Do you ever feel totally exhausted but find yourself unable to drift off into a blissful rest-restoring sleep? In other words, are you “tired but wired”? During the day, despite indulging in numerous cups of coffee, sometimes staying alert can feel like an impossible task, having a knock-on effect on your productivity and work. You crave rest and a good night’s sleep, but when you finally jump into bed and snuggle down under your duvet, your brain simply refuses to embrace the slumber you so desperately crave. What is going on?
This scenario plays out frequently, leaving many people reaching for sleeping pills first, but before you decide to do the same, find out about all the various factors that could contribute to you feeling tired throughout the day but wide awake at night. As they say knowledge is power and learning about sleep can help you implement strategies to enhance your sleep quality by identifying potential triggers for poor sleep hygiene.
Your Circadian Rhythm is disrupted
According to sleep specialist W. Christopher Winter, MD, author of “The Sleep Solution: Why Your Sleep Is Broken and How to Fix It,” the circadian rhythm serves as an internal timekeeper governing our body’s activities over a 24-hour cycle. How does the body know when to fall to asleep? Well, its simple really, when the lights go out so should we. This is why nature has designed the circadian rhythm to take cues from daylight and the approaching darkness of night. These visual cues are combined with our own internal biological clock to regulate vital functions, including body temperature, metabolism, hormone secretion (including melatonin), and the sleep-wake cycle. For example, our biological clocks prime cortisol to spike in the morning allowing us to get ready for a new day. But just as everyone has different colour eyes, hair and skin, people’s circadian rhythms also differ. You all know people who are night owls, who work best at night while others are larks, who are more productive in the morning. The reasons that people fall asleep and wake up at different times may have been an evolutionary adaption allowing humans to survive. Think about the threat to our ancient ancestors posed by sabre tooth tigers. Now, if everyone fell asleep at the same time, it would make the sabre tooth tiger’s job, hunting humans, easier. All it needed to do was to wait for everyone to fall asleep then pounce on unsuspecting victims. So, if all our circadian rhythms were synced then a sabre tooth tiger would probably be writing this blog about extinct humans. But nature made sure that while some of us fell asleep earlier in the evening others were awake to warn us about any attacking sabre tooth tigers. It’s like nature preprogrammed a night watch default in all of us.
How melatonin helps us sleep
You have probably heard of the hormone melatonin and how it is used to help us sleep. You may even have come across supplements containing melatonin. This hormone, melatonin, does indeed help us sleep; in fact, it is sometimes called the “Dracula Hormone” because it always comes out at night. But how does the pineal gland, the place where melatonin is made, know when to release this sleep-inducing hormone? This is due to light falling on part of the brain called the suprachiasmatic nucleus (SCN). This area of the brain is responsible for controlling melatonin production, and so has a direct impact on whether we can fall asleep after a hard day’s work.
During the day when light levels are high the SCN keeps the melatonin production low, but as daylight turns to night the SCN releases the brakes on the melatonin, and it floods the brain causing that irrepressible descent into sleep. Darkness boosts our melatonin production, with levels reaching their peak between 2 and 4 a.m. Our bodies are best primed to fall asleep about 2 hours after melatonin levels start to rise. However, if you’re tired but can’t sleep, your circadian rhythm may be off.
Delayed Sleep Phase Syndrome (DSPS)
Trouble sleeping could be a sign of delayed sleep phase syndrome (DSPS). This occurs when you fall asleep two or more hours later than what’s considered “normal” (10 p.m. to 12 a.m.), making it more difficult to wake up in the morning for school or work. Young people are more affected by DSPS than adults, which explains why it so difficult to wake them for school!
Is there a difference between being tired and sleepy?
What is the difference between being fatigued and tired? Aren’t they both the same thing? Many people use the word “tired” when they mean “sleepy” and vice versa, but there is a subtle difference. Imagine you have just run a marathon (not a fun thought); you will feel fatigued at the finish line, you barely have enough energy to stand, eat or talk, and the last thing on your mind is running another marathon. Does this mean you are sleepy? Not really. You don’t suddenly drift off to sleep the moment you cross the finish line. Being sleepy as opposed to being tired and fatigued is losing battle with staying awake.
Why am I tired during the day?
Feeling tired during the day is reaching pandemic proportions. While this tiredness could be a sign of delayed sleep phase syndrome (DSPS), it could also be caused by many other things.
1. Sleep Apnoea
Sleep apnoea is when you literally stop breathing at night causing you to gasp for air. This obviously would disrupt your sleep because if you didn’t’ wake up to take a life saving breath then you would be dead and you wouldn’t be reading this blog. This leads to fragmented sleep and decreased oxygen levels, resulting in daytime tiredness and impaired cognitive function.
2. Napping
Naps are not bad in themselves, in fact there are several benefits to napping. But as with everything in life, too much of a good thing can be bad for you. Taking naps at the wrong time can actually be causing you have problems drifting off at night.
Research suggests that taking longer naps in the later afternoon can be one of the reasons that you are finding it longer to fall asleep at night, having an overall poor level of sleep and causing you to wake up more often during the night.
It is recommended that you keep your daytime naps to no more than 20-30 minutes in length and nap at the same time each day so that your body can get used to it.
3. Anxiety
You probably knew this one. You know what its like, you have something serious on your mind, which keeps it racing, and this definitely is not conducive to a restful night’s sleep. In fact, sleep disturbance is one of the diagnostic criteria for several anxiety disorders. It’s natural that when you are anxious you are in a state of arousal and therefore you will find it difficult to fall asleep.
