One of the more common problems I hear in the surgery is "I feel tired all the time". Often patients ask for a tonic to help to pick them up in the day, and sometimes something to help them sleep at night.
Sleep deprivation is a common problem and can be due to insomnia (difficulty getting off to sleep) which affects one in ten of us, or sleep fragmentation (a disturbed quality of sleep). Either way sleep deprivation can cause irritability, poor short-term memory, poor concentration, daytime sleepiness, and - in some cases - depression.
One of the more devastating effects of sleep deprivation is motorway accidents, where lack of sleep is often a factor. Driving when tired (usually at night) is an especially dangerous activity when looked at objectively: your sensory stimulation is very low (it's dark, there's little noise) and there is the 'hypnotic' effect of driving (especially on motorways) all combined with your body clock winding down. This combination of factors can be catastrophic. Try to avoid driving for long stretches at a time, avoid driving tired and take plenty of regular breaks. Caffeine (in coffee, tea and some soft drinks) can help for a short time, but don't count on it.
If you suffer with poor sleep, or wake up feeling tired, it is possible that your sleep quality may be affected. Patients sometimes ask for a drug to help them sleep. I personally prefer to try preventative strategies as they can be highly effective, and tackle the root of the problem. Occasionally you can be prescribed medication such as Benzodiazepine – which might be prescribed if you are in acute stress (for example, after a bereavement) - but ideally not for a long period, as it can be addictive.
To get the most out of your sleep, I find that Sleep Hygiene can be used to improve the quality of your sleep. Sleep Hygiene asks you to think about a number of factors that you have control over, in order to get the best out of your sleep. Much of it is about habit and lifestyle, and it can take around six weeks to show the full benefit, but you should see improvement in your sleep quality sooner.
1. Get into a routine
You will be more likely to sleep well if you regulate your sleep time and waking time. We all vary in the amount of sleep we need but the average is about seven hours per night. To maintain the sleep-wake cycle, try and go to bed and wake at the same times every day. Also avoid daytime naps - they make you feel recharged at the time but they will fragment your subsequent night's sleep. If you must nap, ensure it doesn't last longer than 10 minutes.
2. Exercise regularly
Regular exercise lasting 40 minutes will help you sleep well. Do make sure this is at least six hours before bed, to give your body the chance to wind down.
3. Avoid eating too soon before going to bed
Try to allow at least three hours between eating and sleeping. Some people who work late will grab a meal just before bed; this can lead to them waking up feeling exhausted. Your body has to work away digesting and your blood sugar levels will be rising at a time when you should be winding down.
4. Reduce your caffeine intake
This seems to be one of the harder tasks for many of my patients. My advice is to have no more than three cups of coffee in the day (tea generally has half the caffeine as coffee) and preferably your last cup by 11am (yes, I really do mean eleven in the morning!) as the arousal effects on your body can last many hours.
5. Reduce your alcohol intake
You may think alcohol will actually help you sleep better and, in fact, it can induce sleep. But if you were to have several drinks in the evening or before bed, once you are asleep and the alcohol levels drop in your blood, it causes a rebound arousal of your nervous system and even after three hours of the level dropping, your nervous system remains aroused - and so affects the quality of your sleep. This is why you may wake up feeling quite tired despite sleeping for 12 hours after a heavy night!
6. Quit smoking
Obviously quitting entirely is very hard, but the health benefits are huge. I have known patients who have a cigarette before bed "to get them off to sleep". Yet high levels of nicotine stimulate particular receptors in your brain and can affect the quality of your sleep, similarly to caffeine. So, while you're trying to quit, having your last cigarette of the day as early as possible will help you improve the quality of your sleep.
7. Help your bedroom help you
By minimising light and noise in your bedroom you can also help to get the most from your sleep. Try to cut out light from your bedroom, so don't fall asleep with the light on, and consider how much exterior light gets in. You might find that extra thick curtains can help prevent street light straying in. This helps because the hormone Melatonin is released by the brain to help induce sleep, but light inhibits its release. Keep the light out and the Melatonin will help you drift off.
You should also think about noise – it sounds obvious but the less sensory stimulation in the room the better. So try to cut out sound and visual stimulation – televisions in the bedroom aren't helpful for sleep!
A significant number of the patients I see with sleep problems are also stressed. This is a state of arousal of your nervous system with your body releasing adrenaline and cortisol which keeps your body in a 'fight or flight' mode. So when you go to bed worried or stressed your mind is highly active and just can't calm down. This is where training your mind in relaxation exercises (below) can make a difference.
The first thing to do is to keep work out of the bedroom – so keep your files, computer and work documents out. Don't work in bed, and avoid doing any work-related things (reading, writing reports etc.) for at least 2 hours before going to bed. Try a warm bath or a relaxing fun book to take your mind off your worries.
I cannot overemphasise the importance of trying relaxation techniques if you tend to have problems getting off to sleep or keep waking in the night.
There are many different techniques that can be useful. Some people find that yoga classes or meditation help them. I teach my patients meditation exercises as they are easy to use in bed. Here are two very simple, but highly effective, techniques:
This is simply focussed relaxation, and aims to stop you running thoughts in your mind that may be causing you stress and stopping you sleeping. By distracting you from your worries your mind has the chance to relax. I suggest you focus on your breath. While lying in bed, notice your breath as you inhale and as you exhale. Imagine the air entering your nostrils and entering your lungs and then imagine the air coming out as you exhale. You may want to imagine inhaling a relaxing colour and exhaling a different colour to represent your tensions/stress. If you aim to do this for a 20-minute period then the chances are that you will fall asleep.
- Another relaxation technique is to relax physically
Starting with your head and working down, tense your muscles and then relax them completely. So tense the muscles around your eyes then relax, tense the muscles around your mouth and relax, and so on.
You may also like to investigate learning self-hypnosis techniques, as these can help to induce a very relaxed and refreshing sleep.
Do you snore?
People who snore certainly suffer disturbed sleep and the tendency is more common in those who are overweight, smokers and after a lot of alcohol. If you know you are a snorer I strongly suggest looking at these factors first and discussing them with your GP who may be able suggest further management of the snoring.
If you think you have a sleep disorder I would suggest discussing it with your GP who may want to arrange some tests to exclude physical causes, or you may be referred to have a sleep study, when you are monitored overnight to assess your breathing, heart rate and sometimes your brainwave patterns to identify the possible cause of your sleep disorder.
It's all too easy for us to think about sleep as something that just happens, but the benefits of a really good night's sleep are worth a little time and effort. Almost everyone can benefit from this Sleep Hygiene advice. It should help you to get the best out of your time asleep and leave you refreshed and revitalised, ready to face the day ahead.