Sleep problems

Summary
Sleep is a key part of normal body functioning and will work better with a healthy diet with enough fibre (roughage), vitamins and minerals. This means eating plenty of fruit and vegetables and unprocessed cereals. Improving your diet will help boost your energy levels and wellbeing. 

The NHS Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of fluids (at least 6 to 8 glasses a day)

If you’re having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients.

Why sleep hygiene?
One of the most effective ways of getting back to good sleep habits is to set up a proper sleep plan, to treat the job like a full campaign. ‘Sleep hygiene’ is the name often given to cleaning up all the factors that may be interfering with restful sleep, particularly in the bedroom.

Time for bed
In order to sleep, you need to be tired. If you’re not properly tired, you may drop off but the sleep you get may not be deep, good-quality sleep, and you could find yourself waking unrefreshed. So going to bed too early is a bad move. Exercise regularly to help relieve tension and help your body relax. Best time for stress-relieving tiredness-inducing exercise after a busy day, is late afternoon (perhaps a longer walk home from work?). Don’t exercise close to bedtime because it may keep you awake. If you feel sleepy and go to bed but then can’t fall asleep, it’s better to get up and leave the bedroom for a short time. If you can’t sleep don’t get into the habit of reading, or watching TV in bed instead. Keep the bedroom for sleeping in. It’s better to go to another room to read or relax, walk around the house a bit, or have a warm bath. Only go back to bed when you feel that sleep is likely to come more naturally.

Have a consistent bedtime
Your brain and body have their own rhythms of rest and activity. Your brain chemistry and hormone levels vary through the day and night. So having a regular time to sleep and wake can help get you back in synch with your body-clock. This means going to bed regularly, at a time when you are tired. And no matter what sort of sleep you have had, aim to wake at the same time every day, seven days a week. It’s best not to make up for a bad night by sleeping in. However if you wake early, rather than lying in bed awake, get up and get on with your day. If you establish this sort of strict regime, your body-clock should eventually re-set itself.

Avoid late night habits
Some people find a very light bedtime snack stops them from waking hungry in the early hours. The traditional hot milky bedtime drink and digestive biscuit may be helpful. But heavy late-night eating, alcohol and stimulating drinks are definitely out. So is late-night smoking because nicotine wakes the brain up. Sleep laboratories have proved that smokers have more sleep problems. Alcohol can make people sleepy, but the resulting sleep will probably be disturbed and the drinker will wake once the effect wears off. A full bladder won’t help you sleep either. Alcohol also makes obstructive sleep apnoea worse.

Make your bedroom a restful place
The temperature, light and noise level should be as good as you can make them. Make sure your bed is comfortable: not too hard or soft. If your cat or dog sleeps in your bedroom find it somewhere else if it disturbs you. Perhaps the same goes for the restless or snoring partner who shares your bed too!

Summary
When you feel tired it is tempting to reach for stimulating drinks like tea, coffee, colas or so-called ‘energy drinks’. They can give you a quick lift, but if you rely on them for long they only keep you going until your energy stores run down further.

Evidence
In one study people who stopped caffeine (coffee, tea and cola drinks) slept better and for longer. In another study people had less difficulty falling asleep on days when they drank decaffeinated coffee. Large surveys did not find that people who regularly drink coffee were more likely to have insomnia than people who didn’t, but it is possible that there were other differences between people who drink coffee and people who do not that could explain this.

Safety
If you are cutting down on large amounts of caffeine, headaches might be a problem for two or three days. It is better to reduce the amount of caffeine slowly over a few days.

Cost
There are no costs. In fact you will save money.

Summary
Too much alcohol can affect sleep patterns, and smoking and excessive drinking have effects on our overall health that can affect the quality of sleep.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.

Evidence
Large surveys found different results about the effect of moderate drinking on sleep but people who use alcohol to get to sleep tended to drink too much. Cigarette smokers had more trouble with getting to sleep.

