Wellness Matters

Trouble Sleeping? -- A Dozen Reasons Why and What To Do About Them

April 24, 2015

By: Deborah Schoenhoff, MD, medical director, Cone Health Women’s Health Network, Cone Health MedCenter High Point

Lack of sleep (insomnia) is one of the most common concerns I hear from patients. More than 5 million office visits each year in the U.S. are due to problems with sleep. Over time, poor quality sleep may result in irritability, poor work performance, forgetfulness, fatigue, depression and ongoing problems can reduce your quality of life.

There are two major types of insomnia: short term and chronic. Short-term insomnia usually lasts for fewer than three months and may be related to severe stress such as from grief or acute pain. Short-term insomnia usually ends when the stress does or as the individual adapts. Chronic insomnia is marked by a lack of quality sleep for at least three times a week lasting three months or longer. Chronic insomnia has been linked to serious health issues such as heart disease, obesity, high blood pressure and depression.

Here are 12 conditions and behaviors that will rob you of a good night’s rest, along with suggestions for overcoming them.
  • Acute or chronic anxiety and depression - Women often experience these frequent sleep robbers. Depression may cause early morning awakening or sleeping more than usual. Persistent anxiety may make it hard to fall asleep or have you waking in the middle of the night unable to easily go back to sleep.
  • Acid reflux/eating and drinking - What you eat and drink late in the evening will affect your sleep. Stomach acid may cause nighttime heartburn especially after a large, spicy meal. Too much caffeine or alcohol is also an offender. Eat dinner at least three to four hours before bedtime, and avoid heavy or spicy meals. If caffeine keeps you awake, do not drink it during or after dinner. Drink no more than one cocktail, bottle of beer or glass of wine.
  • Lack of exercise - Regular exercise helps you to sleep but avoid strenuous exercise close to bedtime. 
  • Medications - Certain medications such as steroids, stimulants, some anti-depressants and some blood pressure medications may cause a loss of sleep.
  • Menopausal hot flashes - One in four women will have nighttime hot flashes that severely limit sleep. Ask your health care provider if short-term hormone therapy may provide relief from hot flashes. 
  • Neurologic disorders - Parkinson’s disease and Alzheimer’s dementia may significantly change sleep patterns especially if you are over the age of 65.
  • Overactive bladder - Getting up in the middle of the night to go to the bathroom will disrupt anyone’s sleep. Try drinking less after dinner. There are also over-the-counter and prescription medications that will help. A pelvic floor physical therapist can help with muscle strengthening exercises. 
  • Pain disorders - Chronic back pain, leg muscle spasms or arthritis may keep you awake. See if a heating pad at bedtime or supportive pillows makes you more comfortable.
  • Poor sleep hygiene - Unhealthy bedtime habits may be difficult but necessary to change. Keep the cell phone and laptop out of your bedroom and use your bed for sleep and sex only. Go to bed and wake at the same time every day. If you cannot fall asleep within 20 minutes, get up and do a quiet activity until sleepy. Keep the bedroom dark and at a comfortable temperature. 
  • Restless legs syndrome - This condition is more common in women. People describe uncontrollable leg movements or a crawling sensation at night. Try simple solutions first such as massaging your legs before bedtime or taking a hot bath.
  • Sleep apnea - Sleep apnea is repeated pauses of breathing during sleep that robs your body of needed oxygen. You do not have to be severely overweight to have this disorder. Often the symptoms are noted by your partner and can be seen in those who frequently snore.
  • Shift work insomnia - This type of sleep disorder is seen in night-shift workers and comes from disrupting the normal sleep/wake cycle. A sleep specialist best evaluates this.

If poor sleep is related to a medical or psychiatric illness, that condition should be treated first. If it is necessary to use prescription medication, the choice should be individualized according to age, co-existing illness and potential side effects. Excessive drowsiness, impaired driving, dizziness and falls are real concerns, especially in those over age 65. My staff and I at the Women’s Health Network are happy to help with these decisions. 
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Deborah Schoenhoff, MD, NCMP, is the medical director for Cone Health Women’s Health Network located at Cone Health MedCenter High Point, 2630 Willard Dairy Road, Suite 205. She was the first internal medicine physician in the area certified as a menopause practitioner. Schoenhoff can be reached at (336) 884-3666. The Women’s Health Network is part of Cone Health Medical Group.

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