What is normal sleep?
Sleep is a natural process that allows the body & brain to rest & recovery. Sleep is not a continuous period of unconsciousness but a series of 90 min cycles, themselves divided into 3 non-REM stages & the REM stage. REM or rapid eye movement stage is the dreaming stage. When we are younger adults we have more total sleep, including deeper sleep & waking less often/ for shorter periods. As we age, we have less total sleep with more frequent waking/ for longer because ageing reduces sleep need & alters the sleep pattern.
Sleep requirements vary from person to person; average ~ 7-8hrs/night. This decreases by about 90 minutes by the time we are 70. If you are not sleepy or fatigued during the day then your sleep is prolly adequate irrespective of length. The most restorative effects of sleep come in the first 3-5 hrs (‘core sleep’) & research shows if you get your core sleep you can function in the day. Most people with insomnia still obtain their core sleep every night despite believing they got much less.
It is normal to wake a few times during the night. Often this is not remembered. People with insomnia often have anxiety about these awakenings which impacts the ability to fall back asleep. It is also possible to wake from a light sleep at the end of a 90 min sleep cycle & not realise you have been asleep. People often also overestimate the time that they have been awake. This is true as we age when awakenings become more common.
Sleep following sleep loss is deeper & more efficiency than usual thus you don’t have to recoup lost sleep hour for hour. A 2 hr reduction in nightly sleep for 2 wks (28hrs total) can be made up over two nights by taking 3 extra hrs on the first and 2 on the second recovery night. Power naps are also useful to reduce day time tiredness but should be kept brief (5-10mins) to limit interference with the following night’s sleep.
How to promote good sleep? Lots of this will seem logical but when we get busy we can let things lapse. Tidying up the way we approach our sleep (known as good sleep hygiene) can lead to better sleep & supports a regular sleep pattern. Simple steps to good sleep include: > establish regular daytime routines > spend time outdoors, exposure to bright light helps to synchronise the body clock > avoid day time naps (unless brief, 10-15 mins) > daily exercise, reduces anxiety & can deepen sleep > avoid caffeine for at least 5 hrs prior to bedtime/ reduce daily caffeine intake to 2 cups of coffee per day > avoid heavy meal just before bedtime > relax & prepare for sleep, try relaxation/ meditation/ writing lists of thoughts to put aside > have a wind down bedtime routine > avoid smoking at bedtime & through the night (or even better avoid all together 😁) > avoid alcohol close to bedtime > avoid bright lights & technology close to bed time > limit noise/ use ear plugs > go to bed when you feel sleepy or drowsy > get up the same time every morning (yes, including weekends, I agree - boo!! 😢) > judge your nights sleep not when you just wake up as sleep inertia will make you tired & sleepy for a while; judge the nights sleep at the end of the day
Most sleep difficulties are related to stress, anxiety about how much you are sleeping & poor sleep habits. Some underlying causes for sleeping difficulties include medical conditions - e.g. sleep apnoea, restless legs syndrome, depression, pain, diabetes - & certain medications.
It is very easy to introduce good sleep hygiene into your daily habits (see www.cci.health.wa.gov.au, search sleep hygiene for fact sheet). If you are still having issues with sleep or have other symptoms other than daytime sleepiness & fatigue, go see your GP for assessment.
Why can’t I just take a pill?
As my patients will know I am mean about giving out scripts for medications for sleep.
Why? Firstly because the evidence for their efficacy is low & secondly because they can have dangerous side effects & can lead to addiction.
While drug therapies may help for a few nights, non-drug therapies including good sleep hygiene, relaxation, sleep restriction therapy, stimulus control therapy & psychotherapy are more likely to be successful in the long run, have longer lasting benefits & have few if any side effects.
The side effects of sleep medication include addiction (with rapid onset of dependence with these medications), increased risk of falls, reduced drive to breath, dizziness, fatigue, muscle weakness, bed wetting, memory loss, reduced concentration, confusion & depression. If used long term, sleep medications may make sleep problems worse & cause sleep that is more shallow.
Lab studies have show that ppl with insomnia on medication had very similar total night sleep to ppl with insomnia not given medication AND their sleep quality was found to be worse. Another problem with sleep medication if use regularly, when reduced or stopped there is often a sudden return in sleep difficulties. This called rebound insomnia. This often leads to the belief that you can’t sleep without the medication (which is how it leads to addiction). However, this side effect of withdrawal is often temporary & soon passes.
If you are taking sleep medications, consider seeing your GP to wean off these medications as they are not helpful long term and potentially dangerous. If you have sleep difficulties, consider this information before requesting sleep medications & discuss non-drug options with your GP.
Sleep & Me.
The aspect of my life where I struggle is sleep (she says while typing this after 10pm). Going to sleep for me is not something that happens naturally, rather it is an active process that requires effort & discipline. It is far easier to keep reading my book, look at youtube videos, insta.. But I have been able to improve my sleep a fair bit & one of the big things I have noticed how you PERCEIVE your sleep MASSIVELY impacts the effect it has on you.
I used to think I took ages (up to an hr) to fall asleep. I started listening to sleep stories to help & I realised the next morning that I rarely heard the whole thing. It allowed me to see that I was in fact sleeping when I thought I was lying awake. This is common in the early/ lightest stages of sleep.
I often wake with bad sleep inertia - sleepiness / fatigue when you wake. It feels horrible. And when I’ve had another late night on social media, the internal voice starts criticising my lack of self control & anxiety sets in about how I am going to cope with my day. More recently, I have instead just accepted the fatigue in the moment & reminded myself that it will pass rather than get caught up in the anxiety about how tired I am. In just letting go of the anxiety about how I will cope, I cope so much better. The fatigue passes & I manage just fine (if a tad tetchy). I find about once a month, I have a night where I will sleep what feels like only about 3-4 hrs. I am awake all night & nothing will help me nod off. On these nights, I try to get up and do something before trying to get to sleep again. And in the end I just accept that it is my insomnia night & in acceptance, the anxiety about not sleeping is reduced & the lack of sleep has a far smaller impact on me the next day.
Things that have helped me with managing my sleep: > Calm app > Rainy mood app (plays rain sounds) > Headspace app > ASMR / sleep relaxation videos on YouTube
Info from: SA Health - Insomnia Management Kit