This guide is written by clinical psychologists from Newcastle, North
Tyneside & Northumberland Mental Health NHS Trust. Used here with
permission.
“I toss and turn for hours on end. No matter what I do, I just can’t seem to get off to sleep”.
“I’m very restless through the night, often waking and not able to get back to sleep”.
“I wake up two or three hours before I need to get up, and just lie there trying to drop back off to sleep”.
“I never feel like I’ve had a proper night's sleep. I sleep very lightly and seem to drift in and out of sleep".
These are all comments made by people who suffer from different kinds of sleep problem.
This guide aims to help you understand your sleep problem better and to learn some simple ways to cope.
A. UNDERSTANDING SLEEP AND SLEEP PROBLEMS
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 night's
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 needing 10 hours or more. Also the amount of sleep a person
needs varies throughout their life. For example, a newborn baby spends
16-17 hours sleeping per day (though it might not seem like that to
parents). 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 thirties they may require less than 8
hours, and as time progresses this becomes less and less. Many people
in their seventies 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 called 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.
-
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.
-
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.
-
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.
-
Depression and low mood -
when someone is feeling depressed, 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.
-
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.
-
Disrupted sleep routine - people who work shifts which change frequently often have difficulty sleeping.
What sort of sleep problem do you have?
Tick the following options that apply to you:
-
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 they are 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.
Knowing exactly what sort of sleep problem you have can help when it comes to trying to deal with it.
In 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 lifespan. 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 problem
when in fact you are still getting enough sleep but it is different
from what you expect.
B. 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 we have
already 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, it's 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 asleep
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 if you won some money). Sometimes people find it
helpful 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 relaxation tapes/CDs available to buy.
Also there may be booklets and tapes/CDs 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 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 may be 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 such as 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 the guide.
You may find that getting help in another area has a knock-on
effect on your sleeping. Your sleeping may well right itself 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 respects).
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 habits 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.)
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. Nicotine
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, bathtime, pyjamas,
teeth brushed, story, then bed. The same is true for adults. Try to get
into a pattern.
Tiredness
This may seem obvious but do not go to bed until you feel sleepy.
Activity
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. 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:
-
Do go to bed and get up at a regular time.
-
Do have a bedtime routine and wind down before bedtime.
-
Do get up if you are worrying, or are not asleep after 30 minutes, and do something relaxing.
-
Do exercise regularly, but not in the late evening.
-
Do remember that sleep changes throughout our life cycle and that lack of sleep won’t harm us.
-
Do make sure your bed and bedroom are comfortable, for example, noise, temperature, light, etc.
-
Do check whether any medicines you are taking may be affecting your sleep.
And...
-
Don’t worry about not getting enough sleep.
-
Don’t lie in bed worrying about other problems.
-
Don’t use your bed for things other than sleep.
-
Don’t eat or drink caffeine close to bedtime, and cut down during the day.
-
Don’t smoke close to bedtime.
-
Don’t drink alcohol close to bedtime.
-
Don’t go to bed until you feel sleepy.
-
Don’t take naps during the day.
-
Don’t stay in bed longer to catch up on lost sleep.
These techniques have been prove to help many people but take time and hard work. Good luck and sleep well.
© EMIS and PiP 2008 Updated: 23 May 2008
