SLEEP HYGIENE – THE DEEP SLEEP CLEANSE
In order to get a good night’s sleep, you need to first assess and then address your “sleep hygiene”. This isn’t just the need to have a wash and to brush your teeth before you go to bed (although that can come into it), it’s also making sure that your sleeping environment, your diet and lifestyle and all the things you do in the hours before you go to bed are as conducive as possible to a night of restorative slumber.
This chapter begins with a short self-assessment aimed at evaluating the state of your sleep hygiene right now. Then, we look at each element of the sleep hygiene model, so that one by one I can show you the importance of each and offer practical advice on how to resolve any issues. By the end of the chapter, you’ll have all the information you need to optimize your chances of sleep success.
There’s a difference between regularly getting a bad night’s sleep and clinical insomnia, which is a chronic, medical condition. Although many people do have some form of insomnia, there are many thousands of others who could improve their sleep simply by improving their sleep hygiene – a set of sleep-related behaviours, activities and cues that prepares babies, children and adults for good-quality sleep. These sleep-enhancing activities and cues are numerous, complex and interrelated. They can be grouped into four categories for consideration: (1) environmental (including temperature, noise and light); (2) scheduling (when you go to sleep and when you wake up); (3) sleep practices (such as having a bedtime routine); and (4) physiological or lifestyle practices (for example, whether and when you exercise, how much alcohol or caffeine you drink, if any, and when you eat your meals).
We don’t yet fully understand why good sleep hygiene promotes good sleep, but of all the cues sleep practices are probably the most important. This is because these may help to entrain your 24-hour internal rhythms to your environment (the 24-hour cycle of night and day). Conditioning comes into this, too – the psychological links you make between activities and environments and the promotion of sleep.
The following self-assessment is intended to give you some level of understanding of whether there are simple improvements to your lifestyle, sleep environment and overall well-being that might have a beneficial affect on your sleep quality. The questionnaire isn’t meant to be rigorously scientific – it’s simply a means for you to see what you’re doing right and where you might be going wrong, so that you can effectively follow the advice in the rest of this chapter. Choose the answers that relate most closely to you, then tot up the numbers of As, Bs and Cs you have overall and read the summaries at the end.
1. How relaxed do you feel in your bedroom?
a. Very – it’s clutter-free and a place I save for sleep
b. Moderately, but I sometimes bring work to bed with me, or I occasionally watch TV in bed
c. Not at all – I have to use the space for working, gaming and watching TV (or any combination), too
2. How warm is your bedroom?
a. Below 18°C (64.5°F)
b. Between 18°C (64.5°F) and 23°C (73.5°F)
c. Over 23°C (73.5°F)
3. How dark is your room when you go to bed?
a. It’s very dark, almost completely black
b. I sleep with a nightlight, or with moonlight or streetlight
c. I keep the overhead light, hall light or bedside lamp on
4. How quiet is your bedroom at night?
a. Completely quiet
b. Mostly quiet – I’m only ever disturbed by random or unexpected noises
c. There’s street or neighbour noise that regularly disturbs me
5. How comfortable is your bed?
a. Very comfortable – I rarely wake up with aches and pains
b. Fairly comfortable, but I occasionally wake up with an ache, particularly if I’ve slept in a different position c. I wake up every morning with pains, but they go away once I’ve been up for a few hours
About your sleep schedule and practices
Answer the following questions for a typical week, ignoring exceptions. 6. Do you go to bed at the same time every night?
a. Yes, I’m always in bed at the same time to within 30 minutes b. Yes, during my working week, but I tend to stay up later on Friday and Saturday nights
c. No, my bedtime mostly varies depending upon my workload or whether or not I’m doing something social in the evening
7. Do you get up at the same time in the morning?
a. Yes, I get up at the same time, even at the weekend
b. Yes during the working week, but I often lie in at the weekend
c. No, I get up when I feel like it
8. Do you ever take a daytime nap (that is, a nap at any time before your usual bedtime, even if it’s unintentional)?
a. No, I never nap
b. Yes, but only at the weekends
c. Yes, I take a daytime nap more than twice a week
9. Do you have a bedtime ritual (any sequence of events that you regularly perform just before you go to bed counts as a ritual)?
a. Yes, I have a sequence of activities that I perform before I go to bed and I do these most if not all nights of the week
b. I do, but I often get distracted while I’m going about it and so find myself doing other things, too
c. No, I don’t think about the sequence of events before I go to bed – they tend to be random or I just go to bed
10. What makes you decide to go to bed?
a. I feel tired and that’s usually at a particular time of night
b. A certain time comes around, and I go to bed then regardless of whether or not I feel sleepy
c. There’s nothing on TV or I feel bored, so I go to bed
About your lifestyle
Again, answer these questions in the light of a typical week.
11. Do you take regular exercise (any activity that raises your heart rate a little above its resting rate for at least 30 minutes)?
a. Yes, I exercise at least three times a week for at least 30 minutes
b. Yes, but only when I can fit it in – perhaps once one week and twice or three times the next
c. No, I exercise very rarely or not at all
12. If you exercise, do you generally do it:
a. In the morning?
b. Between midday and 5pm?
c. After 5pm?
