This article looks at some of the reasons you may not be sleeping well and offers some things to think about to develop sleep habits that encourage better quality sleep.
Poor sleep does have potentially serious health implications, so if you are persistently not sleeping well seeking professional help is advisable. See the NHS advice at the end of this article.
What is Insomnia?
Insomnia is best described as when a person regularly does not get enough quality sleep, either through difficulty falling asleep or waking frequently/ lying awake in the night disrupting their sleep.
It is sometimes difficult to determine if you are suffering from insomnia because sleep habits are very personal and can vary from person to person. How well rested and revived you feel when you wake for the start of your day is a good indication of the quality of your sleep. Irrespective of how long you spend in bed, if you awake feeling tired and lethargic it could be you are suffering from not getting enough quality sleep. It is worth considering looking at your sleep habits to see how you could improve your chances of better sleep quality.
There are lots of studies out there indicating that insomnia is a common problem and as well as the individual cost, there are some significant societal costs:
Causes of Poor Sleep
For some people, periods of insomnia will be relatively short and related to specific events or experiences, for example a busy time at work or a test or exam. Once the event has passed, sleep patterns return to normal.
However, insomnia can be a symptom of an underlying problem. It is important that the underlying problem is treated in order for quality sleep patterns to return.
Some reasons for insomnia include:
Babies and young children. Being woken in the night by small children is common; any parents reading this will relate to the daily grogginess caused through disturbed nights. Whilst at the time, it might feel like this sleepless time goes on forever, typically it is for a relatively short period in our lives.
Noise disturbance. Loud noises can wake us, for example traffic, music and snoring. Typically we get used to the common background noises of our home and these become acceptable as our norm. Anything out of the ordinary has the potential to disrupt our sleep. I can remember moving into our first home and settling down to sleep on the first night, to be woken abruptly by a train rattling by and sounding its horn! It sounded like it was actually coming through the bedroom. We hadn’t realised the track was so close to the house. That took some getting used to.
Excitement/ nervousness. Most of us can think of a time when sleep has eluded us because we are excited or nervous about something coming up in the near future, a holiday, an event (I might not sleep well on the run up to events…) or an exam.
Jetlag. Anyone who has travelled long haul will have experienced sleep disruption as your body clock adjusts to the new time zone. Waking in the middle of the night despite feeling shattered because your body clock thinks it is time to get up is common and difficult to avoid.
Shift work. Regular changes to sleeping patterns can mean quality sleep is disrupted. It is typically harder to sleep well in the day time due to light and noise disturbance as well as fighting the body’s natural circadian rhythm.
Anxiety, stress or other mental health issues. These are some of the most common causes of poor sleep. Worrying about stuff, what has happened or what might happen, always feels worse when we are tired – especially in the small hours of the morning. Ironically, not sleeping well can also exacerbate the symptoms of these issues.
Medical conditions or illness. Living with certain chronic medical conditions or illness can impact sleep patterns. Sleep is interrupted as a result of symptoms of the condition. This could be due to chronic pain, difficulty breathing, night sweats or alterations in deep sleep reducing quality of sleep overall. Examples include: musculoskeletal problems, like arthritis and fibromyalgia, breathing problems like asthma and emphysema, heart or kidney problems, menopause, cancer. Waking in the night with pain is a sign that whatever you are dealing with needs attention and professional help.
Medications, drugs and alcohol. The side effects of some medicines (and drugs and smoking) include disturbed sleep. These can include insomnia, disturbing dreams, excess fatigue or wakefulness, night sweats, suppressed REM sleep disturbing the natural sleep cycle. Too much caffeine is commonly linked to difficulty falling asleep, and alcohol can have the same effect in some, whilst in others alcohol can cause fragmented sleep.
Sleep disorders. For example, sleep apnea, restless leg syndrome and narcolepsy.
Sleep apnea is where breathing temporarily stops when sleeping. This causes the person to wake during the night, often frequently, resulting in poor quality sleep and exhaustion the following day. It is a common sleep disorder and although easily treated, it can be serious. It is important to see your GP for help and treatment.
Restless leg syndrome or Willis-Ekbom disease is a common condition of the nervous system resulting in an irresistible need to move the legs. This typically gets worse at night and can also include a creeping or crawling sensation in the feet and legs. This condition can be mild with people having infrequent occurrences, or more severe affecting people daily. This has the potential to disrupt sleep with all the associated repercussions.
