How to sleep better

This content mentions depression and anxiety, which some people may find triggering.

HEAL: The four pillars of good sleep

There are four main things that affect the quality of our sleep:

• Health
• Environment
• Attitude
• Lifestyle

Good sleep doesn’t just mean lots of sleep: it means the right kind of sleep.

Sleep affects our ability to use language, maintain attention, understand what we are reading, and summarise what we are hearing; if we compromise on our sleep, we compromise on our performance, our mood, and our interpersonal relationships. Sleep has also been shown to protect the immune system. The amount that each of us needs is different. However, it's recommended that a healthy adult should sleep, on average, between seven and nine hours a night.

The important thing is that you get good quality sleep. The following advice can help to HEAL your sleep problems.

Health

As anyone who has tried to get to sleep with a blocked nose or headache knows, physical health problems can stop you from getting a good night’s sleep.

Speaking to your GP or pharmacist about appropriate medication can help with this. Try to avoid taking medication without speaking to a medical professional, as sometimes the medication itself can stop you from sleeping properly if it’s not right for you.

Mental health problems like anxiety and depression can also affect our sleep. In these cases, a combined approach to tackle both the mental health issue and the poor sleep is often the most effective method of treatment. Speak to your GP or mental health worker (if you have one) for advice on this, or have a look at the ‘Attitude’ and ‘Lifestyle’ sections of this guide for general ways to maintain good mental well-being.

Environment

The bedroom should be somewhere that we associate with sleep.

Where possible, try to remove distractions from your bedroom. It’s better to watch TV, play computer games and eat in another room. This will help you to relax with no distractions in your bedroom.

Be aware of the presence of gadgets and electronics, such as computers, phones, tablets and TVs. The ‘blue light’ displays suppress melatonin production – the hormone that helps you sleep. The suppression of melatonin causes sleep disruption. It’s a good idea not to use these devices two hours before you go to sleep to reduce their effect on your sleeping.

Although we are all different and have our own personal preferences, the common factors that can affect our sleep are light, noise and temperature. Too much light or noise can prevent you from falling asleep or staying asleep. If you can’t control the amount of light and noise, such as light from a street lamp or noise from a neighbour’s music, you could try using an eye mask or ear plugs.

The temperature of the room is also important. A heater or thicker duvet can help if you regularly find yourself too cold at night, or a thinner cover or opening a window can help if you’re too hot. If you are struggling to work out the best sleep environment for you, then it can be useful to keep a sleep diary (there’s one at the end of this guide) to keep track of the conditions that helped you get a good night’s sleep.

Attitude

Lying awake in bed, particularly before an important day, can make us worry. However, this worry then makes it harder for us to get to sleep.

Relaxation techniques can help you to unwind at these times. Alternatively, instead of staying in bed and getting more and more frustrated, you could get up and make yourself a warm drink (avoid coffee, tea or any other caffeine drinks) and return to bed when you feel sleepier.

If you keep having problems sleeping for more than a month, you could speak with your GP about the possibility of using Cognitive Behavioural Therapy (CBT). CBT is used to treat some mental health problems. It can encourage a more positive attitude, which can then help to break the cycle of negative thoughts causing your lack of sleep, and thus can help you to develop a healthier sleep pattern. In England you can self-refer for NHS talking therapies service (which may help reduce unnecessary use of GP time and speed referrals if talking treatments are appropriate).

Alternatively, practices like mindfulness (a type of meditation) can help by reducing stress and anxiety levels. Mindfulness can be practised without a GP prescription.

Lifestyle

There are many things that you can do every day to improve the quality of your sleep.

Eating rice, oats and dairy products can produce chemicals that increase our desire to sleep. However, food and drink containing lots of caffeine or sugar can keep you awake, so drinking less tea and coffee and eating less chocolate and other sugary foods late in the day might help you to sleep better.

Although it can make you feel tired and can help you get to sleep, alcohol impairs the quality of your sleep and makes you more likely to wake up during the night as the effects wear off, and you may need to go to the toilet frequently or get up to drink water if you are dehydrated.

Exercising on a regular basis is thought to help us sleep, as, among other things, it can help to reduce anxiety and relieve stress. It is, however, important to exercise at the right time. Exercising earlier in the day is better, as exercise increases the body’s adrenaline production, making it more difficult to sleep if done just before bedtime.

Sleep Disorders - the problems they cause and possible solutions

Below are some of the most common sleep problems, with techniques that can be used to treat them.

Insomnia

Insomnia is a condition where you are regularly unable to fall asleep or remain asleep for a long enough period of time. As a result, insomnia can have a negative effect on your mood, energy levels, concentration, relationships, ability to stay awake throughout the day, and ability to complete simple daily tasks.

One of the most widely used and successful therapies is Cognitive Behavioural Therapy (CBT); for an easy introduction, read Overcoming Insomnia and Sleep Problems by Colin Espie or ask your local GP or sleep clinic for advice on other CBT books or courses. Regular daytime or early evening exercise can also be a great way to combat insomnia as it helps to reduce anxiety and stress, as can practices such as mindfulness.

Using sleep medication, such as sleeping pills, is common. However, these types of medication are only available by prescription from your GP and you can become reliant on them the longer you use them. Speak to your GP if your insomnia persists.

Sleepwalking

Sleepwalking happens during deep sleep, meaning people can rarely remember doing it. As well as getting out of bed and walking, some people do tasks in their sleep, such as cleaning. Sleepwalking is far more common in children than in adults.

