Sleep problems

What are they?
What are the main symptoms?
What's the risk?
What causes them?
How can I prevent them?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help?

What's it like? (real comments from real people)
Have your say about sleep problems

What are they?

There are a wide variety of sleep problems, the most common of which is insomnia – the inability to get sufficient sleep. Other problems include snoring, sleep apnoea (a condition in which the airway becomes temporarily blocked during sleep) and narcolepsy (an inability to stay awake). There are also sleep problems associated with shift work and jet lag.

The bulk of this section tackles insomnia, but there is also information on snoring and sleep apnoea, narcolepsy, and shift work and jet lag.

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What are the main symptoms?

The symptoms of insomnia include:

• Being unable to fall asleep within 30–40 minutes of going to bed
• Using pills or alcohol to get to sleep
• Waking frequently during the night
• Waking too early or waking up feeling unrefreshed

Insomnia can, in turn, cause a variety of physical and mental health problems.

How much sleep do I really need?

Why we need to sleep

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What's the risk?

• Most people experience an occasional sleepless night. Short-term insomnia, which affects 20–30% of the population each year, can last for two to three weeks.
• Chronic insomnia that lasts for weeks, months or even years is estimated to affect up to 15% of the population.

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What causes them?

The causes of insomnia are numerous and not always immediately obvious. Analysing your health, environment and lifestyle should reveal the source of the problem and how to treat it.

• Psychological factors: stress, worry, anger and grief are common causes. Studies suggest anxiety and depression contribute to up to 80% of cases.
• Medical conditions: pain commonly disturbs sleep, as do heart disease, breathing problems, sleep apnoea, digestive problems, high blood pressure, restless leg syndrome, arthritis, anorexia, and chronic fatigue syndrome (also known as M.E.).
• External factors: noise, light, heat, cold, discomfort, shift work and jet lag all have effects too.
• Drugs: some prescription drugs such as diuretics, certain beta-blockers, appetite suppressants and large doses of steroids can cause sleep problems. Street drugs such as heroine, cocaine, amphetamines, LSD, cannabis and Ecstasy also interfere with sleep quality.
• Lifestyle: lack of bedtime routine, too little exercise, poor eating habits, cigarettes, alcohol and caffeine all disturb your sleep.
• Age: Sleep becomes lighter and shorter as you age. Health problems in later life may also cause insomnia.

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How can I prevent them?

How you sleep at night depends greatly on what you do during the day. Try to eliminate all possible disruption to sleep by following the guidelines in "How can I help myself?"

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Should I see a doctor?

• If you are depressed, a common cause of sleep problems, you should see your doctor.
• Insomnia usually responds well to self-help, but if you still aren't sleeping after trying the advice in "How can I help myself?" then see your GP. He or she can check if your insomnia is caused by a physical illness, prescribed medicine or emotional problems.
• If your sleep has been disturbed for more than a month, has no known medical cause and interferes with your ability to function normally during the day, ask your doctor to refer you to a sleep disorders clinic.

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What are the main treatments?

• Improving "sleep hygiene". Sleep scientists see insomnia as a symptom of an unhealthy lifestyle. The first step therefore is often to clean up your daily routine using a set of self-help guidelines. Sleep hygiene is usually recommended before pills or more radical approaches are suggested. See "How can I help myself?"
• Melatonin. This is a natural hormone released by the pineal gland to help regulate the body's circadian rhythm. A synthetic form is available as a food supplement and it has a rapid, mild, sleep-inducing effect, helpful for shift workers, people with jet lag or those whose insomnia is related to disturbed body rhythms. Melatonin is suitable only for healthy adults who take no other medication and who have no history of psychiatric disorder. In the UK it is available on prescription to named users, which means you can only get it if your GP is willing to prescribe it.
• Biofeedback. This relaxation technique can help if you are kept awake by stress or anxiety. Medical monitoring equipment is used to measure how your heart rate, blood pressure, muscle tension, skin temperature, sweat and blood flow respond to stress. The idea is that you can recognise when you are tense and learn to relax. The benefits are similar to any other form of relaxation technique, but the equipment helps to convince relaxation sceptics.
• Sleep restriction therapy. Sleep clinics sometimes use this radical approach to re-establish healthy sleep habits. Sleep restriction therapy is simple in theory, but it takes discipline to put into practice.
• Sleeping pills and anti-anxiety drugs (usually benzodiazepines or sometimes Zopiclone) can be an effective quick-fix for short-term or occasional insomnia if no other immediate remedy is available. But they do not cure sleep problems, they work for only a few weeks, they tend to make you tired and irritable the next day and they are addictive. They are generally best avoided except in exceptional circumstances.
  How sleeping pills work
  If you have chronic sleep problems, effective treatment will depend on resolving the underlying cause of the problem. Much better help than pills is available, if you demand it.

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How can I help myself?

Making simple changes to your lifestyle and bedtime routine is the basis of "sleep hygiene", one of the main strategies employed by sleep disorder clinics. You won't need to do all of the following recommendations, just start with those you think would be most helpful. If they don't help, try others. Persevere and you should find what works for you.

