Most of us will spend more than a third (36 per cent, to be precise) of our entire lives asleep — and the fact that our biology drives us to sleep shows that it provides us with something of profound importance.
Indeed, while sleep may appear to be a time of total inactivity, it’s when some key and essential biological processes occur, including turning food into energy reserves, making more enzymes that will be needed the next day for activity, and processing the toxins that build up as the by-product of activity, as well as tissue repair and growth.
In the brain itself, it’s when our memories are consolidated and we create new ideas.
In short, without sleep, our ability to function and our health can deteriorate rapidly. So instead of trying to squeeze more into our days and nights, and seeing sleep as a burden or even an enemy, we should be making a good night’s sleep a top priority, as important as a healthy diet and exercise.
Today, in the fourth part of my series for the Mail, I will give you my step-by-step drug-free prescription for dealing with poor sleep.
Even if you’re not a problem sleeper, you can use it to keep your sleep under control so you do not unwittingly slide into bad habits.
Sleep like a baby: Today, in the fourth part of my series for the Mail, I will give you my step-by-step drug-free prescription for dealing with poor sleep
SIMPLE STEPS FOR A GOOD NIGHT’S SLEEP
My prescription is a form of CBTi, or cognitive behavioural therapy for insomnia.
The aim of CBTi is to treat insomnia without using sleeping pills: it’s designed to change bad sleep habits and to encourage people to adopt behaviours that are proven to promote sleep.
CBTi is available via a sleep clinic (where you would make regular, even weekly visits). You can also do it yourself by using some form of app-based digital CBTi such as Sleepstation or Sleepio.
If you are having sleep problems, my advice would be always to try — and stick to — some form of CBTi before resorting to sleeping pills. My prescription has four parts. It shows you what to do during the day and immediately before bed, as well as how to make your bedroom and bed sleep-friendly.
1. WHAT TO DO DURING THE DAY
Get some morning light: You should get as much morning natural light as possible (and avoid light around dusk). This has been shown to move your body clock to an earlier time, so you feel sleepier earlier — and as a result, get longer sleep. Ideally, you need 30 to 60 minutes of natural light after sunrise and before sunset: this doesn’t mean getting up at dawn but, the later in the day, the less effective light is in setting the body clock.
Getting morning light can be really useful if you are an ‘owl’ (someone who naturally gets up or goes to bed later), or even a teenager struggling against the natural drive to go to bed that characterises adolescence.
‘Larks’ (people who like to get up and go to bed early — around 14 per cent of the population) may benefit from delaying their body clocks by getting light exposure in the late afternoon or evening, and avoiding morning light.
This will delay the time you want to go to bed and wake up, and align your clock more closely to the rest of the population.
In the absence of natural light, you could use a light box (available to buy online). Look for one that is strong enough — 2,000 lux, as I explained in Monday’s Mail.
Think twice about a nap: If you need to nap, you are not getting enough sleep at night. But if you must have a nap it should be for 20 minutes only. Longer naps can leave you feeling groggy and lower your alertness for a while. Avoid naps within six hours of bedtime because this will delay sleep.
While the occasional nap is fine, be careful you do not become dependent on daytime naps as it will disrupt your night-time sleep.
Don’t exercise too late: Exercise helps some people sleep, particularly if it’s outside in the light in the morning. But exercise close to bedtime may be a problem for some, as it increases your core body temperature, and falling asleep involves a small drop in body temperature.
By heating you up, exercise may override this drop. This varies with the individual but as a rough rule of thumb, try not to exercise one to two hours before bedtime.
Eat IN THE MORNING AND MIDDLE OF THE DAY: Our digestive processes slow down towards bedtime, so if the major meal of the day is immediately prior to bed, it can lead to problems such as excessive stomach acid production — and a greater risk of acid reflux. The discomfort will disrupt sleep.
Studies have also shown that most of us are more likely to store calories consumed in the evening as fat, rather than burning them for energy. Until quite recently, the main meal of the day (dinner) used to be around noon, with a lighter meal in the evening (supper).
But as artificial lighting spread, dinner started to be eaten later. As dinner moved into the evening or even at night, there was the need for a meal in the middle of the day, which we now call lunch.
Wealthy Edwardians would also have a supper in addition to a late dinner. Another example of how 20th century customs are not best suited to our biology.
Be careful with your last coffee: Caffeine in tea (black and green), coffee and chocolate makes us feel more ‘alert’ by blocking the brain’s receptors for adenosine, the chemical that tells the brain we are tired.
Caffeine typically peaks in the blood about 15 to 45 minutes after consumption.
However, how we respond to it varies, depending on our weight, medication, liver health, caffeine-drinking history and, as always, our genes.
In most healthy adults, significant levels of caffeine remain in the circulation for five to six hours afterwards.
So a strong coffee or tea in the afternoon could delay sleep. For this reason, from late afternoon, stick to decaffeinated drinks or herbal tea.
