Dr Neil Stanley Independent Sleep Expert
© Dr. Neil Stanley 2013-2017
If you're going to rise an hour earlier, should you go to bed an hour earlier too? The most important aspect to waking refreshed is to have a fixed wake-up time 7 days a week. Your body and brain start preparing to wake up approx 90 minutes before you actually do, so if you have a fixed wake up time the body and brain know when they are going to wake an can thus prepare accordingly. Going to bed an hour earlier would only really work if that then also became a new routine. What is the best way to stop your mind whirring with worries at bedtime? The number one prerequisite for getting to sleep is a quiet mind. You cannot fall asleep if your mind is whirring with the care of the day. The first thing to do is to put the day to bed a couple of hours before you go to bed, so after this time don’t open the gas bill, check your works email or have a heated political discussion with your partner. From about 45 minutes before bed no screen, laptops, tablets e-reader, smart phones etc. and then do something that quietens the mind, for some people this can be reading a book or listening to music, for other it can be a warm bath or a mug of a hot milky drink. There is no magic way to sleep; you need to find what works for you. And lastly don’t try and fall asleep the harder you try the less likely you are to fall asleep. Apart from a good sleep, is there anything you can do to wake feeling more alert, rather than groggy and slow? It is not only the quality and quantity of sleep that is important to waking up feeling refreshed it is also the timing, some people are naturally morning people and some people are evening people. This is to a large extent genetically determined. If you are an evening person and you wake up before your natural propensity to wake then you may experience ‘sleep inertia’, that feeling of grogginess, for between 15 minutes and 2 hours after waking. Many people use alcohol as a bedtime sedative, but why should they avoid this? Alcohol works on the same receptors as sleeping tablets so it will help put you to sleep, the problems come later in the night; the headache caused by dehydration, the need to visit the bathroom and the disturbed and restless sleep because of feeling hot as you are burning off all the calories. However a small sherry before bed has never done anyone any harm. What are the immediate effects of lack of sleep? In the short term poor sleep has been shown to be related to Reduction in cognitive performance, memory, problem solving. Increase risk of accidents Increase in reaction time Increase hunger Increase consumption of ‘junk’ food Looking tired Poorer inter-personal relationships, increased irritability. What are the long term effects of lack of sleep? In the long term poor sleep has been shown to be associated with:- Shortened life spans and higher mortality rates. Increased risk of heart disease, stroke and stomach problems. Depression, irritability and mood swings. Increased risk of falls. Increased risk of Alzheimer’s. Increased risk of traffic /occupational accidents. Increased risk of obesity and Type 2 Diabetes Reduced immunity. How much sleep should you be getting? Sleep need is individual like height or shoe size, anywhere between 3 and 11 hours can be considered normal although what is important is that you get the right amount of sleep for you. Your sleep need in genetically determined so, if you are a 9 hour a night person you need to endeavour to get 9 hours. Also if you are naturally a 4 hour a night person you will essentially be wasting your time if you are trying to get what you have been lead to believe is the ideal 8 hours a night, however it needs to be remembered that there is a big difference between getting 4 hours sleep a night and actually needing only 4 hours. Therefore what is important is that you get the right amount of sleep for you. Simply, if you feel awake and function at a high level during the day, you are probably getting enough sleep, but if feel sleepy the next day then for whatever reason you are not getting enough sleep. What are sleep cycles and how does this affect the quality of your sleep? Sleep is divided into two distinct states, Rapid Eye Movement (REM) and Non- REM sleep with Non-REM sleep being further divided into 3 stages of increasing depth. During the night you pass through the five sleep stages: N1, N2, N3 and REM (rapid eye movement) sleep in what are known as ‘sleep cycles’. These stages progress cyclically from 1 through to REM then begin again with stage 1 with each sleep cycle lasting an average of 90 to 110 minutes. The first sleep cycles of the night have long periods of N3 (deep sleep) with relatively short REM periods and but later in the night the REM periods lengthen and N3 is mostly absent. What if your partner snores or fidgets? In 2005 I co-authored a paper that showed that much of your sleep disturbance is caused by your bed partner and so if they are disturbing your sleep because of snoring or fidgeting you may want to consider separate beds or even separate bedroom.  Not sleeping together, if it works for you both, is a mature pragmatic solution to a problem and has no bearing on the strength, or otherwise, of your relationship. Lack of ‘intimacy’ would be much more suggestive of a problem. Can medicines affect sleep? Many prescribed or over-the-counter medicines can cause insomnia, including some antidepressants, epilepsy medicine, medication for high blood pressure, hormone treatments, non-steroidal anti-inflammatory drugs, and some medicines for asthma. Check with your G.P. to see if there are alternatives that do not disturb sleep. What is Periodic Limb Movement? Periodic Limb Movement Disorder is a sleep disorder where the sufferer repeatedly makes repeated kicking and jerking movements with their legs or arms during sleep, usually without being aware of it. As the sufferer is unaware they are doing it, it relies on the bed partner to notice this behaviour, so if your partner repeatedly jerks their limbs during the night or indeed repeatedly seems to ‘punch’ or ‘kick’ you then you should suspect PLMD.  