Even a single night of sleep trouble can feel distressing and lonely. You toss and turn, stare at the ceiling, and wonder how you’ll cope tomorrow. No wonder many people start to worry they’ve developed insomnia.

Insomnia is one of the most talked-about sleep problems, but it’s also one of the most misunderstood.

But just because you can’t sleep, it doesn’t mean you have insomnia. You might have another sleep disorder, or none at all.

What is insomnia?

Let’s clear up some terms, and separate short-term or intermittent sleep problems from what health professionals call “insomnia disorder”.

Sleep problems can involve being awake when you want to be asleep. This could be lying in bed for ages trying to fall asleep, waking in the middle of the night for hours, or waking up too early. Having a sleep problem is a subjective experience – you don’t need to tally up lost hours to prove it’s a problem.

But insomnia disorder is the official term to describe a more problematic and persistent pattern of sleep difficulties. And this long-term or chronic sleep disorder has clear diagnostic criteria. These include at least three nights a week of poor sleep, lasting three months or more. These criteria help researchers and clinicians make sure they’re talking about the same thing, and not confusing it with another sleep problem.

So, what are some reasons why a sleep problem might not be insomnia?

1. It’s short term, or comes and goes

About a third of adults will have a bout of “acute insomnia” in a given year. This short-term problem is typically triggered by stress, illness or big life changes.

The good news is that about 72% of people with acute insomnia return to normal sleep after a few weeks.

Insomnia disorder is a longer-term, persistent problem.

2. It doesn’t affect you the next day

Some people lie awake at night but still function well during the day. More fragmented and less refreshing sleep is also a near-universal part of ageing.

So if your sleep problem doesn’t significantly affect you the next day, it usually isn’t considered to be insomnia.

For people with insomnia, the struggle with sleep spills into the day and affects their mood, energy, concentration and wellbeing. Worry and distress about not sleeping can then make the problem worse, which creates a frustrating cycle of worrying and not sleeping.

3. It’s more about work or caring

If you feel tired during the day, an important question is whether you’re giving yourself enough time to sleep. Sometimes sleep problems reflect a “sleep opportunity” that is too short or too irregular.

Work schedules, child care, or late-night commitments can cut sleep short, and sleep can slip down the priority list. In these cases, the problem is insufficient sleep, not insomnia.

You might have noisy neighbours or an annoying cat. These can also affect your sleep, and reduce your “sleep opportunity”.

The average healthy adult gets around seven hours sleep (though this varies widely). For someone who needs seven, it usually means setting aside about eight to allow for winding down, drifting off, and waking overnight.

4. It’s another sleep disorder

Other sleep disorders can look like insomnia, such as:

• obstructive sleep apnoea (when your breathing stops multiple times during sleep) can cause frequent awakenings through the night and daytime sleepiness
• restless legs syndrome creates an irresistible urge to move your legs in the evening that often interferes with falling asleep. It’s often described as jittery feelings or having “creepy crawlies”, and is often undiagnosed
• circadian rhythm problems, such as being a natural night owl in an early-bird world, can also lead to trouble falling asleep.

5. Medications and substances are interfering

Caffeine, alcohol and nicotine all create insomnia symptoms and worsen the quality of sleep.

Certain medications can also interfere with sleep, such as stimulants (for conditions such as attention-deficit hyperactivity disorder or ADHD) and beta-blockers (for various heart conditions).

These issues need to be considered before labelling the problem as insomnia. However, it’s important to keep taking your medication as prescribed and discuss any concerns with your doctor.

Getting the right help

If your sleep is worrying you, the best first step is to see your GP. They can help rule out other causes, review your medications, or refer you for a sleep study if needed.

However, once insomnia becomes frequent, chronic (long term) and distressing, you can worry too much about your sleep, constantly check or track your sleep, or try too hard to sleep, for instance by spending too much time in bed. These psychological and behavioural mechanisms can backfire, and make good sleep even less likely.

That’s why “cognitive behavioural therapy for insomnia” (or CBT-I) is recommended as the first-line treatment.

This is more effective, and longer-lasting than sleeping pills. This therapy is available via specially trained GPs, and sleep psychologists. You can take part in person or online.

In the meantime

If you’re in a rough patch of sleep:

• remind yourself that short runs of poor sleep usually settle on their own
• avoid lying in bed panicking if you wake at 3.30am. Instead, step out of bed or use the time in a way that feels restful
• keep a consistent wake-up time, even after a poor night. Try to get some morning sunlight to reset your body clock
• make sure you’re putting aside the right amount of time for sleep – not too little, not too much.

