‘Sleep . . . Balm of hurt minds, great nature’s second course, Chief nourisher in life’s feast.’
Shakespeare (Macbeth, Act 2, Scene 2)
ALTHOUGH THESE WORDS WERE WRITTEN over four hundred years ago, they are as true today as they were then. In our current too-busy world many of us have almost forgotten what a good night’s sleep feels like. We may feel like it has been forever since we were able to go to bed, sleep and simply wake up 8 hours later with little memory of the intervening hours. We may long for those days when we woke feeling energised and invigorated, looking forward to the challenges of the day. We may even have developed a sense of despair in our ability to ever sleep well again.
If some or all of this describes your attitude towards sleep then I am pleased that you have picked up this book. I am confident that as you read through the following chapters and learn about the processes of sleep and begin to understand how to manage them, your negative feelings will dissipate. You will gradually rediscover the joy of sleep and once again experience the delight of being nourished and refreshed by sleeping eight uninterrupted hours.
When we can’t sleep and are still awake at 3 am after tossing and turning for hours, we may think that we are the only ones suffering the exhaustion of sleeplessness. This is far from reality and it seems that more and more people are finding sleep increasingly elusive. Research from the US indicates that annually more than 35% of adults suffer sleeplessness symptoms.
Part of the problem is that these days we have so much to do and so much going on around us that we often don’t pay much attention to sleep – instead, we live our lives much like the White Rabbit in Alice in Wonderland. Always rushing from place to place, feeling constantly
like we are running late, might work for a while but, for many of us, there will come a time when maintaining this pace is not sustainable – we may begin to suffer ill-health, we may find we have lost our motivation, and we may feel depressed or just exhausted. There are many reasons why we start to evaluate the way we live our life and at times like these, we may well start to think about the role sleep plays in how we think and feel.
If you are reading this book then chances are you have recognised the importance of sleep and want to do something about your sleeping pattern. This is a great first step. I find it very interesting that so often discussions about our physical and psychological wellbeing centre only on our nutrition and our exercise without mentioning our sleep. Yet sleep is fundamental to how well we are able to live our lives, and if nutrition and exercise are perceived as two pillars of health then sleep needs to be considered our third pillar.
Many of us already understand that sleep is integral to our health – but try as we might we are just not able to achieve the sleep that we know is so necessary for our vitality. For us, our bed has become a battlefield where, instead of experiencing deep slumber, we all too often toss and turn, feeling frustrated, exhausted and even perhaps a sense of helplessness at our inability to sleep, until eventually there is an acceptance that soon, with only a few hours of sleep, we will get up and face a new day. This would be bad enough if it were to happen once or twice a month but for many people it goes on night after night, week after week and year after year.
When we can’t sleep, life can become extremely difficult. Sleep is meant to be our time for refreshment and restoration. It is an opportunity, as Shakespeare said, for our minds and bodies to be ‘nourished’, so that when we wake we are enthusiastic and ready to enjoy the pleasures and to manage the stresses of our life. Without sleep, however, simple tasks and challenges can quickly become insurmountable and our relationships suffer.
So how did this happen? How did sleep become so difficult for so many of us? To understand the reasons behind this we need to realise that there is a major difference between the idea that sleep is natural and the idea that sleep should come naturally to us.
Deep, restful sleep relies upon a whole series of interlocking biological processes. If these processes do not work in harmony then we will not be able to get to sleep or to maintain sleep. While these biological processes have been highly effective in giving humans good sleep for millennia, in recent times we have unknowingly sabotaged our ability to sleep, so that right now we are seeing a serious problem with sleeplessness and its consequent health and relationship problems.
We seem to have put aside the fact that sleep nourishes us. We have filled our world with so much light, noise and activity that sleep has become unnaturally difficult. Somewhere along the way, many of us have become too much like the White Rabbit and lost the ability (or the time) to switch off sufficiently to allow sleep to happen. Without switching off, deep, restful sleep will be elusive.
This book is about learning how to access the off-switch again. Many books about overcoming sleeplessness rely on general solutions that apply to everyone. But, just as there are particular foods that are just right for you and specific exercises that suit you best, so too are there sleep solutions that are right just for you.
Sleep solutions are not one-size-fits-all. Sleep is highly individual and there are many reasons why we may not be sleeping well. I have been working in the world of sleep for almost 20 years now and I have met many people with a wide variety of sleeping difficulties. Throughout this book we are going to meet some of these people and learn about their sleep problems and how these problems manifested in real life. We will learn how they managed to overcome their particular sleep difficulties and discover the processes they implemented in order to do this. It is by understanding these different problems and their various solutions that we will gain an insight into our own particular sleep issues and learn how to manage our sleep so that we are able to achieve good sleep on a regular basis.
