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Health

Are You Getting Enough Sleep?

Your Questions Answered

Mehtab Ghazi Rahman

A Quick Quiz
Does it often take you hours to get to sleep at night, however hard you try? Do you find that you wake up in the middle of the night, and cannot go back to sleep again? Do you wake up very early in the morning, even when you don't want to? Has anyone commented that you are irritable and annoyed after you wake up every morning? Do you start feeling drowsy during mid-day, when your colleagues are buzzing? Do you wake up from sleep when someone makes the slightest noise in the bedroom?

If you have answered 'yes' to three or more of the above questions, it is highly likely that you are sleep-deprived. Insomnia is a medical condition that means an impaired natural sleep-cycle.

The Importance of Sleep
Why is sleep so important for us? This is because sleep is the state of consciousness which enables our tired bodies to rest and build energy for the next day, i.e., it is the time the body recharges itself. But that's not all during sleep, our immune system carries out a large number of its functions at the greatest rate, such as fighting off infections and other diseases. When you sleep, your brain starts 'filing and organising' the events that have occurred during the day. In fact, it is during sleep that many of your memories are stored into your 'hard drive'. Hence, if you are not sleeping well, it makes you feel tired, lethargic, drowsy, irritable and easily confused, while making you more susceptible to illness and have poor memory, thus affecting your mental and physical well-being.

Normal Sleeping Hours
So, how many hours of sleep is considered 'normal'? Every individual is different, so it is difficult to say what is 'normal' for you. But as reference, it is normal for newborn babies to sleep more than 16 hours a day, and for young children of school-going age to sleep upto 10 hours a day. Teenagers and adults normally require 7-9 hours of sleep per night. Those above 70 require less sleep, with 6 hours being the normal sleeping time.

Diagnosing a sleeping problem
If you have answered yes to some of the questions I asked in the beginning and suffer from poor sleep, then this article should be helpful to enable you to sleep better.

Insomnia is classified according to the number of days that a person has poor sleep for. Some insomnias only last for 2-3 days (transient insomnia), some more than 3 days but less than 3 weeks (short-term insomnia) and some most nights for 3 weeks or longer (chronic insomnia). Chronic insomnia is worrying as it leads to a number of mental health problems such as depression, and may lead to alcohol or sedative addiction in order to gain sleep.

Causes of Poor Sleep
* Physical problems such as arthritis, headaches, back pain, hot flushes (in menopause), gastric problems (acidity and reflux), itchiness and Parkinson's Disease usually cause sleeping disturbances. If these are causing you trouble to sleep at night, it is best to take advice from your doctor as the cause of these physical symptoms must be alleviated before your sleep can return to normal.

* Physiological problems such as noise, too much light, sharing a bed with a partner who moves about a lot or snores very loudly, or doing stimulating activities such as reading or exercising immediately before going to sleep causes poor-slumber.

* Psychological symptoms that may cause sleep problems include relationship problems with your partner, stress (work/academic), bereavement of a close one and anxiety. I have met patients who developed insomnia simply because they were worrying too much during bed-time about how little sleep they were getting, rather than using this time to catch up on lost sleep!

* Finally, a common cause of sleep disturbance is side-effects of common medications. Antidepressants (medications for depression), decongestants (medication to unblock your nose during colds), too much thyroid hormone, beta blockers (for high blood pressure) and corticosteroids reduces the quality of sleep.

A Helping Hand
In order to get your sleep back to normal, the most important thing to do is determine what is causing the poor sleep. For example, if you are sleeping poorly because you get acidity after meals at night, your insomnia will not go until you get the acidity treated first. Similarly, if you share a bedroom with a room-mate who is noisy or active when you are trying to sleep, it will hinder your sleep. If you are a hard-working student who has stayed up all night for an exam, don't expect your sleep to return back to normal the next day. It takes time for your body to adjust to changes to your sleeping patterns and balance your 'sleep hormones' before your sleep cycle becomes normal again.

In the UK, non-medical interventions are the first line of treatment for insomnia. Treatments include counseling for those who have had a bereavement or going through stress, cognitive behaviour therapy to alter behaviour and negative thinking patterns, keeping a sleep diary and lifestyle advice.