13. How close to bedtime do you eat your main evening meal?
a. At least four hours before I go to bed
b. Two to four hours before I go to bed
c. Fewer than two hours before I go to bed
14. How often do you drink coffee, tea or other caffeinated drinks after 2pm?
a. Never – I drink my last caffeinated drink with my lunch and then lay off for the rest of the day
b. Less than twice a week, only if I need a pick-me-up in the afternoon
c. More than twice a week
15. How often do you drink over one unit of alcohol in the evening?
a. Once or twice a week, or never
b. Three or four times a week
c. More than four times a week
16. If you do drink alcohol in the evening, how close to bedtime do you have your last drink?
a. More than four hours before bedtime
b. Between two and four hours before bedtime
c. Less than two hours before bedtime
17. How often do you use your bedroom for anything other than sleep and sex?
a. Never – my bedroom is my sanctuary
b. Occasionally – I have a computer in my room/I take my laptop to bed so that I can catch up on some work before I go to sleep if I really need to
c. Often – I have a TV in my room and always watch TV in bed/work in my bedroom
18. How often do you go to bed feeling worried or stressed
a. Very rarely – generally I’m calm when I go to bed
b. Occasionally, if I’ve had a particularly difficult week
c. Frequently – I find it very hard to switch off from the day
What it all means
Mostly As: If you scored mostly As, your sleep hygiene is heading for exemplary! Take a look at the sections where you scored Bs or Cs and address those issues in order to improve your sleep quality. If, after doing this, you still have trouble sleeping, read the chapter on sleep disorders to see if one of them applies to you.
Mostly Bs: You have a relatively good handle on your sleep hygiene, but there are some areas that you could improve. Read the sections that apply to the questions in which you scored Bs and Cs and see what improvements you can make. Also, read the chapter on sleep disorders to rule out whether or not one of these applies to you.
Mostly Cs: It’s likely that you could dramatically improve the quality of your sleep by improving your sleep hygiene. Look at the questions for which you scored Cs and read the relevant sections of this chapter to help you improve those areas of your sleep hygiene. Then, tackle the Bs. Be patient – it may take several months for you to see a significant improvement in your sleep quality. If, however, after six months of implementing my sleep hygiene advice you have no improvement in your sleep, consider whether you’re suffering from a sleep disorder.
Your sleeping space is for sleep and sex. Nothing else. As soon as you step inside your bedroom, the associations have to be clear. To this end, there are a few “keep out” rules that you’ll need to put in place.
Keep out...
... the TV
In the UK recent reports estimate that a staggering one in five under-four-year-olds has a television in his or her bedroom; the figures are worse in the USA. We can only assume that if you grow up with a TV in your bedroom, you’ll continue to have one into adulthood.
Television is one of the greatest reasons for our ignoring the urge to fall asleep on a typical day. If the TV is moved into the bedroom, the ease of having it on while you get ready for bed – and then keeping it on once you’re in bed – means that you may overlook your body’s sleep signals, or even fight them off for as long as possible.
In addition, TV can act as a stimulant, encouraging the brain to keep active, processing pictures and stories. Have you ever watched an action movie and felt your heart pound as the characters face danger? Or perhaps you’ve been overcome with emotion during a movie with a sad story. What you see on the screen is not real, but your emotions most definitely are. Anything that has your adrenaline pumping just before you go to bed can only disrupt your sleep. (Even if you keep the TV in a room that’s more appropriate for it – your living room, for example – you should turn it off a good 45 minutes before bedtime.)
Finally, if you fall asleep while watching TV when you reach the momentary wakefulness that separates cycles of your sleep, you’re far more likely to rise into consciousness – the TV’s sound and the flickering lights will bring you round – especially as you’ll then have to make an effort to turn off the TV. Anything that forces you to engage with reality makes it harder for you to fall back to sleep.
... work
I know at least half-a-dozen people who on a regular basis go to bed with an armful of papers that they need to read before the morning, or even worse with a laptop. Your bedroom is not an office. Your mind associates work with being alert, focused, driven. None of which is conducive to sleep. Furthermore, solving problems or analysing data are active processes at a time when your brain needs to wind down.
Keeping out work also includes closing down your phone during the night, especially if you have a smartphone and could otherwise receive texts and emails at all hours. If you want to keep your phone on for emergencies, make sure it’s turned to silent (including turning off the vibrate function) and in airplane mode. If you can’t change your settings so that the screen doesn’t light up if an email or text comes in, put your silent phone in a nearby drawer.
... pets
It’s estimated that more than 20 per cent of people who visit the Mayo Clinic Sleep Disorders Center in the USA complaining of insomnia share their bedroom with a pet. However, animals do not make good bedfellows. Their sleeping patterns do not exactly imitate ours, many dogs snore or scratch, and cats get up to stretch, prowl or pounce. Furthermore, disease can be passed easily from pets to humans through bed sharing – salmonella, parasites and plague have all occurred in people who co-sleep with cats or dogs.
If you’ve been used to having your dog or cat sleep with you – and if they’ve been used to doing it – getting them out of your bedroom may require some effort. First, put your pet out and shut your bedroom door. Cats may protest (by yowling or scratching), but can be easily distracted with a toy to play with in another room (itself shut off, if possible), or a snug cat basket put somewhere warm.
For dogs it’s a simple matter of training and tough love. Buy a dog bed and put it as far away from your room as possible. If the dog starts scratching at your door, without speaking to it take it back to its own bed – and keep doing that all night if you have to. The process is rather like training a child to sleep in his or her own room. It may take a few weeks of sleepless nights, but you and the dog will get there in the end.
