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Top 4 Causes of Nighttime Restlessness—and How to Manage Them

Getting a good night’s rest is important for so many reasons. Allowing our bodies and minds to “reset” is critical for cognitive and memory function, mood stabilization, and cellular repair. Unfortunately, not everyone gets the rest they need. Whether it’s a new baby or puppy, racing thoughts late at night, or simply too many “to do’s” on our lists, plenty of things temporarily interfere with getting the recommended 7-9 hours every night. Still, more Americans are finding that a regular restful night’s sleep is nothing more than a dream. 

Although it’s normal to experience an occasional night of tossing and turning, chronic restlessness can have a major impact on your quality of life, causing daytime sleepiness, irritability, weight gain, and even lower your immunity making you more vulnerable to viruses. There are several factors that contribute to nighttime restlessness, which we address in this blog. If you experience one or several of these, talk to your primary care provider. You also may be referred to our sleep center for further evaluation.

  • Restless Legs Syndrome
  • Diet
  • Obstructive sleep apnea
  • Poor sleep hygiene
  • Hormones
  • Stress
  • Late night exercise/work schedule

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is usually defined as a persistent need to move your legs due to cramping or unpleasant tingling, burning, or creeping sensations which can most often be relieved by moving around or getting out of bed. Doctors don’t know what causes RLS, but they suspect it may be hereditary. Women are more likely to suffer and the onset of RLS usually occurs after age 45. There is no specific test for RLS, but your doctor can diagnose the condition based on your description of your symptoms. In addition to a persistent need to move your legs, patients with RLS commonly describe symptoms that are triggered by rest, relaxation, or sleep and become worse at night. Symptoms are usually absent or improve by morning. Because there is no cure for RLS, treatment typically focuses on management and minimizing symptoms. Your doctor may prescribe medication to help control symptoms, but those suffering may need to try various types before knowing what works best for them. Lifestyle changes, such as limiting caffeine, tobacco, alcohol, and adding regular exercise and relaxation techniques such as warm baths or massage, may be helpful in controlling RLS. If left untreated, the condition can worsen and not only impede sleep and continue to decrease the amount and disrupt the quality of sleep needed, it also can lead to depression and anxiety. Keep track of your symptoms, medications, lifestyle changes and talk to a board certified sleep medicine physician to help diagnose and determine your plan of care.

Diet

Remember how you feel following a Thanksgiving dinner? All you want to do is lie on the couch and not move, because you are tired from too much food. Yet, in becoming a couch potato, you’re also slowing the digestive process and the body can’t function the way it’s designed. It takes 20 minutes for the brain to signal you’re full. When you overeat and consume too many calories as a result of eating too much too fast, your organs have to work harder.

In order to break down the nutrients, the stomach produces extra enzymes and hormones. However, in the case of overindulging, acids back up into the esophagus and also can cause heartburn. The long and the short story is that it’s never beneficial to the body to eat too much too close to bedtime. The burping, burning, and bulging stomach can leave you feeling sluggish, but unable to relax.

Consuming foods that contain complex sugars or refined carbohydrates before bedtime also can stimulate you, preventing you from falling into deeper stages of sleep and causing you to wake up frequently. Alcoholic beverages and caffeine also inhibit an uninterrupted night’s sleep, because they interfere with the body’s circadian rhythms. This natural, internal process regulates the sleep-wake cycle and repeats roughly every 24 hours.

Caffeine affects the cardiovascular system through heart rate and blood pressure. It’s important to note, too, caffeine can have a ‘half-life’ of 4 to 6 hours. This means the stimulant still remains in your body for hours after consuming it. Multiple, rapid consumption may not allow your body to clear them as quick as a single caffeinated beverage.

Don’t think it’s just those high octane cups of Joe or fancy lattes, either that harbor caffeine. Teas, chocolate, soda, and popular energy drinks have their own levels of caffeine in each, which means they can be as disruptive as coffee when you’re ready to wind down.

When an individual introduces caffeine into their system, blood vessels constrict and expand, while stomach acids and urine output increase. Frequent urination is another reason people wake in the middle of the night, and caffeine also is a diuretic meaning plan on several middle-of-the-night bathroom visits.

Alcohol, on the other hand, is a suppressant. While it may make you feel sleepier than usual, its effects take its toll on the quality and quantity of sleep after imbibing. For one, it reduces the Rapid Eye Movement (R.E.M.) stage of sleep, which is the deepest and most restorative. This occurs roughly 90 minutes into our sleep cycle. And the more one drinks, the more disruptions they can expect during the night.

Alcohol also raises our internal body temperatures causing night sweats and is known to also suppress breathing and may trigger sleep apnea, which happens when an individual stops breathing periodically during the night (which is addressed next in this blog).

