A Short Guide To Improving Your Sleep

Psychosocial & Wellbeing Lead // BEN PORTER

Chief Medical Officer // DR. MATT EDWARDS

We all struggle with it sometimes. If poor sleep is a challenge for you right now, then BEN PORTER and DR. MATT EDWARDS from our psychosocial team might just have the words you need to hear…

Almost all of us experience poor sleep from time to time. Some will wake in the middle of the night with feelings of anxiety, while for some their thoughts will make it hard to get to sleep in the first place. Some will nap too much during the day or evening, leading to sleep problems at night. Some will have very anxious or frightening dreams. Some will sleep but not feel refreshed. And some will sleep extraordinarily long hours (and not being a teenager). 

The important thing to know is that all of these are all very well-known phenomena and are usually straightforward to resolve.

Our bodies are built for sleep and will ensure we get the sleep we need. For the most part, sleep difficulties have some quite simple root causes that – over the course of a few days to a few weeks – resolve with some simple lifestyle adjustments. Occasionally, sleep problems may be a sign of an underlying physical issue. These issues are usually annoying, but not sinister (e.g. the menopause).

In sleep clinics, generally the most common underlying issues that disturb our sleep are too much caffeine, too much alcohol, too much fretting and too little exercise. The thresholds that are enough for each of these to impact our sleep are remarkably low. If those thresholds are sensitised further by increased anxiety then, even if we are used to certain levels of caffeine etc., problems begin to emerge.  

As a rough guide, more than four shots of caffeine in a day (cola counts), two glasses of wine, staying in bed fretting for more than fifteen minutes at night or less than thirty minutes of daily moderate exercise (a walk for example) will impact our sleep rhythms and cascade into difficulties if we encounter additional stress.

WHAT YOU CAN DO ABOUT IT

Here is some basic advice for each of the four most common causes of sleep problems:

Reduce caffeine consumption. Caffeine is a stimulant that hangs around in our bodies for hours. Roughly speaking the amount of caffeine in our system halves every five hours. Avoid caffeinated drinks in the afternoon or evening and dial back the caffeine you are consuming earlier in the day to no more than the equivalent of two espressos. If you’re feeling very motivated, try weaning yourself off caffeine steadily. Try to be caffeine free for two or three days and notice any differences in how alert you feel and your sleep quality.

Reduce alcohol consumption. Alcohol for the first glass or so is a mild stimulant, but further consumption is experienced as a depressant and anaesthetic. Any consumption on top of that will induce a coma-like state of sleep. But comas aren’t sleeping. The normal dream and deep-sleep cycles are disrupted and, when people come round, they don’t feel refreshed. Comatose like states are transient, with the result that people can wake up in the middle of the night and have trouble falling asleep again.

Break the routine of worrying. Fretting or worrying, often experienced as racing thoughts or thoughts that won’t die down, are considerably worse in the very middle of the night (around 3am typically). As you lie there you are steadily conditioning your body to associate being in bed with being anxious, which then makes being in bed anxiety-provoking. It may feel brutal at the time, but the solution is to not stay in bed, awake and fretting, for more than fifteen minutes. At the fifteen minute mark, get up for an hour, make yourself a nice drink and do something that takes your mind away from the anxiety (so don’t switch on the TV and watch the news). Then go back to bed. You will most likely fall asleep. If you don’t – get up and repeat.

Get plenty of exercise. Any sort of exercise is beneficial. To get the most benefit, during the day you should do something that will get your heart beating faster and you feeling a bit out of breath. And if you work at a desk, make sure you get up from where you’re sitting every sixty minutes at most, twenty-five minutes preferably, and move around. You’ll feel better, you’ll be at less risk of nasty physical health problems, and you’ll be a bit more tired when you go to bed.

OTHER THINGS YOU CAN DO

Try to avoid naps. There’s nothing wrong with napping as such, and some people find it helpful (entire nations have words for it like ‘siesta’). The problem is that, as we get older (thirty or over) we need less sleep in any 24-hour period. And so if you need around seven hours sleep per night and have a one-hour nap, you will then be awake after six hours the following night. If you prefer the nap, then your nighttime sleep will take a hit but, equally, will give you an extra hour in the morning. If you prefer not to nap, or find it gets in the way of your life, then there are practical things to do. Avoid sitting or lying anywhere too comfortable, keep moving and save physical activities for when you might nap.

Try not to let dreams disturb you. We all dream every night. Dreams tend to become more unstructured and random as the night progresses. Clinically speaking, we have no idea what their purpose is, beyond acting as a kind of biological ‘defragging’ of our minds – rearranging memories into a coherent order, discarding unwanted or redundant material and consolidating learning from the previous day. We only experience our dreams if we wake in the middle of them or immediately afterwards. 

With sleep disturbance, we tend to wake up early in the morning, and so we’re more likely to wake in the middle of a dream that’s occurring late in our dream cycle – i.e. more chaotic and, probably, experienced as frightening because it is so alien. Reminding ourselves where we are, who we are and that we are safe will help. The details of the dream will fade as the day goes on, but you may recall the fear it evoked. Again, remind yourself of where you are and that you are safe.

Get up at a fixed time each morning. Sleeping very long hours (more than ten hours at a time) is not unusual when people are exhausted. Usually four or five nights will be sufficient for them to recover from this. Long hours sleeping can also become a habit as we slow our bodies down and accommodate a slower rhythm. Generally, regular extended sleep of more than ten hours, lasting more than a week, begins to heighten our risk of ill health and, ironically, depression (ironic because long sleep is also a sign of depression). Again, the solution feels harsh, but it’s simple and it works: set a getting up time and stick to it for a week.

IF, AFTER ALL THIS, SLEEP IS STILL A PROBLEM

If you’ve really done all of the above over an extended period of time (around two weeks) with no benefit, then seek medical help. After a brief physical examination, your health care practitioner will ask you about all the above and, if there are any gaps, ask you to try again. 

On rare occasions there may be an underlying disorder but – for most people – they’d be worried about other symptoms arising from the disorder, rather than their sleep. Occasionally there may be an underlying mental health condition such as depression but, again, for most people who are depressed the first thing that occurs to them is feelings of despair and sadness, rather than sleep problems.

So give the approaches above a go and see what happens over a two-week period. If recent onset sleep problems are one of a number of other physical symptoms, and you are concerned about those, please consult with a medical professional.

If you or someone in your team could benefit with speaking someone about what’s on your mind, then explore counselling with us here.