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Wednesday, May 22, 2013
Nearly two months ago I moved into a flat with my boyfriend and now I can`t sleep through the night. I never used to have a problem when just staying 1 or 2 nights a week. I can fall asleep fine at about 10/11pm as I`m so tired but then by about 2/3am I wake up every couple of hours. I can fall back asleep but I feel very agitated and annoyed. I`ve also had lively vivid dreams every night which I think sometimes wake me up as I can`t switch my mind off. I`ve always been a bit of a worrier but am not particularly stressed at the moment. I don`t drink caffeine or alcohol or smoke. I also have a healthy lifestyle. Having an interrupted nights sleep makes me really grumpy and hard to live with. Can you help me please?
Sleep is not uniform. We go through several cycles of different sleep types (stages) during the night. These cycles of REM and non-REM sleep repeat every 90 minutes on average. "REM sleep" stands for Rapid Eye Movement sleep, which corresponds to dreaming. At the end of each cycle we tend to wake up for a few seconds, then we go back to sleep without remembering much about it. We are more likely to wake up from REM sleep rather than deep non-REM sleep, which is why we tend to remember our dreams, especially if they were vivid as in your case. We are also more likely to wake up for longer periods of time during the second half of the night, when we have had some rest, and when the pressure to remain asleep has decreased.
Factors that wake people up in the middle of the night, as you describe, are quite varied and may include one or more of the following; a poor sleep environment (i.e. the bedroom is too noisy, too bright or too warm), learned poor sleep habits (i.e. watching TV to fall asleep), excessive use of stimulants (medications and common substances such as caffeine and nicotine), stress or anxiety, some psychiatric conditions (i.e. depression, bipolar disorder), pain, medical conditions that may make it uncomfortable or difficult to breath well when lying down, heartburn, and circadian rhythm disturbances (when the body's biologic rhythms are out of synchrony with the environment or is advanced).
Not feeling refreshed and having vivid dreams could be the sign of an underlying sleep problem that is not clearly apparent to you. The onset of these problems with moving in with your boyfriend makes me think that the new environment is the cause. However, it is also possible that the environment is only making the effects of a primary sleep disorder more apparent.
An evaluation for your problem often starts with your primary care physician, but referral to a Sleep Specialist is necessary in some cases. A Sleep Specialist will take a detailed history and perform a physical examination. Based on this information, they will determine if any testing is needed or if a treatment strategy can be initiated.
Some simple strategies you may consider before discussing your problem with your doctor include the following:
- Try writing down a "worry list" 2 hours before bedtime. This should include things you need to do the next day and serve to "free your mind" of the days troubles.
- Establish a relaxing bedtime routine that does not involve listening to music. A warm bath 1-2 hours before bedtime or some light reading may be useful.
- Consider trying a "white noise" machine to provide some background sound that is not musical.
- Make sure your sleep environment is comfortable, dark, quiet, and not too warm.
- Daily exercise, particularly earlier in the daytime, may help you rest better at night.
If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck, and sleep well.
Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University