaking tap keeping me awake at night?</a>
</strong>
</em>
</p>
<hr>
<h2>4. Worry earlier in the day</h2>
<p>Schedule some “<a href="https://www.psychologytoday.com/au/blog/what-mentally-strong-people-dont-do/201811/simple-effective-trick-stop-worrying-so-much">worry time</a>” earlier in the day, so these thoughts don’t happen at night. It can also help to write down some of the things that worry you. </p>
<p>If you start to worry about things during the night, you can remind yourself you have already written them down, and they are waiting for you to work through during your scheduled “worry time” the next day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-brown-noise-can-this-latest-tiktok-trend-really-help-you-sleep-188528">What is brown noise? Can this latest TikTok trend really help you sleep?</a>
</strong>
</em>
</p>
<hr>
<h2>5. Know waking in the night is normal</h2>
<p>Knowing that brief awakenings from sleep are completely normal, and not a sign of ill health, may help.</p>
<p>Sleep occurs in different “cycles” during the night. Each cycle lasts for about 90 minutes, and includes different stages of light, deep, and dreaming (REM) sleep. </p>
<p>Most of our deep sleep occurs in the first half of the night, and most of our light sleep in the second half.</p>
<p>Everyone experiences brief awakenings from sleep, but most people don’t remember these the next morning.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-we-used-to-have-two-sleeps-rather-than-one-should-we-again-57806">Did we used to have two sleeps rather than one? Should we again?</a>
</strong>
</em>
</p>
<hr>
<h2>6. What if these don’t work?</h2>
<p>If these don’t work, the most effective next step is “cognitive behavioural therapy for insomnia” or CBT-i.</p>
<p>This non-drug therapy targets the underlying causes of insomnia, and leads to <a href="https://doi.org/10.1016/j.smrv.2019.08.002">long-lasting improvements</a> in sleep, mental health and daytime function.</p>
<p>You can do a self-guided online program, or access it via your GP or a psychologist. More details, including links to online programs, are available via the <a href="https://www.sleephealthfoundation.org.au/cognitive-behavioural-therapy-for-insomnia-cbt-i.html">Sleep Health Foundation</a>.</p>
<p>We are providing free access to online CBT-i through a research study. To find out more, <a href="https://www.flinders.edu.au/people/alexander.sweetman">contact me</a>.</p>
<hr>
<p><em>The Sleep Health Foundation has several <a href="https://www.sleephealthfoundation.org.au/fact-sheets.html">evidence-based resources</a> about sleep health and insomnia.</em></p><img src="https://counter.theconversation.com/content/207904/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Alexander Sweetman works for the Australasian Sleep Association, the peak sleep health scientific and advocacy body in Australia and New Zealand, and reports previous research funding and/or consultancy work for; the National Health and Medical Research Council, The Hospital Research Foundation, Flinders University, ResMed, Philips, Cerebra, Re-Time, and Australian Doctor.</span></em></p>Make it stop! Six ways to stop your racing mind and get the sleep you need.Alexander Sweetman, Research Fellow, College of Medicine and Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2014672023-03-31T00:35:59Z2023-03-31T00:35:59ZCurious Kids: what happens if you don’t get enough sleep?<figure><img src="https://images.theconversation.com/files/517106/original/file-20230323-14-mhga3z.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-cute-girl-seven-years-old-36122107">Shutterstock</a></span></figcaption></figure><p><em>What would happen to a person if they didn’t get the sleep they needed? Hedya, age 11, Australia</em></p>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>This is a really good question Hedya, because it makes us think about how <a href="https://www.sciencedirect.com/science/article/abs/pii/S2341287917300029">important</a> sleep is. Actually, sleep is one of the most important things we do.</p>
<h2>While you were sleeping …</h2>
<p>When we sleep our bodies are really doing quite a lot of work. In the first few hours, we go into a very deep sleep. That’s when our body is resting and repairing. It’s when we fill up our energy stores for the next day. </p>
<p>At different times of the night, we also have a lot of lighter sleep. This includes something called “rapid eye movement” sleep or REM sleep. That’s when someone’s eyes flicker and move, even when shut.</p>
<p>During this type of sleep, we dream. Our brain is very, very active. It’s busy sorting and organising information, storing memories and even working out problems. </p>