Bedroom ambience
The temperature, light, noise levels and your bed are all crucial factors in making your bedroom a perfect place to sleep. I’ll cover all these in detail over the subsequent pages. In the meantime, also consider the colour of your sleeping space – colours that relax you and make you feel content and calm are best. Try peaceful whites, pale blues or calming greens, which studies show make it easier for us to fall asleep.
BEDROOM FENG SHUI
Feng shui (from the Chinese meaning “wind–water”) is an ancient system of orientation believed to harmonize the flow of qi energy through our environment. The following are three of the most important feng shui considerations when laying out a bedroom:
1. Position your bed-head against a solid wall (but don’t hang anything above the bed) so that you can lie in bed and see beyond the bedroom door. In these ways you’ll feel more secure. Try not to face the door, though, as some feng shui practitioners call feet pointing toward the door the “death position”. If you have more than one door from your bedroom, try to position your bed so that it’s not in line with any of them.
2. Make sure your mattress is raised off the floor on a bedframe and has space under and on either side of it. In Chinese terms, this allows qi energy to flow around and under the bed freely.
3. Have a plant in your bedroom. Nature has a calming effect on the mind and body (just looking at nature can lower blood pressure). However, don’t forget to water it! An unhealthy plant creates an unhappy environment. If you’re hopeless with plants, choose a picture of a natural scene, perhaps a forest, a flower or even a beautiful garden, to hang on the wall instead.
One way to help your bedroom feel calm is to cut down on the clutter. Put your clothes away in the wardrobe, drawers or laundry every night. Avoid boxes or bags of sundry items on the top of your wardrobe or under your bed. If you need to use under-bed storage, buy suitably shallow containers with lids. Keep surfaces clear – dedicate a drawer in a bedside table for toiletries or jewellery, for example.
Finally, think about how you lay out your bedroom furniture. For ideas, you could try taking some tips from the Chinese art of feng shui (see box, opposite).
US President Benjamin Franklin (1706–1790) thought it was impossible to sleep when it was too hot, so he used two beds in a bedroom that he kept as cool as possible. When he got too hot in one bed, he moved to the other. He also slept in the nude. His concerns over getting his nighttime temperature just right were well founded.
Your body has to begin a process of cooling down to trigger the onset of sleep (see box, p.16). If you can’t cool down, you’ll find it harder to drop off. Equally, though, you’re more likely to wake up at the wrong time (probably at around three or four in the morning when your body temperature is at its lowest) if you’re too cold.
The key underlying message is that you’ll find it easier to fall asleep if your bedroom is cool, but you’re more likely to sleep through the night if you have bed linen that prevents you from getting too cold.
It’s very hard to advise how to create an “ideal” bedroom temperature, as there are so many influences over how warm or cold you feel at night, not least your own unique sensitivity to heat and cold. In addition, the average room temperature in your house is probably not exactly the same as even your closest neighbour’s – it will depend on such things as the heating, insulation and air-conditioning systems you have, whether or not you have double glazing and even the material your curtains are made from. What you prefer to wear to bed, the position you sleep in and whether or not you share your bed with someone else are also fundamental to how warm or cold you feel at night. All these factors, and more, influence your temperature in your bedroom in your home, and make it different from anyone else’s.
Some years ago a hotel chain in the UK asked me what temperature they should keep the rooms at in order to keep fuel bills low, but stop guests complaining they were too cold. I told them 18°C (64.5°F) and I would stick by that as a general rule. However, other studies show that around 16°C (60°F) is better. You have to work with your own uniqueness – and if you share a room, go for the cooler of the two preferred temperatures and give your room-mate an extra blanket!
In hot weather/“I’m too hot to fall asleep”
In order to cool you down, your body will try to expel heat from the top of your head, and from your hands and your feet. You’ll also sweat. If you don’t fall asleep easily because generally you’re too hot when you go to bed, try the following:
• Wear cotton or silk nightclothes, even in preference to sleeping naked. Natural fibres wick away moisture from your skin, which in turn allows the body’s cooling mechanisms to work properly. Make sure your nightclothes are loose-fitting and comfortable. If you do prefer to sleep naked, adhere to the following point ...
• Use sheets (top and bottom), and a duvet cover if you have a duvet, made from natural fibres.
• If you can, consider sleeping with your legs spread apart rather than curling yourself up into a ball. Spreading your sleeping surface area will help to keep you cool.
• Try to circulate air through your room. If you don’t have a ceiling fan or air conditioning, leave your bedroom door open. If you live in a house and sleep upstairs, leave the loft hatch open. If it’s safe (and quiet) to do so, leave the windows open, too. You can also invest in a stand-alone fan – larger versions operate more quietly, if you think the noise might be an issue.
• Consider what your mattress is made from. Some people find that futon mattresses are generally cooler, because they’re filled with natural fibres that wick away sweat from the body. If you don’t want to invest in a new mattress, try using a mattress protector made from cotton wadding.
• For some, it can work to keep your pillow in the refrigerator during the day, taking it out just before you go to bed.
• If things are particularly bad and you’re simply tossing and turning, get out of bed and, for an instant cooler, run your wrists and hands under the cold tap for a few minutes. Dry your hands and go straight back to bed.
• If your room is too hot at night during the winter because you’ve had the central heating on all day, I advise keeping the radiator in your bedroom turned off, day and night. If that would make spending time there during the day too cold, turn it off at least four hours before you go to bed, and leave it off all night. Follow the guidelines below for keeping warm during the night when your body temperature drops.
