From theguardian.com
A good night’s sleep is vital for our health, but our needs change throughout our lives. Experts reveal how to maximise the benefits for everyone
Babies
The fundamental purpose of sleep is to “service” our brains so they’re in good working order for the gargantuan tasks we require of them: so it makes perfect sense that babies – whose brains are doing the most demanding work a human brain will ever do – need a lot of sleep. Newborns tend to spend more time asleep than awake (as much as 18 hours in 24), but all babies are different – and their needs change all the time – so don’t worry too much about their sleeping patterns. “The rule of thumb is so long as they’re alert and happy when they’re awake, then they’re getting enough sleep,” says Professor Helen Ball, director of the Durham Infancy & Sleep Centre.
With babies, sleep issues are never just about them – they’re as much (or even more) about the parents’ sleep. Indeed, the impact on sleep is the biggest worry most people have around the birth of a child. New parents fear being kept awake, but it’s also important to realise that our sleeping habits change when there’s a new arrival.
Dr Lindsay Browning, the founder of the sleep advice website Trouble Sleeping, explains more: “When we’re new parents, we’re much more easily woken up, because we want to wake up for the baby. So we find our sleep is lighter, and then you get broken sleep when the baby has woken up. You can have this pressure on yourself to go back to sleep before the baby wakes up again in another two hours, and that stress can lead to people really struggling with sleep.”
Napping can be helpful, says Dr Nerina Ramlakhan, a physiologist and sleep expert whose latest book is Finding Inner Safety: The Key to Healing, Thriving and Overcoming Burnout. However, she stresses, it’s about napping the right way. “Power naps are between five and 20 minutes. Or, if you’re starting to get really run-down, having a replacement nap is usually longer than that: up to 40 minutes. This should happen at some point between 2pm and 4pm, but no later.”
Babies aren’t born knowing the difference between night and day, so some of the work of parenting a child in the first weeks and months is getting them used to this. That’s why it’s important to make sure your baby is exposed to daylight and stimulation during the day, and to ensure they have a dim and quiet environment at night, while moving towards regular bedtimes and wake-up times to regulate their system. “Circadian development is not instantaneous,” says Ball. “It happens over the course of about six months.”
For many parents, getting a crying child to sleep is the hard bit. New research has found that holding and walking with them for five minutes will reduce the child’s heart rate and promote sleep. If you hold the baby for eight minutes after they’ve gone to sleep, and then carefully lay them down in the cot, this should mean they sleep for longer. But whatever the research says, the important thing is to figure out what works for you – and your baby. And at some point you’ll need to make the switch so they’re being put down to sleep while they’re still awake. If the association is always of a parent having to be there, a child won’t learn to settle on their own.
Does playing white noise, via an app or speaker, help? Research has shown it helps babies fall asleep within five minutes, and that they sleep for longer stretches while it’s on. However, there is still debate around this. “Some argue that it creates a womb-like environment that is calming, others that it damages infant hearing, and a few that it affects the brainstem in a way that causes infants to ‘shut down’ – so a freeze reflex – rather than fall asleep,” says Ball. “I don’t think we have a clear grasp on what white noise is doing neurologically to a baby, and until we do I don’t think it should be recommended, but if parents choose to use it, then duration and loudness should be limited to reduce impact on infant hearing development.” It’s not a good idea, she warns, to play white noise through your phone and leave it right next to the baby’s cot.
Toddlers and young children
One of the big requirements for sleep, at any age, is that we feel safe; and for a baby, feeling safe involves knowing their parent is close by. But as your child gets older, they need to learn to sleep alone.
When it comes to how much sleep is needed, parents should focus on the quality of the sleep, not the quantity, and let children follow their own instincts, says Professor Russell Foster, director of the sleep and circadian neuroscience institute at the University of Oxford, in his new book, Life Time: The New Science of the Body Clock, and How It Can Revolutionize Your Sleep and Health. He says that attuning to our natural circadian rhythm can dramatically improve sleep. “What matters is regularity,” he says. “Exposure to morning light and regular mealtimes are important. If your child shows signs of irritability, that’s a sign they may not be getting enough sleep at night.” Don’t be concerned if your child seems to need a lot of sleep. “I don’t think one should necessarily worry about some kids needing 10 hours, 11 hours, or maybe even more in the preteens,” says Foster.