<p>So there’s a lot of really important things that go on when we sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-kids-hate-going-to-sleep-while-adults-usually-love-it-160703">Why do kids hate going to sleep, while adults usually love it?</a>
</strong>
</em>
</p>
<hr>
<h2>So what happens if we don’t sleep?</h2>
<p>The first most obvious thing that happens when we don’t sleep is we get sleepy. When we don’t get enough rest, it’s also harder to be active, want to do things, or get excited about things.</p>
<p>No wonder a lack of sleep can make us grumpy and irritable. </p>
<p>If we don’t get enough REM sleep, it makes it harder to concentrate and learn. It makes it harder to remember school work from one day to the next. All these things make it harder to do <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079209001002">well in school</a>.</p>
<p>So having the right amount of sleep is really important.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/sWEuvQujt_4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Your brain waves tell us what’s going on while you sleep.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-happens-to-your-brain-if-you-dont-get-enough-sleep-200227">Curious Kids: What happens to your brain if you don't get enough sleep?</a>
</strong>
</em>
</p>
<hr>
<h2>How about if I have a few bad nights?</h2>
<p>If we don’t get good sleep on one night or two, we can probably catch up. Our bodies and brains will recover and we will be fine. </p>
<p>But if we don’t have enough sleep or not good quality sleep for a long time, that’s different. As sleep controls so many aspects of our health, this can really mess with our bodies and brains.</p>
<p>We are more likely to <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079209001002">fail a year at school</a>, put on weight, become depressed and get pretty sick for a long time, just to name a <a href="https://www.sciencedirect.com/science/article/abs/pii/S1389945718304829?via%3Dihub">few examples</a>. </p>
<p>So it’s really best to set up <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352721818300135">good sleep patterns</a> early in life so that doesn’t happen to us.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-do-animals-sleep-like-people-do-snails-sleep-in-their-shells-90941">Curious Kids: Do animals sleep like people? Do snails sleep in their shells?</a>
</strong>
</em>
</p>
<hr>
<h2>How much is enough sleep?</h2>
<p>Not everybody needs exactly the same amount of sleep. But people who study sleep, like me, think someone in your age group, Hedya, usually needs between <a href="https://www.sleephealthfoundation.org.au/files/pdfs/Sleep-Needs-Across-Lifespan.pdf">nine and 11 hours a night</a>.</p>
<p>We also need <a href="https://jcsm.aasm.org/doi/full/10.5664/jcsm.6260">good quality sleep</a>. This means it needs to be restful, without too much waking up at night. It also means we need to make sure we go to bed and wake up around the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0022347617314889">same times</a> every day.</p>
<hr>
<p><em>Hello, curious kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/201467/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Blunden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sleep is one of the most important things we do.Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869012023-02-09T13:35:20Z2023-02-09T13:35:20ZCBD is not a cure-all – here’s what science says about its real health benefits<figure><img src="https://images.theconversation.com/files/488378/original/file-20221005-18-19r1y.jpg?ixlib=rb-1.1.0&rect=440%2C26%2C5514%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Since 2018, it has been legal in the U.S. to use a drug made from purified cannabis-derived cannabidiol – CBD – to treat certain childhood seizure disorders.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/scientist-checking-cannabis-plants-in-marijuana-royalty-free-image/1298557693?adppopup=true">Visoot Uthairam/Moment via Getty Images</a></span></figcaption></figure><p>Over the last five years, an often forgotten piece of U.S. federal legislation – the Agriculture Improvement Act of 2018, also known as the <a href="https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019">2018 Farm Bill</a> – has ushered in an <a href="https://peoria.medicine.uic.edu/cbd-blog/">explosion of interest</a> in the medical potential of cannabis-derived cannabidiol, or CBD. </p>
<p>After decades of debate, the bill made it legal for farmers to grow industrial hemp, <a href="https://www.nifa.usda.gov/industrial-hemp">a plant rich in CBD</a>. Hemp itself has tremendous value as a cash crop; it’s used to produce biofuel, textiles and animal feed. But the CBD extracted from the hemp plant also has numerous medicinal properties, with <a href="https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476#">the potential to benefit millions</a> through the treatment of seizure disorders, pain or anxiety. </p>
