Do you struggle to get a good night’s rest? In the wake of the coronavirus, millions more are reporting trouble sleeping — so much so that renowned consultant neurologist and sleep expert Professor Guy Leschziner believes we are on the brink of a global epidemic of sleep problems, as he warned on Saturday in the first part of his guide to help you beat insomnia.
Whether your struggles with sleep are caused by stress, lifestyle changes, illness or are a symptom of long-Covid, there are many steps you can take to significantly improve your sleep — and pills are usually not the answer.
We learned in yesterday’s Mail On Sunday how cognitive behavioural therapy techniques coupled with strategic sessions of controlled sleep deprivation can bring impressive results, helping to retrain your brain to view your bedroom as a haven of nourishing rest.
But your lifestyle may also be contributing to your problems. In the third part of our series, Professor Leschziner helps you to identify your personal ‘sleep saboteurs’ — and offers his expert prescription of practical tips to help you transform your sleep for good.
Professor Guy Leschziner (pictured), who believes we are on the brink of a global epidemic of sleep problems, shared his expert advice for a peaceful night
Often, when they hear I am a sleep doctor, people will ask me what the ‘one thing’ they can do to improve their sleep is. It’s never as easy as that: drinking chamomile tea or lighting a lavender candle will not change your life, and what will help one person may have no impact on another.
And yet, there are multiple little changes we can weave into our daily lives that will mean we’re more likely to drift off.
Today, I’ll share a number of practical steps you can take to help you sleep well and wake feeling refreshed.
But first you need to understand what obstacles are in the way of you having a good night’s sleep. Sleep is a very complex beast, with physiological, behavioural, psychological and environmental factors.
So you need to examine every aspect to find the root of your sleep issue. Then, you can address these factors — making a better night’s sleep much more likely in the long term. Start by asking yourself these questions…
WHAT IS YOUR BODY DOING?
Physical issues are surprisingly frequently behind a patient’s insomnia, and once they are diagnosed and treated, improving their sleep can be (sometimes) gloriously simple.
A typical example is a woman in her 30s I saw who had great difficulties getting off to sleep due to restless legs syndrome (RLS).
Professor Guy Leschziner said 50 per cent of people with insomnia also suffer from mental health concerns, including anxiety and depression (file image)
It is surprising how few patients with restless legs attribute their sleep issues to this symptom. They will usually complain of sleep problems without mentioning this terrible urge to move, which is often accompanied by tingling, buzzing ‘like bees inside the skin of your legs’, pain or cramp.
Symptoms worsen at night, and when the sufferer does fall asleep, they often wake themselves by involuntarily kicking and twitching in sleep.
Studies suggest it affects roughly one in 20 adults, many of whom go for years without a proper diagnosis — partly because it is only recently that the phenomenon has become widely accepted, and partly because in some the symptoms may be subtle, or pain may be the predominant symptom, which means RLS can be misdiagnosed as cramps, for instance.
RLS is often genetic or exacerbated by medications, but it is also linked to low iron levels. In my patient, blood tests revealed exactly that: while her levels of iron were not sufficiently low to cause anaemia and therefore had not been picked up, they were enough to precipitate RLS.
SHOULD YOU USE A SLEEP TRACKER?
The desire to examine every aspect of our activity has grown — and there are ever more devices promising to turn your activity into easy-to-read data.
But is this good for you? When it comes to sleep tracking, I think not.
Even monitoring brainwaves in a lab may not give us a comprehensive representation of sleep. EEG (electroencephalography) — the gold standard for measuring sleep — tells us only what is happening on the surface of the brain. So what hope is there for a device on your wrist?
The greatest impact these trackers have had is on increasing rates of a condition known as orthosomnia — where people become obsessed by their sleep and diagnose themselves with sleep disorders based on their sleep tracker’s data.
Treatment of her very heavy periods and iron supplementation resolved her RLS and restored her sleep.
As with sleep apnoea (where the tissues in the airway collapse during sleep, temporarily cutting off air flow — see tomorrow’s Mail), restless legs can be detrimental to your health. This is because the tendency of these conditions to cut into deep sleep means they are more associated with other illnesses developing, such as type 2 diabetes and heart trouble.
IS YOUR MOOD UNDERMINING SLEEP?
As I explained in Saturday’s Mail, 50 per cent of people with insomnia also suffer from mental health concerns, including anxiety and depression or post-traumatic stress disorder (PTSD). The two can reinforce each other in a spiralling vicious circle.
Early morning waking is often a feature of depression. PTSD can cause recurrent nightmares, waking you in the night and leading to anxiety around sleep. Anxiety at night-time is an obvious preventer of sleep.
Ironically, if you’re sleep-deprived, you might feel more awake. This is because it increases levels of the stress hormones adrenaline and cortisol. That is one of the reasons why those with chronic insomnia will often say, ‘I feel tired but extremely wired’.
It’s no wonder that many patients plagued by severe insomnia also suffer some form of anxiety, with all of the whirring thoughts and physical ‘nerves’ associated with it.
Treatment with relaxation therapies, mindfulness, cognitive behavioural therapy (CBT, which aims to change the way you think about problems) and sometimes anti-anxiety medication can lead to vast improvement.
WHAT’S GOING ON AROUND YOU?
