8 reasons why you're not sleeping

Published: February, 2014

Stop these common sleep stealers before they put your health at risk.

You might remember a time when you could drift off to sleep in an instant and remain
in a state of blissful slumber well past lunchtime the next day. Now your sleep is more
likely to be lighter and more fitful, and when you wake up in the morning you might
not always feel refreshed.

A lack of good-quality sleep could be a natural consequence of changing sleep-wake

patterns after menopause. It's also likely that the issue is physical—and fixable. Many
conditions can disrupt your rest, and they can be treated. It's important to address
these issues. A lack of sleep does more than make you drowsy. Chronic insomnia
has been linked to a variety of health problems, including obesity, high blood
pressure, heart disease, diabetes, and depression.

Go through this list to see whether you might have one of these sleep-stealing
conditions. Also check your medicine cabinet. Some medicines, including
corticosteroids, beta blockers, cold and flu remedies, and certain antidepressants
also can interfere with sleep.

1. Sleep apnea
The conventional image of sleep apnea is of the overweight man who snores, but
women of any size can also develop these repeated pauses in breathing while they
sleep. "A woman who has a narrow jaw or a change in muscle tone can get apnea,"
says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive
biology at Harvard Medical School and author of Successful Sleep Strategies for
Women and Menopause Matters: Your Guide to a Long and Healthy Life. Either of
these anatomical issues can block oxygen from reaching your lungs (and
subsequently the rest of your body) while you sleep. Snoring might not be your main
symptom if you do have sleep apnea, but you will notice that you're especially sleepy
during the day.

 Solution: See a specialist for a sleep study. You may be able to relieve apnea with a
few lifestyle adjustments, such as sleeping on your side or losing weight. Your doctor
might also suggest an oral appliance or a CPAP machine that blows air into your
airways to keep them open at night.

2. Diet
What you eat can affect your sleep. Spicy foods can contribute to painful heartburn.
Big meals leave you uncomfortably full, and over time can contribute to obesity—a
well-known risk factor for sleep apnea. Too much caffeine could keep you wide
awake, even if you finish your coffee in the morning. "It takes six hours to clear half of
the caffeine from your body. If you have enough caffeine, it's still in your body at 4 in
the morning," says Dr. Edelman. And though a glass of wine or two with dinner will
 make you feel relaxed or even sleepy, it won't help you sleep. "You can fall asleep,
but once you're asleep you can't sleep deeply," she says.

 Solution: Eat dinner at least a couple of hours before bedtime, and keep the meal
light. Avoid spicy, fatty foods, as well as alcohol and caffeine. Also, don't drink too
many fluids before bed. Having to constantly get up to go to the bathroom can disrupt
your sleep, too.

3. Lack of exercise
Sleep and exercise complement each other. Working out regularly can help you
sleep better, and conversely, you're more likely to exercise if you get a good night's
rest.

 Solution: Exercise every day if you can, ideally in the morning. Doing a high-energy
aerobic routine too close to bedtime can have the opposite of the intended effect,
making you too energized to sleep. A gentle yoga stretch before bed probably won't
hurt, though. It might even help you relax.

4. Pain
Arthritis aches or any other kinds of pain do not make for restful slumber. Conversely,
a lack of sleep can increase your pain. Researchers believe that a lack of sleep may
activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also
make you more sensitive to the feeling of pain.

 Solution: In addition to the pain remedies your doctor recommends, try using a
heating pad or taking a warm bath before bed to soothe achy joints or muscles. Lying
against a body pillow can put you in a more comfortable position while you sleep.

5. Restless legs syndrome

Women are twice as likely as men to have restless legs syndrome (RLS)—a
condition that causes a creepy, crawly feeling and uncontrollable movements in the
legs at night. It's often linked to hormonal changes early in life and during pregnancy,
but RLS can continue as you get older. RLS isn't just miserably uncomfortable—
researchers at Harvard have linked this condition to an increased risk for heart
disease and depression in women.

 Solution: Try simple interventions first. Exercise every day, take a hot bath before
bed, massage your legs, and cut back on things that can make you jittery—like
caffeine and tobacco. If these measures don't work, your doctor may recommend one
of several medicines that reduce RLS symptoms—including ropinirole (Requip),
pramipexole (Mirapex), rotigotine (Neupro), or gabapentin enacarbil (Horizant).

6. Depression
"Depression is a common compromiser of sleep, and it is much more common in
women than in men," Dr. Edelman says. Women who are depressed may sleep more
 than usual, but their sleep isn't restful. Some of the antidepressants meant to
counteract depression, particularly SSRIs, can also interfere with sleep.

 Solution: See your primary care doctor, psychologist, psychiatrist, or therapist for
help, which may include medications, talk therapy, or both. If your antidepressant
seems to be keeping you awake, ask your doctor to switch you to another drug.

7. Stress
It's impossible to sleep when the weight of the day is pressing on you. Finding a
sense of calm before bed isn't easy—especially when you can't unplug from the
demands of your day.

 Solution: Establish wind-down time. Do a quiet, relaxing activity before bed that
doesn't involve a screen. Talk to a friend or family member, sew, or read a real
book—not one on a backlit tablet device. "Just allow yourself to have quiet time," Dr.
Edelman adds. And don't sleep with your smartphone on your bedside table.

8. Poor sleep habits

Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or
engaging in stimulating activities before bed.

 Solution: Follow a few basic sleep hygiene strategies. Go to bed and wake up at the
same times each day. Keep your bedroom cool, dark, and comfortable. Use your bed
for sleep and sex only. If you can't fall asleep within 15 minutes, get up and leave the
bedroom. Read or do another quiet activity for 15 to 20 minutes until you get sleepy.
"I would encourage women to try sleep strategies first," says Dr. Edelman. "Then if
those strategies don't work, I would recommend they talk to a sleep expert."