Sleep – A How To Guide for the Tired
Everybody, almost every living thing does it, though we might often moan that we don’t get enough of it.
But what does it do? How does it work? Why does it go wrong? Why am I still so tired?
Strangely enough, science still doesn’t have all the answers to these questions, although we are starting to piece things together. In this blog, I want to explain a little more about what sleep is, what happens when we don’t get enough and some of the things we can do to make it better.
When it goes right, sleep feels effortless and natural, allowing us to drift off quickly, and wake up easily, feeling refreshed and well rested. But not everyone feels that way! Worldwide, or at least in the developed world, around 10-12% of the population struggle with insomnia.
Insomnia is defined in the dictionary as ‘habitual sleeplessness, inability to sleep’ while a doctor might go further and define it as ‘difficulty falling asleep or staying asleep, even when the person has a chance to do so’ before then categorising it as ‘transient’ (or ‘acute’) or ‘chronic’. Acute insomnia is generally due to life circumstances such as worry, bad news, excitement or situations such as a forthcoming exam, for example. By its very nature, it tends to be short lived and generally doesn’t need treating.
Chronic insomnia, on the other hand, is described as occurring at least 3 nights each week, for at least 3 months. This is the kind of insomnia that people really find disruptive.
Before we look at how it might be treated, let’s have a look at how sleep ‘should’ be.
Sleep has evolved to be a rhythmic cycle of lighter and heavier sleep, known as REM (‘rapid eye movement’ where the brain produces or experiences dreams) and non REM (or ‘NREM’ where the person is harder to awaken) sleep; each with their own distinct ‘brainwaves’ which can be seen as wavy lines on an electroencephalograph, or EEG.
These electrical brainwave patterns are very different in each stage and are thought to have differing functions, such as processing the events of the day, storing information we have taken in and even moving these newly formed memories around the brain.
While we are awake, our brains are very busy, processing and reacting to the world around us – as you read these words, they are being processed by your language centre, after being recognised by your eyes and vision processing areas as text, and the sense of what I’m writing is being reflected upon by information centres. That’s as well as remembering to breathe for you, monitor your heart rate and blood pressure, modify your muscle tensions so you don’t fall off your chair, simultaneously keeping an ear out for what’s happening around you and probably contemplating whether it’s time for a cup of tea and a biscuit! Our brains are capable of serious multitasking!
During this multitasking busy-ness of our waking hours, our brains give off ‘beta’ waves of activity. As we close our eyes in bed, and start to really relax, that activity changes to slower ‘alpha’ waves seen in calm, resting states and then changes again, as we start to drift off, to even slower ‘theta’ waves. The slowest waves are known as ‘delta’ waves and happen during the deepest NREM.
Surprisingly, those busy beta waves also happen while we’re in REM sleep, which suggests that far from being dormant, our brains are clearly up to something while our bodies are resting, being almost as active (if not more so!) than when we’re wide awake.
While researchers haven’t entirely explained fully what each type of wave does or even how they are created or coordinated, identifying the different types allows us to find out where in their sleep cycle each person is, assuming they’re in a lab and happen to be wearing an EEG headset. Which is rare, to be honest.
If you haven’t drifted into alpha wave formation already with all this technical jargon, you might imagine that we simply go from awake to resting to drowsy to deep sleep and then wake up, but it’s not that simple!
Instead, the brain goes through repeated cycles of the different sleep patterns, starting with the lightest (NREM1) sleep and going gradually through to the deepest, delta-wave heavy NREM3, or slow wave sleep, before going into a period of REM, followed by lighter NREM sleep…..and so on, usually repeated four or five times over the night.
But why is all this important?
It seems that each wave type has a different purpose, and missing out on the full range of REM and NREM sleep affects us in differing ways. We all know that a lack of sleep makes us feel tired, makes it harder to concentrate and leaves us feeling grumpy, often reaching for caffeine! For those with chronic insomnia, this is a pretty permanent and miserable state of affairs.