When it comes to naps, a new study has tried to shed light on why some four- or five-year-olds love a daily snooze, while some three-years-olds might have stopped entirely. It shows that when young children have an immature hippocampus, it reaches a limit of memories that can be stored without them being forgotten, triggering the need for sleep. When the hippocampus is more developed, the suggestion is that children are able to hold on to memories until the end of the day, when overnight sleep can do its work in moving memories to the cerebral cortex (which plays a key role in memory). And remember: babies and small children develop at very different rates, so while it’s helpful to know why, don’t worry if your child is taking a while to wean off a daytime nap – if their body says there’s a need for it, and they’re sleeping well at night, trust in nature.
Young teens
Teens aren’t just being lazy when they don’t want to get up in the morning: there is a genuine biological change in how we sleep. As we move through adolescence, we shift towards an evening or “owl” chronotype (the natural inclination of your body to sleep at a certain time), meaning we’ll want to stay up and wake up later.
It’s unsurprising, then, that secondary school years can be a battlefield. “We see a lot of young people quite sleep-deprived, because the way our schools work isn’t conducive to this kind of sleep cycle,” says Stephanie Romiszewski, director of Sleepyhead Clinic. “Children are not going to do as well in those morning periods when they’re still waking up.”
waking up.”
Light exposure is key. Walking all or part of the way to school in daylight will be helpful. And new research has found that when teens were exposed to two and a half hours of bright light therapy (a light therapy box that mimics outdoor light) in the morning, it helped cue the internal clock to wake teens up a little earlier – a shift should also make it easier for them to fall asleep at an appropriate time.
We all know that ditching screens before bed aids sleep – but it’s not for the reasons we might assume. While it is often claimed that blue light is detrimental to sleep, Foster says that the brightness is extremely unlikely to affect the body’s sleep clock because the screen light is not strong enough. Rather, it’s the effect that flicking through our emails and news feeds has on stimulating our brain that makes it harder to get to sleep. So put screens away at least 30 minutes before bedtime.
While there is now a booming market for melatonin (the sleep-promoting hormone) supplements marketed at children, longer-term studies on their use in the general population are lacking. Most of the studies have been done on children with neurodevelopmental disorders – and in those cases, they’re often very helpful. For other kids, according to a new study, you might be better off investing in a weighted blanket, as they can help activate brain regions that can influence the release of melatonin.
Older teens
From the age of 18 onwards, we should be getting at least seven hours of sleep a night. But for older teens, unhealthy lifestyles and a lack of routine – from changes in diet to late-night partying – can mean sleep takes a hit. This age group are likely to reach for caffeinated products, whether it’s to make it through the day at their first job or to pull all-nighters at the library. Studies show that caffeine interferes with the timing of your body clock: and in a healthy individual it has a half-life of around five hours, which means half the caffeine you drink at 5pm is still in your system at 10pm. A good rule of thumb, says Ramlakhan, is not to drink caffeine after 3pm. But as with everything, be conscious of your own sensitivity to caffeine, and use it accordingly. Look for other ways to stay wakeful, Ramlakhan advises – practise stimulating breathwork (try the Wim Hof method), listen to some energising music, or even take a cold shower.
Alcohol is also likely to come into the mix at this stage – but there are things we can do to mitigate its impact on sleep. “If you go to bed with a stomach full of alcohol, either your body won’t metabolise it and you’ll wake up drunk, or you’ll metabolise it in your sleep, and your sleep will be awful,” says Romiszewski. “You’re better off drinking earlier in the evening and having plenty of water, so there’s time for metabolisation to take place.”
