From telegraph.co.uk
By Miranda Levy
Whether it’s the odd restless night or chronic insomnia, sleep problems are on the rise – but there are solutions
The world tends to fall into two camps. There are those people whose heads hit the pillow and – snap! – eight hours later, it’s the morning. Then there are the rest of us, who suffer from sleeplessness – ranging from the odd stress-induced broken night to the seemingly endless hell of chronic insomnia.
If you’re a member of the second group, you’ll know the frustration, fury and despair of a night without sleep. The tossing and turning, the staring at the numbers on the clock as they relentlessly count down towards dawn and the first snatch of birdsong, which heralds the start of another day you are simply too exhausted to navigate.
Our sleep is bad, and getting worse. Thirty per cent of adults experience sleep problems (up from 23 per cent in 2012). One in 10 of us suffer from chronic insomnia, defined as having trouble sleeping for three days a week for more than three months. Even for those spared the long-term form of the condition, a recent YouGov poll revealed that 21 per cent of Britons have problems falling asleep a few nights a week.
Women tend to sleep less well than men, and older people less well than younger ones.
“Sleep makes us feel good, helps us learn, improves our concentration, helps us manage our weight, gives us greater self-control, reduces our risk of ill-health and is completely free of charge,” says sleep scientist Dr Sophie Bostock. “Insomnia can affect all the above: it’s an awful, lonely condition. But the good news is that there are effective treatments, and however bad things may seem at the time, there is hope.”
However much you’re dreading another tussle with the duvet, here’s the experts’ guide to understanding sleep – and the knowledge that will ease you into better nights.
How much sleep do I need?
There’s a received wisdom about how many hours a person “should” sleep. The oft-quoted magic number is eight hours, sometimes seven, and this has been backed up by several scientific studies over the years.
A 2022 paper from Cambridge University agreed that a minimum of seven hours is recommended for good health. The research was based on hundreds of studies that followed people’s long- term experience of heart disease, diabetes and mental-health difficulties. Those who slept between seven and nine hours were typically at lower risk of future ill-health, hence the recommendation.
But depending on certain variables, including your genetic makeup, age and lifestyle, your “perfect” amount might fall outside this range.
“Just like your shoe size or height, ‘optimum sleep’ varies from person to person,” says Dr Bostock. “For example, some people have a ‘short sleep’ gene, which means they feel alert and refreshed after just five or six hours’ rest. If you wake up naturally without an alarm, feel refreshed and don’t need caffeine, sugar or a nap to get through the day, then you’re probably getting enough.”
Why do I find it hard to get to sleep?
First, the basics: make sure your “sleep hygiene” is up to scratch. So, check that your bedroom is dark, quiet and at optimum temperature – between 18C-21C. Your bedding should be comfortable and, ideally, made of natural fibres. Ensure you’ve had enough natural light and exercise during the day (more of which below).
Dr Guy Meadows is clinical director of the Sleep School and author of The Sleep Book: How to Sleep Well Every Night. “Unfortunately, for many of us, good sleep involves managing your caffeine intake,” he says. “Try not to drink caffeine after the early afternoon, because it can have an impact on your sleep, even many hours later,” he says. Coca-Cola and tea (even green tea) also contain caffeine.
Spending too much time on your devices can also delay the dropping-off process. “Smartphones and technology can have a negative impact on our quality of sleep and mental health,” says Dr Meadows. “Phones trigger brain stimulation, making it much harder to get to sleep and stay asleep.” The “blue light” emitted by devices has also been shown to delay the production of melatonin, the hormone that sends us to sleep.
For many, stress and anxiety – whether about a specific meeting the next day, or an ongoing life situation – can play havoc with our ability to fall asleep. “Stress comes in all different forms,” says Dr Bostock. “Another way of describing it is hyperarousal, or an inability to switch off. You might not recognise yourself as stressed, but you are always ‘on’ ”. For ways to combat this, see below.
Reasons you might wake up in the middle of the night
Most people wake up once or twice a night. “Waking up at night is a perfectly normal part of the sleep cycle, and usually nothing to worry about,” says Dr Bostock. But there can be factors that make the 3am wake-up call more likely.
While alcohol can initially send us into a deep sleep, it can affect the second half of the night. “As you metabolise the alcohol in the liver, it actually behaves as a stimulant, making you more likely to wake up and meaning you spend less time in REM sleep,” (see below) says Dr Bostock. “So even when you have slept for the same number of hours, you haven’t had as restorative a rest as you would have had if it had been true sleep.”
Physical causes, such as pain, prostate problems (meaning you need to get up to use the loo) and the hormonal changes around the menopause, can make matters worse, as can certain medications, including beta blockers and steroids. People who snore or who have sleep apnoea – a condition where the walls of the throat relax and narrow during the night – also have restless nights.
What are the different stages of sleep?
There are two basic types of sleep: rapid-eye movement (REM) sleep and non-REM sleep (which has three different stages). A cycle of sleep lasts approximately 90 minutes.
During a typical night, a person cycles through all stages of non-REM (NREM) and REM sleep several times, with increasingly longer, deeper REM periods occurring towards morning.
Stage 1 non-REM sleep is the switch from wakefulness to sleep. During this short period (lasting several minutes) of relatively light sleep, your heartbeat, breathing and eye movements slow down and your muscles relax, with occasional twitches. Your brain waves begin to slow from their daytime wakefulness patterns.