Unlike in Bangladesh, British doctors are reluctant to prescribe sleep-inducing medications to patients because these only relieve the symptoms but not the cause of the poor-sleep itself. Sleeping pills also have a large number of side-effects, and patients can easily become addicted to them. However, some doctors do prescribe short acting 'benzodiazepenes' to patients with acute sleeping problems for a short-term, such as those who have had surgery or an accident and cannot sleep due to intense pain.

If you are currently taking sleeping tablets, then make sure you take it at night before going to bed, as sleeping pills makes you drowsy and thus more prone to accidents. The only long-term indication for sleeping pills is 'chronic insomnia', in which a person is unable to sleep well for more than three weeks.

What is the best way of improving you sleep? A good night's sleep takes only a few simple steps. Follow these, and I can assure that your sleep will dramatically improve over time :

1. Have a specific wake-up and sleeping time in your mind every day. Stick to these times seven days a week, even if you struggle to successfully wake-up and sleep at the planned times. Doing this will eventually train your body to reset its own natural sleeping rhythm (called the 'circadian' rhythm).

2. Don't waste time lying on your bed trying to force yourself to sleep. Go to bed only when you are tired and sleepy. Let your body crave for sleep. This practice teaches your brain that the bed is for sleep only, not for procrastination.

3. Try to set up a pre-sleep routine. Have dinner, watch some relaxing television programmes, have a glass of warm milk prior to going to bed. Doing these everyday before going to sleep makes the brain associate these activities with sleep, and will naturally cause drowsiness when you repeat them for a few days.

4. If going to sleep at night is difficult, ensure that you do physically demanding activities throughout the day, especially in the early evening. Do not take naps in the afternoon if sleeping does not come easily at night.

5. Make sure you put off your lights before going to sleep. If it is difficult to make your room dark, try wearing an eye-mask.

6. Do not watch television, make phone calls, eat or study while lying on your bed. This confuses the brain and makes it associate the bed with high-energy activities rather than sleep.

7. If you are a worrier, stop spending hours lying down in darkness worrying about things that you have to do tomorrow. Write down all your worries on a piece of paper and keep it on your bedside table. Tell yourself you shall deal with the problems the next day, and forget about them until the morning.

8. No tea, coffee, chocolates or caffeine-containing food at least five hours before your sleeping time.

9. Alcohol and cigarettes are 'stimulants' they wake up your brain and stop it from relaxing. Alcohol may make you sleepy initially, but as soon as the effect of alcohol has worn off, you will wake up again.

10. Do not eat large meals or very-spicy food for dinner, as these may cause gastric reflux, bloating and discomfort. Eat sleep-inducing foods such as fish, bananas and warm milk.

11. Ensure your room temperature is comfortable. Wear cool, light clothes in hot summer nights and cover yourself with a cosy blanket or quilt in a shivery, winter night.

12. Have a mattress that is neither too soft nor too hard. A poor mattress is bad for you back and causes back-pain, making your sleep worse.

13. If you have tried to go to sleep for 30 minutes or more without success, it often makes you quite anxious as you start wondering why you cannot go to sleep. If this is the case, get up from bed, go to another room and distract yourself by reading a magazine or looking outside the window for a while, then try going to sleep again.

14. Do not stress yourself by constantly counting your sleeping hours, such as thinking “It's one in the morning, and I have to wake up for office at seven.” This adds stress and makes you anxious, making it even harder to relax yourself. Sleeping for 5 hours with a relaxed mind is many times better than sleeping for 10 hours with a stressed and anxious mind.

The methods mentioned here have been tried and tested by millions across the world, and there is no reason why this will not work for you. Be positive, but don't expect miracles overnight. It takes three-four weeks for your body and mind to get used to sleeping routines, so be motivated, patient and hope for the best. Remember, a night of poor sleep today means a miserable, glum day tomorrow. If, however, none of these tips work for you, definitely go and see your doctor. The Sleep Council, www.sleepcouncil.com, offers an extensive range of information on all types of sleep disorders and ways of tackling them, so please do visit the site if you require further information. Until then, have a good night!

(The author is a graduate of the Human Bio-Medical Sciences from the University of London, and is currently a finalist student-doctor at St. Bartholomew's and the Royal London Medical School, UoL)