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The RCPsych have produced an informational page on sleep and sleep hygiene, which is reproduced here with their permisison.
If you have trouble sleeping - or know someone who has - this leaflet may be helpful. It covers some common problems with sleep, as well as some more unusual ones. There are some simple tips on how to sleep better, and how to decide if you need more help.
You don't usually need to think very much about sleep. It's an ordinary part of life, but sometimes you just can't sleep properly (we call it insomnia). It's usually just for a short time, perhaps when you're worried or excited. When things settle down, you start to sleep properly again. If you can't sleep properly, it can be a real problem because we all need sleep to keep healthy.
You become unconscious, unaware of what's going on around you. As you sleep, you pass through different stages - and there are two main ones:
This comes and goes throughout the night, and makes up about one fifth of your sleep. The brain is very active, your eyes move quickly from side to side and you dream. Although your brain is active, your muscles are very relaxed.
Your brain is quiet - you are still unconscious - but your body moves around more. Hormones are released into the bloodstream and your body repairs itself after the wear and tear of the day. There are 3 stages of non-REM sleep:
You move between REM and non-REM sleep about 5 times during the night, dreaming more towards the morning.
On a normal night, most people wake up for one or two minutes every 2 hours or so. You aren't usually aware of these 'mini wakes', but may remember them if you feel anxious or there is something else going on - noises outside, a partner snoring etc.
This mainly depends on your age:
Even so, we are all different, even people who are the same age as us. Most of us will need 8 hours a night, but some (a few) people can get by with only 3 hours a night.
The short periods when you are awake (every couple of hours) can feel much longer than they really are. So you can feel that you are not getting as much sleep as you really are.
The occasional night without sleep will make you feel tired the next day, but it won't affect your health.
However, after several sleepless nights, you will start to find that you:
This can be very dangerous if you are driving or operating heavy machinery. Many people are killed each year when they fall asleep while driving.
Lack of sleep can make you more likely to get high blood pressure, diabetes and to be overweight.
You may feel that you aren't getting enough sleep or that, even if you do get the hours, you just aren't getting a good night's rest.
There are many everyday reasons for not sleeping well:
More serious reasons include:
If you try these tips and you still can't sleep, go and see your doctor. You can talk over any problems that may be interfering with your sleep. Your doctor can check that your sleeplessness is not due to a physical illness, a prescribed medicine, or emotional problems. There is evidence that cognitive behavioural therapy can be helpful if you haven't been sleeping well for some time.
People have used sleeping tablets for many years, but we now know that they:
There are some newer sleeping tablets (Zolpidem, Zaleplon and Zopiclone), but these seem to have many of the same drawbacks as the older drugs, such as Nitrazepam, Temazepam and Diazepam.
Sleeping tablets should only be used for short periods (less than 2 weeks) - for instance, if you are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long time, it is best to cut down the dose slowly after discussing it with your doctor.
In some cases, antidepressant tablets can be helpful.
Melatonin is a naturally occurring hormone that can help insomnia. At present, in the UK, it is only licensed for treating sleeplessness in those aged over 55. It should not be taken for more than 3 weeks, and should not be used if you have liver or kidney problems. It can make you drowsy and, occasionally, can cause:
You can buy sleeping remedies at your chemist without a prescription. They often contain an anti-histamine, like you find in medicines for hay-fever, coughs and colds. These do work, but they can make you sleepy well into the next morning. If you do use them, take the warnings seriously and don't drive or operate heavy machinery the next day. Another problem is tolerance - as your body gets used to the substance, you need to take more and more to get the same effect. It is best not to take anti-histamines for a long time.
Herbal medicines are usually based on a herb called Valerian. It probably works best if you take it every night for 2-3 weeks or more. It doesn't seem to work as well if you take it occasionally. As with the anti-histamines, you need to be careful about the effects lasting into the following morning. If you are taking any medication for your blood pressure (or any other sleeping tablets or tranquillisers), have a chat with your doctor before using an over-the-counter remedy.
You may have to work at night, staying awake when you would normally be asleep. If you only have to do this occasionally, it's quite easy to adjust. It is much harder to cope with if you do it regularly. Shift workers, doctors and nurses working all night or nursing mothers may all find that they sleep at times when they ought to be awake. It's like jet lag where rapid travel between time zones means that you are awake when everybody else is asleep.
A good way to get back to normal is to make sure that you wake up quite early at the same time every morning - whatever time you fell asleep the night before. Use an alarm clock to help you. Make sure that you don't go to bed again before about 10 pm that night. If you do this for a few nights, you should soon start to fall asleep naturally at the right time.
A parent's disturbed sleep usually ends as their child becomes more settled at night. Shift work, on the other hand, can go on for years. You may need to do it, to earn a living, but:
You may find that you fall asleep during the day at times when you want to stay awake. This will usually be because you have not been getting enough sleep at night.
If you are still falling asleep in the daytime, even after a week or two of getting enough sleep, see your doctor. Physical illnesses such as diabetes, a viral infection, or a thyroid problem, can cause this sort of tiredness.