Put stress to bed: Try not to let stressful experiences build throughout the day — short-term emotional stress spilling over from daytime is a very powerful sleep disruptor.
If you’re feeling overwhelmed, consider stress management or mindfulness techniques, which are recommended by the NHS.
2. WHAT TO DO JUST BEFORE BED
Dim the house lights: As well as setting our body clock rhythms to the 24-hour day, light can have a direct alerting effect upon the brain, which will then delay sleep. So you need to reduce your light exposure at least 30 minutes prior to bedtime.
In addition to lowering alertness, reducing the lights begins to psychologically prepare you for sleep.
In the main areas of my family home, and in the bedrooms, we have dimmable light switches. One of the problems is the bathroom, which can be very brightly lit in some homes — so don’t put the bathroom cabinet light on while you clean your teeth last thing.
Don’t worry about ‘blue’ light from devices: Many people will have read about the blue light from digital devices delaying sleep and the idea that they should be avoided before bedtime. The argument is that this type of light shifts the body clock, and this has led to the development of software to alter the colour of computer screens, lowering the blue light content.
It’s true that blue-enriched light particularly affects the light receptors in the eye that are key to setting the body clock (known as photosensitive retinal ganglion cells) — but the impact of different colours of light on alertness is complex, and the extent to which the light from screens before bedtime represents a real problem remains unresolved.
For example, one recent study by Harvard University compared the impact of reading an e-book with a printed book for four hours prior to bedtime over five nights. The light intensity of the e-book was on the maximum setting (31 lux), and the light reflected off the page of the printed book was 0.9 lux.
The results showed that e-book use delayed sleep onset by less than ten minutes after five days — a delay that is essentially meaningless. This isn’t really surprising because we know that the photosensitive retinal ganglion cells are insensitive and that for a light box to have a big effect upon the clock requires hundreds to thousands of lux.
The bottom line is that while it’s probably sensible to minimise light exposure prior to bedtime because of its effects on alertness, the impact of the light from digital devices is unclear.
What we do know is that late-night use of technology (such as electronic games, using phones or computers) makes the brain more alert and delays sleep, resulting in tiredness the next day.
So software that shifts the colour of your screen doesn’t mean you don’t need to worry about using electronic devices before bed if you continue to use them until the early hours of the morning. Turn the devices off.
Chill out: Some people find a relaxing behaviour, such as a bath or shower, or warming the hands and feet (try bed socks and mittens) can be useful. This dilates the blood vessels, moves blood to the surface of the body, increasing heat loss and lowering core body temperature, which needs to happen in order for us to sleep.
Warming the hands and feet might be useful if you have poor circulation because you can’t lose as much heat from the extremities (they are already cold). A bath can be part of a bedtime routine that psychologically prepares you for sleep.
avoid prescription sedatives: Some sleeping pills may be helpful in the short term but longer term they can cause unwanted side-effects. Similarly, avoid alcohol and antihistamines (found in some night ‘remedies’) that cause drowsiness.
Don’t argue and write a list: Try not to discuss stressful topics immediately before bed. This can be difficult because this may be the only time for many couples to talk about important matters — but it is worth knowing that the release of the stress hormones cortisol and adrenaline will increase alertness and delay sleep.
Some people find writing a list of the things they need to do the next day stops the mind racing. This does not work for me because I realise how poorly prepared I will be!
3. What to do IN BED
A good mattress, pillows and bedding make sense. But the following may also help…
Use ear plugs: These are obviously helpful if a partner snores, or if there is external noise. But if ear plugs don’t work, then it may be time to find another place to sleep.
This does not reflect on the strength of your relationship, and may even improve the bonds by improving sleep, making you more empathetic, loving and happy. But it’s important then to check your partner does not have obstructive sleep apnoea, characterised by loud snoring, interspersed with episodes where they stop breathing and abruptly wake up.
This is caused by the collapse of the muscles supporting the airway, and raises the risk of other problems including high blood pressure, heart failure and stroke. So it’s essential they see their GP.
Keep it regular: Maintaining a routine of getting up and going to bed at the same time has been shown to be important for sleep. Such a schedule reinforces the exposure to light which acts to set your body clock and so stabilises the sleep and wake cycle.
Natural long sleepers — people who need nine hours or more each night — may struggle to achieve enough sleep during the working week. That’s why most long sleepers oversleep on days off or the weekend. However, it remains unclear whether this oversleeping helps because you are then deprived of the light signals that regulate the body clock. So try to get the extended sleep you need each night.
If you wake up, don’t panic: Waking at night doesn’t mean you won’t go back to sleep but it’s important not to activate your body’s stress responses by remaining in bed and becoming increasingly frustrated.
You could try getting out of bed, keeping the lights low and engaging in a relaxing activity such as reading or listening to music before returning to the bed to sleep.
The key is to avoid caffeinated drinks, doing emails, social media or other alerting activities.