| |
Introduction
You don't usually need to
think very much about sleep. It's an ordinary
part of life, but sometimes you just can't sleep
properly (we call it insomnia). It's usually
just for a short time, perhaps when you're
worried or excited. When things settle down, you
start to sleep properly again. If you can't
sleep properly, it can be a real problem
because we all need sleep to keep healthy.
What happens during sleep?
You become unconscious,
unaware of what's going on around you. As you
sleep, you pass through different stages - and
there are two main ones:
This comes and goes throughout the night, and makes
up about one fifth of your sleep. It makes up about
one fifth of your sleep. The brain is very
active, your eyes move quickly from side to side
and you dream. Although your brain is active, your
muscles are very relaxed.
Your brain is quiet - you are still unconscious
- but your body moves around more. Hormones are
released into the bloodstream and your body repairs
itself after the wear and tear of the day. There
are 3 stages of non-REM sleep:
-
'Pre-sleep' -
your muscles relax, your heart beats slower and
your body temperature falls.
-
'Light sleep' -
you can wake up easily without feeling confused.
-
'Slow wave' sleep -
your blood pressure falls, you may talk or sleep
walk and it's hard to wake up. If somebody does
wake you, you feel confused.
You move between REM and
non-REM sleep about 5 times during the night,
dreaming more towards the morning.
On a normal night, most
people wake up for one or two minutes every 2
hours or so. You aren't usually aware of these
'mini wakes', but may remember them if you feel
anxious or there is something else going on -
noises outside, a partner snoring etc.
How much sleep do I need?
This mainly depends on your
age.
-
Babies sleep for about 17
hours each day.
-
Older children only need 9 or
10 hours each night.
-
Most adults need around 8
hours sleep each night.
-
Older people need the same
amount of sleep, but will often only have one
period of deep sleep during the night, usually
in the first 3 or 4 hours. After that, they wake
more easily. We tend to dream less as we get
older.
Even so, we are all
different, even people who are the same age as
us. Most of us will need 8 hours a night, but
some (a few) people can get by with only 3 hours
a night.
But I never sleep ...
The short periods when you
are awake (every couple of hours) can feel much
longer than they really are. So you can feel
that you are not getting as much sleep as you
really are.
What happens if I don't sleep?
The occasional night without
sleep will make you feel tired the next day, but
it won't affect your health.
However, after several
sleepless nights, you will start to find that
you:
-
feel tired all the time
-
drop off during the day
-
find it difficult to
concentrate
-
find it hard to make
decisions
-
start to feel depressed
-
start to worry about not
being able to sleep.
This can be very dangerous if you are driving or
operating heavy machinery. Many people are
killed each year when they fall asleep while
driving.
Lack of sleep can make
you more likely to get high blood pressure,
diabetes and to be overweight.
Sleeping too little (insomnia)
You may feel that you aren't getting enough sleep or
that, even if you do get the hours, you just aren't
getting a good night's rest.
There are many everyday
reasons for not sleeping well:
-
the bedroom may be too noisy,
too hot or too cold
-
the bed may be uncomfortable
or too small
-
you don't have a regular
sleep routine
-
you partner has a different
pattern of sleep from you
-
you aren't getting enough
exercise
-
you eat too late - and find
it hard to get off to sleep
-
you go to bed hungry - and
wake up too early
-
cigarettes, alcohol and
drinks containing caffeine, such as tea and
coffee
-
illness, pain or a high
temperature.
More serious reasons include:
-
emotional problems
-
difficulties at work
-
anxiety and worry
-
depression - you wake very
early and can't get back to sleep
-
thinking over and over about
problems - usually without getting anywhere with
them
-
physical problems including:
-
heart disease, such as
angina or heart failure
-
breathing problems, such
as chronic obstructive pulmonary disease or
asthma
-
neurological disease,
such as Alzheimer's or Parkinson's disease
-
hormone problems, such as
an overactive thyroid
-
joint or muscle problems,
such as fibromyalgia or arthritis
-
gastroinestonal disease,
such as gastoroesophageal reflux disease or
irritable bowel syndrome
-
genital or urinary
problems, such as incontinence or an
enlarged prostate
-
long-term pain
-
medications
Here are some simple tips that many people find
helpful:
-
Make sure that your bed and
bedroom are comfortable - not too hot, not too
cold, not too noisy.