For young people who have just left school and are now managing their own schedules at university or work, maintaining a regular sleeping pattern can be tricky. A study of undergraduates found that those who kept irregular bedtimes had poorer-quality sleep than those with more consistent sleep schedules, even though they got roughly the same amount overall. Irregular sleep was also associated with poorer academic performance, so try to go to bed at a similar time each night. With all aspects of sleep, regularity is helpful, so even if you can’t manage it in the short term, try to make it your aim.
Many experts are cautious about the vogue for using sound as a sleep aid, but Russell Foster says it could be helpful for students who are up against it with academic work, and unable to sleep because of the noise of others partying downstairs. Silence, he says, is probably the best backdrop to sleep, but at some stages in our lives a soundtrack could be helpful. There’s a whole range of sounds to try, including white noise (which covers all frequencies equally, eg a fan or a vacuum cleaner); pink noise (lower-pitched, constant, gentler, eg wind rustling through the trees, or waves on a beach) and brown noise (deeper still, rumbling sounds, eg heavy rain or a rushing river).
20s and 30s
At this age, having weathered the years of late nights and getting by on too little sleep, it makes sense to get yourself into good habits. Ramlakhan recommends what she calls “five non-negotiables for better sleep”. “This is a gamechanger: do them for seven to 10 days to reset the nervous system,” she says.
Habit one is to always eat breakfast within 30 to 45 minutes of rising – this stabilises the blood sugar for the day ahead. Number two: don’t use caffeine as a substitute for meals, and reduce its use generally if you need to. Three: drink plenty of water through the day – at least 1.5 litres – because being dehydrated can lead to sleep problems, says Ramlakhan. Four: get to bed early three times a week; 9.30 or 10pm is perfect. “This is the sweet spot where nature is setting us up for sleep,” she says. And five: cultivate a healthy relationship with technological devices and don’t scroll on your phone immediately before turning off the light. “Ideally, don’t have the phone in your bedroom at all,” says Ramlakhan.
As we age, our bodies secrete less of two important sleep hormones – melatonin and growth hormone – so we’ll naturally be getting less deep sleep compared with our teen years. Compounding this, we might find ourselves juggling work commitments and busy social lives. “Social jetlag” – which occurs when we go to bed later and wake up later at the weekend – is common and can lead to weight gain, reduced mental performance and chronic illness. And while weekend lie-ins have their place, it’s important to be aware that if you feel you need them, it’s possibly because you’ve had insufficient sleep during the week.
Everyone knows that problems can affect a person’s sleep. If you have major life worries, seeing a therapist could improve your sleep patterns. So could journalling, especially at bedtime: one study found it reduced “bedtime worrying” and helped people fall asleep more quickly. They also slept longer than the participants who didn’t journal before bed.
Most people with a sleep problem are actually experiencing an anxiety or stress problem, says Foster. “That’s at the root of most problems with sleep,” he says. “There’s huge anxiety about sleep, and that’s being driven by misinformation: you get people screaming that you have to have eight hours’ sleep or you die. But in fact sleep is highly dynamic: it’s like shoe size, and one size doesn’t fit all.”
Of the many apps and devices on the market that aim to measure your sleep habits, Foster’s advice is not to take them too seriously. “There are some deeply inaccurate apps out there,” he says. “Something that says you had a good night of sleep or a bad one can be misleading.” The last thing you want is anything that reinforces any anxiety you might have around sleep.
And try to avoid routinely reaching for sleeping pills, he says. “They don’t provide a biological mimic for sleep; they are sedatives and may even interfere with some of the important processes that occur during sleep, such as memory formation and the processing of information.” This doesn’t mean they’re not helpful in the short-term for acute situations: if you’ve suffered a bereavement, for example, you might need to take them for a few days to get some rest.
Foster emphasises the importance that the timing of our meals has in helping us get a good night’s sleep, advising that people should have a big breakfast, a hearty lunch, and a light and early dinner – he suggests 8pm is a good cut-off point for eating. This is because our ability to process food – glucose, for example – is much more efficient during the first half of the day. When we eat late, the muscles that digest and metabolise our food have to keep working when they should be resting.
