This page is based on material provided by the NHS via the Primary Care Psychological Treatment Service (Cambridge)
Coping with Sleep Difficulties
Sleep disruption is not uncommon among teachers, ranging from an occasional difficulty getting to sleep to the frequent experience of very poor sleep. Some people who struggle with disturbed sleep complain that they have great difficulty falling asleep – this is called initial insomnia. Others experience middle insomnia, waking in the middle of the night and finding it hard to fall back asleep again. Still others find that they cannot get enough sleep because they suffer from early morning wakening. Disturbed sleep may be caused by a variety of factors. Many of these factors, as well some ideas about what can be done to deal with them, are discussed below.
Poor Sleep Conditions
Sleep can be very difficult when the conditions in which we try to sleep are poor. Most of us have been in the situation where sleep seems impossible because the room is too hot, the noise from the party next door is too loud, or the bed was simply too uncomfortable. The vast majority of people find it much easier to sleep when the following conditions are met:
1. Get Tired
It is much easier to sleep if you are tired. This may sound obvious, but it is important to remember that it will be much harder to fall asleep if you have taken a long nap that afternoon, or if you are feeling very alert after just spending an hour working on an important work project.
Most people find night-time sleep easier if they avoid taking naps during the day. However, other people do report that a nap can be very refreshing and does not disturb their sleep – but these people limit their naps to 30 minutes or less.
Remember that it does take time to "turn off" all the noise from the day. If you work right up to the time you turn out the lights, or are reviewing all the day's events and planning tomorrow right around the time you go to bed (or even after you turn off the lights), you likely find it difficult to fall asleep. This because you simply cannot just "flip a switch" and drop off to a blissful night's sleep. When your brain is alert, you will not feel tired - you need to allow some time to let your brain “gear down”. There are lots of things you can do to help this process along. Some examples:
- Have a warm bath before bed (try to do this at least an hour before you turn off the lights - a hot bath will raise your body temperature, but it is the drop in body temperature that may leave you feeling sleepy, so leave yourself enough time to cool off)
- Watch television, preferably something that is not too engaging.
- Read a book or magazine, but be sure to choose reading material that is not too demanding or engaging – something a bit dull is best.
- Listen to relaxing music
- Relaxation exercises
2. Get the Environment Right
• The room needs to be a reasonable temperature – not too hot (above 22 degrees), not too cold (below 18 degrees). The best temperature for sleep varies from person to person, and is rarely shared by a couple. Generally, men are usually warmer than women while sleeping, and thus require fewer blankets, fewer bedclothes, and more skin exposed. Fortunately, this can usually be accommodated for without separate bedrooms.
• Lying down on a soft yet supportive surface aids sleep. Sleep tends to be less refreshing and is shorter, with more frequent awakenings, when people sleep sitting up or on very hard surfaces
• Quiet surroundings are important. Use earplugs if necessary, and eliminate any unnecessary noise (for example, if the sound of your teenager’s television is bothering you, ask him/her to turn the volume down). However, some people find it easier to fall asleep if there is “white noise” in the background (a low, drone-type kind of noise, like the sound of a dishwasher, or even the sound of music or a voice, as long as it is rhythmic and regular with no unpredictable changes in tone or volume).
• We sleep better in the dark. Eliminate sources of light, if possible.
Disruption of Circadian Rhythm
We all have a “sleep-wake cycle” or “rhythm” – the daily pattern of alternating wakefulness and sleep. This rhythm is a biological program tied to time, very much like an internal clock. This clock tells us when it time to go to bed and when it is time to wake up. This alternating pattern of sleeping and being awake is only one of many such cycles in the body (an example of another alternating cycle is the internal temperature of our bodies, or the menstrual cycle of women). Because our sleep-wake cycle occurs about once every 24 hours, it is called a circadian rhythm (from circa, meaning about, and dian, meaning day).
Interestingly, our circadian rhythm is not only dictated by biological factors – it is also influenced by cues from the external world. Most of us go to bed not only when we are tired but also when the outside world says it is time – for example, when the news is over or when the clock reads 11:30. Similarly, we tend to wake up when the room becomes bright with morning light, or when the alarm clock goes off.
Research has shown that these cues from the outside world are very important in determining both the quality of sleep and how long we sleep. One of the most influential cues from our environment is exposure to light – light is a signal to our biological rhythm that it is time to be awake, and as a result, most people find it difficult to sleep when they are in a bright room or recently have been exposed to bright light (this can include looking a computer screen). Our circadian rhythm can also be altered by many things we do, such as taking naps, the bedtime we choose, and exercise.
Keeping your circadian rhythm on cycle is very important to restful sleep. Here are some ideas of how you can do this:
• The most important thing you can do is go to bed at the same time every night, and get up at the same time every morning. Even on weekends!
• Your circadian rhythm responds very well to cues that it is time to go to bed. It is important to develop a standard routine of “getting ready for bed” that will serve as a cue to your brain that it is nearly time to go to sleep. Do the same thing, in the same order, every night – for example, you might decide to watch 30 minutes of television, then wash your face, then brush your teeth, and then finally settle into bed. Repeat this every night, in the same order.
• Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. If not, we can associate the bed with other activities and it often becomes difficult to fall asleep.
• Bright light is one of the primary cues that set our circadian rhythm. Because of this, it is a good idea to expose yourself to bright light when you get up in the morning. It is not a good idea to expose yourself to bright light during the evening, right before you go to bed, or during the night. During the evenings, keep the room dim. You may want to avoid spending a lot of time looking at the computer screen during the evening or night because the screen is a source of bright light.
• Again, it is a good idea to avoid naps – and if you do feel you must nap, limit yourself to 30 minutes or less.
Substances: Caffeine, Alcohol, and Nicotine
These substances can have a significant impact on sleep. Caffeine, which can stay in your system as long as 14 hours, increases the amount of time it takes to fall asleep, increases the number of times you awaken at night, and decreases the total amount of sleep time. The effects of nicotine are similar to those of caffeine, with the difference being that at low doses, nicotine tends to act as a sedative, while at high doses it causes awakenings during sleep. Alcohol may initially sedate you, making it easier to fall asleep; however, as it is metabolized and cleared from your system during sleep, it causes intense dreaming, awakenings, and sometimes sweating. People may find that they are also awakened by headaches. Smoking while drinking caffeine and alcohol can interact to affect your sleep dramatically. These sleep disturbances may be most apparent upon awakening, leaving you feeling unrefreshed and groggy, or even hungover.
• Nicotine is a stimulant and should be avoided particularly near bedtime and upon night awakenings. Having a cigarette before bed, although it may feel relaxing, is actually putting a stimulant into your bloodstream.
• Caffeine is also a stimulant and is present in coffee (100-200 mg), fizzy drinks like cola (50-75 mg), tea (50-75 mg), and various overthe-counter medications. It is also in chocolate! Caffeine should be discontinued at least four to six hours before bedtime. If you consume large amounts of caffeine and you cut your self off too quickly, beware; you may get headaches that could keep you awake. This may mean that you need to reduce your caffeine slowly, over the course of days or even weeks.
• Although alcohol is a depressant and may help you fall asleep, the subsequent metabolism that clears it from your body when you are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats.
Psychological Stressors
1. General Worrying and Anxiety
Do you find that you can’t sleep because you are too busy worrying? Psychological stressors like deadlines, exams, marital conflict, and problems at work may prevent us from falling asleep or wake us from sleep throughout the night. Other people find that their brain just seems to start worrying as soon as the lights go off, regardless of the amount of stress they are experiencing.
Another problem arises when people engage in intellectually or emotionally stimulating activities right before bedtime; for example, having an important discussion with a loved one, or working on that project for work until the wee hours of the morning. This kind of mental activity right before bedtime can make it very difficult to fall asleep, even when you feel tired.
Worrying produces two problems – first, it keeps your brain active, and second, it tends to activate the stress response of the body, which increases arousal and makes sleep more difficult. It is therefore important to both deal with the worrying, and work on relaxing your body.
• Dedicate some time to thinking about what is worrying you – but try to do this at least an hour before bedtime. Make a list of all the stressors of the day, along with a plan to deal with them.
• Once you have done this, it may be useful to follow it with a period of relaxation. Try reading, relaxing, meditating, or taking a warm bath.
• You have probably noticed that your problems usually seem worse in the middle of the night – and that your ability to come up with effective solutions is also quite poor. It may be quite useful for your to remind yourself that things will probably seem better in the morning and you will be better able to deal with your problems during the day. Don’t try to force the worries out of your head – this strategy does not tend to work. It is more useful to just push the worry aside, to postpone it until tomorrow. You might find that mental distraction is helpful; for example, adding or counting in your head.
• If you find that worries are keeping you awake, you may want to try keeping some paper and a pen near your bed. When a worry comes into your mind, jot it down on the piece of paper for review in the morning. You may want to set aside a few minutes the next day to think about how you will deal with the worries on the night-time list.
• If you find that worries have kept you awake for longer than 20 minutes, try getting out of bed. Go into another room. Keep the light dim. You may want to spend a few minutes writing down your worries, and even jotting down a note on what you can do to solve that problem. Then practice relaxation exercises. Other people find it more useful to distract themselves from their worries by reading or watching a dull television program. For reasons discussed earlier, we would not recommend spending time on the internet or using the computer at all. When you start to feel sleepy, go back to bed. You should repeat this as many times as necessary.
2. Worrying about Sleep
Some people find that worrying about falling asleep or about getting enough sleep can interfere with their sleep – and they are right, this can happen. Unfortunately, trying to force sleep makes it even harder to fall asleep and get a good nights rest. If you find that worrying about sleep is a problem for you, then you may want to try some of the following suggestions:
• You cannot make yourself fall asleep. If you find yourself thinking thought like “I have to fall asleep right now”, this is probably making things much worse. Try distracting yourself.