Stage 2 non-REM sleep is a period of light sleep. Your heartbeat and breathing slow down and your muscles relax even more. Your body temperature drops and eye movements stop. Brainwave activity slows, but is marked by brief bursts of electrical activity. You spend more of your repeated sleep cycles in stage 2 sleep than in other sleep stages.
Stage 3 non-REM sleep is the period of deep sleep you need to feel refreshed in the morning. It occurs for longer periods during the first half of the night. Your heartbeat and breathing slow to their lowest levels and your muscles are relaxed. It may be difficult to wake you up. Your brain waves become even slower.
How long should I spend in deep sleep?
Each cycle of deep sleep lasts from 20 to 40 minutes. The average person cycles through this about four times a night, but not everyone needs this amount to feel fresh and rested the next day.
What is REM sleep?
REM sleep first occurs about 90 minutes after falling asleep. Your eyes move rapidly from side to side behind closed eyelids, your breathing becomes faster and irregular, and your heart rate and blood pressure increase to close to waking levels. Most of your dreaming occurs during REM sleep, although some can also occur in non-REM sleep. “Some believe REM sleep is the brain essentially doing therapy on itself, processing feelings,” says Dr Bostock.
Your arm and leg muscles become temporarily paralysed, which prevents you from “acting out” your dreams. As you age, you spend less time in REM sleep.
9 expert tips to help you sleep through the night
1) Embrace the light
“From the minute you wake up, you’re effectively winding down for sleep,” says Dr Meadows. Our sleep cycle – or circadian rhythm – is governed by our sense of light and dark: studies show that exposure to natural light helps the body to produce vitamin D (important for bone, tooth and muscle health) and sharpen your focus. “As soon as you wake up, aim to get lots of light into your eyes,” says Dr Meadows. “This tells the brain that the day has begun, banishing the sleep hormone, melatonin, and activating the CAR – the cortisol awakening response.”
2) Keep moving
The earlier in the day you exercise, the more likely it is you’ll fall asleep at a reasonable hour. “Being active, getting a few extra steps – that’s going to help to increase that sleep drive, and help to increase the speed at which you fall asleep,” says Dr Meadows. However, it’s best to avoid any vigorous exercise at least three hours before bed, as the adrenaline may make it hard to drop off.
3) Watch what you eat
According to Dr Meadows, you should also aim to eat at least three hours before bed, avoiding spicy food, or anything that might cause indigestion. “Make your evening meals lighter and healthier, and try adopting a Mediterranean-style diet – plenty of olive oil, healthy fats, such as oily fish and nuts, and vegetables,” he says.
A 2020 study from Columbia University agreed that the Mediterranean diet “appears to provide the best sleep outcome”.
4) Build a routine – and stick to it
“Waking up at the same time every day – including weekends – sets you up for a successful night’s sleep,” says Dr Bostock. “Your body clock will recognise the pattern and you’ll start to wake up more alert every morning and feel sleepy at the same time every night. We can adjust our body clocks by an hour from day to day, but lengthy lie-ins can interfere with your internal rhythms.”
Turn on the lights, eat and shower at the same time every day to train the body to associate those actions with morning.
This, and the following tips, are part of a school of therapy called CBT-I (Cognitive Behavioural Therapy for Insomnia), which has been shown in studies to be far more effective than sleeping pills, which also carry a risk of dependency.
5) Restrict the time you spend in bed
This means spending less “quantity” time in bed for better quality sleep. So, only go to bed when you are tired and get out when you’re not. “Going to bed later increases your natural drive for sleep,” says Dr Bostock.
In the short term, you may feel really tired, but this often means a less broken night. “The idea is to strengthen the link between your bed and sleep in your mind. So, if possible, use your bed only for sleeping, or sex, and nothing else.
Naps can be helpful, but do restrict their duration, and closeness to bedtime.
6) Don’t turn your bedroom into a battleground
After a run of a few bad nights, it’s easy to start to dread going to bed. But, says Dr Bostock, this is counterproductive. “Instead of telling yourself ‘that’s it, I’m never going to sleep again’, reassure yourself ‘I’m a good sleeper, I’m just having a bad night’.”
7) Follow the “quarter-hour rule”
“If you are in bed for 15 minutes and still wide awake, rather than getting frustrated, you should get up, stop stewing and go and read a book,” says Dr Bostock. Television is not recommended because it might stop you feeling sleepy, and the blue light from a phone or a tablet can interfere with the maintenance of melatonin production.
8) Try relaxation and mindfulness techniques
“We also teach clients various tricks and tools to help the brain to switch off its ‘fight or flight’ response to stress,” says Dr Bostock. “Since the mind and body are interconnected, relaxing the muscles can be a shortcut to easing the racing mind. For example, progressive muscle relaxation involves deliberately tensing and then releasing the major muscle groups in turn.”
Meanwhile, the web is full of meditation apps and breathing exercises – there are even sleep playlists on Spotify and “sleep stories” on YouTube.
9) If all else fails, accept your temporary sleeplessness
Dr Meadows is an advocate of Acceptance and Commitment Therapy (ACT), where those who find themselves up at night are taught to accept the discomfort of a racing mind.
“The point is to actually be OK with being awake,” he says. “Because the more willing you are to be awake, the less obstacles there are in the way of sleep.” If you give up trying to sleep at 4am, you may well find yourself waking up with the alarm at seven.
Miranda Levy is the author of The Insomnia Diaries: How I Learned to Sleep Again (Octopus Books)
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