The perfect example of environmental influences on sleep disturbance was a young man I saw who was troubled by sleep-walking and sleep-talking, causing his partner to complain about disturbed nights and occasional aggressive behaviours.
On questioning the two of them, it emerged their flat was next to a busy road and his partner would note that a particularly noisy lorry or motorbike would trigger an episode.
Professor Guy Leschziner said eating very late at night and taking in too much caffeine late in the day are obvious yet so often overlooked sleep-snatchers (file image)
I suggested the man try wearing earplugs at night — and this simple step soon resulted in a huge improvement in his night-time events.
So consider what might be wrong in your bedroom set up. Is it too hot, or too cold? Is it noisy? Is there too much light, perhaps a streetlight stands outside your window?
WHAT ARE YOU DOING WRONG?
There is so much we can do to give ourselves the gift of good sleep, and so much we unwittingly do to rob ourselves of it. Things like eating very late at night, taking in too much caffeine late in the day, or propping our eyelids open in front of bright screens in the evening are obvious yet so often overlooked sleep-snatchers.
This was highlighted in the case of a teenage boy I treated who was having increasing difficulties getting to sleep and was beginning to find he was unable to wake up in time to go to college.
His body clock had shifted to a much later body rhythm, resulting in him missing lessons in the mornings and being rather sleepy.
It turned out he was spending his evenings playing on his computer until fairly late. By stressing the need to limit light exposure after about 9pm, by encouraging relaxing activities such as reading or listening to music before bed, and by suggesting exposure to daylight in the mornings, he was able to get his body clock gradually moved forward, allowing him to sleep earlier.
For more on how you can set yourself up for a better night, see the panel above.
Once you’ve identified your personal sleep saboteurs, use this as a guide to prime your day to lead into a good night’s rest.
TEN STEPS TO A PEACEFUL NIGHT
Use these simple ten rules to prime your body for a great night’s rest.
1 SET A WAKE-UP TIME
It doesn’t matter what time, as long as it’s the same every day, even on weekends, and it’s around eight hours after your bedtime (to ensure you’re not depriving yourself of sleep by spending too little time in bed). The brain loves routine, and ensuring you have a solid bedtime and wake time will prime your body to sleep on schedule.
Daily exercise will help tire the body and send more oxygen and endorphin-rich blood to your brain, potentially boosting mood and meaning a less anxious mind. A less anxious mind is one far less prone to have trouble sleeping. For some, an evening exercise session can be too stimulating, so try to exercise earlier in the day.
3 GET OUTDOORS
If you get that daily exercise outdoors, all the better! Even a walk will do: the key thing is taking the opportunity to absorb natural light during daylight hours. We are all children of the sun, and exposing ourselves to sunshine (even through cloud) tells the cells in our body that it is daytime, which also helps them recognise that when the light dims, it is night-time — strengthening our circadian rhythm. Position yourself near a window while working so you can get all the benefits of daylight at your desk.
4 EAT LESS BEFORE BED
Having a large, carbohydrate-rich meal in the evening can not only cause uncomfortable acid reflux, but may also trigger the production of more insulin to mop up sugar from the blood. This can then encourage rebound low blood sugar at night and cause the release of stress hormones, which can be detrimental to sleep.
5 NO AFTERNOON BREW!
you should stop consuming caffeine after lunch. Caffeine keeps you awake by blocking receptors in the brain from detecting the sleepiness hormone adenosine, and six hours after taking in caffeine half of it is still circulating in the body. So keep it for mornings only.
Any sort of relaxation technique will work nicely to settle the mind and create an aura of calm before bed. Meditation, mindfulness, a slow yoga routine or slow breathing exercises for five to 15 minutes will all reap benefits.
7 HAVE A SOBER SUPPER
IF your sleep is not great, it is best to avoid alcohol in the evening. While many people think alcohol has sedative effects, a drink-induced slumber will not be a good quality one. Sleep is more likely to be disrupted and alcohol can exacerbate symptoms of sleep apnoea.
8 NO LATE CIGARETTES
I’m not going to ask you to give up smoking, even though it is obviously better for your health to do so. But I am going to suggest that if you do smoke, you avoid it within half an hour of bedtime. Nicotine is a stimulant and will stop you nodding off. Smoking can also cause inflammation in the throat and worsen sleep apnoea.
9 SCREEN-FREE READING
Read a book, listen to music, or do something that doesn’t involve bright lights or screens for one to two hours before bedtime.
Light exposure at night inhibits the secretion of the hormone melatonin, which regulates your sleep. This can delay your sleep phase, making you want to sleep later and wake later.
But it’s not just the light, it’s also what we are doing on our gadgets that matters. Watching some exciting film, or getting irritated by something we’re reading on Twitter, is not going to be particularly conducive to a good night’s sleep.
10 UPSTAIRS & LIGHTS OUT
One central element of ‘sleep hygiene’ is to use the bed for nothing but sleep (and sex). We want you to have an almost Pavlovian response to bed — to see your bed and feel overwhelmed with a desire to close your eyes and sleep.
So don’t spend time in the bedroom during the day, if you can help it. Fit blackout curtains, keep good quality sheets clean and the duvet tog right for the season, use low lights, get under the covers… and switch straight off.
Now listen to my podcast: How To Sleep, by Guy Leschziner — your questions answered. Available exclusively for Mail readers at MyMail.co.uk