One of the initial questions I always ask my clients is ‘How are you sleeping?’
Their answer to this question gives me a lot of information about how their problems or their mental health may be impacting on them, often difficult periods in life are accompanied by a disturbed sleep pattern.
They may tell me they are having problems getting to sleep because of worry & thoughts whirling around in their head so they struggle to relax.
They may tell me of waking up multiple times in the night, waking early and not being able to get back to sleep. Many tell me that 3am is a regular waking time, this time seems to be the witching hour.
Many speak of nightmares they have, re-occurring nightmares, new nightmares with a theme, or that they never dream.
I ask them how long sleep has been a problem for them, for some sleep has eluded them for years, for others this is a new experience, some can pin point when sleep started to be a problem for them.
Through their answers about sleep I have a better understanding of how their stress, worry, anxiety or depression is affecting them and the answers can sometimes give me clues as to what has triggered the difficult phase of life they have found themselves in.
At the end of therapy I ask the question again and generally their sleep pattern has improved, they are not lying awake all night worrying, they are getting more sleep, feeling more rested the next day and often the nightmares have stopped or come less often.
This always demonstrates to me that by talking about your problems and stopping them being inside your head that the sleep that alludes you can be restored.
Covid-19 has certainly been a trigger for many to have restless and sleepless nights, the worry of the virus, our constant changing environment, stress and anxiety about now and the future, the change in lifestyle, diet, all have an impact on peoples quality of sleep. By making small changes you can improve your sleep
First of all lets understand a little more about sleep.
Sleep is essential, our bodies require sleep in order to maintain proper function and good health.
We are programmed to sleep each night to restore our bodies and minds.
We all have 2 systems to help us sleep our own internal biological clock (this can change with work patterns ie shift work) and our cicadian rhythm which is like our thermostat for when to sleep and when to wake.
There are 2 main types of sleep REM, Rapid Eye Movement and NREM Non-Rapid eye movement
REM sleep is our active sleep, this is usually when we dream (if you wake from REM you will likely have some memory of dreams)
NREM is our deep sleep and it is unlikely we dream in this state (if you wake from NREM you will have no recollection of dreams)
Our sleep pattern tends to rotate in 90-minute cycles, in and out of REM and NREM, that therefore means every 60-90 minutes you are likely to be in more wakeful sleep (REM)
It can be more difficult to wake someone from NREM sleep than REM sleep.
This cycle of sleep can be affected by
The amount of recent sleep you have had
The time of day or night which is relative to a person’s internal biological clock
Because our internal biological clocks differ the amount of sleep we need varies, it is not about the quantity of sleep you get, but the quality of sleep you get that is important, 7 hours is the recommended average per night, but some people function on a lot less. It is said Margaret Thatcher only required 2 hours sleep a night.
If we take all this into consideration you can help your cicadian rhythm and move towards a better nights sleep by following these tips.
1. Increase your Daylight/Reduce your Blue Light
Natural light helps keep your cicadian rhythm healthy.
Daylight exposure improves quality and duration of sleep.
Start your exposure to daylight as early as possible, open your curtains as soon as you wake up, have breakfast by a window or in a sunny room.
Get out into the daylight and away from artificial light as often as you can, on your breaks at work go outside.
Your cicadian rhythm associates daylight with daytime and dull light with night time, so if you are inside in dull light for too long it will start to think it is night time.
On the flip side, at night you need to reduce the amount of light exposure, as bright light at night tricks your brain into thinking it is still daytime.
Have low lighting on in your rooms
Computers, TV’s and mobile phones emit blue light in large quantities, so it makes sense to reduce your screen time or reduce the blue light on your phones.
It is recommended you stop looking at computers & phones and stop watching the TV 1-2 hours before going to bed and do not have any of these in your bedroom.
To keep your cicadian Rhythm healthy get more daylight during the day and reduce bright light at night, let your brain know the difference between day and night, night is your natural time to sleep.
2. Consider Food and Drink Intake Before Bedtime
Food and drink can have a number of affects on our sleep pattern and reduce the quality and quantity of your sleep.
During isolation our food and drink intake and our usual routines may have changed.
We may be consuming more alcohol, eating more carbs and eating at different times to usual. Maybe you are not drinking so many Costa Coffees which may be good for you.
Caffeine is probably the most well-known stimulant and reducing your caffeine intake will have a positive effect on your sleep pattern.
Caffeine enhances focus, energy and performance so is great for during the daytime but is not conducive to good sleep.
Caffeine stimulates your nervous system and prevents your body from naturally relaxing,
Caffeine can stay elevated in your blood for approx. 6-8 hours so drinking caffeine after about 3-4pm Is not recommended.
Tea also contains caffeine in smaller amounts so decaf tea and coffee is preferable.
If your coffee intake has changed what about your alcohol intake?
Even a couple of alcoholic drinks at night can negatively impact on your sleep
Alcohol is known to increase symptoms of sleep apnea, snoring and disrupted sleep patterns.
What time do you eat dinner?
You should avoid big meals with rich food for at least 2 hours before bed, spicy or acidic food can cause acid reflex which interrupts your sleep.
Foods high in carbs such as bread, rice and pasta should also be avoided before bed.
Although we are told to drink plenty of water try to get your water intake in at least 1-2 hours before bed, as your fluid intake will increase your chances of getting up for the toilet in the night, again disturbing your natural sleep pattern.
3. Keep a Regular Sleep Pattern
Your natural Cicadian rhythm aligns itself to sunrise and sunset and you need to get yourself in sync with your bodies natural rhythm.
If you keep to a consistent sleep pattern your body will naturally know when it should sleep and when it should wake up
Going to bed and waking up at the same time everyday will aid your long term sleep quality.
It can be very tempting to have a late night at the weekend but if you want to keep sleeping well you need to stick with your regular sleep pattern.
Diversions from this can mean you starting again setting up your regular sleep pattern
If you stick to the routine regularly you will find you do not need an alarm clock, you will have set the natural sleep rhythm that suits you.
Sometimes it can be tempting to have an afternoon nap, try to resist encouraging your natural sleep pattern to become normal.
4. Have a Relaxing Routine Before Bed
Studies have shown that a bath or a shower are good to have before you go to bed, especially for older adults, they aid you falling asleep quicker
It is suggested that a bath 90 mins before bed leads to deeper sleep.
If you are not able to have a full bath then consider soaking your feet in hot water as this can help you relax.
Organise a relaxing routine to unwind before bed. This does not include TV in bed, computers or social media.
Dim the lights
Turn off the TV
Put some relaxing music on
Take a warm bath/shower
Listen to an app like Headspace or calm
Read a book
Close your eyes and just relax, don’t worry about sleeping, just try to relax your body
Do some deep breathing or Progressive Muscle relaxation to help you relax.
Worry stress, anxiety and anger can stop you sleeping because of the thoughts going round in your head.
Do your bedtime routine and include writing down any of your negative thoughts in a notebook, close it and tell yourself you will deal with them in the morning.
If you wake in the night and start worrying open your notebook and write them down and put them to one side again.
If you wake in the night and can’t get back to sleep after 15 minutes don’t battle with it, get up and do another relaxing routine and once relaxed go back to bed
5. Optimise your Bedroom Environment