World sleep day is this Friday, 19th March. This years theme is "regular sleep, healthy future". Sleep day highlights the importance of sleep as a "pillar" of health, alongside exercise and nutrition. It also encourages everyone to prioritise sleep to improve their overall health and well being. Sleep should take up around 1/3 of the average persons day. It is as critical to our wellbeing as food, water or shelter. It is both a behavioural phenomenon of disengagement with the environment as well as a period of time where a whole host of complex physiological processes take place. When you first go to sleep, your metabolic rate drops and the depth of your breathing decreases. The volume of air going into and out of your lungs decreases and the carbon dioxide level goes up. Then when you progress into REM (rapid eye movement) sleep, you lose all muscle tone in your skeletal muscles apart from the muscles in your diaphragm and the muscles that move your eyes. So each night when you are dreaming you are immobile.
What happens when we don't sleep well?Most adults function best when they sleep 7-9 hours per night. Almost half of us are sleep deprived.......but not by choice! Sometimes we simply can’t fall asleep or stay asleep due to a range of biological factors and/or lifestyle choices. Lack of sleep can lead to increased fatigue and excessive daytime sleepiness. It can impair your immunity, interfere with your metabolism, muck up your hormones and your mental health. Regularly sleeping fewer than seven hours per night increases the risk of developing heart disease and diabetes. It is also associated with unhealthy eating habits that can lead to other chronic illnesses. Sleep deprivation can cause impairments in short and long term memory, decision making, attention and reaction time. If you are sleep deprived you also tend to make more errors at work and drive more dangerously on the road. Insomnia is defined by a persistent inability to fall asleep or maintain sleep. There is some limited research that shows that insomnia increases with age. Insomnia has substantial negative effects on mental and well as physical health and quality of life.
Lack of sleep and its effectsThe burden of sleep disorders is believed to have risen over the last 12 months thanks to Covid- 19. Many circadian rhythms were (and may still be) out of wack because of stress, drinking more alcohol than usual or weight gain. When we drink more we may find that we fall asleep easily but the quality of the sleep is poor. Sleep loss creates a hormone imbalance in the body that promotes overeating and weight gain. Leptin and ghrelin are hormones that regulate appetite. Without sufficient sleep, the production of these hormones is altered in a way that creates increased feelings of hunger. Lack of sleep also has links with obesity through growth hormone deficiencies and elevated cortisol levels. Insufficient sleep can also impair your metabolism of food. Restricted sleep duration has also been shown to cause a greater tendency to select high-calorie foods. Calories consumed late at night may increase the risk of weight gain. Furthermore, adults who do not get sufficient sleep tend to exercise less because sleep loss causes sleepiness and fatigue during the day.
How does being overweight affect sleep?When you are overweight, the excessive fat that is present acts to insulate and pad your body. It is easy to recognise this extra fat when it appears as a large stomach, hips and bottom and a fuller face. But excess weight is also added in places that we cannot directly see, such as along our airway and at the base of the tongue. This crowds the airways and causes problems. Especially if it is combined with the added weight pressing from the outside of a larger neck or a large stomach restricting the lung volumes. When this airway restriction is mild, it leads to snoring. Snoring is simply turbulent or disrupted airflow. As the airway becomes more crowded and more prone to collapse, the flow of air can completely cease. This will result in pauses in breathing called apnea. This comes from a Greek word that means "without breath."
Pain and sleepThere seems to be a bidirectional relationship between pain and sleep. More pain makes sleep worse and poor sleep makes pain worse. A 2019 study by Ho et al reported that insomnia symptoms, were highly prevalent in individuals presenting with musculoskeletal pain. In this case 71% of people with osteoarthritis, 59% with low back pain and 41% with neck pain reported poor sleep quality, non-restorative sleep, early awakenings and difficultly initiating and maintaining sleep. This has led to the view of insomnia no longer being the consequence of pain but a parallel condition that requires specific management.
How can you improve your sleep?
Improve sleep hygieneThis refers to the science-backed practices — during the day and before bedtime — that help create the ideal conditions for healthy sleep, not just washing your face and cleaning your teeth!