Safety
Cutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side effects including loss of appetite and difficulty sleeping. There are unlikely to be side effects if you are cutting down a moderate alcohol intake but if you are a very heavy drinker, it is better to get help with cutting down.

Cost
No costs are involved and think of the money you will save!

Further information
For more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.

Summary
Compared to 100 ago when people didn’t have cars, washing machines or TV most of us don’t work hard with our bodies. Our lifestyles are relatively inactive – a trend that science tells us is bad for our health. Being more active does more than keep you fit. It makes your heart and lungs work better, tones your muscles and strengthens bones and joints. It also stimulates circulation to your brain and internal organs and boosts the immune system. It helps protect against osteoporosis. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems.

Another reason to exercise is that sleep can often be disrupted by anxiety. This is a consequence of excessive adrenaline and stress hormones. The body has always generated these to get through the day in one piece. Our ancestors probably suffered more stress than we do (think about what it would be like living out in the wild!). The big difference was that they applied these hormones to being more active (the ‘fight-flight’ response). We take our stress sitting down and can more easily go to bed with it still raging. ‘Walking off our adrenaline’ towards the end of the day makes good sense to improve sleep.

So morning exercise probably doesn’t help as much as afternoon or early evening exercise. But don’t exercise just before sleep because it winds the body up and slows down the process of getting to sleep. Exercise probably helps you sleep best if you do it regularly.

Evidence
Several studies have found that physical activity can help you sleep better. One study found that exercise involving regular brisk walking improved sleep in people aged 60 years and over.

Safety
Walking and keeping active in the day are safe. If you have a medical condition or if exercise causes you problems, you should always consult your doctor before starting a new exercise programme

Cost
You can exercise at home for nothing, remember walking and gardening are both forms of exercise. There will probably be a small cost, if you join an organised programme.

Further information
Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.

Summary
Most research suggests that soft, slow melodies, usually classical music, are helpful if played just before going to sleep. In older adults, music may reduce the time needed to fall asleep, and result in less sleep disturbance and a longer time sleeping

Evidence
There have been lots of studies into how listening to music improves sleep.

Safety
Listening to gentle music is safe!

Cost
No costs are involved.

Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Evidence
Several small studies suggest that meditation may help people with sleep problems. The evidence isn’t yet very strong but meditation would be well worth trying if you have a long-term sleep problem.

Safety
There are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.

Cost
Meditation involves certain (simple) techniques that can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially.

Summary
Falling asleep is easier if you are relaxed. If you are feeling stressed or anxious, it can be difficult for your mind to switch off and let go of the day. There are a number of things you can do to help you relax, which may help with your sleep patterns.

A useful technique is progressive muscular relaxation. Progressive muscular relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself in a comfortable position, whether standing, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.

Evidence
The research suggests that using muscular relaxation techniques can help you get to sleep quicker, sleep longer and wake up less often.

Safety
Relaxation techniques are generally safe unless you have a severe or long-standing mental health problem (see our section on Stress and Anxiety).

Cost
Progressive muscular relaxation can be learned from a book, CD, DVD or during exercise classes such as yoga classes (go to ‘Go see someone’ in this section for more information). No costs are involved, although you may need to buy a CD, DVD or book.

Summary
As well as listening to music (see above), listening to natural sounds like waves or gentle wind or even quiet heartbeat rhythms in bed may help you drift off to sleep naturally. Having the radio on quietly, with the snooze button on, helps many people.

Evidence
A small amount of research has been carried out into sleep audios, and these studies suggest they can help.

Safety
There are no safety problems.

Cost
You can buy sleep CDs in some bookshops and some libraries keep them in stock.

Summary
With or without some relaxing bath salts or oils, the tranquilising effects of warm water need no research to tell you it feels good and makes you feel sleepy.

Evidence
Several studies showed that a warm bath in the evening improved the sleep of women of 60 years and over.

Safety
Taking a warm bath is safe but don’t fall asleep!

Cost
No costs are involved.