The repeated movements can disturb the sufferer’s sleep, so whilst they may be unaware of the movements during the night they may notice they are suffering from daytime sleepiness for no apparent reason. Women are more likely to suffer from the condition than men. Causes include too much caffeine, stress and mental health problems. What is Restless Legs Syndrome? Restless Legs Syndrome is a type of sleep-related movement disorder where you have an irresistible urge to move your legs.  Sufferers may feel sensation of pain, tingling, itching, or prickling which is relieved by moving the legs, but returns as soon as the legs are still again, making sleep difficult. The syndrome can be caused by iron deficiency anaemia or folic acid deficiency and there may be a genetic link for some types. Some pregnant women suffer from the condition - especially in the last trimester of pregnancy. The symptoms may also be due to another underlying condition such as diabetes, rheumatoid arthritis, neurological diseases, or Parkinson’s disease. Certain drugs can make RLS worse - these include antidepressants, calcium blockers, anti nausea medications, some anti-allergy drugs and too much caffeine. RLS may be helped by ensuring your diet contains adequate amounts of iron, folic acid and minerals such as calcium, potassium and magnesium. Walking, stretching and yoga may also help to relieve the symptoms. What are Night Cramps? Night cramps are where the calf muscles, or occasionally the muscles in the feet, suddenly contract during the night causing pain which disturbs sleep. Cramps have been linked with various dietary deficiencies including B vitamin, magnesium, calcium and potassium deficiencies so ensuring that you are eating a balanced diet can help. Cramps have also been linked to the use of diuretics and some other medications, dehydration, diabetes and hormonal fluctuations. Gently stretching or massaging your calf muscles before bedtime can also help. There is a licensed over-the-counter medicine that has been shown to be effective in ameliorating the occurrence of cramps, ask your pharmacist. How do hormones affect sleep? Hormones whether associated with the menstrual cycle, pregnancy or menopause can negatively affect sleep. Progesterone plays a crucial role in elevating the body’s temperature and helps in inducing sleep. Low levels of progesterone, especially during the menopausal period, have been associated with a drop in the ability to get a deep and restful sleep. Oestrogen is important for the formation of the brain neurotransmitter serotonin, which is essential for restful sleep. It has been observed that at menopause, a decrease in the levels of oestrogen reduces the production of the neurotransmitter to the brain, which in turn results in insomnia. What can you realistically do if you keep waking up at a certain time and can't get back to sleep? How can you break this pattern? If you are tossing and turning for more than 30 minutes at the start of the night or 20 minutes during the night it may be helpful to get out of bed and do something else, only going back to bed when you feel sleepy again. If you wake early in the morning it may be easier to get up and do something rather than trying to go back to sleep again. What are night terrors? A nightmare is a bad, scary dream and like all dreams if you wake up during it you will remember some of the story and this can be frightening or unsettling. A night terror is a parasomnia like sleep walking or sleep talking this is where the sleeper can appear distressed or frightened and can exhibit bodily movements that add to the impression that they are terrified of something, however unlike a nightmare if the sleeper wakes up they have no memory of what happened during the night terror. They are common in children but adults can have them and the simple advice it observe the sleeper to ensure they come to no harm but do not attempt to wake them. What is the best time to go to bed/wake-up? One of the most important changes you can make it to have a fixed wake up time each, and every, day. This is because your body starts to prepare for waking approx. 1 hour before you wake up, (hence why you can wake before your alarm), but the body needs to know what time you are going to wake. With regards to timing some people are ‘larks’ and some ‘owls’ larks will want to get up early morning and go to bed early in the evening, owls will find it difficult to get up for work in the morning and might not go to bed till the early hours of the morning. When does trouble sleeping turn into insomnia? Poor sleep is a normal reaction to things like stress, anxiety, grief, etc. but if you have problems sleeping on the majority of nights over a period of a couple of months and this is having a detrimental effect on you during the day then you may have insomnia and you should see your GP. What is the best way to get a child to sleep? In order for a child, or even an adult, to fall asleep they need to feel safe, secure and their mind need to be quiet, so in essence anything that relaxes and calms the child will be beneficial to help the child fall asleep. Bedtime stories are a particularly good way because the child and parent are together reinforcing their bond and providing safety and security to the child. How to sleep during the menopause? Many women in the menopausal transition experience hot flashes that, when nocturnal, can disrupt sleep. Ninety percent of women experience symptoms during menopause with 25-50% describing sleep disturbances. In particular hot flashes and night sweats cause repeated awakenings due to the sensation of heat and sweating as well as increased heart rate and anxiety. Because the sleep disturbance is related to temperature it is important for sleep to have a cool temperature in your bedroom with light, cotton, bed linen and you want to avoid anything that also raises body temperature before bed. Hormone replacement therapy, if considered appropriate by your doctor, can help you sleep better by relieving severe hot flashes. Are there any foods that boost melatonin levels? Any food that contains protein will provide the body with the building blocks needed for the production of melatonin. There is very little data showing that dietary tryptophan has any beneficial effects of sleep in normal sleepers.