<p>Prior to the bill’s passage, the resistance to legalizing hemp was due to its association with marijuana, its biological cousin. Though hemp and marijuana belong to the same species of plant, <em>Cannabis sativa</em>, they each have a unique chemistry, <a href="https://doi.org/10.1177%2F2045125312457586">with very different characteristics and effects</a>. Marijuana possesses tetrahydrocannabinol, or THC, <a href="https://nida.nih.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects">the chemical that produces the characteristic high</a> that is associated with cannabis. Hemp, on the other hand, is a strain of the cannabis plant that contains virtually no THC, and <a href="https://www.cdc.gov/marijuana/featured-topics/CBD.html#">neither it nor the CBD derived from it</a> can produce a high sensation. </p>
<p><a href="https://pennstate.pure.elsevier.com/en/persons/kent-vrana">As a professor and chair</a> of the <a href="https://scholar.google.com/citations?user=B7QZGgoAAAAJ&hl=en">department of pharmacology</a> at Penn State, I have been following research developments with CBD closely and have seen some promising evidence for its role in treating a broad range of medical conditions.</p>
<p>While there is growing evidence that CBD can help with certain conditions, caution is needed. Rigorous scientific studies are limited, so it is important that the marketing of CBD products does not get out ahead of the research and of robust evidence.</p>
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<figcaption><span class="caption">Before purchasing any CBD products, first discuss it with your doctor and pharmacist.</span></figcaption>
</figure>
<h2>Unpacking the hype behind CBD</h2>
<p>The primary concern about CBD marketing is that the scientific community is not sure of the best form of CBD to use. CBD can be produced as either a pure compound or a complex mixture of molecules from hemp that constitute <a href="https://www.healthline.com/nutrition/cbd-oil-benefits">CBD oil</a>. CBD can also be formulated as a <a href="https://www.healthline.com/health/best-cbd-cream-for-pain#A-quick-look-at-the-best-CBD-creams-for-pain">topical cream or lotion</a>, or as a <a href="https://www.drugs.com/lifestyle/cbd-gummies-health-benefits-3515165/">gummy</a>, <a href="https://www.medicalnewstoday.com/articles/best-cbd-capsules#how-to-shop">capsule</a> or <a href="https://www.medicalnewstoday.com/articles/cbd-oil-vs-tincture#risks">tincture</a>. </p>
<p>Guidance, backed by clinical research, is needed on the best dose and delivery form of CBD for each medical condition. That research is still in progress.</p>
<p>But in the meantime, the siren’s call of the marketplace has sounded and created an environment in which CBD is often <a href="https://www.nbcnews.com/health/health-news/even-without-proof-cbd-finding-niche-cure-all-n945516">hyped as a cure-all</a> – an elixir <a href="https://www.forbes.com/health/body/cbd-for-sleep/#">for insomnia</a>, <a href="https://www.healthline.com/health/cbd-for-anxiety">anxiety</a>, <a href="https://www.health.harvard.edu/blog/cbd-for-chronic-pain-the-science-doesnt-match-the-marketing-2020092321003">neuropathic pain</a>, <a href="https://www.mdanderson.org/cancerwise/cbd-oil-and-cancer--9-things-to-know.h00-159306201.html">cancer</a> and <a href="https://www.acc.org/About-ACC/Press-Releases/2022/09/06/14/48/As-CBD-Use-Rises-Clinical-Trials-Needed-to-Determine-Safety-Efficacy-in-Heart-Disease-Patients">heart disease</a>. </p>
<p>Sadly, there is precious little rigorous scientific evidence to support many of these claims, and much of the existing research has been performed in animal models. </p>
<p>CBD is simply <a href="https://doi.org/10.1038/d41586-019-02524-5">not a panacea for all that ails you</a>.</p>
<h2>Childhood seizure disorders</h2>
<p>Here’s one thing that is known: Based on rigorous trials with hundreds of patients, CBD has been shown to be a <a href="https://www.neurocenternj.com/blog/cbd-for-seizures-use-effectiveness-side-effects-and-more/#">proven safe and effective drug for seizure disorders, particularly in children</a>. </p>
<p>In 2018, the U.S. Food and Drug Administration granted regulatory approval for the use of a purified <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">CBD product sold under the brand name Epidiolex</a> for the treatment of <a href="https://medlineplus.gov/genetics/condition/lennox-gastaut-syndrome/">Lennox-Gastaut</a> and <a href="https://dravetfoundation.org/what-is-dravet-syndrome/">Dravet syndromes</a> in children. </p>