Amelia Scott, Honorary Affiliate and Clinical Psychologist at the Woolcock Institute of Medical Research, and Macquarie University Research Fellow, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Menopause is a natural biological process that marks the end of a woman’s reproductive years, typically between 45 and 55. As women approach or experience menopause, common “change of life” concerns include hot flushes, sweats and mood swings, brain fog and fatigue.

But many women may not be aware of the long-term effects of menopause on the heart and blood vessels that make up the cardiovascular system. Heart disease accounts for 35% of deaths in women each year – more than all cancers combined.

What should women – and their doctors – know about these risks?

Hormones protect hearts – until they don’t

As early as 1976, the Framingham Heart Study reported more than twice the rates of cardiovascular events in postmenopausal than pre-menopausal women of the same age. Early menopause (younger than age 40) also increases heart risk.

Before menopause, women tend to be protected by their circulating hormones: oestrogen, to a lesser extent progesterone and low levels of testosterone.

These sex hormones help to relax and dilate blood vessels, reduce inflammation and improve lipid (cholesterol) levels. From the mid-40s, a decline in these hormone levels can contribute to unfavourable changes in cholesterol levels, blood pressure and weight gain – all risk factors for heart disease.

4 ways hormone changes impact heart risk

1. Dyslipidaemia– Menopause often involves atherogenic changes – an unhealthy imbalance of lipids in the blood, with higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL-C), dubbed the “bad” cholesterol. There are also reduced levels of high-density lipoprotein (HDL-C) – the “good” cholesterol that helps remove LDL-C from blood. These changes are a major risk factor for heart attack or stroke.

2. Hypertension – Declines in oestrogen and progesterone levels during menopause contribute to narrowing of the large blood vessels on the heart’s surface, arterial stiffness and raise blood pressure.

3. Weight gain – Females are born with one to two million eggs, which develop in follicles. By the time they stop ovulating in midlife, fewer than 1,000 remain. This depletion progressively changes fat distribution and storage, from the hips to the waist and abdomen. Increased waist circumference (greater than 80–88 cm) has been reported to contribute to heart risk – though it is not the only factor to consider.

4. Comorbidities – Changes in body composition, sex hormone decline, increased food consumption, weight gain and sedentary lifestyles impair the body’s ability to effectively use insulin. This increases the risk of developing metabolic syndromes such as type 2 diabetes.

While risk factors apply to both genders, hypertension, smoking, obesity and type 2 diabetes confer a greater relative risk for heart disease in women.

So, what can women do?

Every woman has a different level of baseline cardiovascular and metabolic risk pre-menopause. This is based on their genetics and family history, diet, and lifestyle. But all women can reduce their post-menopause heart risk with:

• regular moderate intensity exercise such as brisk walking, pushing a lawn mower, riding a bike or water aerobics for 30 minutes, four or five times every week
• a healthy heart diet with smaller portion sizes (try using a smaller plate or bowl) and more low-calorie, nutrient-rich foods such as vegetables, fruit and whole grains
• plant sterols (unrefined vegetable oil spreads, nuts, seeds and grains) each day. A review of 14 clinical trials found plant sterols, at doses of at least 2 grams a day, produced an average reduction in serum LDL-C (bad cholesterol) of about 9–14%. This could reduce the risk of heart disease by 25% in two years
• less unhealthy (saturated or trans) fats and more low-fat protein sources (lean meat, poultry, fish – especially oily fish high in omega-3 fatty acids), legumes and low-fat dairy
• less high-calorie, high-sodium foods such as processed or fast foods
• a reduction or cessation of smoking (nicotine or cannabis) and alcohol
• weight-gain management or prevention.

What about hormone therapy medications?

Hormone therapy remains the most effective means of managing hot flushes and night sweats and is beneficial for slowing the loss of bone mineral density.

The decision to recommend oestrogen alone or a combination of oestrogen plus progesterone hormone therapy depends on whether a woman has had a hysterectomy or not. The choice also depends on whether the hormone therapy benefit outweighs the woman’s disease risks. Where symptoms are bothersome, hormone therapy has favourable or neutral effects on coronary heart disease risk and medication risks are low for healthy women younger than 60 or within ten years of menopause.

Depending on the level of stroke or heart risk and the response to lifestyle strategies, some women may also require medication management to control high blood pressure or elevated cholesterol levels. Up until the early 2000s, women were underrepresented in most outcome trials with lipid-lowering medicines.

The Cholesterol Treatment Trialists’ Collaboration analysed 27 clinical trials of statins (medications commonly prescribed to lower cholesterol) with a total of 174,000 participants, of whom 27% were women. Statins were about as effective in women and men who had similar risk of heart disease in preventing events such as stroke and heart attack.

Every woman approaching menopause should ask their GP for a 20-minute Heart Health Check to help better understand their risk of a heart attack or stroke and get tailored strategies to reduce it.

Treasure McGuire, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.