Sleep problems and how to survive them - Dr Ruth Collins Student Welfare and Support Services

Sleep problems and how
to survive them
Dr Ruth Collins
Student Welfare and Support Services
Wednesday 1 October 2014

Understanding sleep

Sleep is:
   • A complex behaviour with specific functions vital
     to our well-being
   • One of our strongest biological drives
   • Part of a 24 hour cycle of activity/inactivity
   • Dictated by an internal biological clock which
     generates a circadian rhythm

Why do we sleep?

• Restoration:
   • Some genes only turned on during sleep; those associated
     with restoration and metabolic pathways. Important neural
     connections strengthened and linked.
• Memory Consolidation:
   • We need sleep in order to consolidate memory
• Creativity:
   • The ability to come up with novel solutions to complex
     problems is enhanced three-fold by sleep

The sleep cycle
• Typically … 4/5 cycles of sleep a night lasting
  approximately 90 minutes
   • Slow-wave sleep (SWS) occurs in only the first
     two cycles
• REM sleep occurs in all of the cycles, and increases
  during the course of the night

The circadian rhythm
• Sleep is controlled by a powerful endogenous pacemaker:
  the suprachiasmatic nucleus (SCN)
• This tells us when we should wake or sleep releasing
  neurotransmitters which turn sleep on or off
• It takes its cues from light received via the retina
• The SCN sends signals to the pineal gland – which releases
  melatonin
• When rhythms get out of sync, sleep becomes disturbed

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Who suffers from sleep problems?

• Anyone can have trouble sleeping
• But chronic sleep disturbance is very distressing; it can
  take several forms:
   • Difficulty in going to sleep
   • Difficulty in staying asleep
   • Early morning wakening with little prospect of returning
     to sleep

• DO YOU HAVE A SLEEP PROBLEM?

Symptoms of insomnia

• Not feeling refreshed after sleep
• Not able to function normally during the day
• Feeling irritable and tired
• Finding it difficult to concentrate
• Waking easily when disturbed by pain or noise

Impact of insomnia

• Impaired memory and concentration
• Reduced creativity
• Reduction in reaction times
• Increased risk of injury or car accident
• Exaggerated emotions or mood
• Obesity
• Stress

Managing Sleep And Insomnia

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Learn to sleep well

• There are many things you can do about poor sleep
• It is possible to learn to sleep well
• If you are having difficulty sleeping and you are
  serious about solving the problem …
• …. You will need to make some lifestyle changes

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Changing the way you think about sleep

• Dysfunctional beliefs/attitudes a person holds about
  sleep may perpetuate insomnia
   • e.g. I must sleep 8 hours or I will get ill
• Re-thinking those beliefs may be helpful
   • e.g. Have I ever been ill because I only slept for 6 hours?
• Alongside developing new, more realistic, beliefs
   • e.g. If I don’t get enough sleep tonight/tomorrow night I may
     be tired during the day but I won’t get ill and my body will
     eventually take the sleep it needs

Cognitive Strategies

• The main aim is to help break the vicious cycle of:
   • worrying about loss of sleep
   • the fear of sleeplessness
   • anxiety over not sleeping
• …which all leads to further insomnia!

Breathing and relaxation
• The breath is a powerful tool for inducing relaxation
• The out-breath releases tension in the chest muscles and allows
  all muscles to release their tension more easily …
• Sit comfortably in a chair and place one hand on your chest and
  the other on your abdomen. Take two or three breaths.
• Practise so that the lower hand on the abdomen moves rather
  than the one on the chest
• If it helps to count, inhale through your nose to the count of
 four and exhale through your mouth to the count of five. Focus
 on the out breath.

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Sleep hygiene

• Sleep hygiene aims to highlight awareness of the
  different factors that may affect sleep
• Involves following simple rules designed to promote
  better quality and/or quantity of sleep
• Focuses on developing good sleep habits and avoiding
  behaviours that prevent good sleep

Good Sleep Hygiene

• Don’t go to bed any earlier than you need to
• If you can’t sleep get up until you can
• Don’t look at the clock!
• Get up at the same time every day regardless of how
  much sleep you have had
• Restrict the amount of time you spend in bed to the
  actual amount of time you sleep

Helpful hints …

• Avoid caffeine within 4 - 6 hours of bedtime:
• CNS stimulant:
    • Reduces fatigue
    • Increases heart rate
    • Constricts blood vessels
    • Stimulates adrenaline
• Diuretic
• Appetite suppressant
• Inhibits iron absorption

Caffeine Consumption

• Instant coffee: 70 – 100mg
• Tea (PG Tips): 40mg/cup
• Brewed coffee: 100 – 170mg
• Energy drinks: 80mmg – 200mg
 More than 250mg a day causes
   • Irritability/restlessness
   • Nervousness
   • Palpitations
   • Sleep disturbance
• NB: Caffeine sensitivity increases with age

Helpful hints

Avoid
   • Alcohol - may initially sedate but reduces quality of
     REM sleep needed to be fully rested
   • Smoking near bedtime - nicotine is a stimulant and can
     cause nightmares
   • Exercise - within 4 - 6 hours of bedtime
   • Napping - especially after lunch
   • Sleeping tablets - if at all possible

Blue light and sleep

Avoid
   • Tablets, smartphones etc, with self-luminous electronic
     displays
   • Night time light exposure suppresses the production of
     melatonin and speeds up metabolism
   • Short-wavelength or “blue” light is the most melatonin-
     suppressive
   • The consequence of night time use are reduced sleep
     duration and disrupted sleep

More Helpful Hints …

Do
     • Exercise early in the day - it improves sleep
     • Perform relaxing rituals before bed (e.g. warm
       bath, a milky drink)
     • Make sure your bed is comfortable and that the
       bedroom is quiet, dark and a good temperature
     • Reserve your bed for sleeping: don't watch TV,
       read, or work in bed

What do you know about sleep?

1. TRUE Everyone has a biological clock. The timing for sleep is
   regulated by an internal pacemaker.
2. FALSE Drinking coffee cures drowsiness. Coffee is a stimulant
   and can be helpful temporarily but its effects are short lived.
3. TRUE Sleep disorders are very treatable. Depends on the
   severity of the sleep disorder but insomnia, for example, can be
   treated with 4/5 sessions of CBT (even for people who’ve
   suffered long-term).

What do you know about sleep?

4. FALSE Driving makes you sleepy. It only makes your actual
   level of sleepiness apparent.
5. TRUE Most teenagers need at least nine hours of sleep each
   night. Teens and young adults do need more sleep.
6. FALSE Sleep is a time for the body and brain to shut down for
   rest. Sleep is an active process.
7. FALSE Snoring is a common problem but it isn’t harmful.
   Snoring may be harmless for most people but it can be a
   symptom of a life-threatening sleep disorder called sleep
   apnoea, especially if accompanied by severe daytime
   sleepiness.

What do you know about sleep?

8. TRUE Being sleepy makes it hard to think straight. It slows
   down information processing.
9. FALSE The body quickly adjusts to different sleep schedules
   The circadian clock attempts to function according to a normal
   day/night schedule even when people try to change it.
10. FALSE Getting 1 hour less sleep per night will not have any
    effect on my daytime performance. Even a small regular
    decrease in nightly sleep can have an effect on daytime
    performance.

Questions?

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