Sleep Problems
Poor quality sleep or lack of sleep can seriously affect your mental
health, your energy levels, patience and stress levels, and your
emotions. Rather than prescribe sleeping pills as a first response,
we would encourage you to try these simple measures that you can
use to get your sleeping back into a good routine
- Reinforce the natural rhythm of alertness during the day and sleepiness at night: do not go to bed until you feel sleepy, and get up at the same time every morning, (even if you would normally sleep late on weekends)
- Provide a proper sleep environment appropriate to your needs - dark and quiet, not too hot, not too cold, not too humid
- Set the mood for sleep - establish a regular bedtime routine
- Reserve the bedroom primarily for sleep. Do not use it for eating, working or watching television
- Avoid substances that interfere with sleep close to bedtime - caffeine, nicotine or alcohol
- Avoid strenuous exercise late in the evening; only exercise gently at this time
- If you are pre-occupied with anxieties, try and take time to solve them before going to bed. If you cannot solve them it can help to write them all down, to clear your mind ready for sleep
- Relaxation routines can help to relax your body, and make you feel more rested
- Avoid naps during the day; they make insomnia worse, and unsettle your sleep routine
This
leaflet aims to help you understand your sleep problem better and to
learn some simple ways to cope. Sleep problems are very common and
are often referred to as insomnia. One study in America found that
only 5% of adults reported never having trouble sleeping. A recent
study found that as many as 30% of the adult population are affected
by sleep problems. Sleep difficulties are particularly common in women,
children and those over 65. In fact, roughly half of the elderly population
complain of insomnia. Therefore to have trouble sleeping at some point
is your life is quite normal
How much sleep do we need?
People can become very distressed when they feel they are not getting
a good nights sleep, which can make it harder to get off to sleep.
But what is a normal amount of sleep? How much sleep do we need? The
answer is that people vary greatly in their need for sleep. There is
a popular idea that we all need 7 to 8 hours sleep every night. This
is not true. Many studies have shown that people range between needing
4 hours a night up to 10 hours or more. Also the amount of sleep a
person needs varies throughout their life. For example, a new-born
baby spends 16-17 hours sleeping per day (though it might not feel
like it). As children grow older they require less sleep, possibly
11 hours around the age of 5 years and maybe 8-9 hours as a teenager.
By the time someone reaches their 30's they may require less than 8
hours, and as time progresses this becomes less and less. Many people
in their 70's require less than 6 hours sleep. Not only does the need
for sleep vary from person to person, and with age, it also varies
depending on level of activity. If someone has retired from work, they
may be less active and therefore require less sleep. On the other hand
if they have a young family and are constantly on the go, then they
may require quite a bit of sleep
Are there different sorts of sleep?
Sleep is not like a light bulb which is either on or off, but has different
stages, varying from light to deep sleep. At least five different types
or stages of sleep have been identified. Broadly, sleep is divided
into what is call REM (Rapid Eye Movement) and non-REM sleep. REM sleep
occurs several times during the night and is where most dreaming is
thought to take place. Non-REM sleep is divided into four stages, each
stage being a bit deeper, almost like a staircase of sleep
Drowsiness
Stage 1 and REM |
Sleep
Stage 2 |
Deeper
sleep Stage 3 |
Deep sleep Stage
4 |
During the night whilst asleep, people go up and down this staircase
many times, and in fact wake up several times. On a typical night a
young adult who sleeps well will spend about 5% in Stage 1, 50% in
Stage 2, 28% in deep sleep (3 or 4) and about 25% in REM sleep. As
with the amount of sleep we need, the sort of sleep we have changes
as we get older. Sleep in older people tends to be lighter and more
broken, with more stage 1 and 2 sleep and more frequent wakening. For
a typical person aged 70, deep sleep takes up less than 10% of the
night's sleep. Therefore, the older person reports waking more times
throughout the night. In summary sleep in older people does tend to
be shorter, more restless and more easily disturbed, but it should
still be refreshing
Are there other changes In sleep patterns?
Not only do we need less sleep and sleep becomes lighter and more broken
as we get older but our pattern of when we sleep often changes too.
It becomes more likely that we drop off to sleep during the day, so
our natural rhythm of sleep can be disturbed
What Causes Sleep Problems?
There are a number of reasons why sleep problems can develop:
1. Normal effects of ageing - as mentioned, when people get older they
tend to sleep less deeply and need less sleep. Not only this, but sometimes
people develop a habit of dropping off to sleep during the day which
again reduces the need for sleep at night. This in itself is not a
problem, but often, not sleeping becomes a greater cause for worry,
frustration and concern, which in turn leads to sleeping less well
2. Medical reasons for disrupted sleep - medical reasons for poor sleep
may or may not be related to getting older. Some examples are: The
need to go to the toilet during the night occurs more in later life.
