Wellbeing

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Sleep is essential to our wellbeing, and our survival. 

We spend approximately one third of our lives asleep, and on average around 7 hours per night. For the purposes of comparison, cats spend approximately two thirds of their lives asleep (which is quite easy to believe!); we need approximately 3 hours a night less than our primate relatives who need approximately 10 hours; and giraffes need only 1.9 hours a night!

Humans can survive without food (approximately 1-2 months) longer than we can survive without sleep (approximately 11 days), and sleep deprivation has been used as form of torture and interrogation for centuries.

It has also been shown to be related to problems with weight, high blood pressure, mood (depression: waking up too early; anxiety: trouble falling asleep; an increased risk of suicide), and memory; an increase in chance of being diagnosed with diabetes or having less control over it if you already are diagnosed; and an occurrence of ADHD symptoms in children (whereby symptoms improved or disappeared when sleep improved).

(Despite this, we’re all guilty of staying up for that one extra episode on Netflix! Feel free to share in the comments which show is currently stealing your sleep! Mine is ‘The OA‘…)

Even though we need sleep in our lives, some of us really struggle with it. This blog post will look at understanding sleep, and suggest ways in which you can try and improve your sleep.

Understanding sleep 

Contrary to popular belief, we do not sleep in one long block overnight from when we go to bed to when our alarm goes off in the morning. We sleep in cycles, and we wake up briefly between each cycle (though we often don’t remember this) on average of 5-12 times per night

Good sleep is about quality (of sleep) rather than quantity (of hours in bed). Sleep problems are usually involved with either trouble getting to sleep, or trouble staying asleep (not getting back to sleep after a sleep cycle). (Also to dispel another sleep myth, it can take 10-15 minutes to fall asleep; falling asleep when your head hits the pillow is actually a sign that you’re sleep-deprived!) 

Within each sleep cycle, we can be in one of 5 potential stages of sleep:

  • Stage W: Wakefulness
  • Stage N1: Relaxed Wakefulness
  • Stage N2: Light Sleep
  • Stage N3: Deep Sleep/ Slow-Wave Sleep (SWS)
  • Stage R: Rapid Eye Movement (REM) Sleep – Dreaming
N = Non-REM

(You may have seen the stages classified slightly differently under the old method of ‘Wake; Stage 1; Stage 2; Stage 3; Stage 4; Stage 5 (REM)). Under the new classification, Stages 3 and 4 have been merged together to make N3, and the others remain the same). N means ‘Non-REM’ sleep.

Stage N1 is the transition between wakefulness and sleep. You are in a deep state of relaxation here as you are drifting off, and this is the stage where you sometimes have illogical thoughts or experience those ‘tripping/falling over’ events that jerk you out of sleep! Your core body temperature starts to drop. Your eyes move slowly. You spend about 5% of your sleep in N1. 

Stage N2 is a light stage of sleep which is still relatively easy to wake from. Your heart rate and blood pressure decrease in this stage, and you may occasionally have fragmented dreams (although the vast majority of dreaming is done in REM sleep). Your heart rate and blood pressure drop, and the muscles in your airway relax, and the sound of your breathing changes. Your eyes don’t move. You spend approximately 45-50% of time in N2. 

Stage N3 is a deep stage of sleep – people would find it hard to wake you at this stage, and if you were woken up you would wake up feeling groggy. This stage is the most restorative stage of sleep, and allows for the removal of waste from the brain through the waste-removal system known as the ‘glymphatic system’ (no, I haven’t made that up!). During this stage your heart rate and blood pressure decrease and there is a release of growth hormone. 

REM sleep occurs when the body is paralysed but the brain is active. This is where our vivid dreaming occurs. If you were to look at your brainwaves during this stage, they would resemble when you are awake! Your eyes also move a lot during this stage (hence the name), your heart rate and blood pressure increase, and you lose muscle tone. You have more REM sleep as the night goes on, and may skip it altogether in the first few couple of cycles of sleep (which is why you tend to remember your dreams as you are waking up). This stage of sleep is concerned with memory consolidation, learning and problem solving, and our mental health, which are all implicated in sleep deprivation; when we are sleep-deprived studies have shown that our brains prioritise ‘making up’ the ‘sleep debt’ in the deeper sleep stages first before making up REM sleep, which is likely why our moods and memories are affected when we haven’t had enough sleep. 

What can I do to improve my sleep? 

I’d like to start with a piece of advice I once heard, and entirely agree with: Don’t try too hard! Would it be good for you to stay up all night trying to get some sleep? 

I will be talking about Sleep Hygiene, Stimulus Control, Relaxation, and Challenging Beliefs. (I will not be talking about Sleep Restriction here, as I believe this should be undertaken under the supervision of a professional due to the initial sleep deprivation).

