Oh to sleep …..

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It is estimated that one in 4 of us has problems sleeping (getting to sleep or staying asleep) at some stage – or for many people most stages of their lives.

The Great British Sleep Survey interviewed 11,129 adults earlier this year. It found that, of those who had trouble sleeping, 55% reported having relationship difficulties as a result, while 77% reported issues of concentration, 64% said they were less productive at work, 83% reported problems with their mood and 93% with energy levels.

Sleep disorders are divided into Primary and Secondary types . A primary disorder is the central cause of a lack of sleep i.e. difficulty in getting off to sleep and disturbed sleep, or a change in sleep behaviour during sleeping such as sleep-talking or snoring. A secondary disorder occurs when a disease (either of mind or body) results in disturbed sleep, e.g. depression, pain, illness or anxiety. Whilst they can be interrelated they are often confused with each other but are quite different and the treatment can therefore also be different. However there are strategies (sometimes called sleep hygiene) which both disorders benefit from.

The Effects of Sleep Loss

Sleepiness Causes Accidents  Sleep deprivation was a factor in some of the biggest disasters in recent history: the 1979 nuclear accident at Three Mile Island, the massive Exxon Valdez oil spill, the 1986 nuclear meltdown at Chernobyl, and others. Drowsiness can slow reaction time as much as driving drunk.

Sleep Loss Dumbs You Down and Impairs Judgment  Sleep is critical to thinking and learning. Lack of sleep impairs attention, alertness, concentration, reasoning, and problem solving. This makes it more difficult to learn efficiently. More importantly, during the night, various sleep cycles play a role in “consolidating” memories in the mind. If you don’t get enough sleep, you won’t be able to remember what you learned and experienced during the day. Lack of sleep can affect our interpretation of events. This hurts our ability to make sound judgments because we may not assess situations accurately and act on them wisely.

Lack of Sleep Kills Sex Drive  Enough said!

Sleepiness Is Depressing  Over time, lack of sleep and sleep disorders can contribute to the symptoms of depression. The most common sleep disorder, insomnia, has the strongest link to depression. In a 2007 study of 10,000 with insomnia were five times as likely to develop depression as those without. In fact, insomnia is often one of the first symptoms of depression.

Lack of Sleep Ages Your Skin  When you don’t get enough sleep, your body releases more of the stress hormone cortisol. In excess amounts, cortisol can break down skin collagen, the protein that keeps skin smooth and elastic.

Sleep loss also causes the body to release too little human growth hormone. When we’re young, human growth hormone promotes growth. As we age, it helps increase muscle mass, thicken skin, and strengthen bones. During stage 4 sleep growth hormone is released, part of normal tissue repair, patching the wear and tear of the day.

Sleepiness Makes You Forgetful  In 2009, researchers determined that brain events called “sharp wave ripples” are responsible for consolidating memory. The ripples also transfer learned information from the hippocampus to the neocortex of the brain, where long-term memories are stored. Sharp wave ripples occur mostly during the deepest levels of sleep.

Losing Sleep Can Make You Gain Weight  A lack of sleep seems to be related to an increase in hunger and appetite, and possibly to obesity. According to a 2004 study, people who sleep less than six hours a day were almost 30 percent more likely to become obese than those who slept seven to nine hours. The peptide Ghrelin stimulates hunger and Leptin signals satiety to the brain and suppresses appetite. Shortened sleep time is associated with decreases in Leptin and elevations in Ghrelin.

Lack of Sleep May Increase Risk of Death  In the “Whitehall II Study,” British researchers looked at how sleep patterns affected the mortality of more than 10,000 British civil servants over two decades. The results, published in 2007, showed that those who had cut their sleep from seven to five hours or fewer a night nearly doubled their risk of death from all causes. In particular, lack of sleep doubled the risk of death from heart disease, high blood pressure, stroke, diabetes and a range of psychological conditions. According to some estimates, 90% of people with insomnia also have another health condition.

The Sleep Cycle

During the night, your sleep should follow a predictable pattern, moving back and forth between deep restorative sleep (stage 4 deep sleep) and more alert stages (stage 1) and dreaming (REM sleep). Together, the stages of REM and non-REM sleep form the Sleep Cycle; with each cycle repeated four to six times over the course of a night.

The amount of time you spend in each stage of sleep changes overnight, with most deep sleep in the first half and REM sleep becoming more pronounced towards morning…possibly related to core body temperature.

There appears to be a strong relationship between several factors that enable us to get a good night’s sleep (sleep hygiene) but of significant interest is the interaction of core body temperature, the ideal sleep cycle and the release of the hormone that helps us sleep and stay asleep, Melatonin.

If we sleep in rooms that are too hot it is impossible to lower our core body temperature and get off to and stay asleep, we maybe drowsy but that is not the same. Research suggest that keeping cool the head cool (in a room at around 16-17° C) but the body warm under the bed covers helps in the coordinated release of Melatonin and ideal sleep cycle. The significance in body temperature before sleep 

So Off to Sleep

Sleep Hygiene is a term used for a range of behaviors that have been shown to improve sleep in Primary sleep disorders and to assist significantly in Secondary disorders. They relate to establishing regular patterns that promote sleep, here are some of the most important:

Factor Getting to Sleep Waking Up

Light As Dark as possible Bright light

Temperature A Cool room (below 17°C) Warm environment

Sound Absolute Silence Noise or Music

Mind Switch off, detach Stimulate, read, TV etc

Lifestyle Eat well, exercise (not late) Breakfast, Hydration.