Midlife
It’s no secret that the night sweats associated with perimenopause and menopause can wreak havoc on sleep. Browning recommends keeping a spare pair of pyjamas next to the bed, sleeping on a towel, and using two single duvets instead of a double if you’re sleeping with a partner, so you can choose a different tog and throw it off if it gets too hot.
Diet makes a definite difference. A study carried out by researchers at Harvard recently found that the risk of developing insomnia for menopausal women was higher among those who ingested more carbs, so a diet rich in fruit and vegetables can reduce the chances.
But the big question is, if you find yourself waking up and not going back to sleep, should you stay under the covers or get up? The answer, says Dr Aric Prather, author of the newly published The Seven-Day Sleep Prescription, is that it depends on whether this is a temporary issue or a chronic problem. If the former, stay in bed and try not to worry too much because your body will be able to cope with the occasional bad night. But if it’s happening on a regular basis, it means you’ve created what he calls conditioned arousal. “Often people say: ‘I was feeling sleepy, but I got into bed and my brain woke up,’” he says. In other words, your body is confused about how to get to sleep, and when you start to feel anxious about going to bed because you fear you won’t sleep, you’re setting up a vicious circle that can be hard to break.
If this is you, Prather’s advice is to get out of bed and engage in some activity that helps you wind down: reading, watching a TV programme or film that you’ve seen before, listening to gentle music or a guided meditation. “The aim is to bring on the feeling of drowsiness, and then you go back to bed,” he says.
But if the problem is long-term, he suggests using strict rules about when you can go to bed and when you rise. “Imagine a balloon that inflates through the day,” he says. “This is your sleep balloon, and you need to start filling it up from the morning.” He recommends getting up at the same time, however little sleep you think you’ve had: it will make all the difference to how tired you feel later. At the other end of the day, push back on when you go to bed, so between the two, says Prather, you’ll ensure your sleep balloon is as full as possible. “What you’re aiming for is that your sleep balloon is really big,” he says. “You want to be watching the clock, waiting to go to bed because you feel really sleepy. And that’s a new experience for someone with insomnia.”
Sleeping with someone else is, generally speaking, a bonus: new research suggests that individuals in shared beds experience less severe insomnia and fatigue, and have more sleep time – it’s possible that having another adult in the bed makes people feel safer on some level.
Testosterone levels naturally decline with age in males, and some studies have shown lower testosterone to be associated with worse sleep and greater problems with sleep apnoea (a breathing disorder). Making lifestyle changes, such as losing weight, giving up smoking and reducing how much alcohol you drink, can make a big difference.
Later life
As we get older, sleep gets lighter and periods of sleep tend to be shorter. “The biggest changes are to the elements of sleep that keep us most rested – slow-wave or deep sleep, which largely happens in the first half of the night and reduces as we get older,” says John Groeger, professor of psychology at Nottingham Trent University. “While it’s natural to wake briefly several times a night, the reduction in deep sleep means we do so more often, and for longer, as we age.”
Sleep, Groeger points out, is closely linked to the demands being made on our brains and our bodies: when we’re younger, we’re growing and learning a huge amount, and sleep fuels all this. As we get older, the ageing body is doing less, and sleep needs are reduced. Studies have found that sleep patterns in later life can be a factor in dementia: people who slept six hours or less a night in their 50s and 60s were more likely to develop dementia later on.
Inactivity, says Groeger, is a “big enemy” of sleep: and while it’s possible to be inactive at any age, it may be a particular issue when you’re older. Physical exertion, especially in the morning and outside in the daylight, is a health boon on many levels, including as an excellent primer for a good night’s sleep.
It’s important to remember, he says, that sleep is a reflection of our lives: if we have balance in our mental and physical health, if we’re getting exercise and not carrying too much excess weight, if we’re in tune with those around us and we’re reasonably happy in the choices we’ve made in our lives, sleep is going to be easier – whatever age we are.
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