About 60% of women and about 70% of men, aged over 65 get out of bed
at least once a night to go to the toilet. This can also happen for
other reasons of course, such as pregnancy. Getting out of bed at night
isn't always a great problem, but can be frustrating if it is difficult
to get back to sleep. Another medical reason is pain. This again can
be common in older age with joint pains such as arthritis. The emotional
upset of loss or bereavement can affect sleep and again this may be
more common in older people. Some medicines can interfere with sleep,
so it is worth checking with your doctor if you are on any tablets.
A very rare sleep problem is called sleep apnoea which involves stopping
breathing whilst asleep. If you or a member of your family suffer from
this you may require medical attention
3. Stress, anxiety and worry - sleep is easily affected by how someone
is feeling. If someone is worrying about something or suffering from
stress, very often they will find it hard to get off to sleep
4. Depression and low mood-when someone is feeling disturbed sleep
is common. It is quite usual for a depressed person to wake up early
in the morning and find it hard to get back to sleep, or alternatively
to have difficulty getting off to sleep
5. Surroundings - can make a big difference to sleep. For example,
a bedroom that is over hot or over cold, a bed that is too hard or
too soft, a room that is too noisy or too light can all make a difference
to how well someone sleeps. Sleeping in a strange place can also affect
someone's sleep
6. Disrupted sleep routine - people who work shifts which change frequently
often have difficulty sleeping
What sort of sleep problem do you have?
Getting to sleep - The most common sleep problem is trouble getting
to sleep. For some people it can take several hours to drop off to
sleep, but once asleep the quality of sleep is good
Staying asleep - The next most common problem is a disturbed sleep
pattern, with frequent waking in the middle of the night and difficulty
getting back to sleep
Waking too early - A third problem is waking earlier than is desired,
again with difficulty getting back to sleep
Poor quality sleep - In addition, some people report sleeping lightly,
with restless, disturbed and inconsistent sleep
Summary
Sleep problems are very common and affect people in different ways.
There is no "right" amount of sleep as this varies between
people and across the life-span. Sleep problems can occur for a number
of reasons; as a result of age; medical reasons; emotional reasons;
unhelpful surroundings; disrupted sleep routines. There are different
sorts of sleep problem. It is also possible to think you have a sleep
problems when in fact you are still getting enough sleep but it is
different to what you expect
Overcoming your sleep problem
One of the first steps in overcoming sleep difficulties is finding
out any possible causes and trying to look for solutions. Is sleeping
your main problem, or is there another problem which may be causing
you to have difficulty sleeping? If there is another problem, is there
anything you can do about that problem? Review these common reasons
for insomnia and try to work out which if any apply (please tick).
There may be different solutions for different problems
Problem: Worrying about not getting enough sleep - are you
expecting too much sleep and worrying about not getting enough? Sometimes
people lie in bed and worry about not sleeping. As mentioned worrying
about not getting enough sleep makes matters worse. Thoughts such as "I'll
be exhausted tomorrow", "I'll never get to sleep", "I
must sleep, its ruining my health", may run through your mind.
The effect of this is that you feel tense and anxious and less likely
to drop off to sleep, which in turn leads to more worrying thoughts
Solution: Try to remind yourself that loss of sleep
will not hurt you. No-one ever died through lack of sleep! You know
you will always fall a sleep eventually. Lying calm and relaxed in
bed can be as refreshing as sleep (and even more enjoyable because
you're awake to experience it!). Don't keep looking to see what the
time is. Try to put sleep out of your mind. Tell yourself you don't
really care whether you get to sleep or not. Have a daydream instead
about something pleasant (for example a holiday, what you'd do you
won some money). Sometimes people find it helps to lie and force themselves
to stay awake. This may sound odd but often if someone tries to force
their eyes open the urge to close them and to go to sleep becomes very
strong. Relaxation may be helpful. There are many tapes available to
buy also there may be booklets and tapes to pick up free of charge
at your local surgery
Problem: Medical reasons - are there any of the reasons already
mentioned that apply to you?
Solution: Check whether you can receive help for that
problem. There may be alternative forms of pain relief you could try
for example
Problem: Loss and bereavement - have you experienced a loss
or bereavement recently?
Solution: It is very common to have disturbed sleep
following a bereavement. Try not to add to your difficulties by worrying
about not sleeping. Your sleep pattern should return to normal in time.
Talking about your feelings may help, either to a friend or to your
GP. A leaflet may be available in your local surgery about coping with
bereavement
Problem: Emotional state (for example, anxiety, depression,
stress) - are you suffering from stress at the moment? Or are you depressed
or anxious?
Solution: Self help booklets are available at your
local surgery for stress, depression and anxiety. It may be that you
need your depression or anxiety treated
Problem: Worry about other problems is your mind working overtime
thinking about problems, try the following be thinking of work, relationships,
money worries
Solution: The following might help. Get out of bed
and sit somewhere quiet and comfortable with a pen and paper. Write
down the problems you are thinking about.
