Insomnia can dramatically affect your mental health
Insomnia is characterised as a sleep disorder and is common in our society. It is estimated that that roughly 30 percent of the general population complains of chronic sleep disruption, and approximately 10 percent have associated symptoms of daytime functional impairment consistent with the diagnosis of insomnia. Interestingly, insomnia is more common in women, especially older women, than in men.
The prevailing features of insomnia are – difficulty initiating sleep; and difficulty maintaining sleep, characterised by frequent awakenings or problems returning to sleep after awakenings. If you are experiencing these symptoms then you are likely suffering insomnia and its terrible mental and physical effects on your day-to-day life.
A lack of Sleep can affect your mental health
Do you think you got enough sleep this past week? … Can you recall the last time you woke up without an alarm clock feeling refreshed, not needing caffeine? If the answer to either of these questions is “no”, you are not alone. It is estimated up to two-thirds of adults throughout the developed nations fail to obtain the recommended eight hours of nightly sleep many of whom go on to develop chronic (or ‘acute’) sleep disorders resulting in the diagnosis of insomnia. I doubt you are surprised by this fact, but you may be surprised by the consequences.
Indeed, sleep is one of the most important aspects of our life, health and longevity and yet it is increasingly neglected in twenty-first century society, with devastating consequences; every major disease in the developed world – Alzheimer’s, cancer, obesity, diabetes- has very strong causal links to deficient sleep. Furthermore, it has been shown that inadequate sleep -even moderate reductions for just one week- contributes to all major psychiatric conditions, including depression, anxiety and suicidality. Insomnia has been recognized as a core symptom of ‘major depressive disorder (“MDD”), bipolar disorder and schizophrenia spectrum disorder.
Within the brain, sleep enriches a diversity of functions, including our ability to learn, memorise, and make logical decisions and choices. Benevolently servicing our psychological health, sleep recalibrates our emotional circuits, allowing us to navigate next-day social and psychological challenges with cool-headed composure. Downstairs in the body, sleep restocks the armoury of our immune system, helping fight malignancy, preventing infection, and warding off all manner of sickness. Sleep reforms the body’s metabolic state by fine-tuning the balance of insulin and circulating glucose. Sleep further regulates our appetite, helping to control body weight through healthy food selection rather than impulsively. Relying on Uber Eats (and other such services) for your meals because you’re too tired to prepare a meal yourself can also lead to unhealthy food choices. Plentiful sleep can also help maintain a flourishing microbiome within your gut, which we know so much of our nutritional health begins.
How do you know if you’re not getting enough sleep
Setting aside the extreme case of sleep deprivation, how do you know whether you’re routinely getting enough sleep. While a clinical sleep assessment is needed to thoroughly as address this issue, an easy rule of thumb is to answer these two simple questions. First, after waking up in the morning, could you fall back asleep at ten or eleven a.m.? If the answer is “yes”, you are likely not getting sufficient sleep quantity and/or quality. Second, can you function optimally without caffeine before noon? If the answer is “no”, then you are most likely self-medicating a state of chronic sleep deprivation. Both these signs you should take seriously and seek to address your sleep deficiency.
We already know that the optimal sleep time for humans is about eight hours per day. So, let’s consider the quality of our sleep because without quality, quantity significantly loses its value. This is because it impairs the sleep cycle: Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM).
There are two basic types of sleep in a sleep cycle: Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM). During NREM sleep, there are three separate stages of sleep. The amount of sleep occurring during each of these stages’ changes throughout a person’s life, particularly as a person ages. Each stage, including REM, affects the brain in different ways, and sleep cycles between REM and NREM sleep several times a night depending on how long one sleeps and the quality of that sleep.
Typically, sleep begins with a NREM sleep stage, cycles through the three NREM stages, and is followed by a REM period. Throughout the night, NREM and REM sleep alternate in a cyclical fashion, over approximately 90 minutes with REM sleep periods getting progressively longer. A sleep cycle can average 70 to 120 minutes, with an average of three to four cycles occurring over a night of sleep.