-
Make sure that your mattress
supports you properly. If it's too firm, your
hips and shoulders are under pressure. If it's
too soft, your body sags which is bad for your
back. Generally, you should replace
your mattress every 10 years to get the best
support and comfort.
-
Get some exercise. Don't
overdo it, but try some regular swimming or
walking. The best time to exercise is in the
daytime - particularly late afternoon or early
evening. Later than this can disturb your sleep.
-
Take some time to relax
properly before going to bed. Some people find
aromatherapy helpful.
-
If something is troubling you
and there is nothing you can do about it right
away, try writing it down before going to bed
and then tell yourself to deal with it tomorrow.
-
If you can't sleep, get up
and do something relaxing. Read, watch
television or listen to quiet music. After a
while, you should feel tired enough to go to bed
again.
Don'ts
-
Don't go without sleep for a
long time. Go to bed when you feel tired and
stick to a routine of getting up at the same
time every day, whether you still feel tired or
not.
-
Caffeine hangs around in your
body for many hours after your last drink of tea
or coffee. There are now many fizzy drinks, and
even mints, that contain a lot of caffeine. Stop
drinking tea or coffee by mid-afternoon. If you
want a hot drink in the evening, try something
milky or herbal (but check there's no caffeine
in it).
-
Don't drink a lot of alcohol.
It may help you fall asleep, but you will almost
certainly wake up during the night.
-
Don't eat or drink a lot late
at night. Try to have your supper early in the
evening rather than late.
-
If you've had a bad night,
don't sleep in the next day - it will make it
harder to get off to sleep the following night.
-
Don't use slimming pills -
many of these will keep you awake.
-
Don't use street drugs like
Ecstasy, cocaine and amphetamines - they are
stimulants, and like caffeine, will tend to keep
you awake.
If you try these tips and you
still can't sleep, go and see your doctor. You
can talk over any problems that may be
interfering with your sleep. Your doctor
can check that your sleeplessness is not due to
a physical illness, a prescribed medicine, or
emotional problems. There is evidence that cognitive
behavioural therapy can
be helpful if you haven't been sleeping well for
some time.
Psychological Treatments
-
Cognitive therapy is
a way of changing unhelpful ways of thinking
that can make you more anxious, and so stop you
from sleeping.
-
Stimulus control helps
you to:
-
strengthen the
link of being in bed with sleeping - by only
getting into bed when you feel tired, and
only using your bed for sleep and sex;
-
weaken the
link of being in bed with doing things that
are likely to keep you awake - like watching
exciting TV programmes, doing work, or
organising things;
-
weaken the
link of being in bed with worrying - if you
can't sleep, instead of lying in bed
worrying, you get up and do something for a
while until you feel tired again.
-
Sleep restriction helps
you to go to bed later. Too much time in bed can
stop you from sleeping.
-
Progressive muscle
relaxation helps
you to relax your muscles deeply. One by one,
you tense and then release the muscles of your
body, working up from your feet to your legs,
arms, shoulders, face and neck.
What about medication?
People have used sleeping tablets for many years,
but we now know that they:
-
don't work for very long
-
make you tired and irritable
the next day
-
lose their effect quite
quickly, so you have to take more and more to
get the same effect
-
are addictive. The longer you
take sleeping tablets, the more likely you
are to become dependent on them.
There are some newer sleeping tablets (Zolpidem,
Zaleplon and Zopiclone), but these seem to have many
of the same drawbacks as the older drugs, such as
Nitrazepam, Temazepam and Diazepam.