4. Depression
Research in 2019 suggests that up to 90% of people diagnosed with depression also have difficulty sleeping. The exact relationship between depression and sleep disturbance is not known but it appears to disrupt the circadian rhythm. This association between depression and insomnia can be due to the disruption of the brain chemicals or even genetic factors.
6. Caffeine
Most of us need that early morning caffeine boost at the start of the day to get us going but get your timings of your coffee breaks wrong and it could lead to sleepless nights. The half life of coffee is 5 hours, this is the time for the concentration of the caffeine in your blood to reduce by half. This means that even 200 milligrams (mg) of caffeine, which works out to about 16 ounces of brewed coffee may impact your sleep. It is recommended that you stop your intake of coffee between 4-6 hours before you go to bed to stop the caffeine interfering with your sleep.
5. Screen time
We have mentioned melatonin before and how it is described as the Dracula hormone that only comes out at night. Well, what has this got to scrolling on your phone in bed before you drift off to sleep. Well, it the blue light that is being emitted from your phone that confuses your brain. This blue light means that the hormone, melatonin, is not released which in turn makes it harder to drift off. So, to prevent this blue light from disrupting your normal sleep, it is recommended that you stop using any devices such as phones, laptops and TV screens at least two hours before bed. Another suggestion would be to use blue blocking glasses at night.
6. COVID
As if all the other symptoms of COVID weren’t bad enough, now researchers are adding insomnia to the list. Researchers have found that insomnia and difficulty in sleeping is a common symptom of COVID and found that after questioning 236,379 people with COVID found that about 5% of them experienced insomnia. With the number rising to 10% in those who suffered from severe infections that required hospitalisation. Researchers are unsure of the cause of the association between COVID and difficulty in sleeping but it may be caused by the autoimmune response to the virus. Other causes of COVID induced insomnia could be related to the social and economic hardships that COVID and the lock down imposed on families.
8. Diet
It would seem that everything that goes wrong in life is linked to our diet! Unfortunately, to a large extent this is true but the connection between insomnia and diet is unclear. Researchers found that an increased intake of saturated fats or carbohydrates at the expense of protein increased the risk of daytime drowsiness and difficulty sleeping at night. While a 2016 review found that high fat diets were linked with less REM sleep, more deep sleep, and increased arousal from sleep. While in the short-term high carb diets were associated with more REM sleep, less deep sleep and falling asleep faster. High protein diets in the evening correlated with less daytime sleepiness.
Another review also found that what you eat before sleeping cam also influence the quality of your sleep. They found that almonds, kiwifruit, and fatty fish which all contain melatonin and so help in getting that restless night’s sleep.
Unfortunately, the research is not conclusive but it worth experimenting with your diet to see if this has any effect on the quality of your sleep.
7. Other reasons why you may be tired but can’t sleep
Hormone imbalances can also trigger sleep disorders, especially in women when they experience low progesterone levels. Progesterone is the hormone which balances oestradiol and when there is an imbalance between the two, insomnia is just one of the many symptoms that can result.
Another cause of disturbed sleep is restless legs syndrome. This is where your legs feel uncomfortable making you want to continually move them. So, obviously if you spend the night moving your legs you aren’t going to get much sleep.
Is being tired such a bad thing anyway?
From the capitalist point of view, being tired during the day means that you are less productive at work. While if we choose to focus on the health paradigm, then by not getting enough good quality sleep at night means that you put yourself at an increased risk of:
- diabetes
- heart disease
- obesity
- depression
- cancer
How can I fall asleep?
OK, so we have gone over the causes of a poor night’s sleep so what can we do about it? The first thing is to create a good, consistent sleep schedule and it goes without saying, stick to it. For example, go to bed when you are tired. Don’t go to bed and immediately pull out your phone and scroll social media for a few hours. Keep the bedroom off limits, except for two activities, sleep, and sex. This may involve you rearranging your schedule slightly so that the time you start to drift off is the exact moment you get into bed.
Other top tips for getting a good night’s sleep include:
- Make sure your bedroom is dark,
- Make sure your bedroom is cool, preferably between (15–19°C),
- Put your phone in a drawer and keep it there until morning (damn this will be hard),
- Try earplugs if you live in a noisy environment, such as opposite a 24-hour petrol station,
- If you suffer from anxiety, try calming activities such as writing in a journal, getting your thoughts on paper helps and maybe try meditating.
- Take a hot bath before you go to bed.
What to do if these tips don’t help
If you suffer from sleep disturbances and have trouble getting to get to sleep and have tried our top tips then it is worthwhile to speaking to a doctor. If you have trouble getting to see your GP you can book an appointment with our consultant psychiatrist, Dr Zak Taylor who specialises in sleep disorders. This consultation will involve a detailed discussion of the issues relating to your sleep and a full medical history. This is essential since Dr Taylor may want to prescribe a temporary sleeping tablet, such as zopiclone 7.5mg and hence he will have to make sure that this is suitable with any other medication before he prescribes it.
You can also try the compounded melatonin 8.5mg transmucosal film tablets, which are specially made by the compounding pharmacy, APC Labs. The melatonin that they supply is unlike any other tablets of melatonin because it comes in a strip which you stick to the inside of your mouth. Once its in place it starts to dissolve and enters the blood stream faster than normal tablets, meaning you get to sleep faster. This compounded melatonin can be purchased without a consultation; you simply need to complete the questionnaire and make the payment, and APC labs will ship the melatonin to your address.
