Dear Sunday: Why Do I Wake Up Tired?

Dear Sunday,

I recently graduated from college and I haven’t been sleeping well for the last six months. I think I get about six or seven hours of sleep every night, but I almost always wake up feeling so tired. I've even tried taking melatonin, but I still end up staying up for hours trying to fall asleep. I’m falling apart and not functioning. I’m anxious. It’s making me a lot less happy. What should I do?

Please help,
Sleepless in Sucat

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Dear Sleepless in Sucat,

Oh, I feel you. Sleep deprivation is miserable. You're right: A poor night’s sleep is the ultimate mood killer, and over time those bad moods add up. People who regularly get less than seven hours of sleep at night are far more likely to develop depression or severe anxiety.

Studies have shown that people who regularly get less than seven hours of sleep at night are much more likely to develop depression or severe anxiety. Poor sleep also affects us in other ways: modest reductions in sleep quality, even without a decrease in sleep quantity, tend to make us feel lonely. And more than that, poor sleep quality leads us to act in ways that increase our isolation, not reduce it. And as if that isn’t enough, the effect is contagious: Well-rested people feel lonelier after even a one-minute encounter with a sleep-deprived person.

The good news is that there are a lot of ways you can learn to get a good night’s sleep again, and this will soothe your anxiety:

1. Reset your circadian rhythm

Our sleep is primarily controlled by a “biological clock” in the center of our brain called the suprachiasmatic nucleus. As the sun sets every afternoon, our brain detects the darkening world, which triggers the release of melatonin, the chemical messenger that commands the body to prepare for sleep. We feel sleepy and our body gets ready to catch some zzz's when melatonin starts to build up in our system.

When we can’t fall asleep, often it’s because we don’t have enough melatonin built up in our system. In the modern world we all live in, we expose ourselves to artificial light after sunset, so our biological clock loses its primary winding mechanism. These days, light doesn’t stop pulsing through the suprachiasmatic nucleus until we turn off our bedroom lights and close our eyes—and even then, if there is still even a tiny source of light in our room, it might not.

For that reason, looking at a phone, iPad, or computer is about the worst thing we can do before bed. One study found that reading on an iPad suppressed melatonin release by over 50 percent, compared to reading a paper book at night. The blue light emitted by our devices can delay the rise of melatonin by three hours, causing us to lose significant amounts of REM sleep—the type of sleep that is important for dreaming and that, when limited, most affects our moods.

So, the first step is to turn the brightness on your screens way down at night, and to crank the “night shift” display settings to “most warm.” Unfortunately, according to some recent research, this won’t be enough to prevent light-induced melatonin suppression. So how can we best give ourselves the darkness we need to prepare for sleep?

• We can reset our biological clocks using light in the morning rather than darkness at night; bright light exposure for at least six and a half hours during the day can eliminate the hindering effects of artificial light exposure at night.
• Although light is the primary way that our biological clock keeps time, our habits also influence our circadian rhythm. This is why so many of the best “healthy sleep guides” emphasize going to bed and waking up at the same time, as well as establishing a good bedtime routine.

2. Reduce your stress

While it’s clear that not being able to sleep stresses most people out, stress itself is also often what starts a cycle of sleeplessness in the first place. According to Walker, the most common cause of chronic insomnia is psychological, rather than biological. 

If your mind starts spinning with worry the moment your head hits the pillow, you aren’t alone. Our smartphones make it entirely possible for us to spend every waking minute (out of bed) consuming information rather than processing it. Instead of reflecting on our lives or about what we are feeling during the daytime—while, say, we eat our lunch or wait for class to start—we check our phones for new messages or updates. Our devices are a never-ending source of stimulation and distraction. They might keep us from ever feeling bored, but they are also often preventing us from ever feeling calm.

Constant stimulation during the day keeps us wound up like tops that are only free to spin once the lights go out. But when we wait until our head hits the pillow to process our day or to feel our emotions, we are more likely to start worrying and less likely to feel relaxed enough to fall asleep. Our nighttime worry and anxiety rev our body’s fight-or-flight system, a mechanism that is designed to keep us awake. Its job is to get us to fight or flee a threat, neither of which we can do if we are asleep. This makes it much more likely that our endless nighttime ruminations are both irrational and unproductive—even if they don’t feel that way when we have them.

It’s critical that we have time for quiet reflection during the day, and that we have ways to process our emotions and cope with stress so that we don’t take it to bed with us. Tons of research shows that daily exercise, meditation, and therapy (especially Cognitive Behavioral Therapy for Insomnia, or CBT-I) are all effective at reducing the worry and anxiety that can keep us up at night.

3. Rule out a biological issue

Sleep, and sleeplessness, are complicated. Sometimes we lose our ability to sleep well because of a change in our biochemistry. Our hormones are intricately tied to our circadian rhythms, and when our hormones get out of balance, our sleep usually does, too. Women famously sleep poorly when they are pregnant or going through menopause.

Even when we aren’t pregnant or menopausal (or female!), our hormones influence our sleep—and are often at the root of sleep problems. We know that the synthetic hormones found in birth control pills, for example, can change the structure of our sleep. (Researchers don’t know exactly why, but they do know that progesterone acts as a natural “hypnogenic,” a chemical that induces sleep.)

Changes to our diet can also cause changes to our sleep. Eating a high-carbohydrate, low-fat diet for just two days can decrease the amount of deep sleep we get. Other studies have shown that sugary foods and other carbohydrates are associated with lighter, less restorative, and more disrupted nighttime sleep.

If you have fixed your circadian rhythm and reduced your stress and you still aren’t sleeping well, then something else might be going on. Have you recently started or stopped birth control pills or had a significant hormonal disruption? Is your menstrual cycle (and therefore your natural hormonal rhythm) regular? When you went back to school, did your diet change? Did you start on a new medication or supplement? If so, you’ll do well to make an appointment with your doctor to discuss these changes and how they might be affecting your sleep.

That’s a long-winded way of saying, no, I don’t think getting a prescription for a sleeping pill will help. In addition to being highly addictive, pharmaceutical sleep aids don’t produce the deep or dreaming sleep that we need—they only sedate us. Even if they make us feel like we’ve been asleep, we haven’t been asleep in the way that we need to be, and so we’ll still suffer from the same problems that insomnia causes. I’m sorry to say that there isn’t a quick fix, sleepless student.

Wishing you many sweet dreams—as well as deep and dreamless sleep.

Yours,
Dear Sunday