As many as one in three people can have some difficulty with sleeping. However, there are many things you can do to help yourself. This leaflet aims to show you some of them. For example, simple things like winding down before bedtime, avoiding certain foods and drinks, and a bedtime routine can help.
Further ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies. Sleeping tablets are not the best way to help with sleep problems because you can get addicted to them and they often stop working if you take them regularly.
Understanding normal sleep
A normal night’s sleep has three main parts:
- Quiet sleep. This is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep.
- Rapid eye movement (REM) sleep. REM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.
- Short periods of waking for 1-2 minutes.
Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night’s sleep. The graph below shows a typical normal pattern of sleep in a young adult.
Normally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them.
What is insomnia?
Insomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean:
- Not being able to get off to sleep.
- Waking up too early.
- Waking for long periods in the night.
- Not feeling refreshed after a night’s sleep.
If you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause:
- Tiredness (fatigue) and loss of energy in the daytime.
- Poor concentration.
- Loss of interest in usual activities.
- Depression and anxiety.
- Inability to do things as well or as much as usual – for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences.
- A worse quality of life.
What is a normal amount of sleep?
Different people need different amounts of sleep. Some people function well and are not tired during the day with just 3-4 hours’ sleep a night. Most people need more than this. To need 6-9 hours per night is average. Most people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep.
So, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: ‘Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.’
Causes of insomnia
Poor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following:
Concern about wakefulness
You may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up. This may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night’s sleep, even when the total amount of time asleep was normal.
Poor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time.
Stress, anxiety or depression
You may find it difficult to switch off your anxieties about work, home or personal problems. Also, poor sleep is sometimes due to depression. Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too.
This sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. Note: most people who snore do not have sleep apnoea and they do sleep well.
Various illnesses keep some people awake. For example, illness causing pain, leg cramps, breathlessness, indigestion, cough, itch, hot flushes, mental health problems, etc.
These can interfere with sleep. There are three common culprits.
- Alcohol – many people take an alcoholic drink to help sleep. Alcohol actually causes broken sleep and early morning wakefulness.
- Caffeine – which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep.
- Nicotine (from smoking) is a stimulant, so it would help not to smoke.
Street drugs (for example, ecstasy, cocaine, cannabis and amfetamines) can affect sleep.
Some medicines sometimes interfere with sleep. For example, ‘water tablets’ (diuretics), some antidepressants, steroids, beta-blockers, painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep.
How can I sleep better?
- Avoid caffeine, smoking and alcohol, especially in the hours before bedtime.
- Avoid heavy meals or strenuous exercise shortly before going to bed.
- Go to bed and get up at the same time each day.
- Regular daytime exercise helps you feel more relaxed and tired at bedtime.
This section will discuss five topics which can help to promote better sleep:
- Understanding some facts.
- Sleep hygiene.
- Relaxation techniques.
- Daytime exercise.
- Psychological treatments called cognitive and behavioural therapies.
In effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort.
A final note
See a doctor if you feel that illness or medication is causing poor sleep. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.
Source: Patient UK . – Read Full Article