Insomnia

We spend a third of our lives, or an average of 24 years sleeping – and yet up to 95% of us at some time have trouble sleeping.
 
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  • Updated:23 May 2000
 

02.Six steps to regular sleep

Step 1: When is it time to sleep?

Your body clock

We all have a clock ticking away inside of us. It has periods marked for sleep when we feel sleepy and find it easy to drop off, and periods set for wakefulness when we feel alert and find it difficult to sleep.
Most of us have clocks with two definite sleep times. The first, as you would expect, is from the late evening till the early hours of the morning, hitting a peak sleepy time around 4 a.m. The second sleepy time is around the middle of the day (siesta time in Europe).
Not everyone’s clock is set exactly the same. Some people are naturally night owls and their clocks are set late, whereas some have a clock that is set early.

The influence of light

Our clocks actually run on a 25-hour cycle, but the influence of light is key. Light makes them constantly adjust to our 24-hour day and sleep patterns.
People who are blind can have lifelong sleep problems, because without the ability to detect light, their 25-hour-day body clock cannot adjust to a 24-hour routine.
A study of elderly people who suffered from insomnia showed that if they spent more time during the day in either sunlight or bright fluorescent light, they slept better.

Working with your body clock

  • Get up at the same time each morning, and have a consistent sleep schedule. Big nights out or watching late night sport on television cause your whole sleep system to crash. Late morning sleep-ins may be blissful at the time, but you’re sleeping in wake time and not getting any early sunlight.
  • If you take a nap after lunch, keep it short. A 20-minute nap will increase your alertness for the afternoon. Sleep for longer, and again, you’ll send your clock into a spin. Don’t try to catch up on lost sleep in the afternoon.
  • Don’t go to bed too early. If you do, you’ll have trouble sleeping and confuse your clock. It sets the time when you’ll be ready for sleep according to your daily exposure to light.
  • Lights out as soon as you get into bed.
  • If you’re a night owl and want to reprogram your clock, get up a little earlier each morning – a dose of sunlight will help your clock reset.
  • If you’re an early riser and want to change, go to bed just a little later each night and get exposure to afternoon sunlight.

Step 2: Comfortable conditions for sleep

Use this checklist to investigate your sleep environment and see if you need to make any changes:

  • Is your bedroom a comfortable temperature? (ideally around 18oC). Maybe you need a fan, a heater or an electric blanket.
  • What’s the humidity level like? A humidifier may help if the air is very dry.
  • Have you got enough fresh air? You may need a flyscreen so you can open another window.
  • Is your mattress in good condition, and comfortable?
  • Does the level of noise allow you to sleep? This can be a problem, particularly if you’re a shiftworker and need to sleep during the day. It may be worth trying earplugs. Another option is a white noise generator. This can be very effective in blocking out other noise. White noise consists of many sound frequencies all at the same level (it sounds similar to when your radio is not quite tuned to the station).
  • Is your bed partner disrupting your sleep? This is a tricky one, but a noisy or restless bedpartner (adult, child or pet) may need to be informed about alternative sleeping arrangements.

TIP: If you’re going to sleep in an unfamiliar bed (on holiday, or a trip to hospital), it may help to take your familiar old pillow along.

Step 3: In good shape for sleep

Caffeine
Caffeine is a stimulant, a chemical which increases your level of alertness and arousal and makes it difficult to sleep. So it’s best avoided for at least four hours before bed – this includes tea, coffee, coke and any other caffeine-containing drink or food. For some people this may need to be longer as caffeine can last for up to 12 hours in the system.

Alcohol
Beware the soothing nightcap. While alcohol may initially help you get off to sleep, as it starts to wear off it has exactly the opposite effect and may be a potent cause of insomnia.

Nicotine
Nicotine is another stimulant which prevents sleep. You can’t smoke in your sleep, so nicotine levels drop and the onset of withdrawal symptoms may wake you. This could be another reason to quit.

Exercise
Exercise has been shown to aid sleep enormously. Any exercise helps, but the best time to exercise to improve sleep is in the afternoon.

Bath or shower before bed
A 20-minute bath or shower before bed actually lowers your internal body temperature, and this acts as a signal to your body to sleep.

Hot milk
While you are relaxing in the bath, why not have a hot milk. Milk contains tryptophan, a protein which promotes sleep. The traditional hot milk is also a perfect carbohydrate mix to settle your stomach. If your stomach is overfull or empty, it makes it difficult for you to get to sleep. However, for some people it may be better to go easy on the fluids in the evening to prevent trips to the toilet through the night.

Relaxation
There are plenty of great ways to do this: listening to gentle music, perhaps sex, or a cuddle, or a prayer. Maybe a relaxation or meditation session, whatever works for you.

Progressive muscle relaxation
This is a simple but brilliant technique developed in 1930 by Edmund Jacobson. It teaches us to recognise when our bodies are truly relaxed, and how to quickly and easily achieve this. First we learn how to tense groups of muscles, and then how to relax them. By doing this, we learn to recognise when muscles are tense and when they are relaxed.
Progressive muscle relaxation is a far cheaper, more effective and enduring treatment for insomnia than any sleeping tablet.

In a Swedish study, 22 insomniacs were taught progressive muscle relaxation: 82% reported a significant improvement in their symptoms. This was still evident a year later. In a 1999 study, 80% of people who learned a relaxation technique were able to drop their sleeping tablets.

