Achieving better sleep: a patient’s guide

Sleep problems are common and affect a large proportion of people at some time in their lives. One question often asked is, “How much sleep do I need?” – for which there is no straightforward answer.

Individuals vary in their sleep requirement and the amount of sleep needed varies during a lifetime. The popular belief that we all need seven to eight hours sleep each night is not true. Age can affect the amount of different types and quality of sleep we have. As we get older sleep can become lighter and more broken. Whatever your age, your sleep should usually be refreshing.

Sleep is a passive process; you cannot make yourself fall asleep. Neither is sleep like a light bulb, either off or on.

Sleep flows through different stages including light sleep, deep sleep and dreaming sleep throughout each night. Stages of sleep can be thought of like a staircase. As you descend your sleep deepens and as you climb up the stairs your sleep is lighter. During each night you will travel up and down the staircase a number of times.

It is useful to recognise that some short periods of wakefulness during the night are normal. During times of stress or anxiety a series of poor night’s sleep is not uncommon; this will often pass after a few days.

Good sleep habits (sleep hygiene)

This is the term used to describe how your sleeping environment and the things you do during the day can influence your sleep, or can be changed to promote better sleep.

Body rhythms

You will find your body responds more positively when regular daily routines are maintained. Therefore regular bed times and get up times are important. Your body will then be ready to sleep at bedtime. You are likely to sleep better overall if you can maintain a steady pattern, the following points are key to this:

• Do not nap during the day. This can upset your body’s routine and make it harder for you to sleep well at night as your body has already had some of its daily sleep requirement.
• Always get up and go to bed at the same time seven days a week. This is important no matter how ever short your time asleep. An alarm clock is helpful to maintain this; you must resist any temptation to lie in. You should not use weekends to catch up with sleep as this will upset the rhythm your body has become used to during the week.
• Spend sufficient time in bed each night. Your bedtime and get up time should allow adequate time for you to have sufficient sleep generally to feel refreshed on waking, and alert through the day. Sleep deprivation can lead to you feeling tired and/or sleepy, as well as affecting your mood and concentration. However, you should not spend excessive amounts of time in bed if you are sleeping poorly, but continue your regular routine. The purpose of this is to encourage your body to rest at the right time.

Sleeping environment

Your bedroom should be a place where you feel comfortable and at ease. It is important to establish a relaxed environment away from daytime activities. The tips below will help you to reinforce to your body that your bedroom is where you sleep:

• It should be dark with good curtains to prevent early morning sunlight coming in. An eye mask can be helpful.
• It should be quiet. Earplugs can be useful if your bed partner is restless or snores, or if you are sensitive to outside noise.
• Your bedroom should be neither too hot nor too cold.
• You should consider changing your bed if it is old or uncomfortable.

Avoid distractions

Don’t use your bedroom for stimulating activities such as work, eating or watching television. Televisions emit bright light and noise which can stimulate your brain and stop you falling asleep or affect the quality of your sleep.

Don’t be tempted to watch the clock. Turn your clock away and set the alarm. Watching the clock can increase anxiety about sleep, therefore making it harder to settle down to sleep.

Before bedtime

• Caffeine (eg coffee, tea, cola, Redbull) – Moderate caffeine intake during the day is unlikely to disrupt your sleep. However, it is a long lasting stimulant which can remain in your system for several hours and disrupt your sleep later in the night if taken in excess. It is best not to consume caffeine after 17:00 (5pm).
• Smoking – Nicotine is also a stimulant and can affect your sleep in the same way as caffeine. It will help if you try not to smoke close to bedtime or during the night.
• Alcohol – Alcohol consumed in large amounts can help you feel relaxed and sleepy, however, it fragments your sleep.
• Food – Going to bed hungry makes you want food and keeps you alert. Eating a large meal close to bedtime can make you feel uncomfortable.
• Exercise – Regular exercise is one of the best ways to maintain general good health and wellbeing. However, exercising too close to bedtime (within three hours) can stimulate your body and mind. Even if your body feels tired, your mind may remain active for some time whilst your body winds down.

Summary

Do

• Establish and maintain regular bed and get up time, seven days a week.
• Ensure your bedroom is a comfortable, quiet and relaxing place.
• Exercise regularly during the day.
• Ensure you spend adequate time in bed seven nights a week.
• Remember that sleep requirements change over a lifetime.
• Remember that waking up for short periods is normal.

Don’t

• Don’t consume caffeine after 17:00 (5pm).
• Don’t drink excessive amounts of alcohol close to bedtime.
• Try not to smoke close to bedtime.
• Don’t exercise within three hours of bedtime.
• Don’t go to bed hungry or within two to three hours of a large meal.
• Don’t nap during the day or evening.
• Don’t lie in during weekends.
• Don’t use your bedroom for anything other than sleep and sexual activity.

These tips, if taken on board as a whole and followed closely, have been shown to help people sleep better. However, they sometimes take time and hard work before the benefits are enjoyed.

Finally

If you feel that there is anything specific that is causing you to sleep poorly, a medical condition or medication for example, talk to your doctor. Common causes of poor sleep include stress, anxiety, low mood and pain; treating any underlying condition may well help improve your sleep quality.

With thanks to Papworth Sleep Centre.