Tips for a better nights sleep

Sleep Better Tips Sleep deprivation is one of the most commonest causes of chronic fatigue which can contribute to physical and mental health issues and even increases the risk of disease such as dementia and cancer (read 6 ways sleep fights cancer). Chronic wakefulness leads to a decay in self esteem, and relationship issue within the family and work place. A normal sleep pattern is uncommon after a diagnosis of an illness. There are a lot of things to worry about, the diagnosis, the treatment, how you will feel, financial and family issues and it is normal to wake up thinking about them at night. This page provides some tips to help you sleep and discusses over the counter medications such as melatonin.

If sleeplessness is associated with depressive thoughts, particularly waking in the early hours and is persistent it may be worth talking to your GP as this as it may be signs of early depression. Apart from this and the other obvious causes of snoring partners, noisy neighbours, restless children, there are also several physical symptoms which disrupt sleep and treatment of these may therefore help:

  • Aches in the joints, pins & needles in figures and toes or other pains
  • Hot flushes (night sweats) or itching
  • Breathlessness when lying flat –  heart failure
  • Passing water more often (nocturia)
  • Heart burn or indigestion
  • Steroids
  • Sore mouth and eyes

Self help lifestyle tips

It is important maintain a regular light-dark cycle as this affects the normal circadian rhythm and hence the production of melatonin, cortisol and other regulatory hormones. This is difficult if you are traveling across time zones and working at night but the following tips may help:

Increase  bright (blue) light exposure during the day: One of the best ways to set your circadian clock is to be exposed to bright light (ideally sunlight) during the day. The component of sunlight that tells your circadian clock that it’s daytime is blue light which trigger sensitive photoreceptors in the eyes and to a lesser extent skin. This is one explanation why you feel in a good mood looking at a blue sea. In generally try to get as much natural light as possible in the day but as a minimum if it’s a sunny day, as little as 15 minutes may do the trick or if cloudy, 30 minutes to an hour.  If there is no opportunity to get natural light in the day, a biological alternative would be to put your head into a light box for at least 15 minutes at roughly the same time every morning or mid-day.  Another option is to make many small changes to brighten your environment during the day by using sunlight spectrum light bulbs in your house (but you’ll want to avoid using these light bulbs in the evening), keep curtains open during the day and try to face a window

Avoid bright and blue light in the evening or at night: Just as it’s important for your body to get the signal that it’s daytime during the day it’s important to tell your body it’s nighttime once the sun goes down.  This means avoiding blue light and sticking with red and yellow wavelengths of light as well as keeping the overall light level much dimmer. You can send this important “darkness signal” to your circadian clock by keeping your indoor lighting as dim as possible in the evenings with dimmer switches, or just turning on fewer lights, in conjunction with investing  in red or yellow light bulbs for whatever lamps will be used in the evening.  If you plan to use a computer monitor or watch TV, there are two options.  The first is to install a flux application on your computer phones or tablets and set the screen brightness to the lowest setting.  The second, and probably the best biohack is to wear amber tinted glasses for the last 2-3 hours of your day.  In fact, several scientific studies show that wearing amber-tinted glasses in the evening improves sleep quality and supports melatonin production.  A more sophisticated option for getting both your bright blue light in the day and your dim red light in the evening is to use programmable light bulbs where you can set the color spectrum and the brightness for the time of day. Once you get to bed, sleep in a completely dark room, cover up any LED lights on phones, toothbrushes, baby monitors, or whatever other gadgets you have plugged in in your room and ditch the nightlights or switch to ones with red light bulbs. Blackout curtains help as can white noise generators especially if there are high frequency/pitch noises in or outside of your home since these are very stimulating for the brain. If you need to use the loo at night either learn to navigate in the dark or use as little light as possible.

Reduce and manage stress: You probably recognize cortisol as being the master stress hormone but as mentioned above it’s also a very important circadian rhythm hormone.  This means that if you’re under stress, not only do you have all the effects of elevated and dysregulated cortisol to deal with, but you also disrupt your circadian rhythms. The section relating to psychological morbidity later on in the book will cover this in more detail.  But salient tips would be making changes to the structure of your work social life, asking for help or making time for regular exercise life, taking up meditation, yoga, going for a walk at lunch, taking a bath, or just making time for a good laugh or a hobby in your life.

