15 tips to banish insomnia
Insomnia adversely affects the health of about 15pc of Irish people, writes Isobel Hayes, but some simple changes to your routine can improve the quality of your sleep
Most of us have woken up at 4am at one time or another and struggled to get back to sleep. But for about 15pc of Irish people, insomnia is adversely affecting their ability to function daily and their long-term health. Sleep disorders physiologist Breege Leddy runs the Insomnia Clinic at Bon Secours Hospital, Dublin - the first of its kind in Ireland to offer cognitive behavioural therapy (CBT) for insomnia. She discusses ways to combat the condition.
1 Assess Your Risk
Insomnia - defined as sleeplessness that occurs at least three nights a week for at least three months - can occur at any time, but some of us are more prone to it than others, says Leddy. Women are twice as likely to get insomnia as men, for instance, while older people are also more at risk. Those who suffer from mental illness, retirees, the unemployed, shift workers and frequent international travellers are all more prone to bouts of sleeplessness.
"People with certain psychological traits, like worriers or over-thinkers, are also more at risk," says Leddy. "It doesn't necessarily mean they are going to get insomnia, but these are the types of people who would be more prone to it."
2 No more napping
According to Leddy, insomniacs often develop ways of coping with sleeplessness - such as taking a nap the next day or drinking more coffee. But these are bad habits that will actually keep the insomnia going for longer, she warns.
Learned behaviour insomnia - or psychophysiological insomnia - is the most common form of insomnia Leddy comes across in the clinic. "If you keep doing something over and over again, the body recognises that as now being normal," she says. "So when you're having a fragmented sleep or restless sleep, the body starts to recognise that as being the normal sleep. While naps may be tempting, they should be avoided," she says.
3 Lay off lie-ins
Getting up at the same time every morning from Monday to Friday and then sleeping late at weekends throws our body clocks out of sync, in much the same way jet lag does. "Sleep doesn't like change," warns Leddy. "It likes the same thing over and over again."
For every hour we travel across international time zones, it takes the body about a day to recover. Lying in has a similar effect. "If you have a three hour lie-in at the weekend, it's nearly Wednesday by the time the body has recovered from that," says Leddy. "It's what we call social jetlag."
According to Leddy, even good sleepers should only allow themselves to sleep in for one extra hour.
4 Kick the caffeine habit
It's well-known that caffeine is a stimulant that can affect our sleep and Leddy recommends drinking no more than two cups of caffeinated drinks a day, including tea. "We're all drinking far too much caffeine," she says. "I also tell people not to have caffeine after two or three o'clock in the day because it takes eight or nine hours to leave our system." Alcohol also disrupts the body's natural sleep pattern and should be avoided.
5 Eliminate smart devices
Many of us are glued to our smartphones and tablets for much of the day and - crucially - the evening. But scrolling through Facebook or watching the latest Netflix release on smart devices before bedtime overstimulates the mind and can affect the quality of sleep. According to Leddy, smart devices emit a blue light that has been proven to reduce melatonin - the naturally-occurring hormone in the brain that promotes sleep. She recommends banning smart devices from the bedroom and avoiding them for at least two hours before bedtime.
6 Make the bedroom a sleep-only zone
Leddy teaches stimulus control therapy, where insomnia sufferers are taught how to strengthen the connection between bed and sleep. When people start to have trouble sleeping, they turn to books, TV and smart devices in bed. "As a result, they start to associate bed with all of these things, but not sleeping," Leddy says. "We have to retrain the mind to think bed means sleep."
As a result, TVs are banned from the bedroom, along with computers, phones and other smart devices. "I even ban reading in bed," says Leddy.
7 Darken the bedroom
The sleeping environment should be as dark as possible, says Leddy. "We only produce melatonin when it's dark, so bedrooms need to be really dark," she says. An eye mask will usually do the trick, but most people find them uncomfortable, says Leddy. "Invest in black-out blinds instead," she advises.