Many people find reading to be a very useful distraction strategy. Your choice of reading material is important – choose something that is not so engaging that you won’t want to put it down, but not so boring that your mind wanders. Turn on a bedside lamp (not too bright, but enough to see what you are reading) and read until you feel very drowsy and you feel your eyelids getting heavy. Don’t stop reading until you feel this way – no matter how long it takes. Then put the book down and turn off the light. If you find yourself worrying again, you can try reading again – repeat as many times as necessary.
Try putting on some headphones and listen to some music. Many people find that listening to a story (book on CD or tape) helps them fall asleep more quickly and takes their mind off their worries.
• Many people find that worries such as “If I don’t get enough sleep I will be unable to function tomorrow” are particularly stressful and tend to keep them awake. If this is the case for you, it may be helpful to learn that people are usually able to function very well after a night of sleeping very poorly. Research has demonstrated that when people are deprived completely of a night’s sleep, their reaction times, problem-solving ability, and accuracy do not show noticeable decline. Most of the time people only have difficulty performing very boring or monotonous tasks. And research has also shown that if people only lose a few hours of sleep, they usually don’t even report feeling tired the next day. When this worry pops into your head during the night, remind yourself of these facts.
• It is often quite useful for people to learn that that they are probably not very good at estimating how much sleep they have actually had. Research has shown that people who think they are getting very little sleep due to insomnia actually vastly underestimate how much sleep they are getting – they are sleeping much more during the night than they think they are! This may mean that you are spending much more time asleep than you think during those nights of tossing and turning.
• Research has also shown that people (especially people who report insomnia) often think they are awake when they are actually asleep! For example, in a study published in 2002 in a research journal called Sleep, researchers woke people up when their brain activity showed they were asleep, and ask them whether they were asleep or awake. Surprisingly, many people reported that they were awake. This was most likely in the early stages of sleep (the first 30 minutes of sleep) and during dream sleep, and was more likely in people who complained of insomnia. • If your sleep difficulties seem to have increased with age, it may be useful to learn that aging plays a major role in sleep. Sleep patterns change throughout the lifespan, with a general trend to a reduction of sleep with age. After the age of 40, sleep patterns change rather dramatically. People tend to wake up more during the night and have shorter overall sleep time. This is normal and is because older people need less sleep. However, worrying about sleep may still be interfering with your required amount of sleep. Reminding yourself that reduced sleep as you get older is nothing to worry about can be helpful in terms of alleviating this worry and allowing you to have a more restful night. • Again, If you are wide awake and worrying, and you have been that way for 20 minutes or longer, try getting out of bed and using the strategies discussed earlier.
• Are you a clock-watcher? Those glances at the clock can be interfering with your sleep. Each time you glance at the clock, you may be increasing your anxiety, especially if you are worried about getting enough sleep. The more anxious you get, the less likely it is that you will fall asleep. If you do find yourself looking at the clock, or counting the number of hours sleep you have left, you may want to try turning your clock around so you can’t see the time. Don’t count down the hours; instead, focus on just relaxing and feeling comfortable. It is useful to allow your body to rest, even if you don’t sleep a wink. This relaxation, combined with the decreased focus on the time, will also make it more likely that you will get some sleep. Don’t worry, the alarm will tell you when it’s time to get up.
Other Factors
There are many other factors that can affect the quality of your sleep. Some of these factors, as well as some additional ideas about how to improve your sleep, are listed below.
• If you are tossing and turning and feel wide awake, and you have been that way for more than 20 minutes, it is probably a good idea to get out of bed and do something else. Again, choose your “something else” carefully – a boring, non-engaging activity is best. Try to avoid using the computer.
• If you drink too much during the evening, you will awake, perhaps multiple times during the night, due to a need to urinate. Try not to drink fluids during the two hours before bedtime.
• A light snack may be sleep-inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates or dairy products. Milk (warm or cold) may be helpful. Avoiding chocolate is important because it contains caffeine.
• Refrain from exercising during the evening (during the four hours before bed-time). Exercise is stimulating, and it also raises your body temperature. It is a drop in body temperature that occurs when you start feeling sleepy.
• Even though you should refrain from exercising during the evening, you should try to get some exercise during the day. There is good evidence that regular exercise improves restful sleep. This includes stretching and aerobic exercise.
• If you are taking any medication, check with your doctor about the effects of that medication on sleep. Ask whether there is an optimal time to take the medication to avoid sleep interference.
• Does your pet sleep with you? This, too, may cause arousals from either allergies or their movements in the bed. Thus, the cat or dog may be better off on the floor than on your sheets.
And, Finally
Give it time. Sometimes a 'sleep strategy' doesn’t work the first time it is tried. It is very common that people find it takes a while for a strategy to start working, so don’t get discouraged too quickly or you may miss out on the benefits of one of the above suggestions. It may be a good idea to try a new strategy for two or three weeks before coming to a conclusion about its usefulness. There are many things you can try to help improve your sleep. This list of suggestions is not exhaustive – there are lots of other things you might try that may help you get a restful sleep. Family and friends may be another good source of ideas.