In order for us to have deep, restful sleep a number of things need to happen. Firstly, we need to understand the processes of sleep and its patterns. Once we understand this it will be possible to discover why you, as an individual, are not sleeping well. When this is established it is then possible to uncover what in particular enhances your sleep, and then to start to manipulate the various sleep processes so that you are able to have deep, restful sleep on a regular basis.
This book is a journey through sleep and it tackles problems progressively. Many of us are tempted to dip in and out of a book like this, seeking out and reading only those bits that we think are particularly relevant to our problem. For example, we may be experiencing long-term trouble trying to get to sleep and so we may decide to go straight to the chapter dealing with this. To completely overcome your sleep difficulties though it’s best to follow this journey in the order that it is presented in this book. By doing this you will be able to fully understand sleep, see where your problem lies and, importantly, how it can be solved.
All of this will take time and effort, but it will be worth it. When the reason for your sleeplessness is discovered it can be treated, and when treated you will rediscover refreshing and invigorating sleep. You will once again experience the joy of sleep and the wondrous nourishing feeling of waking after a long and contented (and undisturbed) sleep.
Sleep is our third pillar of health. It is as important as good nutrition and exercise If we take away one of the pillars our physical and psychological wellbeing will bear the consequences.
So, let’s get started . . .
Understanding the problem
THE IMPORTANCE OF SLEEP WAS recognised as far back as the time of the ancient Greeks and Romans. These civilisations had numerous powerful sleep gods, such as Hypnos, Somnus and Morpheus, and it is from these ancient times that such words as ‘hypnotic’ (to describe a sleepinducing drug), ‘somnolent’ (to describe the state of drowsiness) and ‘morphine’ are derived.
We know that even in these early times, long before the electric light and the internet, people experienced problems with sleep because the use of sleeping aids such as valerian, chamomile and the poppy flower is well documented. The word to describe sleeplessness, ‘insomnia’, comes from the Latin in (meaning not) and somnus (meaning sleep) and was first used by modern medicine around the beginning of the 17th century to describe the inability to sleep.
Today, insomnia is used to describe the situation when someone has difficulty falling asleep and/or staying asleep, and consequently experiences some daytime impairment, such as excessive tiredness, mood changes or lack of energy. Basically someone will be described as having insomnia if they cannot get adequate sleep. While we use only one word to describe this situation – insomnia – we should not make the mistake of thinking that there is only one cause. There are numerous types of insomnia and many causes.
Insomnia is the most common of all sleep disorders and is estimated to affect at least one in three people at some stage of their lives. It can affect all of us, no matter how old or young we are.
Most insomnia only persists for a night or two, but sometimes it will last for weeks, months or even years.
Anyone who has experienced even brief bouts of sleeplessness lasting more than one or two nights knows just how debilitating a few nights of restricted sleep can be. After getting too little sleep for a few days we begin to feel excessively tired, cranky, depressed, unmotivated, indecisive and unable to learn or process information well. We also invariably feel disinclined to exercise or participate in activity. When we do not get enough sleep there is a deregulation of our appetite hormones so we are also very hungry and have a strong desire to eat all the wrong types of food – like chocolate, chips and hamburgers.
Imagine then, how much more these feelings are exacerbated when a person gets 5‒6 hours’ sleep per night three or more times each week over months and perhaps even years. These people truly suffer and they would gladly give almost anything for a good night’s sleep.
Frequently, one of the first steps in the process of overcoming sleeplessness is to classify the type of insomnia being experienced. There are a number of ways this can be done but often it is described either as ‘transient’, lasting anywhere from 1‒2 nights to a few weeks, or ‘chronic’ when the insomnia has persisted for more than 6 months.
While this may be a convenient medical division, for people suffering from sleeplessness the categorisation can be artificial as they may experience repeated episodes of transient insomnia over a period of many years. In situations like these, even though the insomnia would be correctly diagnosed as transient, it is more akin to chronic insomnia as these episodes can be just as distressing as the experience of someone who has struggled with sleep consistently over an extended period of time.