About REM Sleep REM sleep consists of about 20%-25% of total sleep in adults. From a scientific perspective, REM sleep is initiated through acetylcholine secretion and inhibited by neurons that secrete monoamines including serotonin. During REM, most muscles experience temporary paralysis. This is also the stage during which people experience dreams. Interestingly, the percentage of REM sleep in adults changes little over the lifespan, while slow-wave sleep tends to decline with age.
An adult experiences REM sleep every 90 minutes or so, and studies show brain activity is at its highest level at this time. Typically, the longest REM period occurs at the end of a night’s sleep and is cut short if a person does not get their full night of sleep.
No one knows exactly why we have REM sleep, but research shows this stage is essential in keeping our brains sharp. Several studies have explored the benefits of REM sleep and found that not only does an increase in REM improve depression, anxiety and cognitive brain function, it also decreases blood pressure and provides other overall health benefits.
About NREM Sleep Non-REM (NREM) sleep uses significantly less energy than REM sleep. This type of sleep is associated with the brain restoring its supply of adenosine triphosphate (ATP). NREM sleep is divided into three separate sub-stages: N1, N2 and N3 or slow-wave sleep. Each of these stages can last from 5 to 15 minutes or more and NREM stages may repeat until REM sleep is attained.
NREM Stage 1 (N.1): This stage lasts about 5 to 10 minutes and is the transition period between wakefulness and sleep. This stage can also occur during transitions between periods of deep sleep and REM as well. The muscles in the body remain active and a person in this stage of NREM sleep can be easily awoken.
NREM Stage 2 (N.2): This stage is a period of light sleep with slowing brain waves and muscle relaxation. It is generally the period between drowsiness and light sleep and deep slow wave sleep. Adults spend about 50% of their entire night’s sleep in stage 2 sleep. Toward the end of a period of stage 2 sleep, as the body prepares to enter deep sleep, the heart rate slows and body temperature decreases.
NREM Stage 3 (N.3): Stage 3, slow-wave sleep, assists the body to repair and regenerate tissues. A recent study suggests this is also the stage during which the brain flushes out toxic waste. According to a study from Boston University, research shows cerebrospinal fluid may clean out toxic waste from the brain, and that slow- wave sleep greatly aids in the process. This stage of sleep may last up to 40 minutes.
So, we can see that sleep is not just the absence of wakefulness. It is far more complex than that. Our nightime sleep is an exquisitely complex, metabolically active, and deliberately ordered series of unique stages, during which numerous functions of the brain are restored by, and depend on, sleep. No one type of sleep accomplishes all. Each stage of sleep -light NREM sleep, deep NREM sleep, and REM sleep- offer different brain benefits at different times of night. Losing out on one of these types of sleep will cause the brain impairment. Make sure you read about the incredibly important ‘glymphatic’ system discussed below in ‘Alzheimer’s link to a lack of sleep’.
How does your body know when it’s time to sleep
There are two main factors that determine when you want to sleep and when you want to be awake. The first factor is a signal beamed out from your internal twenty-four-hour clock located deep in your brain. The clock, often referred to as the ‘biological’ or ‘master’ clock, creates a cycling, day-night rhythm that makes you feel tired or alert at regular times of night and day, respectively. The second factor is a chemical substance that builds up in your brain and creates “sleep pressure”. The longer you’ve been awake, the more that chemical sleep pressure accumulates, and consequently, the sleepier you feel. It is the balance between these two factors that dictates how alert and attentivitive you are during the day, when you will feel tired and ready for bed at night, and in part, how well you will sleep. Indeed, your sleeping rhythmic patterns essentially determine your timed preferences for eating and drinking, your moods and emotions, your core body temperature, your metabolic rate, and the release of numerous hormones. When these factors are distressed there often follows a detrimental impact to our mental and physical wellbeing.
