It is common and normal for people to occasionally have difficulty falling asleep and staying asleep at night, but if this occurs on a regular basis and interferes with functioning during the daylight hours, you need a medical evaluation to find the cause. Getting fewer than seven hours of sleep each night is associated with increased risk for heart attacks (J Am Coll Cardiol, Jan 2019;73(2):134-144), depression (Dialogues in Clinical Neuroscience, 2008;10(3):329-336), weight gain (BMJ Open Sport Exerc Med, Oct 4, 2018;4(1):e000392) and diabetes (Am J of Physiol-Endocrin and Metab, Nov 7, 2018;315(5)). More than 30 percent of North Americans do not meet their needs for sleep (MMWR, 2016;65(6):137-41).

Lack of Sleep, Lack of Sunlight and Mood Disorders
Lack of sleep can cause depression, difficulty concentrating, irritability, weight gain, and impaired work or school performance. Sustained difficulty falling and staying asleep is associated with serious mood disorders such as depression (Scientific World Journal, May 2, 2012;2012:640389). Lack of sleep and lack of sunlight reduce production of melatonin and serotonin by the brain’s hypothalamus to increase risk for depression (Chronobiol Int, Apr 2015;32(3):368-75).

Lack of Sleep and Heart Attack Risk
Researchers at Harvard Medical School did a study on mice in an effort to explain how sleep disruption can increase risk for heart attacks. They found that sleep disruption causes inflammation that can lead to heart attacks (Nature, Feb 13, 2019;566(7744):383-387). The authors found that lack of deep sleep markedly reduces production by a part of the brain called the hypothalamus of a hormone called hypocretin. Lack of hypocretin causes tiredness, decreased energy levels, and difficulty sleeping deeply. The sleep-deprived mice had high white blood cell counts signifying an overactive immune system, developed large plaques in their arteries, and had other markers of inflammation. Then the researchers gave hypocretin to the sleep-deprived mice and found that markers of inflammation and arteriosclerosis were reduced significantly. This study suggests that lack of sleep is another major risk factor for inflammation that is associated with increased risk for heart attacks in humans.

If You Have Sleep Problems . . .
First, make sure you are not causing your sleep problems by going to bed too late or trying to keep a schedule that requires you to wake up too early. The National Heart, Lung, and Blood Institute recommends 7-8 hours of sleep per night. You should try to: go to bed and wake up at the same time every day, avoid daytime naps, and sleep in a clean comfortable bed with no sound or light to disturb your sleep.

Lifestyle changes to improve sleep quality include:
• Have an exercise program and stay active during the daytime
• Limit or avoid caffeine in the afternoon and evening
• Eat an anti-inflammatory diet with a wide variety of fruits, vegetables, whole grains, beans, nuts and seeds; limit meat from mammals and processed meats, sugar-added foods and drinks, and fried foods
• Restrict or avoid eating and drinking at night
• Avoid smoke, tobacco and alcohol
• Lose weight if overweight
• Remove or turn off sources of light, including TV, computers, iphones or tablets, from the room where you sleep
• Have a comfortable mattress, pillows, and bedding

Circadian Rhythm Disorders
Any disruption in the time you normally go to bed or wake up can disturb your body’s normal circadian rhythms. People who have jobs that require frequent crossing of time zones, and those with alternating day and night shift jobs, frequently have serious sleep problems and increased risk for heart attacks (Eur Heart J, Oct 21, 2021;42(40):4180-4188). Even the time changes for daylight saving time can disrupt your sleep patterns because setting your clock backward in the fall and forward in the spring can confuse your body’s natural circadian rhythms to increase risk for heart attacks, injuries, mental and behavioral disorders, and immune-related diseases around the time-change days (PLoS Comput Biol, 2020 Jun; 16(6): e1007927).

Medical Treatments
If none of the lifestyle changes improve the quality of your sleep, check with your doctor to get tests to see if you have an underlying condition causing your problems. Common conditions that interfere with normal sleep include:
• Nasal and chest congestion from allergies, colds and respiratory diseases
• Sleep apnea
• Frequent urination from an infection or kidney problems
• Chronic pain from arthritis, fibromyalgia, inflammatory bowel disease, headaches, low back pain and so forth
• Stress or anxiety
• Nightmares or sleepwalking
• Many different diseases

Medical treatment for underlying conditions may include various drugs, but long-term use of sleeping pills such as melatonin can have serious side effects. Breathing devices or surgery for sleep apnea, or a dental guard for teeth grinding can help to correct those causes.

My Recommendations
If you go to bed at night and wake up each morning at the same times, get between 7- 9 hours of sleep each night, and you still have difficulty falling or staying asleep at night, check with your doctor to see if you can find a cause. If a medical workup does not reveal a cause, try to:
• Exercise in the morning and relax in the evening to prepare yourself for sleep
• Expose yourself to some daylight and sunshine during the day
• Avoid napping during the day
• Follow the rules for an anti-inflammatory lifestyle