If you’re lying awake counting the minutes until morning many times a week, your health and fertility may be at risk

I guess it makes sense that if we spend one-third of our lives sleeping, some of that time we will experience problems. An occasional night of bad sleep may have us freaked out and off kilter, but “rest assured” (pun intended) that many will sleep even better than usual the next night. However, if you are going on a few days or weeks or months of poor sleep, we need to do something about it!

Long-term lack of sleep can affect your health, including your fertility. Women who don’t consistently get at least seven hours of sleep a night are more likely to have an imbalance of certain reproductive hormones. Studies show that lack of sleep equally influences male fertility and can negatively affect semen quality.

Sleep is also crucial for mental well-being, and we all know it’s tough to get pregnant when you’re stressed and anxious!

So rather than just hoping sleep problems go away while suffering through dreary-eyed days, let’s take a look at whether sleep is the true problem and what might actually fix chronic sleep problems that could contribute to infertility.

When sleep problems become insomnia

Insomnia: inability to fall asleep or maintain sleep 3 nights per week or more.

Chronic insomnia: insomnia lasting over 3 months.

How do you know if you have it? Well, most of us are well aware if we’re not sleeping well. However, there are other ways of documenting the issue. One is to ask your spouse or partner. Yes, but using your partner’s report can be dangerous or humbling. Watches like Fitbit and Apple can give you a snapshot look at a night’s rest. But a formal sleep study can be the ultimate diagnostic tool.

Once you know poor sleep is likely to repeat itself over a few days or weeks, it’s time to develop a plan.

Your nightly routine to beat trouble sleeping

First, find a notebook – a what, you ask? Okay, use the notes section of your smartphone. Keep a log of your sleep hours and quality. I also recommend you keep a log of what you ate, when you exercised, when you showered, what was stressing you out. (Yes, there are apps for this but sometimes it’s just easier to type it in notes!)

Journal out your list each night of the things on your mind – the tasks you need to complete, the problems you replay in your mind over and over, the people you interacted with that day. If you put it down on paper, your brain won’t feel the need to go over it again and again so you won’t forget.

And finally start some sleep hygiene. Sleep hygiene is a set of habits that help you have a good night’s rest. While you may find some practices unique to you, there are some typical habits that are research-proven.

Good sleep hygiene practices

• Don’t watch crazy movies or TV shows in the hour before bed.
• Establish a relaxing bedtime routine, such as taking a warm bath or shower.
• Don’t have caffeine, alcohol, nicotine or chocolate before bed.
• Make your room dark and quiet.
• Avoid distractions in the bedroom (like pets).
• Put your cell phones away; turn off the alerts that tell you when a text comes in or a meeting is scheduled or an email is available.
• Get a good alarm clock system so you don’t wake up worrying whether it will work for an important early meeting.
• Consider purchasing no-sweat clothes and sheets if you find you are having hot flashes or waking up sweaty.
• Buy a fan for white noise and to cool you off.
• Use several light blankets rather than one heavy one.
• Make sure your room temp is optimized (60-67 degrees).
• Have regular sleep patterns – try to go to bed at the same time each night and wake up at the same time (yes, even on Saturday morning)!
• Avoid naps longer than 30 minutes during the day.

Okay so I’ve now told you when it is a bona fide disease, this insomnia thing. And I’ve told you how to optimize your sleep. So what is the cause of insomnia? Why do we get it?

Causes of insomnia

Genetic factors may be in play: some studies have shown an association with ApoE epsilon 4 allele (also associated with Alzheimer’s – now that is something to lose sleep over!). Also, abnormalities on chromosomes 7 and 9 have been associated with sleep disorders. Cardiac disease and diabetes are also seen more frequently in patients who are concurrently diagnosed with insomnia – whether one causes the other is not yet known.

While the genetic underpinnings are less clear, what is clear is that there are many contributing influences: age, sex, stress, depression, chronic pain, restless leg, sleep apnea, snoring, reflux, and medications/drugs. Some of the worst offenders in the drug/medicine category are amphetamines and stimulants, antiepileptic drugs, steroids, and cold and flu medicine.

Treating insomnia

Cognitive behavioral therapy specific for insomnia, also known as CBT-I, should be the first line of treatment after sleep apnea and restless leg syndrome are ruled out by a physician. Seventy percent of patients see a benefit, and this benefit appears to be longer lasting than medication. CBT-1 happens at a therapist’s office where they can train you on how to sleep better.

CBT– I includes:

• Sleep hygiene (see list above).
• Sleep restriction (naps less than 30 minutes, only certain times of the day is sleeping allowed).
• Stimulus control (avoiding TV, reading and phone in the bedroom; maintaining a regular sleep schedule; leaving the bedroom if unable to sleep).
• Relaxation training, including daily exercise and adequate exposure to natural light during the daytime.

If this is not working, it may be time to institute pharmacological intervention.

Insomnia medications

• Melatonin receptor agonist.
• Non-benzodiazepine hypnotics.
• Antidepressants.
• Benzodiazepines.

However, be very careful with the benzodiazepines, as they can become addictive and can cause profound sedation and respiratory depression if too much is taken or taken with other medications, drugs or alcohol. Many of these medicines are not safe in pregnancy, so finding alternatives during your fertility journey is important.

Hopefully this advice will provide many dreamy nights – until of course that new baby keeps you up all night!