Step 4: Bed means sleep

This technique is called stimulus control, creating a strong mental link between your bed and sleeping. When you climb into bed, the unambiguous message to your body is that it’s time to sleep and nothing else:

  • Only ever sleep or have sex in bed. No watching TV, eating, balancing accounts or cramming for exams in bed. Even reading in bed can distort the message – read in a comfortable chair until you start to feel drowsy.
  • Don’t get into bed until you’re tired. Listen to the message from your body clock.
  • Don’t make bed the place you worry. Set aside 20 minutes of worry time earlier in the evening. Sit quietly with a pen and notebook. Think about your day and all your achievements.
  • Then think about the loose ends as well as any major worries you might have. Write them all down, and schedule times to deal with them. That way you can remember and plan to deal with them the next day, not in an hour’s time when you want to sleep (this may not work for everyone and you may need to learn some problem-solving techniques).
  • Don’t spend longer than 15 minutes in bed trying to go to sleep, or lying awake. Get up. If possible, go into another room. Sit and listen to music, have a bath or a hot drink, read a book. Enjoy the time. If you are worrying, add those worries to your list. Wait till you feel sleepy to get back into bed. And you guessed it – if you get back into bed and sleep still defies you after 15 minutes, get up.
  • Wind down with a pleasant routine before bed. Give your body a clear message that you’re getting ready for the time of day when you sleep: with the bath, the hot milk, the relaxation session or ten minute read in your chair.
  • Get up at the same time each morning.

Step 5: Don't be anxious

If you get anxious about sleeping, there is no way you are going to drift off. You’ll be alert and awake due to the heightened anxiety. This is the pivotal problem with insomnia – you can be your own worst enemy.

There’s plenty you can do, however, to resolve this. First, learn a relaxation technique. Second, uncover and question your ideas and beliefs about sleep.

Studies have shown that people with insomnia often have inaccurate ideas about sleep which can be anxiety-provoking. Often you have nurtured these ideas for years, and they will try to creep back in the dead of night. But this is the step which really treats the foundations on which so much of insomnia rests.

Some examples of commonly held myths about sleep are:

  • I need to sleep for at least 8 hours a night

Everyone is different in the amount of sleep they need. Most need between seven and eight hours a night, but anything from five to 10 is normal.

  • To achieve the amount of sleep I need, I must lie in bed for longer

Lying in bed for longer only reinforces bed as the place you lie awake rather than sleep. Get up if you are lying awake longer than 15 minutes.

  • I’m not getting much sleep

People tend to underestimate the amount of sleep they get. Try keeping a sleep diary, a rough record of when you sleep during the day and night. You may surprise yourself and find you’re getting more sleep than you think.
TIP: Turn the alarm clock or clock radio around so you can’t see it. Nothing will make you more anxious about your sleep than counting the hours. The only exception is, obviously, if you are anxious about getting up in time for something like a plane or train.

Step 6: Underlying illness?

There are a number of people who suffer from insomnia as a result of a sleep disorder. If you think your insomnia might be caused by any of the following sleep disorders, you must see your doctor. Once you’ve been treated, steps 1-5 may still provide added benefits for your sleep.
An underlying medical condition can also cause sleeping problems.

Some medications may be another cause, click here to view a list of these.

Sleep disorders

Narcolepsy
This disorder which affects 1 in 2000 people is a malfunction in the part of the brain that decides whether you’re awake or asleep.
People with narcolepsy suddenly fall asleep without warning while carrying out their usual daytime activities. These sleep attacks can be frequent and last from seconds to 30 minutes. Narcolepsy sufferers may also experience sudden loss of muscle control associated with strong emotion, and vivid dreams. More information is available from the Sleep Foundation.

Parasomnias
These conditions interrupt sleep and are very disturbing for sleep partners. They include sleep waking, sleep talking, night terrors and rapid eye movement (REM) disorder. In REM movement disorder the sleeper acts out dreams which, in the confines of the bedroom, can be dangerous.

Restless leg syndrome
This is a common and distressing condition which affects sleep. Sufferers experience unpleasant crawling or prickling sensations in their legs which get worse when lying still. More information is available from the Restless Legs Foundation.

Breathing-related sleep disorders or sleep apnoea

People with sleep apnoea literally stop breathing for periods of around 10 seconds hundreds of times a night. Each time they actually wake a little, leading to a disturbed and unsatisfying night’s sleep. They usually complain of feeling really tired through the day, dropping off to sleep, and lack of concentration. Their partners really complain about their terrible snoring (although occasionally this condition can occur without snoring).
Sleep apnoea is a potentially dangerous condition which is important to diagnose and treat. The Sleep Foundation has more information.

Medical conditions that may affect sleep

  • Depression: this is an illness and does not necessarily relate to something bad or sad having happened. It’s probably the most common medical condition which affects sleep. If you’re suffering from a depressive illness you may also notice an increase or decrease in appetite, feeling demotivated, not looking forward to anything, feeling black, crying easily, suicidal thoughts.
  • Pain: from arthritis or any other condition
  • Heartburn or stomach ulcers
  • Bladder problems
  • Chronic fatigue syndrome
  • Asthma
  • Constipation
  • Parkinsons
  • Dementia
  • Angina at night
  • Stroke
  • Itchiness

Medications that may cause sleep problems

  • Methyldopa (blood pressure)
  • Beta blockers (blood pressure and heart)
  • Diuretics (fluid tablets)
  • Cimetidine (ulcer tablets)
  • Antidepressants
  • Amphetamines (diet tablets)
  • Cortisone tablets
  • Levodopa (Parkinsons tablets)
  • Clonidine (blood pressure)
  • Ventolin (asthma)
 

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