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

Developing a night & day pattern. Try to go to bed and get up at the same time. Once in bed make sure the room is dark (use black out curtains if necessary) and if you get up at night try not to turn on any lights or us any lighted screens such as computers, phones or tablets.

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.

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.

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.