- Dim the lights after dark- Getting enough natural light during the day helps to keep your circadian rhythm (your body clock) on a healthy sleep-wake cycle. Bright light from lamps/electronics at night, can mess with the cycle, making it harder to fall asleep. That’s because the blue light from your laptop or phone, interferes with the release of melatonin, a hormone that tells our body that it’s time to wind down. Dimming the lights at home after you finish dinner, is a great idea.
- Decrease the use of technology during the hour before bed (this includes watching tv, using phones, playing video games, using computers, and more). As well as the light disrupting your body clock, games, videos, work emails, and social media all conspire to keep your mind active and often keep you awake way later than you should be.
- Making sure that you sleep in a room that is cool, quiet and dark. Your mattress and pillows should feel really comfy, allowing your body to settle down and relax. The next blog post will give you tips for sleeping postures/mattresses and pillows.
- Going to bed at the same time each night and waking at the same time each morning (give or take 20 minutes, including weekends). This creates a sleep framework that sets the body’s internal clock to expect to rest at a certain time each day. Even if you haven’t slept well during the night, it’s best not to allow yourself to sleep in later the next morning. Getting up at your usual time will heighten your “sleep drive,” and help you sleep better the following night.
- Avoiding caffeine and alcohol. Alcohol can initially make you feel drowsy but it affects the natural flow of sleep. The different stages of your sleep such as deep sleep, REM sleep, and light sleep are altered. This results in more restless sleep, diminishing sleep depth and quality, so you’re more likely to wake up feeling fatigued.
- Avoid heavy meals close to bed. It takes your stomach 3 to 4 hours to empty. If you lie down right after a big meal, your digestive juices are still working and you may experience indigestion.
- Only use your bed for sleep (or sex)- this trains your brain to see your bed as a place of rest.
- Similarly sleep hygiene experts recommend getting out of bed and going to another room if you don’t fall asleep within 20 minutes. Instead try an activity to help you get drowsy- reading, listening to music, a warm shower. The goal of this technique is to break the association of bed as a place of frustration and worry.
- Limit or avoid naps during the day. They don't make up for poor sleep during the day and can make it harder to fall asleep at night.
ExerciseMost research shows that exercise training has a moderately beneficial effect on sleep quality. That is exercise did not change the sleep duration or disturbance but just improved quality of sleep. Most trials have looked at moderate aerobic exercise (such as endurance training, walking and tai chi) performed for 40-60 minutes over 10-16 weeks.
Cognitive behavioural therapyOverall, research shows that participating in a cognitive behavioural therapy (CBT) program can reduce the time spent awake, improve the quality and efficiency of sleep and increase the total time asleep. CBT treatment usually involves efforts to change thinking patterns. Restful sleep largely depends on having a rested mind, and so the preparation can begin with your mindset...during the day. More often than not, our issues around sleep are rooted in our thinking processes. By gradually training the mind in a specific way — day by day, for a month for example — you gradually create an environment conducive to a good night’s rest. Meditation has been shown to improve the quality and efficiency of sleep. It also improves how quickly you fall asleep, and how long you can stay awake during the day. Meditating before bed can help you to fall asleep faster; once asleep, you’re likely to sleep more soundly, too. Headspace for example has a 30-day Sleep course that is designed to be used during the day. You do the course in conjunction with a simple sleep meditation at bedtime. The aim of these courses is to train the mind for long-term, sustainable change. The bedtime meditation then becomes a specific exercise to send you to sleep. There are many apps available online that can help guide you through sleep mediations. A guided sleep meditation may include
- breathing exercises- where you count your breaths. For example, breathe in for the count of 4, hold your breath for 2 counts then breathe out over 5 counts. This technique slows down your breathing, which signals to the body that it’s time for sleep.
- Mindful body scanning. With this technique, you try to be aware of your breath and the places where your body is touching in your bed. Then, you can think about “switching off” any effort in each part of your body. Often starting at the toes and moving up, part by part.
- Visualisations: imagining a scene or image that then takes you into a mental state that is similar to hypnosis.
- Counting: to slow the mind down.