Taking each problem, write down everything you can possibly think you
might do to solve the problem. Choose the most helpful solution and
write down all the steps you are going to need to take to do it, write
as much as you can. Write down any obstacles and how you might tackle
them. When you are finished say to yourself firmly "OK".
That is it for now. I can't do any more about it at this time of night,
I am not going to let myself worry about it till the morning".
Spend at least half an hour winding down, reading a paper or listening
to some music. When you start to feel sleepy go back to bed. If you
still find yourself worrying, keep saying to yourself "I've dealt
with my worry for now. Worrying about it now will not help. I'll deal
with it tomorrow". If you don't drop off to sleep within 15-30
minutes, don't stay in bed - the importance of this is discussed later
on in this text
You may find that getting help in another area has a knock on effect
on your sleeping. Your sleeping may well right it self if you can solve
some of your other problems. Even so, you may have got into some "bad
habits" which are not helping you get off to sleep. Many people
have bad sleep habits and may get away with it for most of their life.
Having a cigarette last thing at night may not be a problem (although
never to be recommended in bed and bad for your heath in other respect).
Lying in bed reading for hours, drinking coffee may be fine for some
people / some of the time. However when a sleep problem starts, it
is most helpful to try and get rid of any bad sleep habit we have built
up over the years. The following simple checklist of good sleep habits
may help
Good sleep habits
Try not to worry about not getting enough sleep - it may be that you
are getting enough, but it's just less than you expect. Don't take
naps during the day to catch up, this will affect your natural rhythm
and only add to your problem
Remember - that our need for sleep is an individual thing and gets
less as we get older. You may be trying to get too much. Try going
to bed later or getting up earlier.
Surroundings - Go through this basic check list and see whether there
are any simple changes you can make: Noise (too noisy, too quiet?).
Light (too light, too dark?). Comfort of mattress (too hard, too soft?).
Temperature of room (too hot, too cold?). Is your partner (or lack
of one) keeping you awake, (sleeping with someone who is snoring may
be adding to your sleep problem
These simple guidelines really can improve your sleep but they take
time. Please be patient, your hard work will pay off although it can
take many weeks to develop new sleep habits.
Food and Drink - anything that contains caffeine taken near to bedtime,
will reduce the quality of sleep. Examples include coffee, tea, hot
chocolate and cola. It is best not to have any of these things within
four hours of bedtime. If you are having a bedtime drink try to make
sure it is decaffeinated
Cigarettes - smoking last thing at night can keep you awake as nicotine
is a stimulant. If you do smoke, try to have your last cigarette at
least four hours before bedtime. Nicorette patches or chewing gum could
also affect sleep
Medicines and other drugs - Some drugs can affect sleep because they
are stimulants. If you are taking medicine it is worth checking with
your pharmacist or doctor. Examples are certain drugs for asthma and
for migraine. Sleeping tablets, whilst they can help in the short term
often cause sleep problems as they interfere with the quality of sleep
and can alter sleep patterns. They should only be taken for very short
periods
Alcohol - whilst people often feel sleepy after drinking a lot of alcohol,
again the quality of sleep is affected. It is best to avoid drinking
large amounts of alcohol close to bedtime if you are having sleep problems
Consistency - try to get a consistent timetable so that your body knows
where it is. Going to bed and getting up at roughly the same time is
much better during insomnia than trying to catch up on lost sleep or
going to bed early or napping at odd times during the day. If you feel
the need to sleep in at weekends try to make it not more than an hour
later than usual
Pre-sleep routine-try to use the hour before going to bed to unwind
and prepare for sleep. In the same way that you would not expect a
child to go straight from an exciting game to bed, most adults need
to wind down. For a child, a bedtime routine helps with the winding
down process, for example, bath time, pyjamas, teeth brushed,story,
then bed. The same is true for adults. Try to get into a pattern. This
may seem obvious but do not go to bed until you feel sleepy
Gradually - increase your daytime activity and exercise, but don't
exercise too near to bedtime. If you have not fallen asleep within
30 minutes - get up and have a malty drink like Horlicks. Listen to
relaxing music, reading a relaxing book or watch something boring on
TV until you feel sleepy
Make sure your bed is associated with sleep. For example, don't watch
TV, eat, and talk on the telephone in bed. The only exception to this
is making love which can in fact help (and certainly seems to induce
sleep in men!)
These simple guidelines really can improve your sleep but they take
time. Please be patient, your hard work will pay off although it can
take many weeks to develop new sleep habits
Summary
There are a few simple rules, which can help improve your sleep. In
summary, these are:
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These techniques have been prove to help many people but take time and hard work. Good luck and sleep well
Source: Northumberland Mental Health NHS Trust and BSHS
NHS
Direct 0845 46 47 www.nhsdirect.nhs.uk
