How to sleep better and beat insomnia

From which.co.uk

Can't sleep? We ask the experts what works, and whether sleep aids are worth spending your money on 

Struggling to get to sleep or sleep through the night?  You're not alone - the National Institute for Health and Care Excellence (NICE) says that around one-third of adults experience sleep problems at least once a week, with up to one in ten permanently plagued by chronic insomnia (which is defined as difficulty getting to or staying asleep most nights for longer than four weeks). 

Covid and its related worries hasn't exactly helped matters either. A 2021 review of studies showed that around 40% of people suffered from sleep problems during the pandemic. 

We ask Professor Guy Leschziner, professor of neurology and sleep medicine at Guy's Hospital Sleep Disorders Centre, and author of The Secret World of Sleep, about the science behind getting a better kip. 

Get the lowdown on free ways to improve your sleep habits, and if any sleep aids really work.

Why can't I sleep? 

Many factors can hamper your ability to get a good night's sleep, and both biological and psychological influences are at play. Professor Leschziner says: 'Daytime stress causes causes physical and psychological 'activation' or disruption which will make sleep more difficult or of a poorer quality.'  

Over time, positive conditioned responses (such as 'bed is a restful place') may get displaced by negative ones (such as 'bed is somewhere I now associate with not being able to sleep'), creating a vicious cycle. 

6 tips to help you sleep better 

In most instances, disturbed sleep can be helped by addressing 'sleep hygiene' and establishing good practices, such as: 

1. Change poor sleep patterns: sleep less to sleep more 

Professor Leschinzer says: 'It might sound counter-intuitive but depriving yourself of sleep can enable your brain to re-establish a proper sleep schedule.' 

Note down how much time you actually spend asleep on a typical night - as opposed to tossing and turning - then allow yourself to sleep for this amount of time plus 30 minutes. 

For example, if you are trying to sleep for eight hours but only managing five, spend five hours and 30 minutes in bed - based on the time you want to get up and altering your bedtime accordingly - and gradually increasing it once you're spending the majority of time in bed sleeping. 

If you have a smartwatch or fitness tracker the sleep tracking function may help you understand aspects of your sleep, but Professor Leschziner suggests using them with caution as the information could be inaccurate and could even fuel your anxiety - causing further sleep issues. 

2.Get your bedroom temperature right 

Our body temperature drops by a couple of degrees when we are sleeping to help conserve energy for vital functions such as breathing. 

If it's too cold (under about 12°C) it can be difficult to drop off, and if it's too hot (24°C or more) this can lead to a restless sleep. We typically sleep better when the room is cooler - ideally around 16-18°C. 

A 2012 study reported in the Journal of Physiological Anthropology found that room temperature is one of the most important factors when it comes to achieving a good quality sleep. A fan, air conditioner or heater can help you to help achieve a suitable bedroom temperature, but opening a window, or if its cold piling on the blankets, can also help. Bed socks can also make a big difference if you're feeling chilly. 

3. Pick the right mattress - and pillow 

A 2021 Italian Journal of Trauma and Orthopaedics literature review on sleep quality and back pain found that a medium-firm mattress helps with sleep quality, comfort and keeping the spine in the best position. 

The type matters too. When we surveyed Which? members about mattresses, those who have an open coil mattress were less likely to say it helps them get a good night's sleep than those with other types of mattress. 

Lie for around five to ten minutes on several mattresses when you're trying them out, remembering to try turning on them to see how comfortable this is, too. If you sleep with a partner, bear in mind any differences in weight and size between you both, as this affects what type of mattress will suit you best. 

Choosing the right pillow can help, too - for example, a memory foam pillow is a great option for those looking for neck pain relief, as it contours to your body. 

4. Get outside in the morning, and off your phone at night 

If you're not sleeping properly, exposing yourself to natural light in the morning can help reset your 'body clock' so you'll sleep more easily at bedtime. 

Daylight in direct sunlight has up to 10,000 lux (bright office lighting is generally less than 500 lux) which is why daylight is so powerful at helping to reset the sleep-wake cycle. 

