Ask some people how they fall asleep and the response will be: ‘I don’t know . . . it just happens.’ And they have no idea how lucky they are.
For nearly half the world’s population, the frustration and debilitation of broken nights is all too familiar.
An estimated 15 percent of people are living their days — year after year — in the mentally muffled, scratchy-eyed state induced by chronic insomnia.
Studies show long-term insomnia increases the risk of serious illnesses such as diabetes, heart disease, high blood pressure, depression, obesity and even certain cancers.
In our fast-paced, super-stressed lives, insomnia has become a worrying epidemic and one that modern medicine is woefully ill-equipped to manage. But I think I have the answer.
As one of very few university professors with a specialism in sleep, I am at the cutting edge of sleep research. I have drawn on my 18 years of clinical experience and research — and pulled together the very latest tried-and-tested techniques — to create a simple plan that could, and should, free you from the hell of insomnia.
Today, I will help you understand what might be causing your sleep problem and how to use your sleep diary to get the best from my course.
If you work through my recommendations all this week and diligently fill in your sleep diary twice a day you’ll end up with a personalised insomnia plan.
This is the kind of highly effective guidance you’d get from a course of one-to-one sessions with a qualified sleep specialist. By this time next week, you could be sleeping better and deeper than you have done for years.
FIND THE ROOT OF YOUR PROBLEM
Insomnia can strike anyone at any time and though most sleep problems are short-lived, my real concern is how easily they can turn into long-term issues if you don’t take measures to control them.
Studies show the first episode of sleep disturbance is often triggered by a stressful event. It might be something such as divorce, bereavement, the onset of an illness, a change in job or a new baby in the house.
This ‘precipitating event’ will typically trigger your fight-or-flight response — boosting the production of stress hormones and reducing the amount of time you can sleep.
It is nature’s way of keeping you alert to manage a crisis.
Typically, these hormone levels will gradually subside as you adapt and learn to cope with whatever triggered the stress, and your former sleep pattern should return.
However, if you’ve started to adopt a few bad habits — maybe drinking alcohol before bed, pumping yourself up with caffeine in the day or having naps on the sofa — a more sinister form of insomnia can begin to develop independently of the original trigger. This is my main concern and something I urge people with sleep problems to guard against.
Very often, poor sleep can become the focus of fresh, new layers of stress as you worry more and more about the impact tiredness might be having on your life.
Before long, as the initial trigger fades into the background, the insomnia itself takes centre stage.
It is often fuelled by increasingly complex behaviours you might have adopted in your attempts to snatch more sleep when you can and in your worries about the long-term consequences of perpetual fatigue.
That’s why CBT-I (cognitive behavioural therapy for insomnia) is such a powerful tool for people with long-term sleep problems.
HOW A SPECIALISED THERAPY CAN HELP
My sleep plan is based on the principles of cognitive behavioural therapy, which has been specially adapted for insomnia.
CBT-I is a trusted method that has been helping people for more than 30 years — and the benefits are long-term.
The cognitive element refers to clever ways to help people understand, identify and manage the anxieties they have about sleep.
The behavioural side looks at identifying and changing the habits and behaviours that you might not even realise you use to cope with your insomnia, but which could be making things so much worse.
You have taken the first step by beginning your sleep diary. Now it’s time to work on behavioural changes.
Before you do anything else, the single most important action to start to take control of your insomnia is to establish a strict bedtime and wake-up time. And you must stick to those religiously, on weekdays and weekends, lazy days and holidays.
So many poor sleepers worry about ‘sleep debt’ and desperately try to make up their deficit by heading to bed super-early or cancelling their weekend plans so they can have lazy days with long lie-ins.
Sound tempting? No! This — along with daytime napping — is the worst possible thing you could do.
Napping might be a lovely luxury for healthy sleepers, but if you have insomnia, this is one behavioural issue you must change.
If you feel you absolutely have to nap, this could be a sign that something else is wrong. My plan may not be right for you and you should visit your GP to investigate.
Stretching the time you spend in bed can swiftly change your body’s natural rhythms and turn you into a ‘sleep surfer’, where you can doze for hours, drifting in and out of light, unrefreshing sleep.
Such sleep is very vulnerable to being broken by an anxious thought, a hot flush, a noisy neighbour. And because you are effectively diluting your sleep need, you may feel tired, but you’ll still find it very difficult to fall back to sleep.
So, set a firm bedtime and wake-up time and stick to them — no matter what. Put an immediate ban on napping to help consolidate your body’s sleep and wake rhythm.
As long as you don’t go to bed too early, you should start to enjoy deeper, more refreshing sleep.
DON'T EXAGGERATE SLEEP STRUGGLES
Many experts apply the 30/30 rule when diagnosing insomnia — if it takes you more than 30 minutes to get to sleep, or if you are unnecessarily awake for more than 30 minutes during the night, then you probably have some form of it.
But by the time patients come to me, most of them report their problem to be much, much worse.
You may believe it takes you hours to fall asleep at night, that you wake up numerous times and spend long hours awake.
