Human beings need three things to survive: food, water, and sleep.
We are bombarded on a daily basis about how much water we need to drink, what food we should eat, what diet we should follow, but rarely hear any advice about how to secure a good night’s sleep.
When you reflect that the function of sleep is to optimize your physical, emotional, and mental health in order that you can live well the next day, sleeping well moves up your list of priorities.
The main types of sleep deprivation
In general terms, most complaints about poor sleep tend to fall into one of the following 4 sections:
1) Difficulty in falling asleep;
2) Waking up during the night, often more than once, and then struggling to get back to sleep.
3) Early morning waking.
4) Sleeping the whole night but feeling unrefreshed on waking.
Obstructive Sleep Apnea (OSA) and Restless Leg Syndrome are dealt with indirectly in this article and may be helped by following the 12 Commandments. Specialist help if you suffer from either of these chronic conditions is recommended.
How much sleep do I need?
Most of us need between 6- and 8-hours sleep, although there is folk who manage well on less and others who cannot cope with less than 9 or 10. Sleeping less than 5 hours of sleep a night, especially if you work during the day, suggests that you are sleep-deprived.
This figure is also associated with an approximately 15% increase in increased mortality from all causes. So if you want to live long and be healthy, improving your sleep is an excellent place to start.
As we age, our sleep may become more shallow and of shorter duration. Pain syndromes and physical illness are additional challenges to securing a restful night’s sleep. These factors make it more vital for you to take control of your sleep pattern.
The dangers of Insomnia
We all have the occasional bad night, but most of us catch up on lost sleep within a couple of days. Short-term sleep loss is not a major problem. Chronic sleep loss puts you at a high risk of developing both physical and mental illness and increases the seriousness of any illnesses you may already have.
Chronically sleep-deprived individuals are those same patients who populate the nation’s headache clinics complaining of persistent daily headaches and/or migraines. Sleeplessness is a major disability that damages both family and work life.
The brain has its own ‘To Do’ list whilst we sleep. First, it ‘cleans up’ the toxins that accumulate during the day. Rather like the cleaning machines, you see jetting water along the streets at night to wash away the day’s trash; our brain channels expand during sleep to increase the flow of cerebrospinal fluid throughout the brain.
This nocturnal cleaning dislodges the sticky plaque (beta-amyloids) that clusters between our nerve cells and are a key characteristic of Alzheimer’s disease. Sleeping well lowers our risk of developing dementia.
At the same time, this plaque (or protein fragments) attacks our immune system. This means that if you routinely sleep badly, you are less likely to be able to fight infection and disease. This might mean that if you get sick, you take longer to recover. Sleeping well speeds the body’s natural recovery mechanism.
In addition to its cleansing role, the sleeping brain repairs cells and tissues in our major organ systems. Chronically sleep-deprived individuals have an increased risk of becoming hyper-intensive, developing heart disease, kidney disease, or having a stroke.
By following a few simple and effective steps that will help you sleep well – even if you have been previously sleep deprived – you can protect yourself against avoidable disease.
Chronic sleep deprivation is also a vulnerability factor for developing Diabetes. Sleep-deprived individuals produce higher than normal amounts of insulin after eating, leading to an increase in fat storage.
That is why chronic poor sleepers are more likely to be obese. Insomnia also reduces the production of Leptin, the ‘fullness’ hormone that controls our appetite, whilst at the same time increasing the food-craving hormone Ghrelin. That means that if you are sleep deprived, your body is not satisfied after eating a full meal, but still wants more calories. This may have you reaching for a sugar boost to maintain your energy levels.
Whilst we sleep, our brain is hard at work, organizing, and consolidating our memories. The individual who wakes refreshed after a good night’s sleep is, therefore, better able to make decisions, problem-solve, and maintain concentrated focus on tasks.
Meeting the challenges of change is easier after a good night’s sleep, possibly because good sleep promotes creative thinking. If you sleep well, you are better able to regulate your emotions and also less likely to engage in risky behavior.
Poor sleep is associated with impaired memory and concentration. Simply put, if we don’t sleep well, we work more slowly and tend to make mistakes. Stressed at our poor performance leads to the release of the hormone, Cortisol. In small amounts,
Cortisol acts to increase our mental alertness and focus; in excessive amounts, it simply depletes our already tired body and mind. So if you arrive home at the end of the day feeling wound-up and stressed, you should perhaps be examining your sleep pattern.