Narcolepsy is a rare condition where insufficient levels of the hormone regulating staying awake mean sudden bouts of falling asleep, or ‘sleep attacks’ throughout the day.
Ideas for Getting Better Quality Sleep
It is important to remember that quality of sleep is very individual and there are many reasons why this may be affected. Treating any underlying issues is important. Getting help from professional sleep therapists who can offer expert guidance for you may be needed if you are suffering from long term insomnia that is affecting your daily life.
Treating the underlying physical and mental problems is sensible but on its own will not necessarily mean better quality sleep. Other factors impact the quality of our sleep, for example, daily eating and exercise habits and daily routines.
Good quality sleep and our physical and mental wellbeing are closely linked; each one helps the other, so developing good lifestyle habits to encourage better quality sleep is another sensible approach.
The following are intended as ideas for you to think about in relation to developing better health and wellbeing habits which can influence the quality of your sleep. What works for some people may not work for others and these ideas do not replace the advice of professionals.
Ideas for positive habits to encourage quality sleep include:
- A healthy diet and regular exercise. Eating well and avoiding excess fatty, sugary and salty foods during the day mean you are likely to have more even blood sugar levels and less likely to be craving food at the end of the day. Also, avoiding eating big meals close to going to bed, aids digestion and helps your body prepare for relaxation.
Research shows regular exercise helps with quality sleep. It also helps ward off feelings of lethargy during the day.
Sometimes exercising close to going to bed can be stimulating and mean falling asleep is more tricky. I know I am more alert on the nights after a late netball match and need to relax before I can go to bed.
- Manage stress levels. Boost your resilience and you are better able to relax at bedtime.
- Consider your caffeine, nicotine and alcohol intake during the day. As stimulants, all can make falling asleep difficult. Sometimes alcohol induces sleepiness and then causes waking in the night to go to the loo and falling back asleep is sometimes hard.
- Try changing your bedtime routine to better prepare for sleep. On the run up to bedtime practise relaxation or mindfulness techniques to help your body and mind prepare for sleep.
A regular routine of time going to bed and time waking up helps. This can be particularly valuable if you work shifts.
- Avoid screen based activities before going to bed and anything encouraging active thinking, for example avoid focusing on work based issues or solving problems. These can stimulate the brain and result in overactive thinking instead of sleeping.
- Create a relaxing, sleep-friendly environment. Enjoying being in your bedroom means you are more likely to feel relaxed and able to sleep. As far as possible avoid using the room for other activities, like working. Plus ensuring the temperature isn’t too warm or cold and you have black out curtains if you are disturbed by light.
If you fall asleep easily and then wake and have trouble going back to sleep, stop fighting it. Lying awake worrying about being awake doesn’t help and can create more stress. Instead try some of the ideas below.
Ideas for ways to fall asleep and coping with waking in the middle of the night include:
- Reading a relaxing read immediately before going to sleep to allow your mind to drift into calmness. Or listening to a calming podcast where there is no need to pay attention or follow a story, for example Shusher Guided Meditations Archives, Nothing Much Happens: Bedtime Stories for Grown-ups
- Keep a notebook and pen by the bedside to write down any thoughts filling your head and distracting you relaxing into sleep. The act of writing the things down can alleviate your worry of forgetting what is playing on your mind meaning you relax, and sleep.
- Waking in the night can be due to feeling hot and sweaty. A good way of regulating temperature in the middle of the night is to have a cool shower and then go back to bed. Keeping the room at a cooler temperature, 60 – 67 degrees fahrenheit is recommended. Hotter than 71 degrees can cause restlessness and any colder can interrupt sleep through discomfort.
- Sometimes getting up and having a milky drink can help. Avoid screen time or other stimulants.
- And finally, if you wake early in the morning and feel refreshed and ready to start the day, get up. Even if it is earlier than usual. Sleep is very personal and if you are ready to start the day before a conventional time, that is ok.
Keeping a sleep diary can help you track your sleep patterns, your physical and emotional responses to your sleep and the daily routines and habits that can contribute to good quality sleep. Understanding more about what works for you and what doesn’t is really helpful.
Remember, getting help is important. Your GP is a good first port of call if you haven’t slept well for months and changing your sleeping habits hasn’t worked.
Some useful links:
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