A good night’s sleep is something many people take for granted, but for others, getting to sleep isn’t as easy as counting sheep
Sleep is essential. It’s as important as eating, drinking and breathing and is vital for good physical and mental health, according to the Mental Health Foundation. And although sleep is still poorly understood, it is known to be essential for the body’s growth and repair mechanisms and for the brain to consolidate memories, process information and encourage learning. It’s also been shown to benefit the immune system, and can help us to maintain a healthy weight, prevent diabetes, and ward off heart disease.
Losing an occasional night’s sleep can cause tiredness, irritability and grumpiness, and if someone sleeps poorly in the long term, it can impact not only on their mood and concentration, but on their health too. “Sleep problems can give rise to problems with memory, concentration, low mood and loss of energy,” says cognitive hypnotherapist Pat Duckworth. “They can also lead to relationship problems.”
So how much sleep is enough? Well, while everyone needs a different amount of sleep – and this varies throughout life – most adults need around eight hours of good quality sleep every night. Older people tend to get less sleep at night, but are more prone to taking frequent naps during the day. The circadian rhythm (24-hour body clock) influences when we are asleep and awake. It is governed by hormone changes and the level of light in the environment, which is why we generally sleep when it is dark and wake when it is light.
Gender sleep gap
Two surveys published this year have discovered a difference in how well men and women sleep and the effect that this has. According to a UK survey published at the beginning of this year, more women than men have troublesome sleeping habits. The Reclaim Your Sleep survey, supported by the Sleep Apnoea Trust Association and conducted by YouGov for Resmed Ltd, found that 26 per cent of men have trouble sleeping compared with 46 per cent of women. In fact, only 23 per cent of men, versus 36 per cent of women, reported waking up during the night and being unable to get back to sleep.
The survey also revealed that women were more likely to become irritable during the day because of their sleep problems – 60 per cent compared with 47 per cent of men.
Research from the Sleep Research Centre at the University of Surrey in April 2016 also found that women don’t cope as well as men when their circadian rhythm is thrown out of sync. Interfering with women’s circadian clocks affected their brain function more than men’s, especially in the early morning, causing changes in mood and cognition. This means women may be affected more severely if they work night shifts or experience jet lag.
In the Reclaim Your Sleep survey, over 90 per cent of women thought a lack of sleep had a significant impact on their life. Some 46 per cent of women felt that on an average night, they tended to have trouble sleeping and only 14 per cent said they felt well rested when they woke up. Women also admitted that sleeping problems had caused them to put on weight and made their skin look less healthy.
Although women tend to have poorer sleep quality than men, it seems that they are less likely to seek help for issues such as difficulty sleeping or snoring. One in four women who have trouble sleeping turn to herbal remedies to improve how well they sleep, and more women than men are advised to take prescribed medication or sleeping tablets by their healthcare professional. But 22 per cent ignore their sleep problems completely.
There is some evidence that women multitask more often than men and may have more active minds, which can be a cause of insomnia. But according to Professor Kevin Morgan, director of the Clinical Sleep Research Unit (CSRU) at Loughborough University’s School of Sport, Exercise and Health Sciences, a combination of hormonal and societal factors are most likely to influence women’s sleeping patterns. “Women generally report higher levels of insomnia across the age span,” he says. “Menstruation, temperature regulation changes, pregnancy, childbirth and the menopause can affect their sleep. Women also live longer than men so experience more ageing-related problems.”
Sleep apnoea link
Professor Morgan recommends that customers who experience excessive daytime sleepiness and snoring should be referred to a GP, especially if they are obese with fat around their neck, as they may have obstructive sleep apnoea (OSA). This is a debilitating condition that affects around 1.5 million adults in the UK. In people with OSA, the muscles in the throat relax during sleep, causing them to temporarily stop breathing. OSA is often seen as a ‘male problem’, but women can be affected too, with pregnancy and the menopause increasing a woman’s risk.
According to the Sleep Apnoea Trust Association, up to 93 per cent of women with moderate to severe sleep apnoea may be undiagnosed. This may be due to a low level of awareness of the symptoms, risk factors and impact of untreated sleep apnoea, as revealed in the Reclaim Your Sleep survey. Even when presenting with typical OSA symptoms, women are less likely to be referred to sleep clinics and may be misdiagnosed with depression, hypothyroidism or other illnesses. In the survey, 46 per cent of female patients with sleep apnoea claimed to have suffered with sleep problems for over five years before being correctly diagnosed with the condition. The symptoms present differently in women than men and include softer snoring, lower report of sleepiness, insomnia, restless legs, fatigue or day-time sleepiness, depression, headaches and muscle pain.
If left untreated, OSA can lead to high blood pressure, heart attacks, stroke and diabetes. It is therefore important that all healthcare professionals are aware of more serious sleep issues so that people can seek appropriate help as soon as possible.
“GPs are obviously the best and first port of call for those looking for support and advice around sleep apnoea,” says Professor John Stradling, a sleep disorder expert from Oxford University. “However, it is important that all healthcare professionals play a role in discussing the condition with at-risk patients to facilitate diagnosis and treatment. Remaining untreated leaves patients at risk of serious and costly co-morbidities, and successful treatment can improve their quality of life. The sooner a patient’s sleep issues are addressed by a sleep expert, the better.”
