Having trouble getting a good night’s sleep or even getting any sleep at all? It could be the noisy neighbours, the nocturnal rubbish collection - or it could be a bout of insomnia.
Almost all of us have occasional sleepless nights and the majority of us have more sleepless or restless nights than we would like. Just a few days of bad sleep can leave us feeling groggy, unfocussed and temperamental. It is after about day three that someone will pick up the phone and say to me: “Help, I’ve got insomnia.”
I don’t know of any research which demonstrates a link between spring and sleeplessness, apart perhaps from Seasonal Affective Disorder which I wrote about in February, but there has been a recent uptake in queries about insomnia. Perhaps not by coincidence, March 18th was “World Sleep Day” which Spanish Television marked with a themed series of programmes called Impossible to Sleep. If you watched this, you may have been scared out of your wits by the graphic documentaries about certain people who suffer some very dramatic sleep disorders. I for one slept quite unsoundly after watching it. But these disorders are way beyond the kind of sleeplessness that most people know and experience.
Although we use the word “insomnia” liberally, medical professionals use the term to refer to “the difficulty of getting to sleep or staying asleep, or having non-refreshing sleep for at least one month.” Many more of us suffer what is called “transient insomnia” which lasts for less than a week.
There are many, many reasons why a person can experience a bout of insomnia. And equally, there are many ways to go about treating it.
From a clinical point of view, I like to start with the fundamentals and work from there. It is often striking how many people benefit from simple changes of behaviours which require little therapeutic or pharmacological intervention. There are a few “Golden Rules” which are worth following to help improve sleep. Some of them may seem quite obvious, but it’s helpful to run through them.
Firstly, lower your caffeine intake, especially at night. A good rule of thumb is to have your last coffee or cola in the late afternoon—at least six hours before bedtime. If you are a coffee lover, switch to decaf in the evening.
Next, look at any other stimulants you may be ingesting such as cigarettes, medications and chocolate. Cigarettes contain a range of stimulants so smoking before bedtime is generally not a good idea if you want to sleep well. Some medications have sleeplessness as a contraindication. Check the leaflet.
Have your taken the traditional Spanish custom of siesta? If so, try to keep it to under 45 minutes. More than that might disturb your evening sleep.
Alcohol, though a relaxant, is unhelpful for restful unbroken sleep. As ever, avoid excess, especially in the evening and close to bedtime.
Big meals or spicy dinners late in the evening will make it difficult for your body to offer you a tranquil night. Try to eat your main meal four hours before bedtime with a light snack later if you need it.
Going to the gym or other physical exercise is of course good for the body, but exercising in the evening can be stimulating and unhelpful in terms of sleep. If possible, try moving your exercise routine to an earlier time of day and see if that makes a difference.
One other important thing: Make sure your bedroom is a place to sleep (and, yes, have sex) rather than an electronic entertainment centre. TVs, computers and Blackberries in the bedroom mitigate against restful sleep. Last month the US National Sleep Foundation’s latest poll concluded that 43 percent of Americans say they rarely or never get a good night’s sleep and that 95 percent of them use electronic devices within an hour before going to bed. Apart from the mental activation, the energy emanating from these devices is detrimental to the sleep-onset process.
If you’ve made all the necessary changes and are still having difficulty sleeping, there are psychological and medical treatments. There are popular medications available for helping with insomnia, but be careful about taking them for too long as they can become addictive. Always seek a doctor’s advice, follow the dosage guidelines and revisit the doctor at agreed intervals. Therapies such as CBT and hypnotherapy are indicated for the psychological part. If you are having recurring or overly active thoughts while trying to get to sleep, or dread going to bed for fear of not getting a good night’s sleep, or are generally stressed in your daily life and can’t seem to switch off at night, these are good options to explore. Lack of sleep can be linked to depression, but it can also be a passing phase and can often be treated. As ever, it´s best to seek professional guidance. One other piece of over-the-counter advice that may be helpful to city-dwellers - remember the earplugs!