All of us would have had at least one bad night, or even a few bad nights, of sleep due to some stress or disruption to our routine. The reason for the wakefulness is usually apparent and selflimiting. For example, if the difficulty sleeping was caused by an anxiety over an exam, once the exam is completed then normal sleep usually returns. While this is distressing for the days or the week that the bad sleep persists it is generally manageable and short-lived. If a few days or a week of insomnia turns into a month of sleeplessness, however, then this becomes a real problem.
A typical example of this is sometimes seen when a person experiences a traumatic event in their life, such as a relationship breakup. At such times it is common for people to experience difficulty sleeping, often only getting about 4‒5 hours per night. As a result they feel not only emotionally wrought, but also desperately tired. Due to this tiredness they may start to develop some unhealthy sleep habits, which makes sleep even harder to come by. If these bad sleep habits are not cut short then it is likely that what should have been a brief bout of sleeplessness ends up lasting much longer and causing havoc to their wellbeing.
When a person cannot sleep well for a few weeks they will often seek out a sleeping aid. Sleeping aids fall broadly into two categories – self-prescribed or medically prescribed. Selfprescribed aids, referred to as self-medication, include alcohol or illicit drugs, such as marijuana, or over-the-counter medications such as antihistamines, some pain killers or herbal preparations. Medically prescribed sleeping aids are commonly known as sleeping pills. In some cases, these may be an antidepressant with sleepiness as a side-effect.
While a sleeping aid during times of transient insomnia may provide much needed relief and be very effective in achieving sleep, it is important to always use such medications with caution. If care is not taken people can become dependent on the use of the sleeping aid, either physically or emotionally. It is not recommended that sleeping aids be taken any longer than 3‒4 weeks.
While transient insomnia impacts significantly on a person’s health and well-being, the most serious type of insomnia is the chronic form. A person is considered to be suffering from chronic insomnia if they have been experiencing sleeplessness and its negative effects for more than 6 months. The person suffering from chronic insomnia will usually have developed a myriad of coping strategies that they have come to rely on over the years, which continue the cycle of poor sleep.
Unlike transient insomnia, where it is often easy to detect the cause and effect, in chronic insomnia it is generally difficult to discern when and how the problem started. In many instances, in fact, this will never be known. However, in terms of chronic insomnia, how or when it started becomes irrelevant and what is most important is unravelling the current reason for the sleeplessness.
Research into the consequences of chronic insomnia paints a grim picture. Population studies of insomnia have shown that it has both short-term and long-term effects. If you are reading this book and are currently suffering from lack of sleep these consequences will come as no surprise.
When we do not sleep well our mood is affected – and not to our advantage. A bad night of sleep will invariably result in a poor mood state which will include such characteristics as grumpiness, a short temper, intolerance and a general lack of motivation. All of which cannot help but have an impact on our relationships, both personal and professional. Not only are we generally in a bad mood after poor sleep but we are also less inclined to want to exercise and to participate in general activities. This lack of energy directly affects our sex drive, which also decreases as a consequence of sleeplessness.
Jack had not slept well in years. Occasionally he had times where he slept not too badly, but rarely would a week go by when he did not have at least one night where his sleep was truly awful. Over the years he had tried a variety of techniques to help him sleep but most had minimal effect. He had come to accept that he either had to live with his sleeplessness or take a sleeping pill – which he occasionally did when he really needed a good night’s sleep. Mostly he resisted the sleeping pills because they left him feeling ‘foggy’ the next day. By and large, Jack considered he managed his sleeplessness not too badly.
Jack’s wife, however, did not think he was managing his sleeplessness very well at all. It seemed to her that most of the time he was incredibly irritable and, while in the past this irritability seemed mostly concerned with his work, he now seemed irritable almost all the time. This was starting to have a real impact on his family life. He always seemed annoyed about something and when anything went awry, no matter how minor, he would invariably end up yelling at someone.
Jack saw absolutely no association between his sleepless nights and his anger and relationship problems. He was annoyed with his wife when she insisted that he talk to someone about it.
When I first met Jack he steadfastly maintained that while he knew he had problems sleeping he was able to manage them. Sure, he was sleepy, and if I could help with that, that would be good, but otherwise it wasn’t a problem. He did admit that these days he was often irritable or angry but, he was quick to add, this was a result of his work colleagues, friends and family being variously incompetent, non-supportive or downright lazy and he was constantly having to solve one problem or another. His irritable mood, according to him, was definitely not a result of his sleeplessness.
When pressed a little further he mentioned that he and his wife were also having a few relationship problems. Not only did they seem to argue a lot these days, over relatively minor issues, but he also had no interest in sex and this was becoming a big issue between the two of them.