Interestingly, most people with performance difficulties attribute them to the demands of the task. They don’t stop to ask whether their body and mind are operating in a sub-optimal state. Similarly, we tend to accept that as we age, our memory is not as sharp as it was. Memory lapses can be frustrating or embarrassing.
They can often be avoidable. Patients who follow the 12 Sleep Commandments frequently report that they are delighted with the improvement of their memory and concentration, and view it as a miracle. It may be a delight, but it’s not a miracle: it’s simply a result of you taking control of your sleep.
10 best ways to take control of your sleep
Improving your sleep, despite the length of time you have been an insomniac, is simple. That doesn’t necessarily mean that it will be easy as I am asking you to break some old habits and establish new ones.
1) Establish a sleep routine
Routine is possibly one of the most difficult commandments to observe, but also one of the most effective if you want to sleep well. It is a myth to think that if you lose 5 hours of sleep one night, you need to make up those 5 hours.
All of us experience the occasional night of poor sleep and generally find that we recover our energy levels within a day or two. The way to do this is not by have excessive day-time naps but just to get back to our routine.
2) Make sure your bedroom is dark
In general terms, we sleep when it is dark. This is because as the light fades and darkness takes over, a gland in our brain produces the sleep hormone, Melatonin. If your room is light, you will not sleep deeply and wake refreshed.
Television, mobile ‘phones, laptops, and tablets all emit blue light, which makes you alert and stops you from being sleepy. Although there are filters on most computers and ‘phones whose manufacturers state that they block blue light, it is unclear whether their claims are backed up by science.
3) Relax your mind, relax your body
If you want to sleep, you need to be mentally relaxed. It’s no surprise that watching a horror movie or playing on-line video games doesn’t promote good sleep. There are two main reasons. First, your arousal levels will be sky-high – after all, that’s the point of the game or the movie. If you are over-stimulated, you can’t sleep.
You also need to be physically relaxed when you go to sleep. Put simply: if your body is tense, you won’t sleep. The simplest technique is first to get comfortable in bed, and then start tightening and relaxing each set of muscles in turn.
You can start by furrowing your brow for 4-5 seconds and then relax it. Next, screw your eyes tightly and then let them soften. Then, clenching your teeth, and so on. The purpose of this ‘tighten and loosen’ exercise is to teach you what it feels like to be relaxed.
Deep breathing from your belly/diaphragm also prepares the body for sleep. Breathe in for 3-4 seconds, hold the breath for the same time, and then breathe out slowly and fully. As you breathe in, your diaphragm should rise, and then fall back gently on the out-breath.
4) Make your bedroom ‘sleep ready’
We have already talked about having a dark room. It is also important that it is quiet. For some people, this means closing windows that look on to the main street; for others, it’s about asking housemates to keep the noise levels after a certain time. If you have babies or young children, your sleep will almost always be shallower whilst they are young. If you live alone, you may also be at risk of impaired sleep if you worry about your security.
The ideal temperature is about 65 degrees F (18.5C); if it is much hotter, you won’t sleep well. Air conditioning can help in the summer. (If your room temperature is below 54C, you will need a cozy duvet or blankets).
Mattress, sheets, pillows
Make sure that your mattress is comfortable: you will never get a good night’s sleep on a lumpy mattress or if you have springs coming through and digging into your back. Firm mattresses, rather than soft ones, offer the best support. Make sure your pillow suits you too: a comfortable pillow can make the difference between restless sleep and good night’s sleep.
Sheets and nightclothes (if worn) should always be made of natural fabrics, like cotton or linen. Linen, especially, absorbs body moisture and dries quickly. It also has anti-bacterial properties. If you have skin allergies or sweat at night (whether or not you are peri-menopausal or menopausal), linen is the ideal – and traditional – bed linen.
Use your bed for sleep and sexual activity only. Your bed is NOT your office and should not be used for planning the next day’s activities, doing your tax returns, or planning your career. Once you create the connection in your brain that bed is for sleeping, this will be a powerful tool in helping you establish a healthy sleep pattern.
5) Be careful what you put into your body
Try and eat moderately in the evening. Avoid heavy food late at night as your body won’t have time to digest it before you get into bed, and it will prevent you from getting to and staying asleep. Eating a large meal pushes your body temperature up, which results in delayed sleep.
Avoid excessive alcohol as it interferes with good quality sleep. Many people use alcohol as a sleep aid. This is a big mistake. Alcohol may make you fall asleep, but its sedative quality wears off after a few hours. It then acts as an arousal mechanism, resulting in broken sleep throughout the night.
