Which of these six reasons is behind your bad night's sleep?


5 minutes

15 March 2019

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“Why can't you sleep?” It's one the first questions GP Simon Torvaldsen asks a patient when they are looking for a cure to their late nights or drowsy days.

And with more than half of all Australians sleeping poorly or not all, according to research by the Sleep Health Foundation1, it's a question the experienced GP finds himself asking a lot. 

There is always a reason behind a sleep issue, and identifying that underlying problem is the challenge for medical professionals, rather than offering a quick fix.

“Poor sleep is a symptom, not a diagnosis, in the same way pain is a symptom,” said Dr Torvaldsen, who is the Chair of the AMA (WA) Council of General Practice.

“If someone comes in with a pain in the leg I don't diagnose them with a pain in their leg. I want to find a cause.

“So, one of the questions I'll ask them is, ‘Why can't you sleep?’ Straight up.

“They might perceive it as a sleep problem, but it is often the entrée into a whole lot of other things.

“Our job is to find out why they're not sleeping.”

The reasons behind a bad night sleep vary greatly, with some of us kept awake by worry and others missing out on shut-eye because of a sore back.

Dr Torvaldsen, who has 30 years' experience as a GP in Mt Lawley, identified six main reasons we lay awake at night.  

1. Mental health issues

Stress and anxiety are the main causes of insomnia, according to Dr Torvaldsen.

This can take hold in different ways. For some people there is an issue in their life, such as workplace stress, keeping them awake, while others will be living with “free-floating anxiety”.

“There aren't any major issues, but they're just a very anxious person and they're not sleeping as a result,” Dr Torvaldsen said.

“Sometimes the psychology is more about how to relax and sleep, and sometimes it's more about dealing with underlying issues.

“In both cases psychologists can be involved.”

Depression is another mental health issue that can cause sleep issues, particularly in patients who get to sleep OK but then wake in the early hours and struggle to get back to sleep.

The death of a loved one can also be a trigger for sleep issues that people seek support for.

“Someone might say, 'Since my partner died six months ago I can't sleep' … then we will get into the issues around bereavement,” Dr Torvaldsen said.

2. Physical pain

Dr Torvaldsen will often see patients experiencing physical pain that they don’t link to their poor sleep. In many cases the two are often related.

“They'll say, 'I can't sleep', and when I ask them about it, it turns out they can't sleep because their hip or shoulder is hurting them,” Dr Torvaldsen said.

“Then we've got to deal with the pain issue, rather than treating it as a sleep issue.

“With something like hip arthritis, we don't think of it as a sleep issue. We associate it with hip pain, stiffness, and difficulty walking.

“But disturbed sleep is often part of it.”

An overactive thyroid is another physical issue that can cause patients difficulty going to sleep.

3. Sleep disorders

Circadian rhythm disorders, restless legs syndrome and sleep apnoea are all sleep disorders that limit people’s quality of sleep.

Patients experiencing sleep disorders will present to Dr Torvaldsen feeling unrefreshed and drowsy in the morning but unsure what the problem is.

“The most common thing we'd look at in that situation is sleep apnoea, where people stop breathing due to obstructed breathing and then wake up momentarily, sometimes dozens of times every hour,” Dr Torvaldsen said.

“They never get into a proper sleep pattern and they never have the quality of sleep they should have.

“That often goes unrecognised as actually being a sleep problem. People will just say they feel tired, but it is a primary sleep problem.”

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4. Poor sleep hygiene

While there are mental and physical health issues that keep us from sleeping, sometimes we are simply keeping ourselves awake through ingrained habits.  

Poor sleep hygiene includes drinking caffeinated drinks at night and using electronic devices before bed.

“Sometimes people are doing things that naturally will make you not sleep,” Dr Torvaldsen said.  

“The classic would be the person who has a couple of cups of coffee in the evening.

“You're actually taking a drug that keeps you awake, so it's not surprising.

“People also spend time on electronic devices late at night and it has been shown that a lot of screen time just before you try to go to sleep is not good and makes it harder to go to sleep.”

Dr Torvaldsen said these habits can develop when there are other factors at play, such as physical pain, keeping people awake.

5. Alcohol

According to Dr Torvaldsen, alcohol can help you drift off to sleep but will then have a negative impact on your sleep state through the night. It’s a link that patients sometimes struggle to make.

“We do see it and sometimes people will talk about their sleep problems and not talk about the alcohol,” Dr Torvaldsen said. 

“It's often forgotten that while alcohol will put you to sleep, it is common to wake in the middle of the night and be restless.”

6. Genetic background

It can also be the case that patients are simply more prone to poor sleep than others because of their family history or their age.

“There is a genetic component … and you get people who have never been good sleepers,” Dr Torvaldsen said.

“It's also a problem for people as they get older. As we get older we typically don't sleep as well, and our sleep patterns become more broken.”

1 Sleep Health Foundation - Report to the Sleep Health Foundation 2019