The National Sleep foundation has produced a more comprehensive list which details and expands on the snapshot above:

  • Maintain a regular bed and wake time schedule, including weekends.
  • Sleep only when sleepy. If you can’t fall asleep within 20 minutes, get up and do something boring until you feel sleepy e.g. sit quietly in the dark. Don’t expose yourself to bright light while you are up which cues your brain to wake up.
  • Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music. (but not in bed!)
  • Create a sleep-conducive environment that is dark, quiet, comfortable, and cool.
  • Sleep on a comfortable mattress and pillows.
  • Use your bedroom only for sleep and sex. Take work materials, computers, and televisions out of the sleeping environment.
  • Finish eating at least 2 to 3 hours before your regular bedtime.
  • Avoid nicotine (e.g., cigarettes and other tobacco products), caffeine (e.g., coffee, tea, soft drinks, or chocolate) close to bedtime, They are stimulants and will keep you awake.
  • Avoid alcohol close to bedtime. It can lead to disrupted sleep later in the night. (alcohol has an ‘anesthetising’ effect and disrupts the sleep cycle).
  • Exercise regularly. It is best to complete your workout at least a 2 hours before bedtime.
  • Avoiding napping during the day.
  • Avoiding eating a heavy meal late at night. However; a light snack before bed is ok if your stomach is too empty. Dairy products and turkey contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.

So cool down the room, pull the blackout curtains, slip in the earplugs and snuggle up.



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Pat Fox

Pat Fox is an exercise physiologist and exercise specialist. After graduating from Otago University in sport and exercise science he completed his MSc in exercise physiology at Brunel University. Pat has worked with a wide range of groups from young developing sportspeople, older age groups and those with specific needs such as diabetes, cardiovascular disease, musculo-skeletal injury, high blood pressure, arthritis, obesity and those new to exercise.

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19th Mar 2013
Thanks for voting!
I have had restless legs for many years, but in the last 12 months this has turned into severe jerkiness almost like having electric shocks. My very understanding wife and I now sleep in different rooms so that she can get some sleep, I average about 4 hours sleep per night which leaves me feeling as if I am hungover and as I drive for a living this is not good, I have told my doctor about it but she called it night cramps and gave me quinine which did nothing,it is not the muscles causing it but the tendons in my legs which seem to go like wire causing me to spasm.
wendy rowe
29th Jan 2013
Thanks for voting!
I am in constant pain with severe back probs, [just spent £700 on new bed supposedley designed by cyropractics only to find its too hard]. I also have very bad Tinitus in both ears [high pitched whistle] and my husband of 45yrs snores, which even after all these years I have never got used to. We now live in a one bedroom bungalow, so I cant even move to another room to sleep but I dont think that would help anyway. I take a sleeping tablet every other night which is ok but it still means I dont sleep on the alternate nights. I take at least 8 tablets a day that state that they may make you drowsy yet I am still wide awake at 10pm. and I have followed all the above advice.
29th Jan 2013
Thanks for voting!
I had a similar problem with my bed (thought Ortho would be ideal!) so i had to go to a foam factory and got them to cut some foam to the exact size of my bed, helped no end. And for the tinitus, a small pair of headphones plugged into mobile/radio and have a talk show playing (I have LBC on) really low, helps me, will also block his snoring hopefully 🙂
29th Jan 2013
Thanks for voting!
Most of the time I have no problem getting to sleep but maintaining sleep for more than 2 hours is a rarety for me mainly due to my age related night sweats. I don't have the heating on at night and wear very little in bed but still wake up and throw the quilt off 2 or 3 times a night. I keep the room well ventilated when I am able to but obviously if its really cold or there is howling wind I shut them.

How can I reduce my core temperature please? because I'm sure I could sleep better if I could keep cool.
29th Jan 2013
Thanks for voting!
Pat Fox has replied to your question:

15-17 degrees in the bedroom will ensure core temperature is within an ideal range. Core body temperature is automatically maintained, although there is a slightly (again automatic) reduced level during non-REM sleep, and lowest during REM sleep.

With the ‘head’ ( i.e. the shell temperature which is the skin essentially) in this environment and body warm under bed covers all should be ok – as you don’t actually want the core temperature to drop too low, hence controlling the environment which will then allow the core to operate in the best range.

There is a method of achieving control of essential functions which would influence temperature directly which is known as autogenic training – a type of relaxation training. This originally German method is now widely taught to people with a range of health problems. One of its key 'exercises' involves lying or sitting comfortably, having first achieved a sense of relaxation, and then giving mental instructions to different parts of the body (say an arm or the forehead) that it is feeling either warmer or heavier or cooler, and then passively observing the area to evaluate the sensation. By repetition people learn to make an arm or foot warmer, or the forehead cooler (as evidenced by a skin thermometer) at will.

It is a good way of relaxing and may also be beneficial to getting off to sleep. But overly cold or hot is not ideal.
29th Jan 2013
Thanks for voting!
I live in a rented flat which has night storage heating. If I have the heating on, I wake up at all hours, too hot. I could leave the window open but then I'm wasting heat. If I have the heating off, there is ice on the inside of the windows and I am shivering when I get out of bed! I think that the only answer is to move!! At least then I might get a full night's sleep.

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