We spend a quarter to a third of our life doing it and yet there’s still so much about it that’s a mystery. Why do some people need nine hours of it and others thrive on only three or four? Why do we dream and what do our dreams mean? Why does the lack of sleep induce distress akin to mental illness? And the biggest question of all; Why do we sleep?
One thing has become really clear. Sleep is the great healer.
The extent to which it’s critical to our recovery was made clear to me in this excellent TED talk by Jill Bolte Taylor on stroke recovery where she explains how she rebuilt her brain. Prior to her stroke, Jill was a brain scientist so her insights are particularly fascinating.
Like many people she’s critical of the way hospitals are designed around staff rather than patients, with people being woken up at regular intervals to have their ‘vital signs’ checked. This is not conducive to recovery!
Most of us understand the importance of sleep but have you ever noticed how few people report sleeping well. It’s possibly the most important contribution we can make to good health, so here’s my collected wisdom on getting a good night’s shut eye.
When we remove those that sleep well for long enough and wake refreshed, we’re left with those that fall into one or more of the following groups:
- Those that struggle to get to sleep
- Those that struggle to stay asleep, waking once or several times a night
- Those with a medical condition that directly impacts their sleep
- Those that have been asleep for what should be long enough and yet wake feeling tired and unrefreshed by sleep.
Let’s start with the fourth group. If you’re in this category it’s worth having a sleep study done. The most common cause of un-refreshing sleep is apnea (which moves you up into the third group), a condition where you stop breathing intermittently while you sleep. In sever cases it can be life threatening. Even mild cases can have serious affects on your health. You can now get a sleep study kit that you take home overnight. You stick on the electrodes and climb into bed. A little suitcase records all of the information and you usually get a report back within a couple of weeks.
If you’re diagnosed with apnea there are a couple of options, including wearing a device that maintains air pressure while you sleep or having corrective surgery. My husband had surgery last year with great results and he’s now healthier, happier and has much more energy during the day. He couldn’t stand the CPAP machine but lots of people are huge fans.
There are other conditions that might put you in the third group including narcolepsy. These always need medical treatment and you should talk to your doctor about how to improve your condition. All of the other advice here about sleeping will help but some conditions really do need medical intervention.
If your sleep study shows that you don’t have apnea it might also give you some idea of why the quality of your sleep isn’t leaving you refreshed. It could be something as simple as not sleeping deeply enough and this can send you back to the bedroom to look for causes. Which is handy, because that’s exactly what we need to do for people in the first two categories.
Good conditions for sleep might seem proscriptive because we’ve all seen people that can apparently sleep just about anywhere. It’s true that most of us could fall asleep propped up against a wall if we were tired enough but it’s unlikely that the sleep we get would of a very good quality.
Sleep moves through cycles that usually last about 40 minutes. If something is regularly disrupting your sleep you’re not going to achieve the deepest levels of sleep that allow you to feel well rested. Obvious culprits include a snoring partner, a noisy environment or an enthusiastic nocturnal pet. Here’s a short check list of the ideal sleeping environment:
- Dark; light on the outside of your eyelids triggers you to wake up.
- Cool; the ideal temperature for sleep is around 18 degrees celsius which is much cooler than the 22 degrees we like when we’re moving around. If you’re in air conditioning it might be too warm (and too dry) to sleep well.
- Quiet; even low level noise can disturb sleep. Most of us become accustomed to familiar noises which is why it’s possible for us to learn to sleep next to train lines or busy roads. We don’t stop listening when we sleep. Sudden and unusual noises will wake us up or disturb our sleep. Sometimes even the low buzz of an electronic device is enough to mess with our sleep patterns. Try moving the phone and charger or the electronic clock out of the bedroom.
Unfortunately for some of us, our partner might be the source of the noise. In these cases it really is worth considering separate bedrooms if that’s possible. You can still spend time together before going to sleep or in the morning.
- Comfortable; I think there’s a lot of hype and money in the mattress industry these days. Interestingly, most of the european population sleeps perfectly well on foam mattresses but in Australia we’re obsessed with the inner-spring. The best mattress is one that provides enough support to keep your back aligned along with enough padding to stop your bony bits becoming uncomfortable. I’ve avoided replacing my latex mattress by adding a topper to it in memory foam.
- Clean; Dust mites, mould and allergens can all have a negative impact on your ability to sleep. Fresh air is also important and this can be a real problem if you can’t have windows open due to noise or live somewhere where the outside air is far from fresh. A portable air conditioner or dehumidifier is probably your only option here.
- Un-interupted; I adore my cat. He comes in each morning for a cuddle. He doesn’t sleep with me because he thinks it’s a great idea to get up at 3.00am and run around the house like a deranged lunatic. When our sleep is interrupted it prevents us achieving deep sleep. Do what you can to protect your peace.
If you’re finding it hard to get to sleep or to stay asleep then start with your sleeping environment. A lot of people have solved their sleeping problems with some very minor adjustments, like black-out blinds or a thermostat adjustment.
If you’ve run a diagnostic on your bedroom, created the ideal sleeping environment and it’s still not happening for you then here’s a list of the most common things that disturb our sleep:
- Overstimulation; we sleep best when we’ve spent the last hour or so of the evening winding down. Do whatever helps you to relax. The obvious exception to the overstimulation rule would be sex. Nothing beats an orgasm for facilitating sleep. Isn’t that good news!