Conversely, blue light emitted by many devices including smartphones and laptops has been found in multiple studies to contribute to poor sleep and excessive daytime sleepiness. 

Stop using screens an hour before bedtime - even if they are in night mode, to avoid overstimulation preventing good sleep. 

5. Take a warm bath or shower 

A 2019 study published in the journal Sleep Medicine Reviews found that taking a warm bath or shower of 40-42.5 °C one to two hours before bedtime improved sleep quality and sleep efficiency (the time spent asleep when you're in bed), and reduced by an average of 10 minutes the amount of time it takes to drop off to sleep. 

During the night our temperature drops and this aids better sleep, so although it sounds counter-intuitive, warming ourselves up by immersing ourselves in warm or hot water a little while before we go to bed actually helps to aid this natural drop. 

The way it does this is by taking heat away from the body's core and to the hands and feet from where it is dispersed. 

6. Try a sleep app 

If sleep hygiene doesn't seem to be helping, online self-help apps offering cognitive behavioural therapy for insomnia (CBT-I) can be an effective insomnia solution - and in some cases even better than face-to-face therapy. 

Research carried out in 2020 by the Oxford Academic Health Science Network found that Sleepio - a six-week digital treatment for insomnia - helped those with insomnia gain almost six hours more sleep a week, as well as reducing sleeping pill use, time off sick and the number of GP visits. 

CBT-I helps you to identify thoughts and behaviours that are causing your sleep problems and replace them with more constructive ones to promote healthy sleep through better habits. 

https://www.which.co.uk/news/article/how-to-sleep-better-and-beat-insomnia-adkTs0w409oF

Ten practical ways to relieve insomnia

From spokesman-recorder.com

No sleep, no wellness!

Great sleep is the foundation for great health. During sleep our physical and mental selves get a chance to relax, rejuvenate and restore themselves so that we can continue to carry out our daily obligations. 

We all know that sleep is important on many levels. We have all heard that we need to sleep in order to grow, or when we are sick we need to sleep in order to get better. We have long recognized even in our children that if they are not sleeping well their behaviour becomes unreasonable. That is demonstrated by watching any toddler who has missed their nap! 

Great sleep is recognized as important even in our workplace with the sound advice to sleep on a big decision before making it. 

Photo by Anna Shvets on Pexels.com

Sleep is by definition a state of reversible, often supine, decreased muscular activity with specific brain wave patterns, often with eyes closed and a decreased level of consciousness. Sleep is what we want at the end of a stressful day or when we are not feeling well just to tune out and go off the grid for a little while. 

How incredibly stressful it becomes, then, when we want to sleep but it eludes us! Insomnia by definition means that we are taking more than half an hour to get to sleep. While there are many causes of insomnia, such as racing mind, pain, sleep apnoea,  and medications, I will focus on providing some practical solutions to help decrease your chances of ongoing insomnia.

1.  Keep a routine bedtime and wake-up schedule. This means trying to go to bed about the same time and getting up about the same time each day. This will help your body’s hormones and circadian rhythm to sync, and this in turn will help you get to sleep and feel more refreshed when you wake up.

2.  Do not look at the alarm clock! Be sure that the alarm clock is facing away from you so you are not seeing the time that is passing as you try to fall asleep. Remind yourself that what time it is is not important and the more you see what time it is, the more likely you are to have further delay getting to sleep. The light emitted from the numbers on the clock can also impair your ability to get to sleep.  

3. Set the alarm for the time that does not allow you to snooze. Snoozing more often than not makes you feel more tired, as you are not able to get into as deep a sleep again. This adds to sleep disruption. Hearing the alarm should tell you that you must get up immediately or you will be late.

4. Try to not eat within a couple hours of bedtime. Eating close to bedtime leads to ongoing production of stomach acids and GI irritation, which add to sleep disruption.

5.  Control pain. If you have a chronic pain condition, give yourself time to find a comfortable position. If medications are needed, take them as directed so that chronic pain is not preventing you from getting to sleep and staying asleep.