In cold weather/“I’m too cold to sleep well”
Even in cold weather, keeping the heating on during the night in your bedroom is often not the answer. If your room is cold, you have the best possible platform to get your nighttime temperature right. Apart from anything else, central heating will cause your sinuses to block up, which means you’re likely to develop a stuffy nose that in itself might wake you. Keep warm by having bedclothes that do the job. Have you heard the old adage “snug as a bug in a rug”? That has to be you.
• Use cotton or other natural fibre bedding to ensure that you lose heat effectively as you try to drop off to sleep, but that during the night you have bedding over you to keep you warm.
• Try using layers of blankets rather than a lone duvet. That way, if you find you’ve overestimated you can pull a blanket off during the night (or put it back on if you’re then too cold). Most of us are able to do this without rousing fully from sleep. This also works well if you share a bed with someone who doesn’t share your need for extra layers!
• If you prefer to sleep with a duvet, use one that’s of a suitable weight for the colder months, and as long as you aren’t allergic to natural fibres, find one filled with feathers and down. Not only will natural fibres allow your skin to breathe during the night, they’re more likely to fall snugly round you.
• Use a mattress pad so that you don’t lose heat into your mattress. A blanket underneath your sheet can help, too. I don’t recommend electric blankets. You mustn’t keep one on overnight for safety reasons, in which case it will keep you warm at the wrong point – as you’re trying to fall asleep.
• Try wearing flannel cotton nightclothes, which are warmer than the thin cotton you might use for the summer months. Make sure your nightclothes are loose-fitting, though, as you still want your skin to breathe. If you like to sleep in the nude, use flannel cotton sheets, as well as your duvet, to keep warm.
• Wear bedsocks, or in extreme circumstances even gloves or a hat to help keep in the heat. However, unless your room is cold rather than cool, this may make it harder to fall asleep.
Overall, once you’ve discovered what works for your body temperature, stick to it. If you share a bed with a partner who has different temperature needs, you’ll need to concentrate on the solutions that can work for each individual – beginning with what you each wear to bed.
From our first months of life, we develop the psychological association that darkness triggers sleep. Of course, physiological associations come into play, too. Darkness triggers the release of a host of hormones, including melatonin – the “vampire” hormone (see box, p.17) that sets our biological clock. We cease secretion of melatonin when the dawn breaks, providing one of the signals that tells the body it’s time to wake up. In order to stay asleep, we need darkness so that there’s no cessation (momentary or otherwise) in our melatonin secretion.
For many years, scientists thought that light had to be very bright (like sunlight) to stop melatonin secretion. Now we know that isn’t true. More recent research suggests that even the light of a nightlight is enough to trick the brain into thinking that dawn is breaking.
Keep light out
One of the simplest and most effective things you can do to encourage fully restorative sleep is to make sure you have the best-quality curtains or blackout blinds you can afford. If you have curtains, make sure they’re lined. Blackout-lining (available in fabric stores) is ideal.
If you have a streetlamp outside your bedroom window, you may find that the light creeps in around the edges of the curtains. Blinds are often better than curtains in these circumstances, as they tend to lie flatter against the window. Choose those that fit inside the window recess, rather than outside it. You could also try talking to your local authority about turning out the street lighting between certain hours of the night.
Finally, a word of warning. Your body does need morning light to reset your body clock for the day. If you find you’re waking later in the mornings, leave a small gap in the curtains on one or two nights a week so that ambient light creeps in to keep your body clock in sync.
Don’t bring light in
I once heard a friend reassure his daughter that rather than being scary, “the darkness is your friend”. Unless you’re very afraid of darkness (and by that I mean actually phobic), avoid using nightlights, or leaving a hall or landing light on and your bedroom door open.
If you regularly get up to go to the loo at night and you’re worried about tripping, find nightlights for the passageway between your room and the loo that use red bulbs rather than white ones – and never put on the overhead light. The brain doesn’t register red light as encroaching daylight, so red light doesn’t interrupt melatonin secretion.
If there are no conveniently located sockets, keep a torch with a red bulb beside your bed and use that instead. Alternatively, it’s now possible to buy battery-operated movement-sensitive nightlights that come on to emit a gradual and gentle glow if they detect movement during the night. You can position them strategically along corridors and in the bathroom. See the Resources on page 234 for details.
According to research by the World Health Organisation (WHO), a staggering one in five Europeans is subjected to noise that disturbs their sleep. In fact, noise disturbance is generally considered to be one of the main causes of insomnia. Interestingly, we’re not born with such sensitivity to noise – babies are able to sleep through most loud noises.
In a quiet street you’re likely to be woken by a sudden, unexpected noise – such as the roar of a lone car, the screech of a siren or the bark of a dog. Noise becomes a problem only when it’s persistent and it frequently disturbs your sleep, manifesting as shifts in sleeping position and increased heart rate (not necessarily coming to full wakefulness). In an attempt to address the issue of noise-related sleep disturbance, the WHO released guidelines that stipulate that, on average, no household should be subjected to noise levels greater than 40dB. This sound level is equivalent to the noise you would expect from a residential street at night. As soon as the noise levels tip consistently above 55dB (average, per night), which is the noise you would expect from a busy road with a more or less constant stream of traffic, residents run the risk of developing high blood pressure, increasing susceptibility to heart attack. To put all this into context, a normal-level conversation operates at about 60dB. These findings are based on research in Europe that was conducted over six years – such rigorous and lengthy analysis makes the results all the more troubling.