But actually, sleep studies have frequently shown that poor sleepers often unconsciously exaggerate the amount of time they spend awake.
It is a perfectly natural thing to do. Time flies when you are busy, but it trickles by very, very slowly when you are desperately trying to fall back to sleep. The real problem is the stress this causes — a feeling that inevitably intensifies the insomnia.
When you wire up people in a sleep laboratory and observe their nightly patterns, very often you find their sleep problem is not as serious as they’d initially thought.
Your sleep diary is the key to revealing the true extent of your problem and, with luck, you may find things are not as bad as you’d feared.
It is vital to be positive and optimistic in a quest to ease your stress levels and calm the intensity of your insomnia. Try the following simple tests to screen for what specialists call ‘sleep distortion’.
They should help you gauge whether you are overestimating the time it takes you to fall asleep, the number of times you wake in the night or how early you wake up in the morning.
Even if you suffer from all three of the following problems, pick one at a time and test it for a week (recording the results in your sleep diary).
This exercise could help turn down the volume on your sleep problem. It also provides a true starting point, which allows you to measure progress accurately as you work through the course.
If it takes you hours to fall asleep...
You may believe your biggest problem is falling asleep and worry that you take too long to drop off.
To see if this is actually true, try the following exercise. First, estimate how long it normally takes you to fall asleep — for now, let’s say 97 minutes.
Then, set an alarm on your phone — just a soft ping loud enough for you to notice if you are awake, but not enough to wake you — for 97 minutes after the time you get into bed.
When you get up in the morning, make a note in your sleep diary of whether or not you heard the ping and you’ll know whether or not you were actually awake.
If you wake dozens of times in the night...
Make a good estimate of how many times you wake up — let’s say six times.
One night, keep a pen and paper by your bed and every time you wake up, put a dash on the paper.
When you get up in the morning, look at your notes to see how many dashes you scribbled down.
Record this in your diary each day to track your progress.
If you wake up hours before your alarm...
You may think you wake up far earlier than you need most mornings.
To find out how frequently this actually happens, try estimating the length of time you typically wake before you need to be up. Let’s say 38 minutes.
Then set a quiet alarm on your phone for 38 minutes before you are due to wake up and, in the morning, record in your diary whether or not you heard it go off.
WHY YOU COULD BE WORRIED FOR NOTHING
Though a newborn baby can snooze for 14 to 17 hours a day, our need for sleep tapers off as we get older.
In our teens — when we can seemingly sleep all day if we want to — we need eight to ten hours a night. But in adulthood, we can usually function quite happily on seven hours.
However, from the age of 65 our sleep need drops again. So, at this stage of life, even though we might complain that sleep quality is dipping and worry that we need more hours in bed to compensate, the truth is we don’t.
Usually six hours of sleep each night is fine. Problems tend to occur only if you dip below five hours on a regular basis.
If you find yourself worrying about not getting enough sleep, use this simple test to work out your true sleep need — you may be surprised to find that your body doesn’t need the conventional eight hours you thought it did.
Next time you have a free week, make a point of going to bed and getting up at whatever time you want. Minimise all possible interruptions. If your partner snores, wear ear plugs. If you have a pet, make sure they are not in the room.
Record how much sleep you get each night. Ignore the results of the first four nights because you will be acclimatising to this new routine and getting rid of any sleep debt or social jet-lag.
But the timings of the last three nights, when your body has slipped into its preferred rhythm, are crucial for this experiment.
At the end of the week, take an average score of the last three nights (add up the total amount of sleep you got across those nights and divide by three).
This result will show you exactly how much sleep your body needs at this time of your life.
YOU'RE MORE AT RISK IN MIDDLE AGE
Middle age is a common time for chronic insomnia to creep in.
If you are aged 50 or over, you may have found yourself ticking quite a few boxes in the previous quiz — much of which is unavoidable. By your 50s and 60s, you are at greater risk of developing some sort of chronic illness that could affect your sleep (such as prostate problems in men, plus bladder problems and various arthritic or painful conditions).
Because of this you are more likely to be taking medication that could be interfering with your body’s natural rhythms. Menopause is a factor for women.
More generally, the delicate signalling mechanism that triggers falling asleep and waking up (our circadian rhythm) starts to deteriorate with age.
With this acting less efficiently, we produce less of the sleep hormone melatonin and can end up with broken sleep during the night.
Studies show that older adults tend to spend more time in the lighter stages of sleep, making them more vulnerable to frequent waking.
You can add into the mix the unhelpful behavioural habits retirement can instigate: the temptation to go to bed sooner, wake earlier in the morning and the susceptibility to snooze or snatch a nap during the day.
Though a good night’s sleep in your youth might have been eight hours of concentrated deep slumber, you could now find yourself ‘sleep surfing’ — spending longer hours in bed but only lightly snoozing.
I wouldn’t call this insomnia. It would be more accurately described as a self-imposed adjustment, which doesn’t necessarily make it bad or unhealthy.
The only cause for concern might be if this pattern of long and light sleeping becomes conditioned and then turns into chronic insomnia.
Either way, you would certainly benefit from some of the advice in this course.
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