<p>These two rare syndromes, appearing early in life, produce large numbers of frequent seizures that are <a href="https://www.neurologylive.com/view/childhood-epilepsies-dravet-and-lennox-gastaut-syndromes">resistant to traditional epilepsy treatments</a>. CBD delivered as an oral solution as Epidiolex, however, <a href="https://doi.org/10.3389/fphar.2020.00063">can produce a significant reduction</a> – greater than 25% – in the frequency of seizures in these children, with 5% of the patients becoming seizure-free. </p>
<h2>More than 200 scientific trials</h2>
<p>CBD is what pharmacologists call a promiscuous drug. That means it could be effective for treating a number of medical conditions. In broad strokes, CBD affects more than one process in the body – a <a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922">term called polypharmacology</a> – and so could benefit more than one medical condition.</p>
<p>As of early 2023, there are <a href="https://clinicaltrials.gov/ct2/results?cond=&term=cannabidiol&cntry=US&state=&city=&dist=">202 ongoing or completed scientific trials</a> examining the effectiveness of CBD in humans on such diverse disorders as chronic pain, substance use disorders, anxiety and arthritis. </p>
<p>In particular, CBD appears to be <a href="https://www.ncbi.nlm.nih.gov/books/NBK547742/">an anti-inflammatory agent and analgesic</a>, similar to the functions of aspirin. This means it might be helpful for treating people suffering with inflammatory pain, like arthritis, or headaches and body aches. </p>
<p>CBD also holds potential for use in <a href="https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy.html">cancer therapy</a>, although it has not been approved by the FDA for this purpose. </p>
<p>The potential for CBD in the context of cancer is twofold: </p>
<p>First, there is evidence that it <a href="https://doi.org/10.3390/biom11040582">can directly kill cancer cells</a>, enhancing the ability of traditional therapies to treat the disease. This is not to say that CBD will replace those traditional therapies; the data is not that compelling. </p>
<p>Second, because of its ability to reduce pain and perhaps anxiety, the addition of CBD to a treatment plan may <a href="https://doi.org/10.3390/biom11040582">reduce side effects</a> and increase the quality of life for people with cancer.</p>
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<figcaption><span class="caption">Things to consider before purchasing a CBD product.</span></figcaption>
</figure>
<h2>The risks of unregulated CBD</h2>
<p>While prescription CBD is safe when used as directed, other forms of the molecule come with risks. This is especially true for CBD oils. The over-the-counter CBD oil industry <a href="https://www.forbes.com/health/body/cbd-legalization-by-state/">is unregulated and not necessarily safe</a>, in that there are no regulatory requirements for monitoring what is in a product. </p>
<p>What’s more, rigorous science does not support the unsubstantiated marketing claims made by many CBD products. </p>
<p>In a <a href="https://doi.org/10.1159/000489287">2018 commentary</a>, the author describes the results of his own study, which was published in Dutch (in 2017). His team obtained samples of CBD products from patients <a href="https://www.researchgate.net/publication/321679450_Grote_variatie_in_samenstelling_cannabisolie_noopt_tot_regels">and analyzed their content</a>. Virtually none of the 21 samples contained the advertised quantity of CBD; indeed, 13 had little to no CBD at all and many contained significant levels of THC, the compound in marijuana that leads to a high – and that was not supposed to have been present. </p>
<p>In fact, studies have shown that there is <a href="https://theconversation.com/the-dietary-supplement-youre-taking-could-be-tainted-with-prescription-medications-and-dangerous-hidden-ingredients-according-to-a-new-study-181418">little control of the contaminants that may be present</a> in over-the-counter products. The FDA has <a href="https://www.fda.gov/news-events/public-health-focus/warning-letters-and-test-results-cannabidiol-related-products">issued scores of warning letters</a> to companies that market unapproved drugs containing CBD. In spite of the marketing of CBD oils as all-natural, plant-derived products, consumers should be aware of the risks of unknown compounds in their products or unintended interactions with their prescription drugs. </p>
<p>Regulatory guidelines for CBD <a href="https://www.statnews.com/2023/02/03/fda-right-agency-regulate-cbd-products-but-it-needs-help/">are sorely lacking</a>. Most recently, in January 2023, the FDA concluded that the existing framework is “not appropriate for CBD” and said it would work with Congress to chart a way forward. In a statement, the agency said that “<a href="https://www.fda.gov/news-events/press-announcements/fda-concludes-existing-regulatory-frameworks-foods-and-supplements-are-not-appropriate-cannabidiol">a new regulatory pathway for CBD is needed</a> that balances individuals’ desire for access to CBD products with the regulatory oversight needed to manage risks.” </p>