6.  Make sure the room you are sleeping in is darkened so that the sun rising earlier than your desired wakeup time does not cause you to wake up sooner than you would like to. You may need to wear an eye mask.

7.  Wear earplugs. Keeping your sleep environment as quiet as possible is helpful in maintaining sleep. Having earplugs in if needed helps to block out distracting noises that can cause you to wake up prematurely. For example, if you know that on Tuesday mornings your recycle truck comes for pickup and it is loud, you may choose to wear an ear plug that night at minimum in the ear that is not on the pillow.

8.   If you take a medication for sleep, take it as directed and see your prescribing provider if you desire any dosage change. Many of the medications that are prescribed to help with sleep have adverse effects if stopped abruptly.

9.  If you have a difficult time getting to sleep or staying asleep, consider setting the mood:  

• Use blue and green light filters on cell phones and on any backlit electronics and computer screens. This will help to keep your own melatonin level as high as possible, which leads to better sleep.
• Take a bath at night. Feeling and smelling clean, especially using bath salts such as eucalyptus, is relaxing. 
• Meditate. Browse the many apps that are available, many of which are free! Mediation will help you to slow down your mind and not relive, rewrite and replay the past or perceived future.
• Do something relaxing at night such as read a book as opposed to watching a show or another activity that might get you upset.
• Turn off social media and notifications when getting ready for bed.

10.  Limit your activities in the bedroom to do those that are sleep-promoting. Consider consulting with a sleep specialist to discuss the details of your sleep problem. They can discuss and, if need be, prescribe cognitive behavioural therapy and medications.

https://spokesman-recorder.com/2022/04/15/ten-practical-ways-to-relieve-insomnia/?utm_source=rss&utm_medium=rss&utm_campaign=ten-practical-ways-to-relieve-insomnia

The elderly and insomnia

From bereamail.co.za

Sleep problems in the elderly are often mistakenly considered a normal part of ageing. Insomnia, the most common sleep disorder, is a subjective report of insufficient or non-restorative sleep despite adequate opportunity to sleep

INSOMNIA

Insomnia is a prevalent problem in late life and Pharmacists and Doctors are often approached with elderly patients looking for an instant cure. Sleep problems in the elderly are often mistakenly considered a normal part of ageing. Insomnia, the most common sleep disorder, is a subjective report of insufficient or non-restorative sleep despite adequate opportunity to sleep. Even though more than 50% of elderly people have insomnia, it is typically undertreated, and non-pharmacologic interventions are underused by health care practitioners. The latter very often solves the problem and is as important as proper sleep hygiene.

CAUSES OF SLEEPLESSNESS

Two primary factors control the physiologic need for sleep: the total quantity of sleep (average of ∼8 hours of sleep each 24-hour period) and the daily circadian rhythm of sleepiness and alertness. Sleep requirements and patterns change throughout life, but sleep problems in the elderly are not a normal part of ageing. The progression of sleep across the night is called sleep architecture, and it is displayed as a sleep histogram or hypnogram. Sleep architecture is composed of 3 segments. The first segment includes light sleep (stages 1 and 2), and the second segment includes deep sleep (stages 3 and 4). Taken together, stages 3 and 4 are referred to as delta sleep or slow wave sleep (SWS). SWS is believed to be the most restorative part of sleep. Stages 1 to 4 constitute nonrapid eye movement (non-REM) sleep.

Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors that may interfere with sleeping. Psychiatric disorders are often associated with persistent insomnia. Depression is usually associated with fragmented sleep, decreased total sleep time, earlier onset of REM sleep, a shift of REM activity to the first half of the night and a loss of slow-wave sleep. In manic disorders, a reduced total sleep time and a decreased need for sleep are cardinal features of the condition. Sleep related panic disorders occur in the transition from stage 2 to stage 3. Abuse of alcohol may cause or be secondary to the sleep disturbance. Heavy smoking (more than a pack a day) causes difficulty falling asleep. Excess intake near bedtime of caffeine and other stimulants as found in over-the-counter medicines and  remedies causes decreased total sleep time – mostly non-REM sleep. Some medical conditions, like chronic pain, respiratory conditions like asthma, uremia, thyroid disorders and nocturia could be causes of insomnia.