The most important factor in manipulating your sleeping rhythmic pattern -central to which is the circadian system- is exposure to and/or avoidance of bright light at specific times of the ‘biological night’. Going to sleep in front of the TV for example might interfere with your sleep cycle; jet-lag after a long-haul flight is a common outcome from the disturbance of one’s circadian rhythm.
Most people have heard of the ‘circadian rhythm’ and sometimes confuse it with the biological clock. While they are directly related, they are not the same. Natural factors within the body produce circadian rhythms. However, signals from the environment also affect them. The main cue influencing circadian rhythms is daylight. This light can turn on or turn off genes that control the molecular structure of biological clocks. Changing the light-dark cycles can speed up, slow down, or reset our biological clocks as well as circadian rhythms.
Biological rhythms serve to align our physiological functions with the environment. We are a diurnal species and thus, we normally sleep at night and are active during the daytime. The timing of functions with prominent rhythms such as sleep, sleepiness, metabolism, alertness and performance in a normal environment is such that they are optimal during the most suitable phase of the day Abrupt deviations from ‘normal’ timing of work and sleep can lead to problems, for example sleep taken during the day is usually shorter and of worse quality than when taken at night. Alertness and performance reach their nadir at night during peak sleep propensity and fatigue and close to the low point of core body temperature and the peak of melatonin secretion. The health problems and increased risk of major disease in long-term shift workers are ascribed largely to working out of phase with the internal biological clock. It is likely that many perceptions of the detrimental effects of clock disruption or abnormal timing derive from observations in shift workers.
There is little doubt that shift work is associated with a number of health problems, for example poor sleep, gastrointestinal disorders, abnormal metabolic responses and increased risk of accidents. The internal circadian clock adapts slowly, if at all, to rapid transitions between different shift schedules. For example, a night shift worker whose circadian clock is in day mode, or unadapted, will secrete melatonin during work hours. Similarly, a worker who has adapted their clock to night shift will secrete melatonin during the day and on return to day shift or rest days will secrete melatonin during the hours of natural daylight.
Circadian rhythms are found in most living things, including animals, plants, and many tiny microbes. Interesting, the study of circadian rhythms is called chronobiology and is a growing field of science, particularly in light of the growing evidence linking sleep to mental health.
Reduced cognisance when you’re sleep deprived
In a research study led by Dr Gregory Belenky at Walter Read Army Institute of Research (USA), participants were asked about their subjective sense of how impaired they were after being subject to a controlled deprivation of sleep. From a number of cognitive precise problem solving tasks required of them it was found that they consistently underestimated their degree of performance disability. It was a miserable predictor of how bad their performance actually, objectively was. It was the equivalent of someone at a bar who has had far too many drinks picking up their car keys and confidently telling you “I’m fine to drive home.”
Similarly problematic is baseline resetting. With chronic sleep restriction over months or years, an individual will actually acclimate to their impaired performance, lower alertness, and reduced energy levels. That low-level exhaustion becomes their accepted norm, or baseline. Individuals fail to recognise how their perennial state of sleep deficiency has come to compromise the mental aptitude and physiological vitality, including the slow accumulation of ill health. A link between the former and latter is rarely made in their mind.
Based on epidemiological studies, of average sleep time, millions of individuals unwittingly spend years of their life in a sub-optimal state of psychological and physiological functioning, never maximising their potential of mind or body due to their blind persistence in sleeping too little. Thus, it is indisputable that there is a clear link between chronic sleep deprivation and the major mental health disorders of anxiety and depression. This is why at CBT Counselling one of the first things we do is examine your sleeping habits to determine whether there might be a causal link to your insomnia in the form of a depressive and/or anxiety disorder.
Sleep inducing medication might do more damage than good
No past or current sleeping medications on the legal (or illegal) market induce natural sleep. Of course, no one would argue that you are awake after taking prescription sleeping pills; but this is not natural sleep, which is key. Indeed, the long-term use of sleeping pills can damage your health, and can in-fact increase the risk of life-threatening diseases.