- Exposure to light in the blue spectrum; this signals our brain that it’s day time. Unfortunately computer screens and energy saving globes are both common sources of light in the blue spectrum. You can get an ap called f.lux that will adjust the light on your computer and you can also get ‘warm’ globes. Fortunately, exposure to light in the yellow/red range has the opposite effect so taking advantage of candle light and fire light will help you wind down.
- Not enough sun; it seems odd that we need sunshine to sleep well but it turns out that eating our breakfast in the daylight is a great way to set our body clock. This is particularly important for people on shift work or those recovering from jet lag. When you wake up, go outside and get some sun. If your ‘morning’ occurs during darkness then you might want to invest in a light that simulates sunlight. This should improve your ability to get to sleep and the quality of that sleep.
- Overindulgence; too much food or alcohol will disrupt your sleep. Alcohol might seem like a great way to unwind but it actually disrupts your sleep cycle and this (along with dehydration and altered brain chemistry) contributes to feeling hung over the next day.
- Anxiety; a big favourite with those of us dealing with serious illness and this one deserves a book rather than a few lines. Luckily there have already been several great books written about dealing with anxiety. My favourite is Russ Harris’s ‘The Reality Slap’. Breathing exercises, meditation and yoga are also wonderful. Don’t just put up with it. It isn’t helping you to recover and it’s robbing you of your sleep. If it’s really bad then get counselling for it.
- Pain; for many people it’s the great sleep thief. Fortunately there’s now been some great advances in managing chronic pain, including improvements in medication and a much wider range of medication-free strategies. Calming music, gentle exercise and meditation can all help with handling pain. So can hypnosis and counselling from a good psychologist (particularly one with ACT training). Massage and other ‘touch therapies’ are also excellent for helping to deal with pain.
- Monkey Mind; I love this Buddhist term for the way our minds will jump around from one thing to another, never settling in one place. They recommend meditation and it certainly works well. Another great technique is to spend ten minutes listing all of the things that are occupying your thoughts. Write them down. Then you can put your head on the pillow and when ideas pop up you can thank your mind, remind it that you’ve already made a note of that for tomorrow and then relax.
My husband and I have both had periods of time where we kept waking up in the middle of the night, often at the same time every night. For me, a short passage in a book about the subconscious helped me to overcome this. It explained that when we spend all day talking about how we can’t sleep we’re actually programming ourselves not to sleep well. I started changing my internal dialogue to “I will sleep well and wake up feeling great” and I stopped talking to other people about my bad sleeping habits. This solved my problem.
My husband not only woke during the night, he then experienced annoyance and frustration at being awake. This, of course, made it much harder for him to get back to sleep again. Recently a friend shared an article about a bit of historical research that indicates it was once quite common for people to sleep twice during the night. It seems they would go to bed shortly after sunset, wake some time during the middle of the night, use that time to read or do bookwork by candle light, and then go back to bed for their ‘second sleep’. This has made a huge difference to Graham. He’s in the kind of job that he can dip in and out of and it’s often some sort of complex work problem that wakes him. Now he gets up, spends a couple of hours on it and then goes back to bed.
If you remember that sleep moves in roughly a 40 minute cycle then there’s no reason why we couldn’t break our sleep up into whatever sort of pattern works best for us. When my daughter was a baby the key to coping in the early weeks, when she had terrible sleeping patterns, came from a friend who suggested that I sleep whenever she slept. It seemed counterintuitive to me that grabbing a couple of hours here and there could make up for ‘a good night’s sleep’, but it did.
My other really interesting experience with sleep happened following my first surgery to remove the remaining tumour from my breast. I was in a shared ward with a woman that had been through reconstructive surgery. She was experiencing high levels of pain and was calling out with distress throughout the night in spite of the morphine pump. I put my headphones in and spent the night listening to calming yoga music and led meditations. I didn’t sleep. To my surprise I felt as refreshed the following day as if I’d had a really good sleep! This wasn’t a fluke. I now regularly use my iPod when I’m having difficulty sleeping. Sometimes I fall asleep and sometimes I don’t but I always feel great the next day. (Tip; get some of those ear buds that sports people use so they don’t fall out.)
Most of the techniques that help you get to sleep involve some kind of mindfulness, or some kind of activity designed to distract your mind from your everyday concerns (like counting sheep). Here’s just a couple of my favourites:
4 – 7 – 8 Breathing
Alternate nostril breathing
These are both beautiful yoga breathing exercises that help me to calm anxiety and relax my body. I’ve done both from the comfort of my bed.
It might seem strange, but I also find that doing pelvic floor exercises and counting them backwards from 1,000 helps. This is a simple activity to distract my mind and hey, who doesn’t need to do more pelvic floor exercises!
There’s a very popular yoga relaxation technique where you clench and then relax each part of your body, starting with your feet and moving to your calves, knees, thighs and so on, all the way to the top of your head.
If that’s all a bit much then just a simple meditation on the breath can help to get you ready for sleep. You don’t try to force your breath at all. You just observe it. Count as you breathe in and count as you breathe out. Now gradually start to increase you exhale by one or two counts.
My final tip is that if you’ve tried everything and sleep just isn’t happening then you’re better off getting up and having a glass of milk than staying in bed and fretting about it. Don’t reach for any electronic devices. Just have a drink of milk and then head back to bed and start again. If you can’t sleep, try to rest and relax rather than fretting over your lack of sleep.
Most importantly of all, remember that sleep is the great healer so if you’re finding you need more of it than usual during treatment or recovery just go with it. When I was having chemo I was sleeping up to 14 hours a day. During radiation treatment it was about ten hours a day. I’m now back to around eight or nine hours every night. Healing bodies need much more sleep, so snuggle up and don’t feel guilty about it.