Sleeping tablets should only be used for short
periods (less than 2 weeks) - for instance, if you
are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long
time, it is best to cut down the dose slowly after
discussing it with your doctor.
In some cases, antidepressant tablets can be
helpful.
Melatonin is a naturally occurring hormone that can
help insomnia. At present, in the UK, it is only
licensed for treating sleeplessness in those aged
over 55. It should not be taken for more than 3
weeks, and should not be used if you have liver or
kidney problems. It can make you drowsy and,
occasionally, can cause:
-
irritability
-
dizziness
-
migraines
-
constipation
-
stomach pain
-
weight gain.
Over-the-counter medication
You can buy sleeping remedies at your chemist
without a prescription. They often contain an
anti-histamine, like you find in medicines for
hay-fever, coughs and colds. These do work, but they
can make you sleepy well into the next morning. If
you do use them, take the warnings seriously and
don't drive or operate heavy machinery the next day.
Another problem is tolerance - as your body gets
used to the substance, you need to take more and
more to get the same effect. It is best not to take
anti-histamines for a long time.
Herbal medicines are usually
based on a herb called Valerian.
It probably works best if you take it every
night for 2-3 weeks or more. It doesn't seem to
work as well if you take it occasionally. As
with the anti-histamines, you need to be careful
about the effects lasting into the following
morning. If you are taking any medication for
your blood pressure (or any other sleeping
tablets or tranquillisers), have a chat with
your doctor before using an over-the-counter
remedy.
Sleeping at the wrong time - shift work and
parenthood
You may have to work at night, staying awake when
you would normally be asleep. If you only have to do
this occasionally, it's quite easy to adjust. It is
much harder to cope with if you do it regularly.
Shift workers, doctors and nurses working all night
or nursing mothers may all find that they sleep at
times when they ought to be awake. It's like jet lag
where rapid travel between time zones means that you
are awake when everybody else is asleep.
A good way to get back to
normal is to make sure that you wake up quite
early at the same time every morning - whatever
time you fell asleep the night before. Use an
alarm clock to help you. Make sure that you
don't go to bed again before about 10 pm that
night. If you do this for a few nights, you
should soon start to fall asleep naturally at
the right time.
Sleeping too much
You may find that
you fall asleep during the day at times when you
want to stay awake. This will usually be because
you have not been getting enough sleep at night.
If you are still falling
asleep in the daytime, even after a week or two
of getting enough sleep, see your
doctor. Physical illnesses such as diabetes, a
viral infection, or a thyroid problem, can cause
this sort of tiredness.
There are other conditions
which make people sleep too much:
Narcolepsy (daytime
sleepiness)
This is an uncommon problem, so it's easy for a
doctor to miss it.
There are two main symptoms:
-
you feel sleepy in the daytime, with sudden
uncontrollable attacks of sleepiness even when
you are with other people
-
cataplexy - you suddenly lose
control of your muscles and collapse when you
are angry, laughing or excited. This sometimes
gets better with age.
You may also find that you:
-
can't speak or move when
falling asleep or waking up - (sleep paralysis)
-
hear odd sounds or see
dream-like images (hallucinations)
-
'run on auto-pilot' - you
have done things, but can't remember doing them,
as if you had been asleep
-
wake with hot flushes during
the night.
The cause for this has
recently been found - a lack of a substance
called orexin, or hypocretin.
Treatment consists of taking
regular exercise and getting yourself into a
regular night-time routine. If this simple
approach does not work, medication may help.
These include:
-
Modafinil which makes you
more awake in the day-time;
-
Antidepressants, such as
Clomipramine or Fluoxetine, can help with
cataplexy;
-
Sodium Oxybate helps the
day-time sleepiness and poor sleep at night.
Sleep Apnoea
(interrupted sleep)
-
You snore loudly and stop
breathing for short periods during the night.
This happens because the upper part of your
airway closes. Every time you stop breathing,
you wake suddenly and your body or arms and legs
may jerk.
