Saturday 21 July 2018

How to get a good night's sleep

Many of us struggle to get the rest we need, even though we’re busier than ever. But there are things you can do to help yourself. Tanya Sweeney asks the experts everything you’ve ever wanted to know about sleep

The blue light from devices acts as a sort of contamination in the bedroom. Stock image
The blue light from devices acts as a sort of contamination in the bedroom. Stock image
Stock image

In association with the Health Service Executive

It may seem like the most natural, relaxing and easy thing for some, yet for many Irish people a good night's sleep remains frustratingly out of reach.

A recent RTÉ documentary, Awake, threw up some enlightening, if disturbing, statistics concerning how little we sleep in Ireland.

Forty-one percent of us get six hours' sleep or less on an average weeknight; females are more likely than males to sleep five hours or less on any night of the week; 27pc of Irish adults have used alcohol in the past month to help them sleep, while 18pc of Irish adults have used sleeping tablets to get to sleep.

Wider research shows this to be a worldwide malaise. In 1942, less than 8pc of the Western population was trying to survive on six hours or less sleep a night; in 2017, almost one in two people are. Children and teenagers of all ages are sleeping two hours and 10 minutes less a night, on average, than they did a century ago.

So why exactly do some of us have problems, and what can we do about it? We asked some experts to find out.

How much sleep do I need?

Deirdre McSwiney, sleep technician/cognitive behavioural therapist: The known average need for sleep for adults is 7-7.5 hours of sleep a night; a number designated by sleep societies all over the world. It has been found that our bodies run through various stages of sleep cycles, and each sleep stage has a particular attribute. Stage 2, for instance, is important for memory consolidation, and Stage 3, a deeper sleep, is restorative for the body's muscles and the mind, and designed to keep you healthy into old age. Sleep can go AWOL for lots of reasons. Ultimately, your body knows how to go looking for sleep, and how to heal itself. Other groups, like new parents, have a hard time sleeping; at the other end of the scale, for carers looking after elderly parents who have to be up during the night, that presents another difficulty.

Why do we need to sleep?

Elaine Purcell, consultant at the Sleep Disorders Clinic at the Mater Private Hospital: Sleep as a process is quite poorly understood, though we can derive, mainly by what happens if we don't sleep enough, the fallout. A lack of sleep affects every system in the body. It controls metabolism; a lack of sleep revs up our appetite, leading to weight gain; it affects short-term memory and our concentration becomes cloudy.

What happens if I don't get enough sleep?

Motty Varghese, senior sleep physiologist at St James's Hospital and therapist at the Sleep Therapy Clinic (sleeptherapy.ie): There are different theories but it's thought sleep is needed primarily for energy conservation. It's also linked to learning and memory formation. There are two types of memory: during REM sleep, which is the stage where we see our dreams, there's a high chance of retaining procedural memory. Procedural memory is a type of unconscious, long-term memory which aids the performance of particular types of tasks without conscious awareness of these previous experiences. If you spent time in Stage 3 sleep, a deeper stage of non-REM sleep, there's a higher chance of us retaining declarative memory. Declarative memory ('knowing what') is the memory of facts and events, and refers to those memories that can be consciously recalled (or 'declared').

There has been a lot of research revealed recently about how sleep deprivation can shorten our life. Is this true?

Motty Varghese: Sleep has also been linked to chronic health conditions. If you don't get enough good-quality sleep, it has been linked to higher instances of obesity, cancer, mood disturbances and mental health issues like anxiety. In fact, anxiety is seen quite a lot in people who experience insomnia. People who are anxious tend to worry about their sleep; the less they sleep, the more anxious they become. It's a vicious circle.

Elaine Purcell: It also has a big effect on our cardiovascular system. During sleep, our heart rate and blood pressure are supposed to slow down to give it a breather. Sleeping for fewer hours means that the heart has to work harder. It revs up the blood pressure, so it can lead to high blood pressure. A lot of research has found a link between dementia and Alzheimer's. We also see instances of cancer more commonly in night workers and shift workers, and this might be related to melatonin, the hormone which regulates our sleep cycles.

Is all sleep of equal value or is napping, for instance, less useful than deep night-time sleep?