The bottom line is when it comes to diet, you’re in control of preventing certain sleep disturbances by keeping evening snack and meal portions small and by consuming healthier options instead of simple or refined sugar, carbs, and fat-laden foods. Peanut butter on toast, yogurt and fruit, or string cheese and whole grain crackers will satiate you without stuffing you. Finally, curb or eliminate alcohol and caffeine hours before bed so you have time to properly digest.

Obstructive Sleep Apnea

Obstructive sleep apnea is a common, yet serious condition that causes your breathing to repeatedly stop and start during sleep. Nearly 30 million U.S. adults suffer from it. When the muscles of the upper airway relax during sleep (and even more so by gravity when sleeping on your back), the passage is narrowed and can become blocked. This limits the amount of oxygen to the lungs and usually results in snorting, coughing, or choking noises as the body tries to breathe. At times, this may occur hundreds of times during the night, waking an individual – and their partners – from slumber.

The lack of oxygen long-term, if left undiagnosed and treated, can do much more than cause you to feel grumpy and groggy the next day. It can also bring with it heart disease, stroke, high blood pressure, pre-diabetes or diabetes, and depression. If your doctor suspects you have sleep apnea, he or she will refer you to specialist for a sleep study.

During a sleep study, breathing and other vital signs are monitored to find the origin of the problem. Sleep apnea can be successfully treated with losing weight, changing your diet, and getting more exercise. However, if these lifestyle changes do not work, a continuous positive airway pressure (CPAP) device may be recommended, or another oral appliance to ensure open passages during sleep. Sometimes, surgery may be necessary.

Poor Sleep Hygiene

Just as it’s important to brush our teeth and use soap in the shower, there is an aspect of preparing our bodies for rest by following a routine. When it comes to sleep hygiene, it means adhering to habits that ensure a regular bedtime schedule and environment conducive to a good night’s rest without any interruptions. Consider your senses in preparing for bed – specifically sight, sound, and touch.

A cool, dark, quiet room is optimal for a comfortable night’s sleep. Limiting the use and presence of electronic devices in the bedroom has proven to be a success for many. Without the beeps, blips, buzz, and bright lights of a TV, iPad, or smart phone, we are not stimulating our senses and therefore, allow the body systems to begin winding down, which can take 4-5 hours prior to falling asleep. All electronics should be off at least one hour before the lights go out. White noise, in the form of a machine or perhaps an oscillating fan, can lull some to sleep and is a different type of noise than sporadic interruptions from electronics.

The body’s core temperature also drops in preparation for sleep. Conversely, the body temperature rises toward sunrise to stimulate wakefulness. For anyone who has woken in the middle of the night in a sweat or kicking off covers, they don’t need scientific facts to confirm cooler is better. Still, experts agree that a bedroom temperature between 60 and 67 degrees Fahrenheit is best for sleeping. And while most people like to sleep in on the weekends or their days off, sleep specialists suggest staying within a one hour timeframe from our usual bed and wake times to keep our body’s internal clocks consistent. Too much sleep can be as detrimental as too little, so avoid lingering in bed on the weekends and keep a regular sleep schedule.

The good news is that most problems with sleep hygiene can be easily corrected. If any of the above issues may be causing you to be restless at night, you should avoid daytime naps, which can hinder nighttime rest, and heed the advice of powering down electronics and establishing a dark, cool bedroom.

As with most recommendations when it comes to our overall health, proper nutrition, regular exercise, and exposure to natural light during the day also are helpful in making sure you feel refreshed, rested, and ready to both start and end your day on a positive note.

Hormones

From pregnancy to menopause, women’s hormones play a significant role in sleep quality. Hot flashes, night sweats, frequent urination, and general discomfort can be attributed to the drop or increase in hormone levels depending upon what is causing them. These disturbances often occur in the first half of the night when women are trying to fall sleep. While both expecting a child and nearing the end of one’s menstrual cycle is temporary, for those suffering during the months or years during their experience, it can seem like a lifetime.

While not every woman’s experiences are the same, it’s safe to assume most women with growing bellies or those in throes of menopause will experience sleep problems from time to time since our biology is predicated on hormones. This, of course, makes women more vulnerable to restless sleep.

There are declining levels of the hormone estrogen long before menopause actually occurs. Estrogen supplements may be an option for some, although not every woman is a candidate for hormone therapy. Guided imagery, such as mediation, and environmental factors play a role in helping women find a peaceful night’s rest – similar to some of the other sleep disturbance solutions. It’s important to talk to your doctor and determine if your menstrual cycle or the absence of it is at the root of your insomnia or nighttime waking. There are many factors and conditions that could point to night sweats or irritability. For example, low estrogen levels causing sleep disorders in postpartum women are also associated with depression.