Of course, noise disturbance doesn’t always have to come from outside. A clock ticking in the bedroom will keep some people awake, as will a snoring bed partner. And it’s not only the presence of noise that can be a problem – research suggests that it takes only a week to ten days to become accustomed to sleeping with low-level noise, such as a ticking clock. If we then try to sleep in a room without that regular noise, the silence itself becomes a sleep thief. First things first, though: what can be done to reduce noise disturbance at night?
When you put together all the colours of the rainbow, you get white light. When you put together all the sound frequencies, you get white noise. People variously describe white noise as sounding like the noise of a fan, the static of an untuned radio, the whoosh of wind through trees or the rhythmical drum of heavy rain on a window.
White noise has a neutralizing effect on other noises, and is therefore able to mask them. A simple way to look at it is to think of a single tone. If you play this tone on its own, your ears pick out the sound and your brain interprets it. If you played two tones at the same time, you could probably still pick out one tone over the other. Your brain might even be able to do that if three or four tones were played at the same time. However, if you played 20,000 tones at the same time, your brain would not be able to identify one from another, instead perceiving an indistinguishable flat hum. White noise works as a sleep aid because your brain simply adds any room noise to the mêlée of 20,000 frequencies played together.
There are many, many gadgets that you can buy or apps that you can download to your smartphone that are intended to stream white noise. Some are for playing through headphones and others are intended for the room at large. You’ll need to discuss with your partner which you should go for, as well as considering whether or not you would find it uncomfortable to wear headphones in bed.
If you want to try this technique, I suggest opting for a white-noise gadget that doesn’t loop the sound but generates sound as it goes. This is because your brain is very good at picking out the tiny skip in sound as the loop begins again, which in itself can become disturbing.
Earplugs
Probably the simplest option for blocking out noise is to invest in a pair of earplugs. My advice is to buy the best earplugs you can afford.
My husband finds the traffic noise outside our home really disturbing for his sleep, but I sleep through it. Why?
You could be one of a lucky few. Preliminary research conducted in 2010 at Harvard University in the USA has indicated that some people may be better at blocking out noise at night than others. We already know that sleep spindles (see p.22) block sensory information passing into the areas of the brain that perceive noise. The research team revealed that those participants in their study who experienced greater numbers of sleep spindles were less likely to be roused from sleep when a telephone rang or the noise of traffic was played in the sleep laboratory. The evidence is not conclusive, but it does suggest that some of us might be genetically predisposed to finding noise much less of a problem than others.
Earplugs can reduce sound by up to 30dB, so can be extremely effective, but only if they fit properly. Find a pair that completely blocks your ear canal (the part of your ear that carries sound to your eardrum). Experiment with different shapes and sizes, or ideally look for brands that mould to the shape of your ear. You could even try talking to your doctor about investing in a pair that’s custom-made. Foam earplugs tend to be more effective, but silicone ones may be more comfortable.
When you fit the earplug, twist it so that it’s as small as it will go before placing it inside your ear. This way it will expand within your ear canal, filling the cavity as much as possible. The downside of earplugs is that you may become more susceptible to ear infections if you regularly block up your ears.
I’m worried that if I try to block out sound so that I sleep better, I won’t hear my children call for me in the night.
There’s no doubt that the main problem with anything that blocks sound (whether that’s because it’s become part of white noise or because you’re wearing earplugs) is that you run the risk of not hearing something you need to hear – such as your baby crying or a smoke alarm. Earplugs are particularly effective at blocking out low tones (such as the hum of traffic) and less good at stopping high-pitched sounds, which means you’re still likely to hear the urgent screech of an alarm or your children’s cries. In fact, women in particular have a primal instinct to hear their children, and even white noise is unlikely to drown them out. Nonetheless, if you don’t want to risk blocking out sound altogether, try the alternative solutions below. These leave your hearing unmuffled, but should help to reduce the impact of noise on your sleep.
Other solutions to noise disturbance
Finally, the following pointers will help to reduce noise disturbance, but without muffling your hearing.
• Use heavy curtains in your bedroom, which will not only block out light (see p.55) but also reduce noise.
• Keep your windows closed at night and use a quiet fan or air-conditioner to circulate air in hot weather.
• If you don’t already have it, consider double or triple glazing or even secondary glazing for your bedroom.
• If snoring is the problem, ask your partner to read pages 192–201 and seriously consider getting treatment!
If the real princess in the Hans Christian Andersen fairytale The Princess and the Pea could feel the pea beneath 20 mattresses and 20 feather beds, she really needed to examine her sensitivity to her sleeping surface! Nonetheless, she couldn’t get a proper night’s sleep. In my opinion your bed, and more specifically your mattress, is the single most important component of your sleeping environment.
Size matters
Sleep Council guidelines in the UK recommend that your mattress is between 10cm and 15cm (4 and 6in) longer than the tallest person who sleeps on it. It’s unlikely that you’ll sleep with your head perfectly aligned to one end of the mattress, so having a bit of extra length enables you to move around, including shuffling up and down, during the night without your feet dangling off the end.
In practice this means that if you’re 182cm (6ft) tall, your mattress should be 192 to 197cm (6ft 4in to 6ft 6in) long. The approximate length for a regular single or double mattress is 190cm (6ft 3in), whereas kingsize and superking tend to be around 200cm (6ft 6in) long. If you or your partner is over 190cm tall, you may need to consider having a mattress (and a bedframe) specially made for you.