                  

SIGNS AND SYMPTOMS:  

Persons having sleep problems may typically complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or a combination of these. Difficulty in falling asleep may suggest delayed sleep phase syndrome, chronic psychophysiological insomnia, inadequate sleep hygiene, restless leg syndrome, or childhood phobias. Difficulty in maintaining sleep suggest advanced sleep phase syndrome, major depression, central sleep apnoea syndrome, periodic limb movement disorder, or ageing.

The Epworth Sleepiness scale can be used to determine excessive daytime sleeping.

Situation

Sitting and Reading

Watching TV

Sitting inactive in a public place

Riding as a car passenger for one hour continuously

Lying down to rest in the afternoon

Sitting and talking to someone

Sitting quietly after lunch (no alcohol)

Sitting in a car stopped for a few minutes in traffic For each situation, probability of dozing is self-rated as none (0), slight (1), moderate (2), or high (3). A score of ≥ 10 suggests abnormal daytime sleepiness. TREATMENT In general, there are two broad classes of treatment for insomnia and the two may be combined: psychological (cognitive-behavioural) treated by practitioners with expertise in CBTI and pharmacologic. The latter may be treated with over-the-counter medicines from your local pharmacy with sedating antihistamines which might induce sleep, but it might not treat the intermittent wakefulness during the night which means a visit to your medical doctor is necessary. The possibility of drug dependence should always be kept in mind, and one should be aware of that possibility when using prescribed treatment for insomnia. Newer generations of hypnotics have a much smaller chance of a patient becoming dependent on them and causes less of a “groggy” feeling the next morning although one soon becomes desensitised towards these unwelcome side-effects should they occur. Good sleep hygiene is very important. Go to bed only when feeling sleepy. Use the bedroom only for sleeping and sex. If still awake after 20 minutes, leave the bedroom, pursue a restful activity (such as a bath or meditation) and only return when sleepy. Get up at the same time every morning regardless of the amount of sleep during the night. Discontinue caffeine and nicotine, at least in the evening if not totally. Establish a daily exercise programme. Avoid alcohol as it may disrupt continuity of sleep. Limit fluids in the evening. Learn and practice relaxation techniques. Establish a bedtime ritual and a routine for going to sleep. Research suggests that cognitive behavioural therapy for insomnia is as effective as prescribed medication with benefits sustained 1 year after treatment.          WHEN DO YOU KNOW IT IS TIME TO VISIT YOUR DOCTOR? Persistent insomnias that do not respond to sleep hygiene practice or over-the-counter treatment should warrant a visit to the doctor. Also, if psychiatric disorders like depression or delirium, pain, respiratory distress syndromes, uremia, asthma, thyroid disorders, and bedwetting due to benign prostatic hyperplasia seems to be likely, a visit is necessary.       ADVICE Before looking at medication as a relief for insomnia, proper “sleep hygiene” should be looked at as a point of departure. Compile a sleep diary for at least two weeks and show it to your doctor or pharmacist and give them a proper history of all your chronic conditions i.e. pain, diabetes, hypertension, anxiety, depression. Try lifestyle modification at first and re-evaluate after two weeks. Only then start with a sedating antihistamine obtainable from your pharmacist as a first option, and if insomnia persists, visit your doctor.     REFLECTION Sleep requirements and patterns change throughout life, but sleep problems in the elderly are not a normal part of ageing. Whether older people need less sleep or cannot get the sleep they need, requires ongoing research. There is currently no gold standard for how much sleep is normal in the elderly. Good night! Johann Kruger M.Pharm., M.Phil., PhD., FPS is a Director at Medwell SA – The Home Health Care Specialists and the Head of EDNA Medical Distributors, an incorporated company at Medwell SA.  For more information visit www.edna.co.za or www.medwell.co.za https://bereamail.co.za/284142/the-elderly-and-insomnia/