In the early 2000’s, insomnia rates ballooned and sleeping pill prescriptions escalated dramatically. The older sleep medications -termed “sedative hypnotics”, such as diazepam- were blunt instruments. They sedated you rather than assisting you sleep. Understandably, many people mistake the former for the latter. Most of the newer sleeping pills on the market present a similar situation, though they are slightly less heavy in their sedating effects.
Notably, sleeping pills, old and new, target the same system in the brain that alcohol does- the receptors that stop your brain cells from firing- and are thus part of the same general class of drugs; sedatives. Sleeping pills essentially knock out the higher regions of your brain’s cortex.
Thus, the NREM and REM sleeping cycles, and thus the functions of the brain during such cycles, do not occur. Thus, the natural and physiological purpose of sleep is not achieved. It is no wonder that it is common for people having taken sleeping pills, to wake up groggy and go on to suffer throughout the day the after-effects of the sedative nature of the medication such as daytime forgetfulness, and a slowing of mental reaction times that can impact motor (physical) skills such as driving a motor vehicle for example. Even one’s rationalising and decision-making processes are hindered.
Interestingly, it is older adults who are the heaviest users of sleeping pills, representing more than 50 percent of the individuals prescribed these drugs. Obviously, With medicated induced drowsiness there is a substantially increased risk of such persons falling or tripping at night or upon waking in the morning; we know that a fall of an elderly person presents significant dangers to that person, and as well to others around them.
Another deeply unpleasant feature of sleeping pills is rebound insomnia. When individuals stop taking these medications, they frequently suffer far worse sleep, sometimes even worse that the poor sleep that led them to seek out sleeping pills to begin with. The cause of rebound insomnia is a type of dependency in which the brain alters its balance of receptors as a reaction to the increased drug dose, trying to become somewhat less sensitive as a way of countering the foreign chemical in the brain. But when the drug is stopped, there is a withdrawal process, part of which involves an unpleasant spike in insomnia severity.
We should not be surprised by this. The majority of prescription sleeping pills are, after all, in a class of physically addictive drugs. Obviously, the detrimental physiological effects of sleep medication is exacerbated by drug (legal and illegal) and alcohol abuse. Many such persons take a cocktail of drugs – ‘uppers and downers’ in a futile attempt to manage their mental and physical state sometimes resulting in permanent organ damage, and perhaps most importantly, brain damage.
When we think about sleep inducing medications -sleeping pills- we also have to think about medications people take to combat the effect of their inevitable drowsiness, caffeine being the most such widely consumed stimulant. Did you know that, more than 80 per cent of adults (Australia & New Zealand) regularly consume caffeine; and not just to combat the effects of sleeping pills but, also just to combat the effects of ordinary sleep deprivation, “I need a coffee to start the day”. Indeed, excessive consumption of caffeine, or even the moderate intake of caffeine late in the day, can diminish the natural build-up of ‘sleep pressure’ leading to a poor and disrupted sleep pattern, potentially resulting in chronic insomnia – a vicious circle indeed.
Sleep pressure and Caffeine
As mentioned, your twenty-four-hour circadian rhythm is the first of the two factors determining wake and sleep. The second is sleep pressure. At this moment, a chemical called ‘adenosine’ is building up in your brain. It will continue to increase in concentration with every waking minute that elapses. The longer you are awake, the more adenosine will accumulate. Think of adenosine as a chemical barometer that continuously registers the amount of elapsed time since you woke up in the morning. One consequence of increasing adenosine in the brain is an increasing desire to sleep. This is known as ‘sleep pressure’. It happens to most people after about 12 to sixteen hours of time awake.
You can however, mute that sleep signal of adenosine by using a chemical that makes you feel more alter and awake: caffeine. Caffeine is not a food supplement. Rather, caffeine is the most widely used (and abused) psychoactive stimulant in the world. It is the second most traded commodity on the planet, after oil. One might say that the consumption of caffeine represents one of the longest and largest unsupervised drug studies ever conducted on the human race, perhaps rivalled only by alcohol.