Caffeine is another substance that prevents us from getting a decent night’s sleep. Caffeine takes about 20 minutes to kick in, so it is possible to fall asleep after a cup of coffee, but then you may find yourself wide-awake in the small hours of the night as the caffeine is absorbed into your bloodstream.
Caffeine interrupts the activity of the drowsiness hormone Adenosine. As caffeine has a half-life of 5 hours, it is still working in your body at half strength 5 hours after you have consumed it. It is recommended not to have tea, coffee, or any caffeinated drinks after 4.00 in the afternoon.
Check your medication, as many of these also contain caffeine. Some cough and cold medicines, such as decongestants, contain caffeine. Discuss with your doctor the best time to take these medications, so they don’t interfere with your sleep.
Keeping well hydrated throughout the day is an important factor in helping you sleep well. If you are not used to drinking the recommended amount of water, you may need to increase your intake gradually. In general, drink less in an hour or so before you want to go to sleep to reduce the number of bathroom trips in the night.
6) Deal with your worries!
Worry is one of the most common reasons for stopping people from getting to sleep (delayed sleep latency); it also wakes people up in the middle of the night and leaving them to endlessly – and fruitlessly – battle with their worries.
Make a list of your main worries and then write down some possible solutions. For example, if you are worried about paying a bill, you could make a note to check balances in the morning, look at your other outgoings and see what you can shift or postpone, or decide to call your bank manager to have a chat.
Writing out action steps and (where possible) allocating time to when you will focus on the problem, is an effective way to undermine your anxiety, and frees yourself up to sleep well.
7) Don’t lie in bed if you can’t get back to sleep: get up.
If you wake up in the middle of the night and find that you can’t get back to sleep, don’t just lie there. If you don’t drop off, get up, and leave the bedroom. Make yourself a cup of (decaffeinated) herbal tea and find something to do like reading a magazine or looking at holiday photos.
Do NOT do anything that is intellectually demanding, like working out your mortgage repayments. Don’t watch TV or go on your computer. Only when your body is begging you to sleep, do you go back to bed. If after another 20 minutes, you are still awake – which is highly unlikely – get up again.
8) Keep a sleep diary
This is an essential tool to re-set your sleep pattern. You need to complete it every morning within half an hour of waking.
Keeping a sleep diary will allow you to work out how much sleep you are getting and how much you actually need. It will also enable you to notice what factors might have a significant impact (both positive and negative) on the quality of your sleep.
9) If you are stressed, anxious, or depressed, or suffer from Post-Traumatic Stress Disorder (PTSD), get help.
Poor emotional health wreaks havoc with sleep. As noted at the outset of this article, mental illness may lead to chronic physical illness. If you are experiencing symptoms of anxiety, depression, serious stress, or PTSD, please get a referral for psychological and/or psychiatric help.
Poor mental health has a hugely disabling impact on people’s functioning and quality of life but can be significantly improved by the many effective treatments which are available.
Anxious people typically struggle to get to sleep or wake up in the middle of the night thinking, ‘What if…’?’ These anxious thoughts may relate both to the past and to the future. Being fearful about the future prevent you from sleeping, and paradoxically, prevent you from developing the problem-solving skills that could help reduce your anxieties.
Depression leads to rumination, a kind of thinking that is characterized by thoughts that just go round and round without ever getting resolved. Depressed people frequently wake up 3-4 hours earlier than non-depressed individuals.
They then struggle during the day with low energy, no desire to socialize with friends or family, difficulty concentrating on anything for any length of time, and increasing tiredness. In extreme cases, depression may lead to people taking their own lives.
10) Don’t get addicted to sleep medication
Benzodiazepines and non-benzodiazepine sedatives are the class of medication most commonly prescribed for Insomnia. They can be very helpful in improving acute Insomnia that follows an extreme stressor or major surgery.
Like opioid medication, benzodiazepines are highly addictive, and therefore only recommended for short-term use.
If you have been taking benzodiazepines for more than a week, you should start looking for an alternative and more natural ways of improving your sleep. These may be over-the-counter preparations like anti-histamines. Herbal teas can also be surprisingly helpful in preparing the body for sleep. Gentle exercise, such as yoga or simple stretches, may help.
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You would be surprised how many people who complain about poor sleep struggle with this commandment. If you don’t actually take yourself to bed, the rest of the program becomes a lot more difficult….