They wake up feeling unrested, perhaps having woken several times in the night, and often try and grab ‘forty winks’ whenever they can. If they find it hard to get to sleep initially, many will watch tv in bed as a distraction, or, in desperation when counting sheep hasn’t worked, try alcohol, over the counter remedies or queue at the doctors for a prescription for sleeping tablets.
As a pharmacist, I dispense many prescriptions for ‘sleeping tablets’. And I’m not alone. Nationwide in the UK in 2017 pharmacists dispensed just over 12 million prescriptions for sedatives, accounting for over £72 million of the NHS drugs bill. Money well spent if it gave all those people a great night’s sleep; but again – it’s not that simple. ‘Sleeping tablets’ do make you sleepy, but they don’t always leave patients feeling refreshed and ready for their day.
The side effects of the various types of sleeping tablets are many and varied. Some of them are as you might expect – feeling drowsy when you wake up, impaired driving, increased likelihood of a fall if you’re elderly. But some side effects are unexpected.
Yes, medications used to help people sleep have i n s o m n i a as a side effect!
To understand how that could come about we have to remind ourselves of the two different kinds of sleep, REM and NREM. Scientists are pretty adamant that we need both types of sleep, REM and NREM, for our bodies to function well – REM sleep is particularly involved with processing emotional events for example, and also with thinking creatively, and problem solving. NREM, on the other hand, is needed for us to feel physically refreshed as well as for new memories to be laid down. This explains why a lack of NREM sleep causes issues with physical health and also with learning and remembering things.
Many depressed patients have dysfunctional patterns of sleep, finding themselves waking up, (usually as they come out of each session of REM), or having troubling thoughts overnight, and report unsatisfying sleep, which leaves them tired the next morning.
EEG studies show the brain cutting short the slow wave sleep of deep NREM and having shorter gaps between each period of REM, too, as the poor over-worked brain tries to cycle through the sleep stages more quickly.
What is interesting about this is that the most commonly used antidepressants reduce the amount of REM sleep in a night. This means that while they may not experience the vivid dreams we often remember when we wake up, and may feel like they have been more deeply asleep, depressed patients haven’t effectively been able to process the emotional content of their day and remain more distressed, or anxious. This emotional distress makes it harder for them to relax and ease into sleep next time, and has the effect of further disrupting sleep the following night!
These tired and sleep deprived patients often keep themselves going with caffeine during the day, then ask for sleeping tablets to neutralise the caffeine buzz and give them a decent night’s sleep; but…..sleeping tablets also have an detrimental effect on REM, reducing it further. This because rather than promoting ‘natural’ sleep, sleeping tablets (which are often a group of drugs called benzodiazepines, or related drugs that work in the same way) effectively turn the brain off, sedating patients.
They knock out the brain’s ability to produce refreshing slow wave sleep and reduce the amount of emotion-smoothing creative REM sleep, too.
Another surprising thing about sedatives is that they only really make a tiny bit of difference to falling asleep, or to total sleep time, anyway. In laboratory tests against placebo tablets, sedatives only made the tired human guinea pigs fall asleep 22 minutes quicker, while at home in their normal bed it was merely 7 minutes faster! Add to this the fact that sedatives make you feel groggy the next day (caffeine, anyone?!) that regular use can cause dependence and that weird rebound effect of sleep disruption when they are stopped – they’re really not ideal.
I don’t even want to tell you about the fact that heavy sedative users taking tablets three or more times a week are five – 5 – times more likely to die than non-users in the same year. That kind of thing is downright scary.
So, what CAN you do to get a decent night’s sleep?
Researchers call it sleep hygiene. It’s the basic, kinda boring stuff that we might all know, but simply don’t do, so in no particular order, here’s a reminder:
- Reduce stimulants like caffeine in your day. Caffeine takes about 8 hours for the body to get rid of half of it, so a midday cup of coffee or tea, or Red Bull etc can still wreak havoc on your sleep hours later.
