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If you would like to discuss how counselling might help you please contact Andrew

www.andrewcornick.co.uk

Tel:      01793 710252

Mobile: 07732 570346

Please email me

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sleep Problems

 

About one in five people has some difficulty with sleeping. However, there are many things you can do to help yourself. This leaflet aims to show you some of them. For example, simple things like winding down before bedtime, avoiding certain foods and drinks, and a bedtime routine can help. Further ways to promote sleep in more difficult cases include relaxation techniques, regular exercise, and behavioural and cognitive therapies. Sleeping tablets are not the best way to help with sleep problems because you can get addicted to them, and they often stop working if you take them regularly

 

Understanding normal sleep

A normal night's sleep has three main parts.:

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Quiet sleep. This is divided into stages 1-4. Each stage becomes more 'deep'. Quiet sleep is sometimes called deep sleep.

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Rapid Eye Movement (REM) sleep. REM sleep is when the brain is very active, but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.

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Short periods of waking for 1-2 minutes.

Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult.
 

Normally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc), then the wakeful times tend to last longer, and you are more likely to remember them.

 

What is insomnia?

Insomnia means poor sleep. About one in five adults does not get as much sleep as they would like. Poor sleep can mean:

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Not being able to get off to sleep.

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Waking up too early.

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Waking for long periods in the night.

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Not feeling refreshed after a night's sleep.

If you have poor sleep, you may be tired in the daytime, have reduced concentration, become irritable, or just not function well.

 

What is a normal amount of sleep?

Different people need different amounts of sleep. Some people function well and are not tired during the day with just 3-4 hours' sleep a night. Most people need more than this. To need 6-8 hours per night is average. Most people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. Many people in their 70s sleep less than six hours per night.

So, everyone is different. What is important is that the amount of sleep that you get is sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is ...'difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness'.

 

What are the causes of poor sleep?

Poor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following:

Concern about wakefulness

You may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may 'clock watch', and check the time each time you wake up. This may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even if the total amount of time asleep was normal.

Temporary problems

Poor sleep is often temporary. This may be because of stress, a work or family problem, jet-lag, a change of routine, a strange bed, etc. Poor sleep in these situations usually improves in time.

Anxiety or depression

You may find it difficult to switch off your anxieties about work, home or personal problems. Also, poor sleep is sometimes due to depression. Other symptoms of depression include: a low mood, lethargy, poor concentration, tearfulness, and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too.

Sleep apnoea

This sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring, but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. See separate leaflet called 'Sleep Apnoea' for details. Note: most people who snore do not have sleep apnoea, and sleep well.

Other illnesses

Various illnesses keep some people awake. For example, illness causing pain, leg cramps, breathlessness, indigestion, cough, itch, hot flushes, mental health problems, etc.

Stimulants

These can interfere with sleep. There are three common culprits.

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Alcohol - many people take an alcoholic drink to help sleep. Alcohol actually causes broken sleep and early morning wakefulness.

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Caffeine - which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other drugs (check the ingredients on the drug packet). Caffeine is a stimulant and may cause poor sleep.

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Nicotine (from smoking) is a stimulant, and it would help not to smoke.

Street drugs

For example, ecstasy, cocaine, cannabis and amphetamines can affect sleep.

Prescribed drugs

Some drugs sometimes interfere with sleep. For example, diuretics ('water tablets'), some antidepressants, steroids, beta blockers, some slimming tablets, painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative drugs, this can cause 'rebound' poor sleep.

Unrealistic expectations

Some people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, then you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night!

A vicious cycle

Whatever the initial cause, worry about poor sleep, and worry about feeling tired the next day, are common reasons for the problem to become worse.

What can I do to help improve poor sleep?

This section will discuss five topics which can help to promote better sleep - understanding some facts, sleep hygiene, relaxation techniques, daytime exercise, and cognitive and behavioural treatments. In effect, these can be used in a step-wise fashion. You need only go on to the next 'step' if the previous step is not very helpful, but each step requires a greater degree of effort.

Understanding some facts

It is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night. Also, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days.

General tips for sleeping better (often called 'Sleep Hygiene')

The following are commonly advised to help promote sleep and are often all that is necessary:

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Reduce caffeine - do not have any food, drugs, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the entire day has helped.

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Do not smoke within six hours before bedtime.

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Do not drink alcohol within six hours before bedtime.

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Do not have a heavy meal just before bedtime (although a light snack may be helpful).

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Do not do any strenuous exercise within four hours of bedtime (but exercise earlier in the day is helpful).

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Body rhythms - try to get into a routine of wakefulness during the day, and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore:
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No matter how tired you are, do not sleep or nap during the day.

