A Good Night’s Sleep

A good night’s sleep should be the most natural thing in the world. When we get good sleep, we feel revived and better able to cope with anything.

Everyone has the odd bad night of sleep. Some of us are unlucky enough to have frequent sleepless nights in a row. We may find it hard to fall asleep, or hard to stay asleep, or may drift in and out of unrefreshing sleep.

Many medical conditions can affect our sleep and leave us feeling exhausted and unable to concentrate the next day. Common conditions known to affect sleep include stress, depression, anxiety, heartburn, menopause, pain, and restless legs. People who drink a lot of alcohol, smoke a lot or use recreational drugs can also have sleep problems. But often it is difficult to work out the exact cause of poor sleep. It is always worth seeing your doctor in case your particular sleep problem needs special medical care.

Although there are prescription drugs available from your doctor to help with sleep, these medicines are never a first-line choice. Drugs like Zolpidem and Xanax can be good in the short term, but it is often best to avoid them. Even if you do find yourself needing a prescription sleep medicine, it is still worth considering other ways to get your sleep patterns back on track.

So what non-drug options are available to help with sleep? The following tips will not work for everyone, but many people will benefit from a different focus when they are trying to improve sleep. Even just trying to work out what it is that is preventing you sleeping can help provide a starting point for sleep improvement.

Let’s start with the obvious suggestions. These are things we all know about but somehow we never fully focus on for longer than a few nights. They should all become long-term habits.

• Routine – dull though it may sound, a fixed routine every single night can go a long way to improving sleep. This includes having a fixed time for going to bed and for waking up. And don’t try to change this fixed time routine at weekends.
• Single purpose – avoid using your bedroom as an office or a movie room. Try to choose a small bedroom, so you won’t end up using it for multiple other non-bedroom purposes.
• Relax – yes, really! Choose an activity (or activities) that signals it is the end of your day and time to get ready for bed. This may include having a warm bath, changing into pyjamas, soaking your feet, massaging in hand cream, cleansing your face, listening to a chapter of a talking book, reading a magazine, drinking something warm (like milk with honey or herbal tea), laying out clothes for tomorrow, or watering your spider plant. It should not include checking emails or Instagram, or binge-watching a box set.
• Screens – it should go without saying: keep the TV, computer and mobile phone away. If you feel you must have your mobile nearby, have it propped up against a wall outside your closed bedroom door. Use an old-fashioned alarm clock in your bedroom instead. No charging up mobile phones or computers in the bedroom – the flashing lights are too distracting and create unnecessary low-level light.
• Comfort – think about the temperature (comfortable) and brightness (not too bright). Things about room dressings such as curtains, quality of pillows, duvet and mattress, and what you wear (or don’t wear in bed) can all help.

What to avoid: Again, these are all things we know about, but many people ignore these or don’t consistently follow through.

• Avoid napping during the day.
• Avoid caffeine (including chocolate), nicotine, and alcohol – timings vary but it is probably best to avoid these within six hours of going to bed (but avoiding for four hours before may work well enough).
• Avoid a heavy meal close to bedtime.
• Avoid exercise (or not): there is some conflict about how close to bedtime it is still OK to exercise. In general, it seems that any exercise you do earlier in the day is good to help you get to sleep. If you don’t exercise at all, then add some exercise into your day. Standard advice used to be not to exercise too close to bedtime, but this doesn’t seem to apply to everyone. Go by your own judgement – if you feel your sleep varies according to exercise timing, then change your exercise schedule as you wish.

Do psychological therapies help?

Cognitive behavioural therapy (CBT) done face-to-face with a trained professional can be very helpful in getting your sleep sorted out. But it is not always easily available, and it can take several weeks to get a noticeable effect.

In the absence of CBT, there are some self-help options:

Focused relaxation tricks include thinking about relaxing each muscle in turn, breathing techniques, and colouring (see “Recommended Reading” in this issue for a great colouring book). This very helpful PDF leaflet on relaxation from MIND (a UK-based mental health charity) gives some exercises and tips.

Keep a detailed Sleep Diary. There are lots of templates online. I like this Sleep Diary from The Sleep Council (a UK-based, non-medical consumer site). It is quite detailed but doesn’t take up too much time. In two weeks of dedicated diary keeping, you may discover patterns in your sleep disturbance. Once you identify these, you have a baseline on which to focus changes.

Do your own Sleep Restriction Therapy. This is about reducing the time you spend lying in bed at night awake, and increasing the time you spend asleep.

You need to keep a Sleep Diary first to work out how much time you actually spend asleep. Say you spend eight hours in bed every night between 23:00 and 7:00, but only actually sleep for a total of four hours (adding all the separate bits of sleep together). Then you should restrict your time in bed (your “in-bed” time) to four hours – you do this by going to bed at 3:00, but still getting up at 7:00. You need to do this for two weeks. No daytime naps are allowed and you still need to continue your diary throughout. If you are getting better sleep, you can then start making adjustments bit by bit by adding an extra 15 to 30 minutes each night to your “in-bed” time (in my example, you would then start going to bed earlier at 2:30 or 2:45 instead of 3:00). If you are not sleeping better, you knock time off of “in-bed” time (so go to bed 15 minutes later, at 3:15).

This is a gradual but effective method of sleeping for longer lengths of time at night. You keep slowly adjusting the “in-bed” time until you reach a good length of time spent in bed actually asleep. There are lots of online resources that show you how to try Sleep Restriction.

What else works?

There are certainly lots of other options to try such as yoga, tai chi, meditation, mindfulness, acupuncture, valerian, lavender preparations, and sleep teas. Whether these genuinely work or not, it is hard to say. Anything that improves your mood and sense of wellbeing can improve your sleep. Many people swear by their own tried-and-trusted sleep tricks.

Sleep may be the most natural thing in the world, but when sleep doesn’t come naturally, most of us are willing to give anything a try.

Feel free to share your sleep tips below!

By Dr. Jahura Hossain

Born and brought up in London, Jahura is a U.K.-qualified doctor. She has worked in hospitals, general practice, public health, prison medicine, and the pharmaceutical industry.

Illustration by Lara Friedrich

Lara has been a freelance illustrator for Mothering Matters since early 2013. She is in her third year of University (majoring in psychology), where she’s currently working as an assistant in a research project in pedagogy. Lara is also an assistant translator from German to English for various fiction books, and also works as a demo singer for the songwriter Kate Northrop. 

© Copyright. Jahura Hossain. 2016. All rights reserved. No part of this article may be reproduced without the express consent of the author.