- Don’t have your bedroom too warm. Around 18C is perfect, as feeling cool is a sign for the body to enter into sleep
- Get outside and see some natural daylight, preferably without sunglasses, in the mid morning. This resets your body’s natural time keeping system.
- On the same subject, reduce the amount of artificial light in the evening, especially that from tv’s, laptops, e-readers and phones. Yes, tech before bed is not your friend. Sorry (not really, you’ll thank me later)
- Don’t nap in the day, even if you’re feeling really shattered. Do something distracting and save the sleepiness for bedtime.
- Do some physical exercise, though not too close to bedtime. At least 2-3 hours before is good.
- If you really really can’t get off to sleep after a night shift or jet lag, for example, try not to give into the temptation of sleeping tablets. Try milky drinks, camomile tea or reading a book – if nothing on this list has worked, try something herbal before asking for prescription meds. Herbal supplements will mildly relax you, rather than knock you out & natural sleep is much more likely with these than over the counter meds like Nytol or Sominex or the prescription strength ones I discussed earlier.
- Don’t be tempted to have a ‘nightcap’ to make you sleepy. Yes, you may fall asleep quicker, but alcohol works just like benzodiazepines in counteracting that lovely natural sleep pattern. It also makes you wake up to pee more often.
- Have a hot bath before bed. It causes the core body temperature to drop as the body cools your skin down, cueing natural sleep onset – it makes you a little like a sleepy hibernating bear!
- Keep your bedroom for sleep, and er, other bed-related activities. Not for tv watching, or idle phone scrolling and definitely not for work.
- If you can’t get to sleep, don’t lie there clock-watching and stressing. Get up and go and do something really dull – ironing, dusting, filing etc – until you feel drowsy enough to try again.
- Manage stress. As we learned, being emotional disrupts our ability to do REM effectively, so try to get a handle on the emotional events of the day by perhaps talking them through constructively with a friend, or writing down what was actually good about your day (tip – there’s always something!)
Admittedly, I may be biased here, but managing stress and coping with your day to day life better is probably the single most effective thing you can do to improve your sleep.
And, again, as a hypnotherapist I might be biased, but hypnotherapy is the most effective way to do that.
If you’d like to get a taste of what hypnotherapy might be like (and it’s almost certainly not what TV and stage shows might have you think!) click here to download my relaxation audio.
It’s a DIY hypnosis session you can do at home, as you’re relaxing in bed and ready for sleep. It will help fine tune your sleep cycle and hopefully, give you a better night’s rest.
Finally, if you’ve been reliant on sleeping tablets, or taking antidepressants and would like to reduce or come off them, do please please chat to your GP and your pharmacist first.
Stopping prescription medications like these is always best done gradually, and with their support and advice. Stopping suddenly may cause some withdrawal effects, as I mentioned above, so have a chat with someone qualified in medicines first!
About the Author: Claire Noyelle practices from her tranquil garden therapy room at her home in Bearsted, Maidstone East, in the heart of the garden county of Kent. Claire is a member of the Association for Solution Focused Hypnotherapists, National Council for Hypnotherapy and the Complimentary and Natural Healthcare Council and a member of both the General Pharmaceutical Council and the Royal Pharmaceutical Society.
If you would like to explore how hypnotherapy can help you get a good nights sleep get in touch to book your FREE initial consultation with your local Inspired to Change hypnotherapist. Inspired to Change Hypnotherapists are based across the UK in Birmingham, Bristol, Cambridgeshire, Devon, Essex, Fife, Kent, Leicestershire, Lincolnshire, Northamptonshire, Norfolk and Somerset.
Inspired to Change Hypnotherapists are all recognised by the National Council for Hypnotherapy, the UK’s leading not-for-profit hypnotherapy professional association.
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