-
You stay awake just for a
short time, then fall off to sleep again. This
will happen several times during the night. You
may have a dry mouth and a headache when you
wake up in the morning. You feel tired in the
day and may have an irresistible urge to go to
sleep.
You are more likely to get
sleep apnoea if you are:
-
older
-
overweight
-
a smoker
-
a heavy drinker.
The problem is
often noticed by a partner. Treatment is usually
simple - cut down smoking and drinking, lose
weight, and sleep in a different position. If
your apnoea is very bad, you may need to wear a
Continuous Positive Airway Pressure (CPAP) mask.
This blows high-pressure air into your nose
which keeps the airway open.
Other problems with sleeping
At some point in their life, about 1 in 20 adults
have night terrors, and 1 in 100 report that they
sleep-walk.
Sleepwalking: when
you sleepwalk, you appear (to other people) to wake
from a deep sleep. You then get up and do things.
These may be quite complicated, like walking around
or going up and down stairs. This can land you in
embarrassing (and occasionally dangerous)
situations. Unless someone else wakes you up, you
won't remember anything about it. Sleepwalking
sometimes happens after a night terror (see below).
If your sleep is broken or you aren't getting sleep,
you are more likely to sleepwalk.
A sleepwalker should be
guided gently back to bed and should not be
woken up. You may need to take precautions to
protect them or other people, such as locking
doors and windows, or locking away sharp
objects, like knives and tools.
Night terrors: can happen
on their own, without sleepwalking. Like a
sleepwalker, a person with night terrors will
appear to wake suddenly from a deep sleep. They
look half-awake and very frightened, but will
usually settle back to sleep without waking up
completely. All you can do is sit with them
until they fall asleep again.
Night terrors are different
from vivid dreams or nightmares as people don't
seem to remember anything about them the next
morning.
Nightmares: most
of us have had frightening dreams or nightmares.
They usually happen during the later part of the
night, when we have our most vivid and memorable
dreams. They don't usually cause problems unless
they happen regularly, perhaps because of
emotional distress. Nightmares often follow a
distressing or life-threatening event such as a
death, a disaster, an accident or a violent
attack. Counselling may be helpful.
Restless Legs
Syndrome (RLS)
-
You feel you have to move
your legs (but also, sometimes, other parts of
the body).
-
You may have uncomfortable,
painful or burning feelings in your legs.
-
These feelings only bother
you when you are resting.
-
They are generally worse at
night.
-
Walking or stretching helps,
but only for as long as you carry on doing it.
-
You may not be able to sit
still in the daytime or sleep properly.
People usually first ask for
help with this in middle age, even though they
may have had symptoms since childhood. It often
runs in families.
RLS usually occurs on its
own. Pregnancy or a physical illness (iron and
vitamin deficiencies, diabetes or kidney
problems) can occasionally be responsible.
If it is not caused by
another physical illness, treatment depends on
how bad it is. In mild RLS, the symptoms can
usually be controlled by simple steps designed
to help you sleep better (see above 'Helping
yourself'). In more severe RLS, medications may
help. These include medications used in
Parkinson's disease, anti-epileptic medications,
benzodiazepine tranquillisers and pain-killers.
If simple measures do not
help, you can be referred to a sleep or movement
disorders specialist.
Autism
Some people with autism do not seem to realise that
night time is for sleeping, and may be up and about
when everyone else wants to sleep. This will usually
need the help of a specialist.
REM Sleep Behaviour Disorder (RBD)
A person will start thrashing about during REM or
dream sleep, as though responding to a dream. They
may punch, kick, shout, or jump out of bed. Quite
often, the person will wake and be able to remember
the dream that prompted their physical reactions.
Someone sharing the same bed can be disturbed and,
sometimes, injured.
The problem seems to be that, unlike normal REM
sleep where the muscles are relaxed, in RBD they are
not. It can happen on its own or it can be a symptom
of a neurological illness, so it's best to be
assessed by a specialist. |
|