<p>As a natural product, CBD is still acting as a drug – much like aspirin, acetaminophen or even a cancer chemotherapy. Health care providers simply need to better understand the risks or benefits.</p>
<p>CBD may <a href="https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743#">interact with the body in ways that are unintended</a>. CBD is eliminated from the body by the same liver enzymes that remove a variety of drugs such as blood thinners, antidepressants and organ transplant drugs. Adding CBD oil to your medication list without consulting a physician could be risky and could interfere with prescription medications. </p>
<p>In an effort to help prevent these unwanted interactions, my colleague Dr. Paul Kocis, a clinical pharmacist, and I have created a free online application called the <a href="https://cann-dir.psu.edu/">CANNabinoid Drug Interaction Resource</a>. It identifies how CBD could potentially interact with other prescription medications. And we urge all people to disclose both over-the-counter CBD or recreational or medical marijuana use to their health care providers to prevent undesirable drug interactions.</p>
<p>In the end, I believe that CBD will prove to have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">place in people’s medicine cabinets</a> – but not until the medical community has established the right form to take and the right dosage for a given medical condition.</p><img src="https://counter.theconversation.com/content/186901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kent E Vrana receives unrestricted research grant funding from PA Options for Wellness (a Pennsylvania-approved clinical registrant medical marijuana company).
Vrana is the director of the Pennsylvania-designated Medical Marijuana Academic Clinical Research Center at Penn State. </span></em></p>CBD isn’t a miracle cure for everything that ails a person – but science shows that it has the potential to help treat a number of health conditions.Kent E Vrana, Professor and Chair of Pharmacology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947332023-01-18T19:23:35Z2023-01-18T19:23:35ZDrip, drip, drip. Why is my leaking tap keeping me awake at night?<figure><img src="https://images.theconversation.com/files/496028/original/file-20221117-5721-hem8al.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bathroom-tap-leaking-water-drops-saving-649340482">Shutterstock</a></span></figcaption></figure><p>People describe the sound of a dripping tap in the middle of the night as anything from <a href="https://twitter.com/loserssaywot/status/1291196310909902848">annoying</a> to <a href="https://twitter.com/caffandconcrete/status/1111932062708183040">torture</a>. Others sleep through, seemingly oblivious.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1111932062708183040"}"></div></p>
<p>But if this common sound is keeping you awake, you can do something about it.</p>
<p>Here are some tips of how to rethink the sound of your leaking tap, which should help bring you a decent night’s sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-we-wake-around-3am-and-dwell-on-our-fears-and-shortcomings-169635">Why do we wake around 3am and dwell on our fears and shortcomings?</a>
</strong>
</em>
</p>
<hr>
<h2>Taps, snoring, roosters, traffic</h2>
<p>Dripping taps, a partner snoring, the neighbour’s roosters, traffic noise. All can be the nemeses of the land of nod. </p>
<p>Unwanted light can also interrupt our sleep but we can close our eyes to block it out. We cannot close our ears to silence these disruptive noises.</p>
<p>So unless we wear ear plugs or very expensive noise-cancelling headphones, sounds at night will vibrate our ear drums, be converted to nerve impulses and wend their way up to the brain. </p>
<p>So we can hear these sounds if we are awake. If we’re asleep already, they may wake us.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clicks-bonks-and-dripping-taps-listen-to-the-calls-of-6-frogs-out-and-about-this-summer-150084">Clicks, bonks and dripping taps: listen to the calls of 6 frogs out and about this summer</a>
</strong>
</em>
</p>
<hr>
<h2>Why are some sounds more likely to wake us?</h2>
<p>Sounds that are loud, variable, unpredictable and meaningful are most likely to wake us. </p>
<p>We analyse meaning in the top or “smart” part of the brain, the cerebral cortex. This receives the information from the ears, even when we are asleep, and assesses the importance of the sound. </p>