Aim for regular bed times and try to get enough sleep: Your melatonin starts increasing about two hours before bed to prepare your body for sleep.  If you’re muscling through that with a sugary snack, a scary movie, or whatever else you do to keep yourself awake at night, you are affecting your circadian rhythms. Aim for 7-10 hours of sleep every night and most people will need between 8 – 9 hours).  This means shifting your bedtime earlier so you aren’t struggling through that fatigue to get a second wind (which by the way, usually also means you’re increasing your cortisol right when it’s supposed to be at its lowest).

Exercise generally promotes good quality sleep and also helps reduce anxiety and depression. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.

Diet; Steer clear of heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep. Processed sugar in the evening is particularly bad for a sleep a it causes peaks then troughs in blood sure levels. Probiotic bacteria can help with digestion and improve mood.

Manage your blood sugars: Many hormones are sensitive to swings in blood sugar, including both melatonin and cortisol.  Eating a big meal just before bedtime will increasethe risk of heart burn and indigestion, Avoid spikes in blood sugar from high glycemic load foods, instead concentrate on complex carbohydrates and even healthy fats as these will help you avoid hunger pangs overnight.

Eat melatonin-rich foods: Melatonin is made from serotonin, which in turn is made from tryptophan.  Seafood has more tryptophan while also having less of the other amino acids, which compete with tryptophan to cross the blood-brain barrier.  Montmorency and morello cherries are also rich in plant precursors of melatonin (known as phytomelatonins). So, eating more seafood and cherries is a good way to boost production both of serotonin and melatonin. Seafood also contributes long-chain omega-3 fats to your diet that also help support circadian rhythms by improving general brain health. Ginger also has phytomelatonin so a good nightcap would be some grated ginger with hot water, a little lemon and mint but avoid drinking a lot of liquids prior to bed as it fills the stomach and makes you need the bathroom at night.

Stay cool at night: The temperature that you’re sleeping in is also a cue to your circadian clock.  Ideally your indoor temperature at night should be lower than temperatures in the day

Ditch the alarm clock: Waking up to a jarring noise is very stressful.  If you don’t have the luxury of sleeping until your body naturally wants to wake every morning (which is the best option for protecting your circadian rhythms and overall health), use a light alarm which gradually gets louder can be set on most mobile devices

Cognitive behavioural therapy (CBT) is highly recommended for for Insomnia – It improves behaviors and sleep habits by firstly identifying, and then changing the thought patterns and behaviors that affect a person’s ability to sleep or to sleep well. CBT can be performed by a clinical psychologist or a trained GP.  Self help books can e very helpful. It often involves the flowing steps:

  • Stimulus-control therapy –  associate the bedroom with sleep and establish a consistent sleep/wake pattern
  • Sleep restriction therapy – limiting the amount of time spent in bed to the actual amount of time spent asleep,
  • Sleep deprivation; controlled resistance may increased desire to sleep
  • Relaxation training – reduces tension or minimise intrusive thoughts at night
  • Paradoxical intention –  stay awake and avoid any intention of falling asleep;
  • Biofeedback – sensors on your body help recognise muscle tension when you’re not relaxed

Sleep Hygiene Guidelines

  • Discontinuing or reduce the use of caffeine (tea, coffee, energy drinks) after 4pm and preferably after 2pm. If this does not help, try cutting these altogether.
  • Avoid sweet foods in the evening
  • Alcohol may make you initially sleepy but often you then have a restless night waking throughout the night -try giving up for 2 weeks to see if this helps
  • Nicotine is a stimulant which can keep you awake so avoid smoking at night.
  • Heavy smokers actually suffer withdrawal of nicotine at night so they wake up anxious and alert
  • Avoid drinking large amounts of liquids prior to bedtime – it fills the stomach and causes you to have to pass water often
  • Avoid hunger or excessive eating prior to bedtime
  • Avoid taking daytime naps unless essential.
  • Establish a regular pattern of sleeping – set a time to go to bed & when to wake up.
  • Sleep only as much as you need to feel rested.
  • Go to bed only when you are sleepy
  • If you are unable to fall asleep within 20 – 30 minutes leave the bed and perform a relaxing activity until drowsy and ready for sleep (avoid light exposure).
  • It is important not to expose yourself to bright or artificial lights at night even from smart phones or computers.
  • Exercise regularly but do not exercise within 2 hours of bedtime.
  • Engage in a quiet relaxing activity before bedtime
  • Do not watch exciting TV programs or read stimulating books in bed last thing at – read something boring!
  • Avoid temperature extremes, noise and light when in beds
  • Ensure room is dark – use black out curtains if necessary
  • Try to ensure the room is quite – wear ear plugs if necessary