Caffeine works by successfully battling with adenosine for the privilege of latching on to adenosine welcome receptors in the brain. Once caffeine occupies those receptors it effectively inactivates them, acting as a masking agent. By hijacking and occupying these receptors, caffeine blocks the sleepiness signal normally communicated to the brain by adenosine. The upshot; caffeine tricks you into feeling alert and awake, despite the high levels of adenosine that would otherwise seduce you into sleep.
Most people don’t realise how long it takes to overcome a single dose of caffeine, and therefore fail to make the link between the bad night of sleep we wake from in the morning and the cup of coffee we had ten hours earlier at dinner. Indeed, caffeine has an average life of five to seven hours. Let’s say that you have a cup of coffee after your evening meal, around 7pm for example. This means that by 12 midnight, some of that caffeine may still be active and circulating throughout your brain tissue. In other words, by 1.am, you’re only partway to completing the job cleansing your brain of the caffeine you drank at dinner. Of course, caffeine is not just found in coffee, it is often the prime ‘boosting’ chemical found in energy drinks, and is present in most teas, dark chocolate, ice cream and weight loss pills as well as pain relievers. (refer to footnote  for further information)
Insomnia can play havoc with intimate relationships
Women are more likely than men to have sleep problems, and the most common sexual complaint that women bring to sex therapists and physicians is low desire. Strikingly, being too tired for sex is the top reason that women give for their loss of desire.
When the body becomes stressed because of sleep difficulties, the brain suppresses the production of sex hormones like estrogen and testosterone in favour of stress hormones like cortisol. This shift in hormone levels can lead to decreased sex drive, infertility, or erectile dysfunction. Unsurprisingly therefore, when you’re tired, you have fewer warm and fuzzy feelings towards your partner.
Consequently, the feelings of closeness, playfulness and sexual attraction you once experienced as a couple (inside and outside of the bedroom) may be replaced with irritability and resentments. One partner may feel helpless to rid themselves of the insomnia, the other partner may feel unimportant and cast aside. A study published in the Journal of Sexual Medicine (USA) in 2015 found that just one hour extra per night increased the odds of a woman wanting sex the next day by around 15%. The research also revealed that as a result of sleep deprivation couples are less able to read each other’s emotions when tired, and that this lack of empathy makes rows more likely. 
Sharing the bed with a duvet hog, seismic snorer or furious fidgeter presents a difficult situation for the affected partner, which simply can’t be left unaddressed. If your partner’s sleep habits are impacting on your quality of sleep, you could be at risk of sleep deprivation. of course, it is difficult to raise these issues with your partner when they might be in a constant state of stress as a result of their insomnia. This is where counselling can be of particular assistance in helping to address issues in a way so as not to cause distress for either partner.
It was not until relatively recently that the association between disturbed sleep and Alzheimer’s disease was realised to be more than just an association. While much remains to be understood, we now recognise that sleep disruption and Alzheimer’s disease interact in a self-fulfilling negative spiral that can initiate and/or accelerate the condition.
Alzheimer’s disease is associated with the build-up of a toxic form of protein called beta-amyloid, which aggregates in sticky clumps, or plaques, within the brain. Amyloid plaques are poisonous to neurons, killing the surrounding brain cells. What is strange, however, is that amyloid plaques only effect some parts of the brain while not others, the reasons for which remain unclear.
Experiments have found that the more amyloid deposits there were in the middle regions of the frontal lobe, the area of the brain Alzheimer’s disease is most obvious, the more impaired the deep sleep was in the individual. It is not just in the form of general loss of deep sleep, which is common as we get older, but the very deepest of the powerful slow brainwaves of NREM sleep that the disease was ruthlessly eroding. The distinction was important, since it meant that the sleep impairment caused by amyloid build-up in the brain was more than just normal aging.