<p>We are much more likely to awaken to the sound of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-8986.1974.tb00815.x">our own name</a> than another name. A baby’s cry at night can wake us to feed it. Unusual sounds, possibly indicating danger, are more likely to wake us. Loud sounds, usually indicating something is getting very close, will wake us.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1291196310909902848"}"></div></p>
<p>It is perhaps a good thing we cannot close our ears when we fall asleep. Having our ears “open” to potential danger while asleep may have been helpful for our ancestors, improving their chances of survival and our own subsequent existence.</p>
<p>How deeply we’re sleeping also affects if sounds wake us. Our sleep pattern is like a roller coaster. We first descend into deep sleep then ascend into light sleep <a href="https://www.sleephealthfoundation.org.au/pdfs/Facts-About-Sleep.pdf">about every 90 minutes</a>. During phases of light sleep, we are much more likely to be awoken by noises, even if they are soft and regular. </p>
<p>These light phases of sleep have probably served as brief “sentry” points across the sleep period. They may have helped our ancestors survive any night-time threats.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fan next to someone asleep in bed" src="https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500901/original/file-20221214-525-srnvx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We can get used to regular or predictable sounds, such as a whirring fan.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-sleeping-on-bed-turn-fan-1469214524">Shutterstock</a></span>
</figcaption>
</figure>
<p>Sounds that are soft, regular, familiar, predictable and unimportant are not likely to awaken us.</p>
<p>We can also become used to regular or predictable sounds, such as a dripping tap, refrigerator or fan. That’s because over time our brain predicts the regular pattern, gets used to it, and doesn’t perceive it as a threat.</p>
<p>But a change in the pattern of the sound, such as when it suddenly stops, can wake us.</p>
<p>We have completed a <a href="https://academic.oup.com/sleep/article/45/8/zsac085/6568580?login=false">large sleep study</a> of the effects of wind farm noise. We found no objective disturbance to sleep of typical intensity wind farm noise, which is a soft noise and regular. </p>
<p>To our surprise, even people who reported they found the wind farm noise annoying at home and felt it disturbed their sleep were not, in fact, woken by it. Nor was there any disruption of the objectively measured quality of their sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-brown-noise-can-this-latest-tiktok-trend-really-help-you-sleep-188528">What is brown noise? Can this latest TikTok trend really help you sleep?</a>
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</em>
</p>
<hr>
<h2>OK, so how about taps?</h2>
<p>Sounds that represent a possible threat or challenge are much more likely to wake us. They are also more likely to stop us from falling asleep even when they are at low intensity and regular, such as a dripping tap.</p>
<p>The tap might be a challenge because it represents a job needing to be done, or a waste of water. But the strongest threat of the dripping tap on our sleep may be the belief that it will keep us awake and therefore affect how we function the next day. </p>
<p>The nightly association of the sound of the dripping tap with worry about our sleep and its “downstream” effects can trigger an anxious “fight or flight” response. This further delays us falling asleep. It can also develop into an “alert” habit, contributing to developing insomnia.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/znWdpx5W-e0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dripping laundry tap or existential crisis?</span></figcaption>
</figure>
<h2>What can I do about it?</h2>
<p>Cognitive/behaviour therapy for insomnia is a <a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">very effective treatment</a>.</p>
<p>This cognitive approach may involve re-interpreting the meaning or threat the dripping tap poses.</p>
<p>Depending on its rate, you could interpret the dripping noises positively as someone’s heart beating regularly. If it drips at a slower rate, you could synchronise your breathing in a meditative-type practice to relax.</p>
<p>Alternatively, it may be quicker to wear earplugs, or fix the tap. </p>
<p>If you have insomnia, the dripping tap is unlikely to be the only trigger. So behavioural therapies can be used to increase your drive for sleep and ensure sleep, regardless of annoying noises.</p>
<p>A GP is a good place to start discussions about the option of referring you to a sleep psychologist to treat severe, chronic insomnia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">Explainer: what is insomnia and what can you do about it?</a>