It took Jack some time to be convinced that many of the problems he was facing, including his decreased sex drive, could well be the consequence of his insomnia. By working out what was causing this and treating it, many, if not all his problems would either disappear or improve considerably. Once Jack was ready to accept that not only did his lack of sleep cause his sleepiness, it also impacted significantly on his good health, good mood and energy levels, he was also able to see just why he was so often annoyed and irritated with those around him and why he had lost interest in sex.
This realisation was a really important step as it motivated Jack to look further into what was causing his sleeplessness. As it turned out, Jack had undiagnosed restless legs – a sleep disorder that severely affects a person’s ability to maintain sleep – and once this was treated Jack was able to get at least 7 hours of consolidated sleep most nights.
Not surprisingly, Jack’s life turned around, almost overnight. He no longer felt annoyed by minor problems and was far less likely to lose his temper. Most importantly his family life was more harmonious and he and his wife were getting on far better than they had in years – and both were very happy that they could enjoy sex again.
As if the negative mood consequences were not enough, lack of sleep also directly affects our ability to learn and to think. In a sleep-deprived state it has been shown time and again that we become poor decision-makers, we are much more likely to make mistakes and our ability to learn is seriously impaired. An interesting and important study in this regard, involving over 1500 full-time university students aged 17 to 25 years of age, found that sleep quality and duration were among the main predictors of academic performance – the better the sleep the better the performance.
While the negative impacts on mood and thinking are considerable, a far greater and more serious problem of sleeplessness is the increased likelihood of an occupational or motor vehicle accident. Studies show that people with sleeping problems are seven times more likely to be involved in such accidents. Indeed, some of the more famous occupational disasters such as the Air France crash in 2009, the Chernobyl nuclear plant disaster, the Exxon Valdez oil spill and the Space Shuttle Challenger explosion have been found to be a direct result of operator fatigue.
While the short-term consequences of sleeplessness are well recognised by anyone who suffers from them, the long-term consequences of unresolved insomnia may come as a surprise. People suffering from chronic insomnia are far more likely to develop depression; certain types of cancer; cardiovascular diseases, such as high blood pressure and heart disease; and metabolic diseases, such as type 2 diabetes and obesity. These consequences of sleeplessness may be overwhelming but I mention them here because it is critically important that we know about them and are aware of the damage that ongoing sleeplessness can have on our health, wellbeing and relationships. If we realise these serious consequences we are far more likely to be that little bit more determined to work on our sleeping problems. For some it will take both time and effort to improve their sleep but, given the alternatives, it will be time and energy well spent.
This book offers a systematic approach to discover the basis of your nightly battle with sleep. It is important that you assume nothing because only by having an open mind will you be able to unmask the cause for your sleeplessness and then treat it.
A word of caution
Some of you may find the work you need to do to get your sleep in order difficult, especially when you are already feeling tired and unmotivated. You may be tempted to keep taking your sleeping pills. You are not alone. Research shows that an estimated 6–10% of adults take prescribed sleeping pills. But this is certainly not without its risks and you would be well advised to try to avoid this path.
A large US study published in 2012 evaluated more than 10,000 patients who received sleeping pill prescriptions and followed them for 2.5 years comparing their health outcomes to over 23,000 people who received no such prescriptions. The researchers found that people who took sleeping pills had four times the mortality rate of the group with no sleeping pill prescriptions. Even patients prescribed less than eighteen doses per year were more likely to die during the study period than those who did not take any sleeping pills. Equally as worrying is the finding that there was a 35% increase in the development of cancer in those who had been prescribed more than 132 doses per year.
Despite these potentially serious health outcomes some may still choose to pop a pill as it seems like an easy option. But I would encourage you to stop and ask yourself this question:
‘If the sleeping pills are solving my sleep problem why do I continue to take them?’
The answer is blatantly clear. The sleeping pill does not solve the underlying issue of your sleeplessness: it merely allows for a chemically induced sleep, often leaving you feeling not so great the next day.
A better approach would be to speak with your doctor about the need to continue taking sleeping pills and to start investigating the underlying cause (or causes) of your sleeplessness. Armed with that information you can start implementing permanent solutions and look forward to the day (or night) when all you need as a sleeping aid is a comfortable bed and pillow.
Excerpted from The Complete Guide to a Good Night’s Sleep by Dr Carmel Harrington. Copyright © 2014 by Dr Carmel Harrington.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Pan Macmillan Australia solely for the personal use of visitors to this web site.