Interestingly enough, some birth control pills may also cause sleep disturbances. Those women still getting their periods may also have a difficult time during their cycles with cramping, nausea, or heavy bleeding that can also interfere with rest. Heating pads, a warm shower, over-the-counter medication, chamomile tea, and yoga can benefit these minor forms of discomfort that are a major problem each month. As always, it’s important to talk to your doctor about your symptoms, severity, and frequency so that a proper diagnosis and remedies are given.

Stress

Everybody experiences it thanks to hectic work schedules, family obligations, health situations, major lifestyle changes, and even celebratory moments that require time and effort to plan and attend. Stress is a part of life and while acute stress can motivate and help us focus on a task, chronic stress has serious ramifications and restless sleep is one of the first signs of a problem.

Tossing and turning over everything that needs to be accomplished the next day, the argument you had with your boss or significant other, money problems, or perhaps having received an unfavorable health diagnosis can linger if you don’t address the issue. Allowing anything to interfere with sleep isn’t going to change a situation that evening or prepare you mentally and physically in finding a solution in the light of day.

Taking care of yourself is a significant step one, as well as admitting you may need a little help. Delegating tasks at home and in the workplace can help lighten your load and assist you in getting your tasks completed. Sometimes we associate asking for help as a form of weakness, when in fact, it’s an act of empowerment. Nobody can do it all every day and some people have certain resources, skills, and time that can complement our own strengths.

Whether it’s helping prepare dinner, transportation to appointments, or simply guidance during a difficult transition in your life, reaching out to others can only benefit you and believe it or not, also may help them. People want to be useful and appreciated. It’s not a burden to lean on those who offer or want to help.

In the instance of more serious stressors such as a death in the family, major diagnosis, loss of employment, or financial crisis, seeking professional help in the form of a counselor, financial advisor, or spiritual/religious guide is encouraged. The anxiety and emotional tumult of any of these scenarios can create chronic stress in the body and that is counterproductive to the rest the body needs to heal or repair itself.

Chronic stress threatens our heart health and can lead to a heart attack, abnormal heart rhythms, and even stroke. In a less dramatic reaction, our waistline also can take a toll as some people eat or drink to deal with emotions and find solace in their favorite foods. When it comes to sleep, there needs to be a commitment of 7-9 hours for adults. Once again, maintaining healthy lifestyle rituals are necessary and critical, along with seeking extra help for whatever weighs on your mind. Because it most certainly will also affect your body.

Lifestyle

From shift work to exercising late at night, or even our habit of watching Netflix far too long, there are aspects of our lifestyle that can negatively affect our sleep. When routines are off or non-existent, the body’s internal clock or circadian rhythms take a major hit. If working overnight is the way you earn a paycheck, there isn’t much you can do about traditional sleep hours, but this is where sleep hygiene is important as outlined earlier in this blog. Maintaining a routine, comfortable sleep environment, and limiting stimulants before bed, all can help get you on track despite working in the evening hours.

In the case of shift work, the body cannot regulate its production of melatonin, the natural hormone produced by the brain to signal sleep. Research has shown as little as 0.5 mg in the form of a tablet taken several hours before sleep can aid in the process. It’s also important to recognize that while you may leave work with a long to-do list, sleep is imperative for your overall well-being and ability to stay alert and do your job again the next day. So do not compromise proper rest and try to do too much when you should be sleeping.

When it comes to the topic of exercise, it’s proven that physical activity helps with lowering blood pressure, cholesterol, and reduces the risk of chronic illness and disease. Regular exercise also improves your mood, sleep quality, and your appearance. Remember, if you’re stressed out and anxious, you’re not likely going to sleep well, so with that in mind, exercise helps to burn not only calories, but also that negative energy.

Yet, exactly when an individual should exercise remains questionable among many. What research has determined is that the early bird doesn’t always get the worm OR the benefits of morning exercise, but rather establishing a habit and respecting the body will yield long-term success. Experts also say it’s about intensity coupled with timing. In other words, whatever your chosen physical activity, if it’s within an hour of bedtime, choose wisely.

A brisk walk versus a spin class or run may actually help you sleep better. A tired body, after all, is already prepped for sleep. Follow your chosen activity by a warm cup of decaf tea, a bath, mediation, and otherwise allowing the body and mind to relax before turning in. Incorporating exercise into your lifestyle is important for your general health, period. So if nighttime is the only time to squeeze in your workout, experts say the benefits far outweigh any disadvantages.

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