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It is best to go to bed only when sleepy-tired in the late evening.

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Switch the light out as soon as you get into bed.

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Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to 'lie-in' - even after a poor night's sleep. Do not use weekends to 'catch up' on sleep, as this may upset the natural body rhythm that you have got used to in the week.

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The bedroom should be a quiet, relaxing place to sleep.
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It should not be too hot, cold, or noisy.

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Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.

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Make sure the bedroom is dark with good curtains to stop early morning sunlight.

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Don't use the bedroom for activities such as work, eating or television.

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Consider changing your bed if it is old, or not comfortable.

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Hide your alarm clock under your bed. Many people will 'clock watch' and this does not help you to get off to sleep.

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Mood and atmosphere - try to relax and 'wind down' with a routine before going to bed. For example:
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A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening.

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Do not do anything that is mentally demanding within 90 minutes of going to bed - such as studying.

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Go to bed when sleepy-tired.

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Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.

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If you cannot get off to sleep after 20-30 minutes - then get up. Go into another room, and do something else such as reading or watching TV rather than brooding in bed. Go back to bed when sleepy. You can repeat this as often as necessary until you are asleep.

Relaxation techniques

These aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious, but find it hard to get off to sleep. There are a number of techniques. For example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. See separate leaflet called 'Relaxation Exercises' where it is described more fully.

Your GP or a counsellor may be able to recommend a tape or CD that takes you through deep breathing exercises, and other methods to help you relax.

Daytime exercise

Regular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days. Even a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week.

Moderate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing, and heavy housework are all moderate-intensity physical exercises. See separate leaflet called 'Physical Activity For Health' for more details.

Although exercise to improve sleep is often thought of as 'common sense' - there is some research evidence to back this up. One research study looked at some older people with primary insomnia. The study compared a group of people who embarked on a programme of moderate intensity exercise to a group who did not exercise. After 16 weeks, on average, the 'exercise group' had a significantly improved quality of sleep, a reduced time taken to fall to sleep, and an increased time spent asleep, compared with the group who did not do exercise. (See references at the end for details.)

If you would like to discuss any of the mental health issues raised on this page or find out how counselling might help please contact me.

Websites

Sleep Council

A non-profit making organisation that aims to raise awareness of the importance of a good night's sleep to health and wellbeing. It provides helpful advice and tips on how to improve sleep quality and on how to choose the right bed for optimum sleeping comfort. It is funded by the National Bed Federation - the trade association for British bed manufacturers - but works independently and does not recommend or endorse specific companies or products. It produces a number of free leaflets.
www.sleepcouncil.org.uk

 

Sleep Apnoea Trust

The Sleep Apnoea Trust Association (SATA) exists to improve the lives of sleep apnoea patients, their partners and their families.

Managed entirely by volunteers, SATA is the leading UK charity working in the field of sleep apnoea.

http://www.sleep-apnoea-trust.org/

 

Cry-sis

From its modest beginnings, Cry-sis has developed to become a well-respected and national charity. The stated aims remain 'to be efficient and effective in providing self-help and support to families with excessively crying, sleepless and demanding babies'.

http://www.cry-sis.org.uk/

 

 

Anxiety UK

Anxiety UK is a national registered charity formed 40 years ago by a sufferer of agoraphobia for those affected by anxiety disorders. Today they are still a user-led organisation, run by sufferers and ex-sufferers of anxiety disorders, supported by a high-profile medical advisory panel. Anxiety UK works to relieve and support those living with anxiety disorders by providing information, support and understanding via an extensive range of services.

http://www.anxietyuk.org.uk/

 

MIND

Mind helps people take control of their mental health. We do this by providing high-quality information and advice, and campaigning to promote and protect good mental health for everyone. How can we help you

http://www.mind.org.uk/

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Leaflets

In this section you will find a selection of leaflets you can download or print.

Leaflet from Royal College of Psychiatrists

Self Help leaflet from Get-Self-Help

Self help leaflet from NHS Northumberland

Self help leaflet from MoodJuice

Local Resources in Swindon

Swindon Samaritans

Swindon and District Samaritans has been offering emotional support to those in crisis for more than 40 years. You can call or email 24hrs a day.

http://www.samaritans.org/swindon/

 

Swindon MIND

Local branch of the national charity providing support, resources and drop-in sessions.

http://www.swindonmind.org/

 

 

This information was put together by Swindon Counsellor and Psychotherapist Andrew Cornick. If you would like to find out how counselling might help you please contact me at any time.

www.andrewcornick.co.uk

Tel:      01793 710252

Mobile: 07732 570346

Please email me

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