Interestingly, this toxin is removed in a type of sewage network called the ‘glymphatic system’ which exists in our brains. Its name is derived from the body’s equivalent ‘lymphatic system’, but is composed of cells called ‘glia (from the Greek root word for ‘glue’). Glia cells are distributed throughout your entire brain, situated side by side with neurons that generate the electrical impulses of your brain. Just as the lymphatic system drains contaminants from your body, the glymphatic system collects and removes dangerous metabolic contaminants generated by the hard work performed by the neurons in your brain, rather like a support team surrounding an elite athlete. Another analogy is to think of the wash-cycles of a clothes washing machine, you set the cycle (program) to perform a specific wash-cycle to achieve the wash you desire, your brain is similarly programmed to achieve a predetermined wash-cycle. (predetermined from our primordial past)
Although the glymphatic system is active during the day, it is during sleep that this neural sanitisation work kicks into high gear. Associated with pulsing rhythm of deep NREM sleep comes a ten-to twentyfold increase in effluent expulsion from the brain. In what can be described as a night-time power cleanse, the purifying work of the glymphatic system is accomplished by cerebrospinal fluid that bathes the brain. Amyloid protein -the poisonousness element associated with Alzheimer’s disease– is removed during this cleansing process. Without sufficient sleep, particularly sufficient deep NREM sleep, an escalation of poisonous Alzheimer’s-related protein can accumulate in our brains. Phrased differently, and perhaps more simply, wakefulness is low-level brain damage, while sleep is neurological sanitisation. Thus, there is evidence to conclude that without sufficient sleep the pathology of Alzheimer’s disease interact in a viscous cycle.
Getting help for your insomnia
With proper diagnosis and treatment, most cases of insomnia can be addressed with changes you can make on your own — without turning to prescription or over-the-counter sleeping pills.
Since many people complain that frustrating, negative thoughts and worries prevent them from sleeping at night, cognitive-behavioural therapy (CBT) can be much more effective in addressing insomnia. CBT is a form of psychotherapy that treats problems by modifying negative thoughts, emotions, and patterns of behaviour. It can be conducted individually, in a group, or even online. A study at Harvard Medical School found that CBT was more effective at treating chronic insomnia than prescription sleep medication—but without the risks or side effects.
More often than not, by addressing the underlying causes of your insomnia and making simple changes to your daily habits and sleep environment, you will likely be able to put a stop to your frustration and finally get a good night’s sleep.
As discussed above, we know that anxiety, stress, and depression are some of the most common causes of insomnia; and that having difficulty sleeping can also make anxiety, stress, and depression symptoms worse. Other common emotional and psychological causes of insomnia can include anger, worry, grief, bipolar disorder, and trauma. In most cases, these conditions can be successfully addressed by a range of psychotherapeutic treatments offered by CBT Counselling & Psychotherapy.
While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you. We at CBT Counselling & Psychotherapy look forward to helping you.
Author: Tim Pratten
Principal CBT Counselling & Psychotherapy
Title: Insomnia can dramatically affect your mental health
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In severe cases of a mental health disorder, including severe cases of any those disorders described herein, or any others such as bipolar disorder, psychosis or schizophrenia, medication may need to be prescribed to the sufferer. Only a Psychiatrist can legally prescribe medications to address such disorders, for example antipsychotic drugs and antidepressants.
If at any time you are concerned about your personal safety or the safety of another person, please contact your local hospital emergency department, or otherwise contact emergency services on 000 for immediate assistance. Where there is not an immediate emergency ‘Lifeline’ may also be able to provide assistance on 13 11 14.
 Insomnia is a recognised mental health disorder – see the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM) is the handbook used by health care professionals throughout much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders.
 See Zhang, B, Wing, Y.K. (2006). Sex differences in insomnia: a meta-analysis. Sleep: 29(1): 85–93. Also Mallampalli, M.P., Carter, C.L. (2014). Exploring Sex and Gender Differences in Sleep Health: A Society for Women’s Health Research Report. Journal of Women’s Health; 23(7): 553-562.