Sleepwalking is not dangerous unless you start doing risky activities in your sleep. It is often related to stress or lack of sleep, or (in adults) drinking alcohol, so it is important to try and get regular, good-quality sleep by looking at the HEAL factors mentioned earlier in this guide.

Night terrors

A night terror is different to a nightmare. It occurs during deep sleep, meaning that you rarely remember it. Often an extreme and frightening experience, night terrors make your heart beat faster and might cause you to sweat or scream. Night terrors often begin in childhood, but rarely continue into adulthood.

Little is known about how to treat people who have regular night terrors, although, in some cases, they can be linked to a traumatic experience. If this is the case, and your night terrors are affecting your everyday life or ability to sleep, your GP might be able to refer you for therapy to help you deal with the underlying trauma.

Snoring

Snoring is a very common problem, affecting 41.5% of adults in the UK. Snoring is a breathing problem, rather than sleep problem, and happens when a blockage in the airway causes the organs that help us breathe to vibrate.

Nasal strips can help by widening the nasal passage and improving the airflow when breathing. It is also better to sleep on your side, as sleeping on your back can cause your tongue to fall backwards and partially block your airflow. Drinking less alcohol, exercising more regularly, and taking steps to lose weight (if you are overweight) can also reduce your snoring.

Sleep apnoea

Sleep apnoea causes shallow breathing or pauses in breathing that may last up to 30 seconds at a time. In most cases, you will begin to breathe normally again, often making a loud snort or choking sound to clear your airway. People with sleep apnoea can wake up frequently throughout the night feeling sweaty with a dry mouth and a headache.

Unlike snoring, it is more important to treat sleep apnoea in order to prevent the brain from being deprived of oxygen. A continuous positive airway pressure (CPAP) device can help by easing your airflow. Your GP will be able to recommend where you can get an assessment for a CPAP device.

Top tips from the sleep doctor

1. Don’t get caught napping!
   If you have trouble sleeping, you may feel tempted to catch up on sleep by taking naps. However, unless you’re feeling dangerously sleepy (while driving or operating machinery, for instance), this usually does more harm than good as it makes it more difficult to sleep at night. If you feel tired during the day, get up and take a walk around, get some fresh air, or do something challenging for a short while, like a crossword or a Sudoku.
2. If you’re not tired, get up
   If you’re finding it difficult to get to sleep, don’t just lie there worrying. Get up for a few minutes and get a drink (no sugar or caffeine, remember!), and go back to bed when you’re feeling a bit sleepier.
3. Set yourself a ‘get fit’ plan
   Eating healthily and getting regular exercise are great ways of helping yourself sleep better. However, plan your meals and exercise to avoid exercising or eating a big meal after mid-evening: doing either of these too close to your bedtime can stop you from sleeping.
4. Don’t stress it!
   Thinking about sleep too much or trying to force yourself to sleep will only keep you awake. Learning how to relax both your body and mind instead will help you to get to sleep much more easily.
5. Keep a sleep diary
   The amount of noise, light, and distractions, what and when you eat, and the temperature of your bedroom can affect how well you sleep. Keeping a sleep diary to make a note of what the conditions were when you went to bed the night before can be useful for letting you look back and see what has and what hasn’t worked for you. It also helps you to see how your sleep varies from night to night, and might help you note patterns in your sleeping.

Further information

• Sleepio - an organisation dedicated to helping people sleep better, co-founded by Professor Colin Espie, Director of the University of Oxford Sleep Research Centre and the ‘top tips’ sleep doctor in this guide. The Sleepio website includes information about various sleep problems.
• Your local GP - If you continue to be concerned about the amount and quality of sleep you are having, and the effects it is having on other aspects of your life, you should speak to your GP, who will be able to help and provide further guidance and support.
• British Snoring & Sleep Apnoea Association - a not-for-profit organisation dedicated to helping snorers and their bed partners improve their sleep.
• Be Mindful
  Be Mindful to make courses in mindfulness meditation available to everyone who wants or needs them. This site provides useful information on what mindfulness is and the different mindfulness-based courses available. You can also search for mindfulness courses near you, or sign up for the specially developed online course.
• British Sleep Society - a charity for medical, scientific and healthcare workers dealing with sleep disorders in the UK.

Sleep diary

Working out the reasons why you might have problems sleeping can be difficult. Keeping a sleep diary can help you keep track of when you slept well or poorly, and the possible reasons why that happened.

To complete the sleep diary, simply read and answer the following questions for at least a week.

Remember, this diary is your personal record of how well you slept and why, so be honest!

Questions for the sleep diary

1. How did you sleep last night?
2. What time did you go to bed?
3. Approximately how long did it take you to get to sleep?
4. How many times did you wake up during the night?
5. What time did you wake up?
6. How long did you sleep for in total?
7. What did you eat or drink (if anything) within four hours of going to bed (e.g. cup of tea/coffee/milky drink, glass of wine/beer, sleeping pills, dinner), and how long before bed did you have it?
8. What was the temperature outside and in your bedroom?
9. What light sources were there when you went to sleep?
10. How much noise was there when you went to sleep?
11. What activities did you do before you went to sleep?
12. Any other comments?
13. How well did you feel throughout the next day (1 = awful, 5 = average, 10 = great)? Include a description, if appropriate (e.g. drowsy, grumpy, spaced out).

Random sleep facts

1. The Beatles’ song ‘Yesterday’ came to Paul McCartney in a dream. It was only when no one he spoke to recognised the tune that he realised he had written it himself.
2. Driver sleepiness may contribute to around 20% of accidents on long journeys.
3. Pythons sleep for up to 18 hours a day. Giraffes generally sleep for less than two.

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