There are other conditions which make people sleep too much:
This is an uncommon problem, so it's easy for a doctor to miss it.
There are two main symptoms:
You may also find that you:
The cause for this has recently been found - a lack of a substance called orexin, or hypocretin.
Treatment consists of taking regular exercise and getting yourself into a regular night-time routine. If this simple approach does not work, medication may help. These include:
You are more likely to get sleep apnoea if you are:
The problem is often noticed by a partner. Treatment is usually simple - cut down smoking and drinking, lose weight, and sleep in a different position. If your apnoea is very bad, you may need to wear a Continuous Positive Airway Pressure (CPAP) mask. This blows high-pressure air into your nose which keeps the airway open.
At some point in their life, about 1 in 20 adults have night terrors, and 1 in 100 report that they sleep-walk. Both these conditions are more common in children.
Sleepwalking: when you sleepwalk, you appear (to other people) to wake from a deep sleep. You then get up and do things. These may be quite complicated, like walking around or going up and down stairs. This can land you in embarrassing (and occasionally dangerous) situations. Unless someone else wakes you up, you won't remember anything about it. Sleepwalking sometimes happens after a night terror (see below). If your sleep is broken or you aren't getting sleep, you are more likely to sleepwalk.
A sleepwalker should be guided gently back to bed and should not be woken up. You may need to take precautions to protect them or other people, such as locking doors and windows, or locking away sharp objects, like knives and tools.
Night terrors: can happen on their own, without sleepwalking. Like a sleepwalker, a person with night terrors will appear to wake suddenly from a deep sleep. They look half-awake and very frightened, but will usually settle back to sleep without waking up completely. All you can do is sit with them until they fall asleep again.
Night terrors are different from vivid dreams or nightmares as people don't seem to remember anything about them the next morning.
Nightmares: most of us have had frightening dreams or nightmares. They usually happen during the later part of the night, when we have our most vivid and memorable dreams. They don't usually cause problems unless they happen regularly, perhaps because of emotional distress. Nightmares often follow a distressing or life-threatening event such as a death, a disaster, an accident or a violent attack. Counselling may be helpful.
Restless Legs Syndrome (RLS)
People usually first ask for help with this in middle age, even though they may have had symptoms since childhood. It often runs in families.
RLS usually occurs on its own. Pregnancy or a physical illness (iron and vitamin deficiencies, diabetes or kidney problems) can occasionally be responsible.
If it is not caused by another physical illness, treatment depends on how bad it is. In mild RLS, the symptoms can usually be controlled by simple steps designed to help you sleep better (see above 'Helping yourself'). In more severe RLS, medications may help. These include medications used in Parkinson's disease, anti-epileptic medications, benzodiazepine tranquillisers and pain-killers.
If simple measures do not help, you can be referred to a sleep or movement disorders specialist.
Some people with autism do not seem to realise that night time is for sleeping, and may be up and about when everyone else wants to sleep. This will usually need the help of a specialist.
REM Sleep Behaviour Disorder (RBD)
A person will start thrashing about during REM or dream sleep, as though responding to a dream. They may punch, kick, shout, or jump out of bed. Quite often, the person will wake and be able to remember the dream that prompted their physical reactions. Someone sharing the same bed can be disturbed and, sometimes, injured.
The problem seems to be that, unlike normal REM sleep where the muscles are relaxed, in RBD they are not. It can happen on its own or it can be a symptom of a neurological illness, so it's best to be assessed by a specialist.
The Sleep Council
Promotes the benefits of sleeping well. Provides information leaflets on sleep and beds.
Helps snorers and their sleeping partners worldwide.
American website with information on sleep and sleep disorders.
Sleep Disorder Clinics. There are a number of Sleep Disorder Clinics, but referral to one of them should be made through your GP. Patients cannot refer themselves.
Reading Well Agency: Books on PrescriptionReading Well Books on Prescription helps you manage your well-being using self-help reading. The scheme is endorsed by health professionals, including the Royal College of Psychiatrists, and is supported by public libraries.
Coping with Shift Work: UCLA Sleep Disorders Centre
Esquirol Y, Bongard V, Mabile L, Jonnier B, Soulat JM, Perret B. Shift work and metabolic syndrome: respective impacts of job strain, physical activity, and dietary rhythms. Chronobiol Int. 2009 Apr;26(3):544-59.
Falloon K, Arroll B, Elley CR, and Fernando A (2011) The assessment and management of insomnia in primary care, British Medical Journal, 342, 1251-1255.
Johanssen K et al (2011): Longer term effects of very low energy diet on obstructive sleep apnoea in a cohort derived from a randomised controlled trial: prospective observational follow-up study. British Medical Journal, 342, 1248.
Shift work and vascular events: systematic review and meta-analysis. BMJ 2012;345:e4800.
This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board.
Expert review: Professor A J Williams, Lane-Fox Respiratory Unit and Sleep Disorder Centre, St Thomas' Hospital, London.
This leaflet reflects the best available evidence available at the time of writing.
© Ilustration by Lo Cole: www.locole.co.uk/
© Updated: September 2015. Due for review: September 2018. The Royal College of Psychiatrists.
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