 Some 90% of individuals with MDD have reported insomnia-related sleep disturbance. See Krystal AD. Psychiatric disorders and sleep. Neurol Clin. 2012;30(4):1389–1413: Abad VC, Guilleminault C. Sleep and psychiatry. Dialogues Clin Neurosci. 2005;7(4):291–303: Anderson KN, Bradley AJ. Sleep disturbance in mental health problems and neurodegenerative disease. Nat Sci Sleep. 2013;5:61–75.
 A study of online food delivery has revealed more than 85% of the most popular menu items are unhealthy. Researchers from the University of Sydney and University of Auckland examined public data on popular food outlets and menu items advertised on Uber eats and found 88% of options in Auckland according to the Australian Dietary Guidelines, while in Sydney it was 84%. Only 5% of food out-lets in Sydney were classified as healthy. The study was done pre-epidemic. 14.10.2020 DT.
 The most commonly used sleeping pills in Australia (as at 31 March 2020) are ‘Benzodiazepines and ‘benzodiazepine-like medication. These are the most commonly used sleeping tablets in Australia and include temazepam (Temaze, Normison), zopiclone (Imovane) and zolpidem (Stilnox). They work by enhancing the activity of sleep pathways in the brain. They are recommended for short term use (less than 4 weeks).
Suvorexant (Belsomra). This works by reducing the activity of the wake pathways in the brain. It is more helpful for people with chronic insomnia who spend time awake during the night after initially falling asleep. It can be used for longer periods than conventional sleeping tablets.
Melatonin (Circadin). This is a synthetic version of the chemical made by the brain each night. It has been approved for short term use in people aged over 55.
Sedating anti-histamines (e.g., Polaramine, Avil, Restavit). These medications are used to treat allergic disease. Although they can cause sleepiness as an unwanted side effect, they are not intended to be used as sleeping tablets.
Antidepressants and antipsychotics (e.g., Endep, Avanza, Seroquel). These medications are generally used for people with underlying mental health conditions and are not recommended for use in primary insomnia.
 Up to 400 milligrams (mg) of caffeine a day appears to be safe for most healthy adults. That’s roughly the amount of caffeine in four cups of brewed coffee, 10 cans of cola or two “energy shot” drinks. Keep in mind that the actual caffeine content in beverages varies widely, especially among energy drinks. — On average a regular cappuccino or latte is about 100mg (= 1 espresso shot) – Long black is about 200mg (= 2.0 espresso shots) – 250ml can Red Bull is about 80mg – 1 cup instant coffee (average brew) is about 60mg – 1 cup instant decaf coffee is about 3mg – 1 cup plunger coffee (average brew) is about 80mg – 1 cup green tea is about 30mg – 1 cup black tea (average brew) is about 30mg – 500ml can Monster original is about 160mg – 375ml can Coke is about 50gm.
 See – Kalmbach DA, et al. The impact of sleep on female sexual response and behaviour: a pilot study. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25772315 :: See also Dr Simon Kyle. Do sleepless nights mean worse fights? Available from: https://www.sleepio.com/clinic/library/article/do-sleepless-nights-mean-worse-fights/
 Insufficient sleep is only one of several risk factors associated with Alzheimer’s disease. Sleep alone will not be the magic bullet that eradicates dementia. Nevertheless, prioritising sleep across the life-span is clearly becoming a significant factor for lowering Alzheimer’s disease risk.
 In some case we may suggest that you seek a medical diagnosis and treatment from a medical practitioner. For example, if the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep. If you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep centre. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements. -::- Note: Sleep Apnea and Men’s Libido – Men with obstructive sleep apnea (OSA), an inability to breathe properly during sleep, commonly report low libidos and sexual activity. This may be because OSA may be associated with lower testosterone levels in some men. A 2002 study of men at the Technion Sleep Laboratory in Israel found that nearly half of those who suffered from severe sleep apnea also secreted abnormally low levels of testosterone during the night. Conditions such as OSA will likely require medical intervention.