Many factors can affect a person’s sleep, but bad sleeping habits are often the underlying issue, rather than anything more serious. Simple lifestyle changes can usually resolve many bad sleeping habits. Dr Nerina Ramlakhan, physiologist, sleep therapist, author and sleep expert for the bed company Silentnight, says making good lifestyle choices is important in controlling the impact of short-term insomnia. “Our energy levels aren’t just about how we sleep,” she says. “We can make choices to balance out the effects of short-term insomnia – good nutrition, exercise, getting fresh air and moving regularly, hydration, how we breathe, paying attention to our relationships and doing things that have meaning and purpose.”
According to Pat Duckworth, pharmacy staff play an important role in checking for any underlying issues. “Ask customers about the context of their sleep problems,” she says. “For example, what was happening at the time they started to experience poor sleep? Sleep problems may be due to stress, trauma or some other life event that will pass. Are they taking any medication that may, as a side effect, be disturbing their sleep? If they have been experiencing a severe lack of sleep for a month or more, they should consult their GP. Refer them to the NHS Choices website for tips on getting better sleep or print out the tips to give to customers.”
Healthy sleep habits are often referred to as ‘sleep hygiene’. Useful tips to pass on to pharmacy customers include:
- Stick to a regular sleep routine: going to bed at the same time in the evening and waking up at the same time each morning will help keep the body clock on an even keel
- Keep the bedroom quiet, dark and not too hot or too cold, so that it’s the right environment for falling – and staying – asleep
- Change your mattress every 10 years or so
- Exercise during the day, such as 30 minutes of walking or cycling, as this will help to make sure you are tired in the evening, but don’t exercise too close to bedtime
- Cut down on caffeinated drinks such as tea, coffee, cola and energy drinks. To encourage sleep, try a warm milky drink or herbal tea
- Avoid eating too much food or alcohol late at night, as this can affect sleeping patterns
- Have a warm bath, listen to quiet music and read a book before bedtime. Switch off all back-lit devices, such as televisions, phones, tablets and computers
- Write down a list of worries in the evening so that it’s easier to forget about them until the morning
- If unable to sleep, don’t lie in bed worrying about it – get up and do something else for a while until you feel sleepy.
Pat suggests that if customers are still having trouble sleeping after trying lifestyle changes, they could try over-the-counter or herbal sleep aids. “Lavender oil and lavender pillows can be very soothing,” she adds. “Cherry concentrate tablets and liquid help to promote the production of melatonin, which is associated with a good sleep pattern.”
For some people, insomnia can last for months or even years, and can have a significant impact on their day-to-day lives. Professor Morgan says chronic insomnia can be managed with two different approaches – cognitive behavioural therapy (CBT) or prescribed medication in the form of sleeping tablets. CBT is recommended by the National Institute for Health and Care Excellence (NICE) as the first-line treatment for insomnia, and has been shown to be effective in various clinical trials. It teaches techniques that address any underlying mental or cognitive factors associated with the insomnia (such as an overactive mind) and overcome the worry and negative emotions associated with not being able to sleep properly. Long term, it helps people to establish healthy sleep patterns. Prescribed medications should be used as a last resort as they are only a short-term solution.
Children and sleep
Sleep is essential for children’s growth and development. A newborn will sleep for 16-18 hours over a 24-hour period. By the time children reach three years of age, they generally get 11-12 hours a night, with maybe one short nap in the day. This gradually reduces as they reach their adolescent years.
According to the NHS Choices website, a child is likely to be getting enough sleep if they get up fairly easily in the morning, are alert and happy for most of the day and aren’t grumpy. If children struggle with a regular sleep routine, this can have a significant impact on the whole family, as well as their own physical and mental health. “Poor sleep in children leads to fatigue, poor memory retention, mood swings, overeating and poor performance at school,” says cognitive hypnotherapist Pat Duckworth.
Insomnia in children tends to be lifestyle related and can be resolved with simple sleep hygiene measures such as a regular bedtime routine, a quiet bedroom and no television or electronic items late at night. “Often, parents simply need to manipulate a child’s sleep regime so they are appropriately sleepy at bedtime,” says Professor Kevin Morgan, director of the Clinical Sleep Research Unit at Loughborough University. “There’s more likely to be an underlying problem with younger children who can’t sleep. They may be in discomfort or pain or have a febrile condition, or there may be something worrying them.”
Teenagers need more sleep than adults (around nine hours a night), possibly due to their rapid growth and the physiological changes occurring in their body during puberty. “If teenagers suddenly experience insomnia, look at their lifestyle,” says Professor Morgan. “For example, their energy drink intake, bed time and use of technology.”
Some teenagers experience a shift in their natural circadian rhythm – called delayed sleep phase syndrome – where they need to stay up later to feel sleepy and then wake up later in the morning. If they have to wake up early for school, this can mean they’re sleep deprived during the day.
Most sleep problems in children are not serious and get better on their own. If children or teenagers have persistent insomnia, parents should consult their GP as there could be an underlying physical or mental health problem. A GP can refer children and teenagers to a paediatrician or local child and adolescent mental health service.
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