Sleep Hygiene 

Creating a better sleep hygiene involves making small changes in your environment and lifestyle to help aid falling asleep. 

  • Limiting caffeine. The NHS recommends no more than 400mg of caffeine per day (and less for pregnant women), but everyone reacts differently. Some people can go to bed after a cup of tea of coffee, and others can’t get to sleep if they’ve had any caffeine after lunch. Become aware of the caffeine content of your drinks (some have much more than you think), and experiment by cutting out caffeine earlier in the day. Taper down to prevent withdrawal headaches.
  • No bright lights. Bright light interferes with the production of Melatonin, which is produced when it gets dark and helps us fall asleep. Dim or turn of lights altogether 1-2 hours before bed, and preferably turn off all devices (or limit significantly, such as inverting the screen on your Kindle).
  • Don’t look at the clock! This can increase anxiety about how much time you’ve got left to sleep. Turn it towards the wall.
  • Cut out alcohol before bed. We wake up as we are clearing the alcohol from our system, which causes us to stay in the lights stages of sleep.
  • Cut out nicotine before bed. Nicotine is a stimulant – which will cause us to wake up more! Don’t smoke before bed, or if you wake during the night.
  • Set a regular wake-up time. Stick to it every day, even on weekends! Setting your ‘body-clock’ isn’t just a saying.
  • Review your medication with your doctor. Certain medications can interfere with sleep cycles (such as antihistamines potentially causing you to stay in the lighter stages of sleep). Please do not come off of medication without checking with your doctor first.
  • Sleep in another room if your partner snores. 1 in 4 partners sleep in separate bedrooms, and for some it has been the key in saving their relationship as they are able to get a full night’s sleep.

Stimulus Control

If we are doing things in bed other than sleeping (and sex), we can disrupt the conditioned response we should have to feel sleepy when we get into bed. This is concerned with training your body to feel sleepy when you go to bed, rather than feeling nervous and tossing/turning.

  • Only use your bed for sleeping and sex. No ‘awake time’, daytime activities, or watching TV in bed.
  • Try and divide your living and working space. If you can only have a desk in your room, make sure you work with your back to the bed, or block the area with a curtain/screen if possible. Consider working elsewhere such as a library.
  • Stick to your previous wake-up time. Yes, even on weekends!
  • Don’t take naps. One overnight sleep is better than broken sleep over 24 hours. You also want to build up ‘Sleep Pressure’, which will be less if you’re napping.
  • Implement a nightly bedtime routine.
  • Only go to bed when you are feeling very sleepy. This way your body will start to learn that you go to bed to fall asleep.
  • Get up again if you haven’t fallen asleep in 20-30 minutes. This will be guesswork, as remember I’ve advised you to not look at the clock?
  • Do something boring! Preferably do this in the dark or in dim light. No TV/devices, drinking alcohol, smoking, or ingesting caffeine!
  • Go to bed again when feeling very sleepy.
  • Repeat the last 3 steps as required until you fall asleep. Continue this each night.

Relaxation exercises.

  • Breathing exercises such as those on my Five Minute Calm page can help to quieten a busy mind when trying to fall asleep.
  • Keep a journal next to your bed. Write down your worries so they are ‘out of your mind’, and close your journal again.
  • Progressive Muscle Relaxation. This involves tensing and releasing muscle groups one at a time. Start at the bottom (such as your left foot), and tense the muscles in your foot for 5 seconds. After this, breathe out and as you relax the muscles, and wait 10 seconds. Move onto the next muscle group (lower leg). Repeat this all the way up your body to your head, down your arms, and back again. If you have any physical injuries, please consult your doctor before trying this exercise.

Challenge your beliefs about sleep

  • Write down your beliefs about sleep, then try and find an alternative viewpoint. For example:
  • “I cannot function on less than 8 hours sleep” could be met with “Most of us do, and sleepiness ebbs and flows as the day goes on”;
  • “If I can’t sleep it will ruin my day/I will have to cancel my plans” could be met with ” It’s not the end of the world, just unpleasant – small adjustments to plans are fine, but they don’t need to be cancelled!”;
  • “I shouldn’t keep waking up in the middle of the night” could be met with “But Vicki’s blog post said that it’s normal to wake up in the middle of the night…”

I hope some of these techniques are useful for you, and that you can get a better night’s sleep soon. Please remember that this isn’t an exhaustive list, and there can be other things that can be affecting sleep, so please consult your doctor to rule things any medical conditions that may be affecting your sleep.

Additionally, a suitably qualified mental health professional may be able to help further with other interventions such as Sleep Restriction, or by exploring unresolved trauma which may be affecting your sleep.

If you would like to book an appointment to discuss your sleep, please get in touch via the Book An Appointment page.

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