If you’re sharing a bed with a partner, your mattress needs to be wide enough to give you both space to move around without disturbing the other. Choose a new mattress together. Lie side by side on your backs and put your hands behind your head, elbows out to the sides. If the bed is wide enough, neither of you should have your outermost elbow hanging off the side, and your innermost elbows shouldn’t touch.
If you sleep alone in a single bed, make sure that it’s wide enough for you to roll over fully in both directions without feeling that you’re going to roll off. Ideally, choose the widest single bed you can for the space available; or if you have the space and budget, sleep in a double.
TESTING YOUR MATTRESS
Use these steps to assess the suitability of your present mattress and any mattress you consider buying in the future.
1. Lie in your normal sleeping position. Do you feel supported where you need support and comfort everywhere else? If there are pressure points on your body, the mattress is too firm. If you feel that you’re sinking into the mattress, it’s too soft.
2. Turn over onto your side and roll back again to the other side. You should be able to turn easily from side to side. If that’s the case, your spine is horizontal and your body properly supported, and you’re far less likely to wake up when you shuffle about in your sleep. If rolling takes effort, the mattress is too soft.
3. Lie on one side. Put your hand between the mattress and the natural indent at your waist. You should be able to slide your hand under with a snug fit. If you have to squeeze your hand through with effort, the mattress is too soft. If the gap makes it very easy to get your hand through, the mattress is too hard.
Soft or hard?
First, let’s imagine that even if you have a partner this bed is just for you. The firmness of your mattress depends on a number of things, beginning with your weight. The heavier you are, the more you’re going to sink into a mattress, so the firmer it will need to be to give you adequate support. Spend a few moments testing your mattress now, using the experiment in the box on the previous page.
When you buy a new mattress you must test it properly before you commit – and you can’t do that by lying on it momentarily in one position in the showroom. Run through all the tests in the box on the previous page and spend at least ten minutes lying on it in your normal sleeping position. Don’t be shy: ten minutes is only a fraction of the time you’ll actually spend sleeping on that mattress if you buy it, so it’s the least you owe your sleeping health. Finally, there are no industry standards for mattress firmness – what’s firm in one brand may be considered medium in another, and so on. Always test a new mattress before you buy and don’t rely on what you had before.
Once you’ve found your perfect mattress, you need to see if it matches your partner’s preferences, too. If it does, life is easy. If, however, you have different needs – and particularly if there’s a difference of 20kg (42lb) in your weights – you might consider buying two single mattresses, one to accommodate each of you, that zip together. The type of mattress filling you buy can also help to make sleep more comfortable for both of you, and I cover that next.
Not all mattresses are created equal
There are two main types of mattress: foam and sprung. If you’re going for a foam mattress, I recommend memory foam (technically called temperature-sensitive visco-elastic). This was first used to cushion astronauts’ bodies as they reentered our atmosphere. Memory foam mattresses respond to the body’s heat, moulding to the contour of your shape and remoulding as you move. Their aim is to make sure that your body is always supported and your spine is straight. They have the added benefit of being an inhospitable environment for dust mites and bed bugs, making them a great choice if you suffer from allergies.
My daughter suffers from asthma and her laboured breathing disturbs her sleep. How can I keep her mattress dust-mite-free?
Asthma and allergies can be brought on by allergens found on the faeces of house dust mites. The simplest way to prevent dust mites from living in a mattress is to buy a mattress made of foam (see main text, opposite). However, in sprung mattresses using protective covers, and regular airing and vacuum-cleaning can slow down mite infestation, although it won’t prevent it altogether. Mites live by drinking the water naturally present in the air (humidity). Another way to keep them at bay is to invest in a dehumidifier. When the average daily indoor humidity is lower than 50 per cent, mites can’t survive, and within several months the mite population can be dramatically reduced or even culled altogether.
Sprung mattresses are made from large metal coils and they come in three main types:
• Open spring (or open coil) mattresses are made up of rows of individual coil springs linked together and held in position by a border wire. Better-quality versions have a thick mattress wadding over the top so that you can’t feel the springs. However, compared with other types of mattress coil, open springs are more likely to shift within the structure, which means the mattress can become uneven and uncomfortable.
• Continuous spring mattresses are made from a single piece of wire that is coiled up and down and knitted together. The tighter the coil, the firmer the mattress will be. The benefit of this type of mattress is that there are no individual springs to move out of place and cause obvious lumps in the bed.
• Pocket-spring mattresses contain lots of sewn-together fabric pockets, each housing a single spring. The more pockets (more springs) you have – some have several thousand – the better quality the mattress as there are more places where the mattress will “give” to the contours of your body. If you’re sharing your bed with someone else, more pockets means that the mattress will give more independently for each of you.
A word of warning when choosing your new mattress – treat sceptically any claims that particular brands are orthopaedically or medically proven to reduce back pain or stiffness. So much depends on the individual – body shape, weight, sleeping position and so on – that there is no one-size-fits-all option. Shop with an open mind and don’t be influenced by manufacturers’ claims of medical supremacy.
Take a turn
Should you turn your mattress? Not if you have a memory foam mattress, but sprung mattresses do need the odd spin. When you first get a new mattress, spin it top to bottom (rather than turning it over, end over end) once a week for the first three or four weeks, and then once every two months thereafter. Many modern mattresses don’t need an end-over-end turn at all, but check your manufacturer’s recommendations. If you do need to flip the mattress, ask someone to help you.
Other bed basics
Your mattress isn’t the only component of your bed. The frame, pillows and bedding can also affect your chances of a good night’s sleep.
