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Understanding the cause of your sleep problems

Most of us know the feeling - it's 4 am and you're still tossing and turning, or you've woken up and are now super-alert. It's never fun, but you are in good company. At any one time, about 1 in 5 people are having some problem sleeping - but the good news is that for the vast majority of people, insomnia is temporary.

What we already know

Doctors use the term 'insomnia' to refer to any kind of poor sleep. This could mean difficulty getting to sleep in the first place; disturbed sleep, where you wake regularly for long enough to remember it; waking early and not being able to get back to sleep; or feeling tired even after an apparently good night's sleep.

One of the most common myths is that everyone needs to sleep for eight hours every night - you don't. It's common to need less sleep as you get older, and everyone's 'normal' need for sleep is slightly different. If you only get six hours sleep a night but function just fine the next day, it's not a problem. And even if you have the odd night's poor sleep, it's not going to do you long-term harm.

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Causes and cures

Can't keep still

The remedy for poor sleep often depends on the cause, so it's worth asking yourself what could be stopping you from sleeping. Joint pain can be worse when you lie down if, for instance, it affects the side you're used to lying on. I regularly see patients who say they can't get off to sleep - and when I probe deeper it's because their legs start to feel fidgety as soon as they lie down. Restless legs syndrome causes strange sensations in your legs - different people describe fidgetiness, tiny electric shocks, jerkiness or even pain. It tends to come on in the evening or at night, and is briefly relieved by moving around or massaging your legs.

Obstructive sleep apnoea is a condition which causes you to stop breathing for short periods during sleep, jerking awake when your body becomes deprived of oxygen. You may not even realise it's happening, but it often leads to feeling worn out the next day, even though you think you've slept for a long time.

Mind your mood

Depression is a very common culprit where insomnia is concerned. The 'classic' pattern of sleep upset in depression is early morning wakening, but depression can also stop you getting to sleep, or can lead to you waking frequently during the night. Of course, there are lots of possible causes of poor sleep other than depression, but it might be worth asking yourself two questions. In the last two weeks, how often have you been bothered by feeling down, hopeless or depressed; and how often have you not enjoyed events you would usually relish?. If the answer to either of these questions is 'at least half of days', it's worth seeing your doctor to talk about whether you might be depressed.

Stress is also a common cause of disrupted sleep. We all need some stress - otherwise we'd never bother to get out of bed and get anything done. But if stress levels rise, your mind can start whirring when you lie down in a quiet bedroom with no distractions. This can lead to a vicious cycle - if you have a bad night's sleep, the next night you might feel anxious that the same thing will happen. This means the moment you turn the light out the adrenaline kicks in. And what does adrenaline do? Keeps you alert!

Medication misery

A surprisingly wide variety of medications can affect your sleep. Antidepressant medications can disturb your sleep, and it can be difficult to know whether it's the cause (depression) or the fix (antidepressants) that's to blame. Try taking your medicine in the morning to see if it helps, and stick with it - most of the side effects of antidepressants wear off in the majority of people within a few weeks.

Some beta-blockers, used for abnormal heart rhythms, can also disturb your sleep, leading to nightmares and vivid dreams. Speak with your GP if you're troubled by this - sometimes changing to a different, 'cardio-selective' version can help.

High doses of asthma medications, including salbutamol and steroid tablets, can make it harder to sleep. Steroid inhalers don't have the same effect. By getting your asthma under better control, you should be able to cut down on the need for both reliever inhalers like salbutamol, and courses of steroid tablets for acute flare-ups of asthma. Poorly controlled asthma can also disturb your sleep, so you'll get a double benefit.

Water tablets used for high blood pressure and fluid retention can leave you running to the loo all night. Taking them earlier in the day (although not just before you leave the house, for the same reason) may be enough to solve the problem.

A look at lifestyle

Caffeine is great for keeping you awake if you're working shifts or have had a late night. It's a highly effective stimulant, but some people are more sensitive than others to its effects. Try cutting out caffeine (including tea, coffee, chocolate and colas) from midday to see if it helps. Most people can still have a cup or two in the mornings without a knock-on effect.

Most importantly, remember that for most people, insomnia is a temporary problem. The more you convince yourself that you will sleep well again one day, the quicker that day (or night) will come.

With thanks to 'My Weekly' where this article was originally published.

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