Medical interventions

The first priority is to recognise and hopefully treatment the medical conditions listed above which would help to remove distractions and improve comfort at night. Early recognition of anxiety and depression should be treated with appropriate counselling, support and treatment of psychological disorders is important will prevent stem more serious events later.

 

Sleeping tablets (hypnotics, Z-drugs) are medications that encourage sleep, if your insomnia is severe as a temporary measure. Doctors are understandibly  reluctant to recommend sleeping tablets in the long-term because they just mask the symptoms without treating the underlying cause. The amount to time they work for gets shorter and shorter over time so users often wake in the early hours unable to get back to sleep.

Antihistamines

Some people use over the counter antihistamines to help them sleep as they can cause can cause drowsiness, — but routine use of antihistamines for insomnia isn’t recommended.

Antihistamines, mainly used to treat symptoms of hay fever or other allergies, induce drowsiness by working against histamine, a chemical produced by the central nervous system. In fact, most over-the-counter sleep aids contain antihistamines. These sleep aids are intended to be used for only two to three nights at a time, however, such as when stress, travel or other disruptions keep you awake.

Tolerance to the sedative effects of antihistamines can develop quickly. As a result, the longer you take them, the less likely they are to make you sleepy. Side effects might include daytime drowsiness, dry mouth and dizziness.

Also, diphenhydramine and doxylamine — sedating antihistamines found in various over-the-counter sleep aids — aren’t recommended for people who have closed-angle glaucoma, asthma, chronic obstructive pulmonary disease or severe liver disease. Recent studies have shown that anticholinergics might increase the risk of dementia. These drugs also have numerous side effects in older adults, such as confusion, hallucinations, dry mouth, blurred vision, constipation, nausea, impaired sweating, inability to empty the bladder completely (urinary retention) and rapid heart rate (tachycardia).

Melatonin (N-acetyl-5-methoxytryptamine) is licenced in the UK within a product called Circadin and is licensed for in adults who are aged 55 or over and it is not recommended to take more than a 13 week course. It can be obtained with a prescription and comes in the form of a ‘prolonged-release’ tablet.

The release of melatonin correlates with the body’s cycle of day and night. The highest levels of the hormone are produced at night.

Melatonin may play an essential role in relieving sleeping disorders, depression, and immune system deficiencies. As light inhibits its production, and darkness stimulates it, melatonin regulates the body’s internal clock. Double blind research shows that this hormone helps people sleep, shortens the number of awakenings in the night, and improves the quality of sleep. It is also very useful in treating jet lag, as it promotes quicker recovery from that “out of it” stage one may experience after extended periods of flight. Research has also shown that having enough melatonin exhibits positive psychological benefits on a person’s mood, while a lack of melatonin corresponds to anxiety, fatigue, and hostility.

Melatonin has also been investigated for its anti-aging potential. Adults experience a reduction in melatonin levels as they age. Frequent travelers and those who work rotating shifts may also improve their sleep levels. Sleep is definitely important to weight-trainers, bodybuilders, and athletes, as muscles grow and repair during sleep.

Levels of melatonin intake should vary with a person’s age. The body produces some melatonin naturally during sleep and many doctors and experts recommend a level similar to the body’s own production, between one to three milligrams taken two hours or one-half hour before a person wants to go to sleep. Melatonin should not be taken during the day. Some uncommon side effects are reports of grogginess, sleepwalking, and disorientation. Pregnant or breast-feeding women should not take it.

Melatonin products, some in the form of ‘immediate-release’ capsules, tablets or liquids, are available from specialist suppliers and on the internet. These are not licensed for use in any patient group in the UK and so are known as ‘unlicensed’.

References: van Heukelom RO, Prins JB, Smits MG, Bleijenberg G. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol. 2006;13:55-60.