I’ve had my mattress for seven years. Does a mattress have a shelf life and should I buy a new one?
The Furniture Industry Research Association in the UK has shown that a mattress can deteriorate by as much as 70 per cent over ten years. Most sleep experts recommend ten years as being the trigger point for a new investment. However, if you answer yes to any of the following questions, regardless of how long you’ve had your current mattress, it might be time to go shopping.
1. Do you wake up with stiffness, aches or pains (especially in your shoulders, neck, back or hips) that ease as the day progresses?
2. Do you remember when you slept better on your present mattress – perhaps six months or a year ago?
3. Does your mattress show signs of visible wear and tear (frayed edges, springs that protrude, loose or broken stitching)?
4. Can you see any obvious dips or sagging in the mattress?
• Your bed frame influences how soft or firm a mattress feels. If you have a bedstead or divan with a mesh or sprung base (rather than a solid or slatted base), the mattress will feel softer. Bear this in mind if you buy one without the other.
• Choose your pillow carefully. As you lie down on your back or side, your head and neck should naturally align with your spine. This way you’ll avoid putting stress on your neck and waking with pain (your head is the heaviest part of your body, so it needs good support). Feather pillows keep their shape for longer than manmade-fibre pillows; although manmade fibres are a good choice for allergy sufferers. Memory foam pillows mould to your posture and don’t harbour mites and bed bugs.
• Sprung mattress toppers or protectors help save your mattress from sweat, which can attract mites and bugs. They’re also easy to wash to keep your bed hygiene at good levels.
• Smooth, clean sheets are more conducive to restful sleep. Use a fitted cotton bottom sheet, which is breathable and also less likely to wrinkle beneath you. Tuck in your cotton topsheet properly at the end of your bed, and particularly on the bottom corners (think “hospital corners”), so that it doesn’t become tangled as you move in your sleep. Wash your bed linen at least once a week, and your duvet once a month. (See also pages 51–55 for advice about temperature and your choice of linen.)
Good sleep hygiene includes two “ritual” components: the way in which you schedule your sleep and the activities you undertake in order to prepare your body for sleep.
Good sleep–wake habits
One of the most important things you can do to get a proper night’s sleep and to wake feeling refreshed in the morning is to have a regular bedtime and to get up at the same time every day – even on the days when you have no pressing appointment to get up for. Your body likes routine. If you’re having trouble sleeping, you need to condition your body to feel sleepy at the right time at night and to wake up so that you feel alert at the right time in the morning. Take a look at the box on p.69 and follow its advice to set your sleep–wake cycles.
Of course, there will be times when you go to bed later than your usual bedtime. As long as you’ve conditioned your body successfully into a healthy sleep–wake cycle, the occasional late night isn’t going to upset all your hard work. However, even if you go to bed later than is typical, get up at your normal waking time. Your body will recover the sleep debt by maxing out your deep sleep the following night – but if you sleep in, you run the risk of not feeling sleepy at your usual bedtime. If you absolutely need to grab some extra shut-eye long before bedtime, take a nap in the early afternoon and set your alarm to wake you after 30 minutes. Then, go to bed at your normal time.
A word about naps: they should be the exceptions rather than the rule – only when you really need to make up for a very late night and only occasionally. Many nighttime insomnia sufferers reveal themselves to be daytime nappers. In most cases, napping is a sleep thief.
Bedtime rituals
If you’ve set up your sleep–wake cycle, you’ll be going to bed at a time when you feel naturally sleepy. Nonetheless, a bedtime ritual helps to reinforce the message to your brain that it’s time to sleep. Your ritual doesn’t have to be elaborate or even very long, but it must be calming. For example, you could:
• turn off the TV an hour before your bedtime and do something quiet and contemplative, perhaps along with a warm glass of milk or a soporific herbal tea
then
• lock the front and back doors, and turn out the lights except the light in your bathroom and a low-wattage bedside lamp
then
• get into your nightclothes and wash your face and brush your teeth, turning out the bathroom light as you leave the room
SETTING YOUR SLEEP–WAKE CYCLE
The following might affect your social life, but shouldn’t affect your working or school life at all. For simplicity, I’ve assumed that you want to condition your body so that it’s ready for sleep at 11pm and ready to wake up at 7am. If these times don’t suit you (for example, if 10pm until 6am works better with your schedule), that’s fine – you can change the times, but try to make sure they allow for seven to eight hours of shut-eye every night.
1. You’ll need to set aside four weeks for this, because conditioning your body into a new routine won’t happen overnight (excuse the pun). Clear your diary of all social engagements that would keep you out late in the evening, and let your friends and family know that you are not contactable between 11pm and 7am.
2. Set your alarm clock for 7am and make sure that it’s on its loudest setting so that it wakes you straightaway. Put the alarm clock out of reach so you have to get out of bed to stop its noise.
3. On the first night of your new routine, practise your pre-sleep rituals in time for you to be actually in your bed by 11pm with your eyes closed, regardless of whether or not you feel sleepy.