Like electronic screens, energy-efficient bulbs also emit a blue light that interferes with the production of melatonin. So, people should expose themselves to lots of natural light during the day to keep their body clock in sync and boost their ability to sleep at night. "We're all being exposed to far too much artificial light and not enough daylight," says Leddy.
8 Routine, routine, routine
Leddy sees a lot of retirees who suffer from insomnia, partly due to a lack of routine in their day. Getting up at the same time each morning and going to bed at the same time every night helps to train our minds to sleep, she says.
"The most important thing is routine," says Leddy. "People who are retired or unemployed don't have to get up when the alarm goes off in the morning. But we're very boring creatures: the body likes the same thing over and over again, particularly sleep. If you keep to the same routine, the body will start to feel sleepy at the same time every night."
9 Sleep when you're sleepy
"People think they should be in bed at a certain time, which is a common misconception," she says. "They're going to bed because they think it's bedtime, but they're not really sleepy enough. The best bedtime is when you're sleepy."
Current guidelines state that between five and nine hours of sleep a night are appropriate for adults, with the ideal length being seven to eight hours. "As we progress through life, our need for sleep decreases," says Leddy.
10 Keep regular meal times
Keeping to a routine includes eating your meals at the same time each day. "People don't realise this but mealtimes are time-givers," says Leddy. "They give the body a sense of time. When there's no routine there, the body gets confused."
Eating too late at night can also affect sleep. Leddy recommends eating the main meal by 7pm. "That's difficult for a lot of people," she says. "We're getting up earlier in the mornings to commute and we're getting home later at night. Our day has become so much longer and sleep is being affected by that."
11 Exercise early
Exercise can be beneficial for those suffering with insomnia, with studies showing regular aerobic exercise improves the quality of sleep. Leddy agrees exercise is important, but says it has to be at the right time. "We're all exercising too late at night," she says. "It's all about giving our body wind-down time." Leddy recommends laying off exercise from 7pm - "8pm at the very latest".
12 Empty your mind
Most people Leddy sees are suffering from sleep maintenance insomnia. They have no trouble falling asleep, but wake up during the night and have difficulty nodding off again. "They wake up and start to panic that they're not going to get back to sleep," says Leddy. "The busy mind sets in." Leddy teaches her clients relaxation techniques to help reduce middle-of-the-night anxiety. Winding down before bedtime without any stimulus also helps to empty the mind. "For people with insomnia, no two nights are the same and they never know what to expect," says Leddy. "That causes a huge amount of anxiety."
13 Get them when they're young
"I see a lot of younger people and the biggest problem with their sleeping really is the smart devices, the Xbox," says Leddy. "These are all in the bedrooms and it's so bad for them. Parents might think their children are sleeping soundly, but in fact they're on the Xbox or watching television in their bedrooms rather than sleeping," says Leddy.
Leddy recommends banishing all televisions and computers from bedrooms and ensuring all smart devices are shut down two hours prior to bedtime.
14 Examine your lifestyle
"I see more and more people whose lifestyle is having a huge impact on their sleep, such as stress in work," says Leddy.
One of the most common patients she sees is working women with children who are struggling to cope. "They're trying to juggle a work life, and children and home life and I think sleep does suffer a lot," says Leddy.
Longer working day and lengthy commutes for many workers also play a role. "We're not seeing sleep as important. We're thinking, 'I don't have time for that'," says Leddy. "But it's so, so important for our overall health."
15 Seek help
The treatment of insomnia has changed a lot over the last couple of years, says Leddy. It is now treated as a disorder in its own right, independently of what may be causing it. GPs are becoming more aware of the importance of sleep and there is more information out there on how to deal with it.
"Until CBT, the only treatment was sleeping medication," says Leddy. "But people are becoming more aware of the negative effects of sleeping medication and they don't necessarily want to go on it."
There is a place for sleeping medication, but it should only be short term, Leddy believes. "They should only be prescribed at the lowest possible dose and for about two weeks at a time," she says. "Otherwise you have to keep upping the dose to get the same effect."
÷For more information on the Insomnia Clinic Dublin, visit www.bonsecours.ie/insomnia-clinic
Health & Living