Improve your sleep with these simple steps

Many people have difficulties with their sleep. Some people have trouble falling asleep, others staying asleep and also getting into the right sleep ‘zone’. Insomnia has been defined as experiencing these issues for more than 4 weeks ⁽¹⁾.

People who don’t sleep for long enough (less than 6 hours) may be more prone to health problems ⁽³⁾. Similarly, sleeping too long (more than 8 hours per night) has been associated with increased mortality ⁽⁵⁾.

The core problems that arise from disordered sleep are:

• Emotional imbalance
• Hormonal and metabolic dysfunction
• Tiredness, fatigue and poor performance

Emotional imbalances

Being tired is closely linked with depression and anxiety. Good sleep is related to positive emotions ⁽¹⁾. Mood disorders such as depression and bipolar disorder are very common in people with chronic sleep problems. People with depression have been shown to have particular problems with continuous sleep, slow wave sleep and Rapid Eye Movement Sleep ⁽²⁾.

Hormonal and metabolic dysfunction

Lack of sleep affects stress hormones and serotonin (an important neurotransmitter closely linked with depression and heart disease) ⁽⁴⁾. People may have their stress hormone cycle altered. Cortisol is typically high in the morning and lower after midday, but with sleep related disturbances and work stress and activity, this balance may be altered where morning cortisol is low and then high in the evening which makes it difficult to wind down.

Additionally, one of the most important hormones, Growth Hormone is affected by poor sleep because it is released while we sleep in certain stages. This change in hormone secretion can be related to a whole range of body functions than can go wrong if we go for long periods of time without sleeping properly. Diabetes in particular is associated with poor sleep.

Tiredness, fatigue and poor performance

Everyone knows that performance is poorer when you don’t get enough sleep. Not only is concentration and performance changed, but our ability to perform different tasks is dependent on how we sleep. Some aspects of performance are more affected by interrupted sleep than the length of sleep. Sleeping too long can increase how tired you feel during the day and can increase fragmented sleep, which can then become a cycle ⁽⁵⁾.

So how can I naturally improve my sleep?

• Avoid using technology for 2-3 hours before bed
• Try not to watch TV in your bedroom
• Be ritualistic about the time you go to bed and the time you get up
• Sleep ins are tempting but ruin the point of routine awakening times
• Let the sun shine in to your bedroom in the morning if possible
• Use relaxation music or hypnosis/relaxation cds before bed
• Dim the lights in your room/house 1-2 hours before bed because this helps to release melatonin which is the hormone that helps you sleep
• Keep caffeine intake to the morning or around lunch time only because caffeine is not only a stimulant, but it increases stress hormones that cause problems for many people
• Keep alcohol to a minimum if you do drink. Alcohol changes your sleep ‘architecture’ and can block the healing and repair phases of sleep.

If none of those solutions have any impact, you may have a problem with stress, depression or some other health condition that is worth checking out with a doctor. Allergies and asthma are also associated with the risk of sleep apnea so if you suffer from any breathing problems, it’s worth getting that checked as well.

The problem with sleep drugs

Most of the pharmaceuticals used for sleep are good in the short term and can knock you out for a few nights, but they generally lead to other problems. The main drugs used are either benzodiazepines or non-benzodiazepines. Benzodiazepines include temazepam, alprozolam and generally end in ‘...am’. Different drugs are selected based on how long they stay in the body and exert an effect. The drug safety profile, clinical experience of the doctor and patient history will usually determine the choice of medication used.

Benzodiazepines are still commonly used, but other non-benzodiazepine ‘hypnotic’ drugs are also effective for short-term use in some cases. Some have been associated with strange side effects, so it is worth checking these before use with your doctor.

Non-benzodiazepine drugs such as sedative antipsychotics and antidepressants are also used to help people sleep if the situation warrants their use.

Many drugs can produce ‘hangover’ effects and some are addictive. The drug strategy is not the best strategy for improving sleep, but for some people with mental health conditions, long-term drug treatment is the only thing that works to provide some relief from persistent insomnia.

Non-drug options

There are herbal and other non-drug agents that may help improve sleep. Magnesium is a very important mineral that is involved in many biological processes. It may be worth considering supplementing with magnesium. Many people are low in magnesium and it’s not frequently tested. It is associated with relaxation and reducing muscle tension. Magnesium is sometimes recommended for women with period pain.

There are many herbs available to help with sleep including valerian, hops, skullcap, california poppy and kava. Some of the herbs are available fairly inexpensively and are generally regarded as being quite safe. Many herbs can have strange and unpredictable effects when combined with alcohol and other drugs, so if you are thinking about using any herbal agents, talk to your health professional. Be aware that very few people understand or know about drug-herb reactions, and in many cases the potential side effects are either theoretical or unknown so it's very important to be cautious with drugs and herbs. People forget that herbs contain strong chemicals that are still basically pharmaceutical agents that exert a strong effect on the body.

Melatonin (the sleep hormone) is also available as a supplement. Some doctors are increasingly prescribing melatonin. In Australia, it is not easy to get but it is available generally in 3-5mg doses. Melatonin is also generally regarded as safe and people will respond in different ways.

Summary

In summary, sleep is really important and frequently misunderstood. It seems that 6-8 hours a night is fairly normal and optimal based on some of the current research available. There are drugs and supplements that may help you sleep better but they have issues and are not necessarily good to use in the long term. There are many simple and practical steps you can take to improve your sleep. Reduce stress and wind down at the end of the day through relaxation. Try to minimise stimulating activity as well as too much alcohol and any other drugs. These are some of the most important aspects of promoting your mental health and longevity by improving your sleep habits.

References

1. BAGLIONI, C., SPIEGELHALDER, K., LOMBARDO, C. & RIEMANN, D. 2010. Sleep and emotions: A focus on insomnia. Sleep Medicine Reviews, 14, 227-238.
2. BENCA, R. M., OKAWA, M., UCHIYAMA, M., OZAKI, S., NAKAJIMA, T., SHIBUI, K. & OBERMEYER, W. H. 1997. Sleep and mood disorders. Sleep Medicine Reviews, 1, 45-56.
3. GRANDNER, M. A., PATEL, N. P., GEHRMAN, P. R., PERLIS, M. L. & PACK, A. I. 2010. Problems associated with short sleep: Bridging the gap between laboratory and epidemiological studies. Sleep Medicine Reviews, 14, 239-247.
4. MEERLO, P., SGOIFO, A. & SUCHECKI, D. 2008. Restricted and disrupted sleep: Effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Medicine Reviews, 12, 197-210.
5. YOUNGSTEDT, S. D. & KRIPKE, D. F. 2004. Long sleep and mortality: rationale for sleep restriction. Sleep Medicine Reviews, 8, 159-174.