• Create a sleep sanctuary
  Keep your bedroom for sleep and sex only, not for working, eating, telephoning or watching television. Your room should be quiet, dark and warm, but not too hot – a temperature of around 18°C (65°F) is most conducive to restful sleep. Hang heavy curtains if you are disturbed by light. Soft ear plugs can block out noise.
• Buy a good bed
  You spend about a third of your life in bed so make sure yours is comfortable. A good bed should support your back while allowing your spine to settle into its natural slight "S" shape when you lie flat. It should also be less than ten years old. A French survey reported that even chronic poor sleepers slept better and for almost an hour longer in a new bed compared with one that was ten years old.
• Change your diet
  The basic rules of healthy eating form the foundations of a sound sleep diet. So go for fresh wholefoods, plenty of vegetables and regular light meals. Timing is also important: eat your evening meal at least two hours before bedtime. If you get the munchies later at night have a lettuce, banana, or peanut butter sandwich, or a bowl of cereal. All of these contain the amino acid tryptophan which helps your body produce the sleep hormone melatonin. A warm milky drink has a similar effect or try a relaxing herbal tea such as camomile or lime flower.
• Avoid stimulants
  Cut out or cut down on all stimulants such as cigarettes, alcohol, food additives, junk food and caffeinated drinks. If you have mild insomnia avoid coffee after 2 pm – if it's serious don't drink it at all. Reduce your intake slowly as sudden withdrawal may temporarily worsen your sleep. A cigarette at bedtime is even worse than a cup of coffee. Even in heavy smokers a late-night cigarette can delay sleep by 30–40 minutes.
  Alcohol and sleep
• Get active
  Two things guaranteed to send you to sleep are physical tiredness and monotony. Exercise can deliver both. Regular gentle exercise such as a swim, walk or one of the soft martial arts can help you get to sleep quickly and sleep more deeply when practised early in the day. Regular exercise also makes you feel good, and can prevent snoring and sleep apnoea by improving breathing, toning slack muscles and reducing body weight.
• Ease the pressure
  Keep your mind and body as relaxed as possible throughout the day. Give yourself time to do what you need to do, and learn to say no to unrealistic demands. Talk through problems with a friend, colleague or your partner. Make time to have some fun in your life and learn to relax. You may simply need some "quiet time" each day, or you could practise a relaxation technique such as meditation. One research study showed insomniacs who combined meditation with sleep hygiene techniques fell asleep 77% faster than previously.
• Establish a pre-sleep routine
  Only someone who was exhausted or suffered from narcolepsy would fall asleep without some sort of preparation. Make a cut-off point between day and evening at least an hour before bedtime. If you find it hard to switch off, write down what's on your mind, then forget about it. Go for a stroll, read something unrelated to work and/or have a bath. Warm water is relaxing and it raises body temperature so that you feel sleepy. Add 6–8 drops of an essential oil such as lavender, camomile or sandalwood for extra sedative effects.
• Reinforce your body clock
  If you only change one thing about your lifestyle, make it this one: go to bed at the same time every night and get up at the same time every morning. This helps to regulate your circadian rhythm, the internal biological clock that governs your sleep/wake cycles. Aim to go to bed before midnight to maximise the deep sleep that occurs early in the night and get up early every morning, even if you've had a late night. Research has shown that shifting your sleep pattern by only three hours – say, going to bed at 1 am rather than 10 pm – can cause poor daytime mood and performance, even if you get eight hours' sleep.
• Try a sleep remedy
  Herbs such as valerian, hops, passiflora, oats or kava can make safe and effective sleep remedies. Products vary in safety, quality and potency, so treat all remedies, even natural ones, with care, and only take them for as long as you need to. Antihistamine-based over-the-counter sleeping pills are also useful, non-addictive, short-term remedies.

Daytime napping is not recommended as it disrupts your natural sleep pattern. However, there are exceptions to this rule:

• Powernaps, quick 10–15-minute snoozes, can make those short of sleep more alert if they nap about eight hours after waking in the morning (during the afternoon sleepy period). Taking a nap 10–12 hours after waking is likely to disturb night-time sleep.
• For shift-workers, long-distance lorry drivers and parents of young babies, frequent naps may be the only way to get any sleep. Nap only until you can get back to a regular routine. Regular hours of sleeping and waking are the best way to ensure that you get the sleep you need.

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What's the outlook?

If you follow the sleep hygiene guidelines, and get professional help if you need it, there's an excellent chance that you can overcome your insomnia.

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Who else can help?

British Snoring and Sleep Apnoea Association
Web site: www.britishsnoring.co.uk
52 Albert Road North,
Reigate RH2 9EL
Tel: 01737 245638,
Fax: 01737 248744
E-mail: marianne@britishsnoring.co.uk

Narcolepsy Association
Web site: www.narcolepsy.org.uk
PO Box 68
Lewes BN7 2UK
Tel: 0845 4500 394
E-mail: info@narcolepsy.org.uk

Sleep Matters Medical Advisory Service
Tel: 020 8994 9874

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By Sheila Lavery, a freelance health writer and author who writes for numerous national magazines and newspapers, including Zest, The Sunday Times and The Express. She has also written several books, including The Healing Power of Sleep. She is a member of the Guild of Health Writers and the Society of Authors.

Have your say about sleep problems

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