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</em>
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<img src="https://counter.theconversation.com/content/194733/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leon Lack receives funding from the Australian Research Council and the National Health and Medical Research Council. </span></em></p>Here are some tips of how to rethink the sound of your leaking tap, which should help bring you a decent night’s sleep. Or you could just fix the tap.Leon Lack, Professor of Psychology, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947982023-01-05T06:17:59Z2023-01-05T06:17:59ZHow COVID can disturb your sleep and dreams – and what could help<figure><img src="https://images.theconversation.com/files/502939/original/file-20230103-24-ifowib.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5440%2C3053&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/insomnia-pain-african-american-girl-closed-1742211797">Prostock-studio/Shutterstock</a></span></figcaption></figure><p>By the end of 2022, more than 650 million COVID infections had been reported to the <a href="https://covid19.who.int/">World Health Organization</a>. With the true number likely much higher, and the tally increasing by hundreds of thousands every week, the scientific community has been focused on understanding the impact of COVID on our physical health, mental health and brain function. </p>
<p>In the early stage of the pandemic, sleep scientists charted the costs and benefits of lockdowns <a href="https://theconversation.com/were-sleeping-more-in-lockdown-but-the-quality-is-worse-155797">on sleep patterns</a>. The main finding was that we slept more in lockdown but the quality of our sleep was worse.</p>
<p>Now a second wave of data is beginning to explain how becoming infected with COVID is affecting our sleep and even intruding into our dreams.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-a-lack-of-sleep-affects-your-brain-and-personality-66604">How a lack of sleep affects your brain – and personality</a>
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</em>
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<p>The most recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782754/">meta-analysis</a>, a review of all the currently available scientific literature, estimates that 52% of people who contract COVID suffer from sleep disturbances during the infection. </p>
<p>The most common type of sleep disturbance reported is <a href="https://www.nhs.uk/conditions/insomnia/">insomnia</a>. People with <a href="https://jamanetwork.com/journals/jama/article-abstract/1653540">insomnia</a> typically find it difficult to fall asleep or stay asleep, and often wake up early in the mornings.</p>
<p>Worryingly, sleep problems sometimes persist even after recovery from the infection. A <a href="https://www.sciencedirect.com/science/article/pii/S1389945721000939">study in China</a> found that 26% of people who were admitted to hospital with COVID showed symptoms of insomnia two weeks after discharge. </p>
<p>And a <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2021.795320/full">US study</a> showed that people who had been infected with COVID were more likely than people who had never been infected to have trouble sleeping, even up to a month after a positive COVID test.</p>
<h2>Sleep difficulties and long COVID</h2>
<p>While most people recover from COVID quickly, some continue to have symptoms in the longer term. People suffering from long COVID seem very likely to face persistent sleep problems. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S2589537021002996">2021 study</a> surveyed more than 3,000 people with long COVID. Almost 80% of participants self-reported sleep problems, most commonly insomnia.</p>
<p>A more <a href="https://www.jmir.org/2022/7/e38000/">recent study</a> collected data on both sleep duration and quality using smart wristbands. Participants with long COVID slept less overall and got less deep sleep than participants who had never had COVID. </p>
<p>Loss of deep sleep is particularly concerning, as this type of sleep reduces how tired we feel and strengthens concentration and memory. Lack of deep sleep may be partly responsible for the commonly reported “brain fog” during and after COVID.</p>
<p>The fact COVID often interferes with sleep is also worrying because sleep helps our immune system <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/">to fight infections</a>. </p>
<h2>Why does COVID affect our sleep?</h2>
<p>There are many reasons why a COVID infection might lead to poor sleep. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253893/">One review</a> identified physiological, psychological and environmental factors. </p>