Motty Varghese: Sleep has different stages, and each stage has its own function. When we fall asleep, we go into Stage 1, which is a light stage of sleeping. We spend 5pc of our sleep time in this stage before we progress to Stage 2. There, our breathing and heart slow down, and muscles become more relaxed. Then we go to Stage 3, also known as 'slow-wave sleep', and that's the refreshing sleep. We spend about 20pc of the night in Stage 3. Then, you have REM (rapid eye movement) sleep, which has a major role in memory formation and consolidation.

Basically, if you're only sleeping four hours at a time, you're not getting enough of some of these stages of sleep, and it has an effect on our ability to focus and concentrate. If you are sleep-deprived and need to, for instance, drive somewhere, it's advisable to take a nap. But it's best to just nap for 30 minutes. If you nap for longer than that, you'll go into the deeper stages of sleep and, while you'll feel fully refreshed, you won't feel the need for sleep by night-time.

What is insomnia?

Deirdre McSwiney: The definition of insomnia is having difficulties initiating or maintaining sleep that has become persistent: around four out of seven nights of the week, for three or four months.

Why does CBT work as a remedy for insomnia? How does it work?

Elaine Purcell: When someone has insomnia, they don't have enough drive to fall asleep and stay asleep, and people with insomnia spend an awful lot of time awake in their bed. As a result, their association with bed changes. We should associate bed with sleeping, but instead we associate it with wakefulness, which is why many people say they feel sleepy at night but once they get into bed, they feel wide awake. CBT helps to re-establish the association between bed and sleep, and once that is built, people will find it easier to fall asleep.

What is the best sleep set-up? How should my bedroom be optimised for good sleep?

Deirdre McSwiney: The key for good sleep is a cool, dark room, with little external noise coming from outside. We produce melatonin at night, also known as the hormone of darkness, and that's why we feel a little tired when the sky is darkening. If you're the sort of person who wakes too early because of light in the morning, it may be a case of getting a blackout blind. Noise is a key one too, even if it's just the person sleeping next to you who is breathing too heavily. The simple use of earplugs can be a big help.

The use of devices (in the bedroom) is simply appalling. I don't understand why people feel the need to Facebook from the pillow. The blue light from devices acts as a sort of contamination. For people who come to me with sleep difficulties, I ban screen time for two hours before bed.

What else helps us to tell ourselves that it's time for bed?

Deirdre McSwiney: Some people swear by a hot bath before bed but it's not conducive to sleep, as body temperature needs to be cool. We simply sleep better in a cooler temperature. I'm also a stickler for a dress code: people have a bath and get into their bathrobes, then stay in the living room in their bed clothes. People should get back into their day clothes or, after work, change into a tracksuit, not pyjamas. It's all about giving the brain signals when it is bedtime.

I also tell clients to eliminate caffeine intake after 5pm, as the effects of caffeine can last 4-6 hours. A lot of products contain caffeine too, including that lovely couple of squares of dark chocolate you might have while watching the Nine O'Clock News. And you should check any painkillers you take as they may contain caffeine. Nicotine, too, is a stimulant that raises the blood pressure. Alcohol may make us feel like we're diving into a deep sleep, but it actually fragments our sleep.

If you can't sleep, what is the best thing to do?

Deirdre McSwiney: If you're dealing with a racing mind, I advise people to practise mindfulness and breathing exercises. It also helps, in an earlier part of the evening, to take care of things like a to-do list for tomorrow, so that your brain landscape is cleared for the night.

Is there an optimum time to be asleep? Is sleeping from 9pm to 5am better than sleeping from midnight to 8am, or is it the same?

Elaine Purcell: Not really. There isn't an exact advantage of sleeping at certain hours in the night. As long as you get the requisite hours, it doesn't really matter. There are definite advantages in terms of sleep hormones, of sleeping during darkness, but it's the consistency of your sleep pattern that's important. Sticking to the same bedtime and waking hours, seven days a week, is really helpful for our body clock.

What is our 'circadian rhythm' and why is it important?

Motty Varghese: It's our 24-hour body clock and it should ideally be in alignment with our external clock. The reason we fall asleep and wake is because we get this alerting signal in the morning (thanks to our circadian rhythms), and at night our body starts to produce melatonin, the hormone that induces sleep. Because of smartphones and laptops, there is a lot of blue light in our homes, and this inhibits melatonin production, or the melatonin production process starts at a later stage in the night.

Useful links...

HSE guide to treating insomnia: hse.ie/eng/health/az/I/Insomnia/Treating-insomnia.html

Irish Independent

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