Sleep

Shakespeare described Sleep as life’s ‘Chief Nourisher’ when he wrote “Not poppy, nor mandragora, nor all the drowsy syrups of the world, shall ever medicine thee, to that sweet sleep which thou owedst yesterday.”

Many people are surprised but relieved to hear the sentence “My first aim is getting you to have a good nights sleep”. That is because, as Shakespeare said, sleep is the essence of our body, mind, soul, and life. And nothing can replace a good nights sleep.

Circadian rhythms are our internal ‘body clocks’ and this is how as humans we adapt to the 24-hour cycles of light and dark. Our body clocks dictate that adults have one major episode of sleep at night that typically lasts for about 8 hours per night (ranging from 6-9).

Each person has a different tolerance range for sleep that changes as we grow older, and must be reviewed on a regular basis. By following a few simple rules the amount of required sleep for each person can be determined. If you feel rested in the morning and alert throughout the day then you are achieving an adequate amount of sleep.

If no amount of sleep can make you feel rested and alert, then you should seek medical advice that includes being evaluated for a sleep disorder.

Lifestyle factors, diet, illness, pain, and poor sleep habits (referred to as hygiene) are among the most common problems encountered in our society today with regard to sleep quantity and quality. We interrupt our sleep patterns with drugs, chemicals, and work, and we overstimulate ourselves with activities late at night such as watching television.

It is important to understand that we cannot “catch up” on lost sleep, nor can we store sleep for the future. Research shows that people tend to sleep about 30 minutes longer on weekends indicating a ‘sleep debt’ during the week. Lost sleep on any night has immediate consequences for the next day such as loss of concentration, poor work or study performance, and poor memory.

Pain & Sleep

Insomnia, sleep deprivation, and interrupted sleep cycles are a significant problem for many pain sufferers. A night of poor sleep is often followed by a significantly more painful day, and a painful day is more often than not, followed by a night of poorer sleep.

This constant cycle of pain and impaired sleep can often lead to mental distress including anxiety, mood changes, and depression.

Poor sleep quality accounts for a positive relationship between pain and fatigue, whilst disrupted sleep is considered to be an important factor in the development of symptoms in musculoskeletal disorders such as Fibromyalgia.

For any patient in pain, Sleep Hygiene is a significant and very important aspect of their condition that can play a major role in coping, recovery, and remission.

Sleep Hygiene

The key to realising good sleep hygiene is to make the bedroom or regular sleeping area a place that the brain associates with “rest”, “relaxation”, and “recovery”. Therefore, the sleeping area should immediately bring on a sense of calm.

Fix a regular bedtime.

The body gets used to falling asleep and waking at regular times according to our body clocks. By keeping the time you go to sleep reasonably constant, you will fall asleep faster and wake at the same time each morning. Even if you are retired or not working, this is an essential component of good sleeping habits.

Avoid napping during the day. If you nap throughout the day, falling asleep at night is often much more difficult. If you do need an afternoon nap, try to limit the nap to 30–45 minutes in the late afternoon (3-4p.m.) so that you will still sleep well at night.

Avoid alcohol 4 hours before bedtime.

Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.void napping during the day.

Avoid caffeine and smoking 4-6 hours before bedtime.

So many people will say “A coffee / cigarette before bed has no effect on me”. Whilst these same people may be able to immediately ‘fall asleep’ caffeine and nicotine are stimulants. Typical sleep patterns are disrupted, deep slow wave sleep is not achieved, and arousals from sleep increase and these all lead to poor sleep ‘quality’. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate.

Exercise regularly, but not right before bed.

Regular exercise, particularly in the afternoon, can help deepen sleep and encourage a sleep routine. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep as the body is still wide awake.
Relaxation techniques. Techniques such as yoga, deep breathing, and meditation may help relieve anxiety, aid the mind in ‘switching off’ and reduce muscle tension.

Don’t take your worries into the bedroom.

The bedroom is not a place to discuss or think about life events that evoke anxiety such as worries about job, school, finances, relationships, etc. Discuss and think of all of these things before you enter the bedroom so there is a sense of calm when entering the bedroom.

Do not go to bed hungry. Hunger will disrupt sleep patterns. Eat a healthy snack before bed if you are hungry. Warm milk or herbal tea (caffeine free) and foods high in the amino acid Tryptophan such as banana’s can help induce sleep. Avoid heavy, fatty, and spicy foods.

Establish a pre-sleep routine.

Pre-sleep routines such as a warm bath, a foot rub, very light stretching, or a few minutes of reading in low light can help induce sleep. Use comfortable bed and bedding. An uncomfortable mattress or pillows can prevent good sleep. If you regularly wake up uncomfortable, consider replacing your bedding. Keep the bedroom well ventilated and the temperature set correctly. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.

Block out and eliminate as much noise and light as possible.

Reserve the bedroom or sleeping area for sleep and sex only. The bedroom is not an office, workshop, or conference area. If you must have a study area in the bedroom, keep the bed and immediate area free from books and clutter. Let your body "know" that the bed is associated with sleeping.

Television is like caffeine and nicotine.

It is a stimulating and very engaging activity. Many people fall asleep with the television on in their bedroom and swear that it does not affect their sleep patterns. Prior to going to bed, the television should be switched off and not located in the bedroom so the brain has time to prepare itself for sleep.

Waking Up in the Middle of the Night.

For many various reasons, most people will wake 1 or 2 times in the middle of the night. If you cannot get back to sleep ‘within 15-20 minutes’, do not get upset or angry about it, and do not lay there in bed trying ‘really hard to fall asleep’. Get up out of bed and go and sit quietly in another room, read in dim light, have a light healthy snack if hungry, take a bath, or do some other quiet and relaxing activity. Generally, you will feel sleepy again quickly by doing this and you should go back to bed within 15 minutes or so. DO NOT watch television, do the housework, turn on the computer, or do any other task that is engaging or challenging mentally or physically, and do not stay up for an hour or more waiting until you are ‘really sleepy’.

Medications can often cause insomnia and sleep difficulties as a side effect.

If any medications are taken within 4 hours of going to bed, you should consult with your doctor to assess if these are contributing to your sleep problems. Often, other medications can be substituted that do not cause insomnia or they can be taken earlier in the day.

Depression, anxiety, and stress are often associated with sleeping difficulty.

In many cases, difficulty falling asleep or difficulty staying asleep may be the only presenting sign. A doctor should be consulted if you feel that you may have depression, anxiety, or stress that is continuing to affect your sleep patterns.

Sleep medications can be prescribed in certain cases for assistance with short-term relief of a sleep problem. However, the cause of the sleep problem needs to be addressed at the same time.

The role of quality sleep in our lives cannot be overestimated and often we just do not allow ourselves enough rest and our bodies to recover from daily tasks. By following a few of these simple guidelines even if you think you sleep well each night, you will wake more refreshed, alert, active, and alive each day. And in some people, it may just SAVE your life.