<p>COVID can have a direct impact <a href="https://www.nature.com/articles/d41586-020-02599-5">on the brain</a>, including the areas that control both wake and sleep states. We don’t yet have a clear understanding of how this works, but possible mechanisms could include the virus infecting the central nervous system or affecting the brain’s blood supply. </p>
<p>Typical symptoms of COVID include fever, coughing and breathing difficulties. These are also well known to disturb sleep. </p>
<figure class="align-center ">
<img alt="A man lies awake in bed. A clock on the bedside table shows 2:04." src="https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502958/original/file-20230103-20-wb47rt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Scientists are studying how COVID affects our sleep.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-man-suffering-insomnia-lying-bed-662022823">amenic181/Shutterstock</a></span>
</figcaption>
</figure>
<p>Poor mental health can lead to sleep problems and vice versa. There’s a <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14506">strong link</a> between catching COVID and mental health issues, particularly depression and anxiety. This can be caused by worries about recovery, loneliness or social isolation. Such anxieties may make sleeping harder. </p>
<p>Meanwhile, hospitalised COVID patients can face additional difficulties trying to sleep in busy hospital environments where sleep is often disturbed by noise, treatment and other patients. </p>
<h2>What about dreams?</h2>
<p>The <a href="https://www.ox.ac.uk/news/2020-06-12-oxford-researchers-lead-international-study-effects-covid-19-sleep">International COVID-19 Sleep Study</a>, a global research project involving sleep scientists from 14 countries, recently released <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8800372/">its findings into dreaming</a>. </p>
<p>The study surveyed infected and uninfected participants about their dreams. Both groups had more dreams after the start of the pandemic than before. Intriguingly, the infected participants had more nightmares than the uninfected participants, while there was no difference between the groups before the pandemic.</p>
<p>There’s no simple explanation for why catching COVID may increase nightmares, but mental health may again play a role. Poor mental health is often accompanied <a href="https://link.springer.com/article/10.1007/s00127-017-1408-7">by nightmares</a>. The International COVID-19 Sleep Study team found the infected group showed more symptoms of conditions such as anxiety and depression.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-we-dream-135609">Why do we dream?</a>
</strong>
</em>
</p>
<hr>
<h2>Getting help</h2>
<p>The close links between sleep and both mental and physical health mean that prevention and treatment of disturbed sleep have never been more important, and will require <a href="https://www.sciencedirect.com/science/article/pii/S1389945721002483">creative solutions</a> from governments and healthcare providers.</p>
<p>If you’ve had trouble sleeping during or after COVID, or are having more bad dreams than you used to, you’re not alone.</p>
<p>Both short- and long-term insomnia can often be treated with cognitive behavioural therapy (CBT) that you may be able to access through your doctor. </p>
<p>For less severe sleep problems, the <a href="https://esrs.eu/news/education/european-academy-for-cognitive-behavioral-treatment-of-insomnia-cbt-i/">European Academy for Cognitive-Behavioral Treatment of Insomnia</a> has compiled <a href="https://onlinelibrary.wiley.com/doi/10.1111/jsr.13052">recommendations</a>, some based on principles applied in CBT, that you can follow at home. These include:</p>
<ul>
<li>keeping a regular sleep-wake schedule</li>
<li>restricting thinking about things that make you feel stressed to specific times of day</li>
<li>using your bed only for sleep and sex</li>
<li>going to bed and getting up when you naturally feel inclined to do so</li>
<li>sharing feelings of stress and anxiety with family and friends</li>
<li>reducing sleep disruption due to light exposure by making sure your bedroom is as dark as possible</li>
<li>exercising regularly in daylight</li>
<li>avoiding eating close to bedtime.</li>
</ul><img src="https://counter.theconversation.com/content/194798/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jakke Tamminen has received funding from the Economic and Social Research Council and The Waterloo Foundation.</span></em></p><p class="fine-print"><em><span>Rebecca Crowley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’ve had trouble sleeping during or after a COVID infection, you’re not alone.Jakke Tamminen, Lecturer in Psychology, Royal Holloway University of LondonRebecca Crowley, PhD Candidate, Psychology, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.