4. When your alarm goes off, get up. Immediately. Go to the window, open the curtains and let light flood in. If it’s still dark outside, turn on all the lights. Artificial light isn’t as effective at setting your biological clock as natural light, but it’s better than trying to wake up in the gloom. continued
5. Repeat this ritual every night and morning for the whole four weeks, by the end of which you should have reconditioned your body into a healthy sleep–wake cycle. You’ll know you’ve done it because you’ll naturally feel sleepy at 11pm and you’ll be on the cusp of wakefulness when the alarm sounds in the morning.
then
• sit or lie on a folded blanket on your bedroom floor and practise a ten-minute muscle relaxation (see box on page 71)
then
• slide under the covers and turn out the bedside lamp
Some people include a warm bath in their bedtime rituals – but anything from putting out the cat to luxuriating in an aromatherapy bubble bath can form part of the routine as long as you practise it in the same sequence and with regularity. Avoid anything that might stimulate your body at this time – television, work, vigorous exercise or conversations with your partner about children, the house, money or other emotive issues do not make for a successful bedtime ritual. Look at the advice for stress-free slumber on page 71, too.
See the light
It may seem like a long way until your next bedtime, but the first hour of your waking is an important time for setting your biological clock. Dawning light filters through your eyelids and will begin to rouse you from sleep up to two hours before you actually wake up. This is one way in which light helps to set the biological clock so that it’s in tune with the Earth’s 24-hour cycle of light and dark. But there’s another way, too. In the sleep hygiene review (see pp.42–45), I asked if you ever make a point of getting the daylight on your face when you wake up. Making this part of your waking ritual will help to prepare your body for its next night of sleep.
RELAXING YOUR MUSCLES
Progressive muscle relaxation releases tension from all the body’s muscle groups in turn. Lie on your bedroom floor on a yoga mat if you have one, or otherwise on a folded blanket.
1. Lie on your back, arms by your sides and your legs straight, but not rigid. Allow your knees and toes to fall naturally outward.
2. Focus your attention on the top of your head. Screw up your brow into a deep frown. Hold it tight, then release it.
3. Scrunch your shoulders up toward your ears. Hold for a few seconds, then release. Feel your shoulders sink into the floor beneath you, and your neck lengthen again naturally.
4. Scrunch up your arms and chest by pulling your hands into fists, folding your arms at the elbows and tucking your fists under your chin. Hold, then release – first your chest, then the top of your arms, then your lower arms (unfolding them to your sides again) and finally your fists.
5. Tense your buttocks. Hold them tight, then let them go so that they sink back down.
6. Pull your thigh muscles tight by locking your knees and tensing. Hold, and release allowing your hips and thighs to relax.
7. Push your heels downwards and point your toes toward the ceiling, pulling on your calf muscles and stretching the muscles in the soles of your feet. Hold and release.
8. Curl up your toes tightly. When you release them, feel the tingle as the tension dissipates.
9. Lie still for a few minutes and give your body an internal self-check. Can you feel any areas of tension that you haven’t released? If so, consciously tense the muscles in that area and then let go so that the tension ebbs away, too. When you’re ready, get into bed. Your body is ready for sleep.
Facing daylight first thing doesn’t mean sitting in the garden or on the terrace for an hour, come rain or shine, with your morning coffee. It’s much easier and quicker than that. All you have to do is to open the window and let the light flood your face for a few moments. You could even leave the windows closed if it’s too cold or wet to open them. The light receptors in your retinas send chemical messages to your brain to confirm that the morning is here and that it’s time to wake up. If your biological clock is set to give you a wake-up call at the correct time in the morning, its natural rhythm will help to prepare you to feel sleepy at the right time in the evening, too.
From what and when we eat to how much alcohol we drink, how much stress we’re under and when we exercise, all sorts of lifestyle factors impact our ability to sleep soundly. This section looks at how you can top off all the other aspects of your sleep hygiene in order to have a healthy, fulfilling lifestyle that also provides refreshing, restorative sleep.
Your weight
The purpose of this book is not to tell you that you need to reach a target weight nor what you need to eat in order to optimize your nutritional intake. However, it’s important to say that being overweight is detrimental to good-quality sleep.
Many studies show that there is a connection between achieving too little sleep and gaining weight, and unfortunately it’s also true that the more weight you gain, the poorer your sleep. Being overweight interferes with your breathing, because it makes it harder for your throat to stay open as it relaxes between each breath. This is why overweight people tend to snore (see p.192). Being overweight also makes it harder to get comfortable in bed.
When being overweight turns into being obese, you may risk developing “sleep apnoea”, which causes a momentary cessation in breathing during sleep and puts a strain on your heart. As soon as your brain realizes that it’s being starved of oxygen, it wakes you up so that your breathing kicks in again. See pages 193–194 for more on this.
Overall, the message is clear: if you’re overweight, try to bring your weight back to within the healthy range for your build. A combination of a nutritious diet and the right amount of physical exercise so that you burn more calories than you put in is as complex as any weight-loss programme needs to get. The important thing is to lose weight in a way that makes your target weight sustainable into the future.
Mealtimes
The timing of your meals is one way in which your body clock aligns itself with the cycle of day and night. For this reason it’s important to follow a regular mealtime schedule, with breakfast, lunch and supper at more or less the same times each day.
We also already know that it’s perfectly normal to feel sleepy after a big meal, when your tummy is full. For this reason, we might expect that having the day’s largest meal in the evening will help the body get ready for sleep. However, it’s not as simple as that.
Eating is the way in which your body derives energy. After a meal, and after any initial feelings of sluggishness have passed, you should feel refuelled and energized. Obviously, this is exactly the opposite to how you want to feel before you go to bed. The best way to eat for optimum sleep is to eat little and often. Three light but well-balanced meals a day help to prevent the energy dips of mid-afternoon, but also avoid you feeling overfull or overenergized when you go to bed.
The kinds of food you eat at supper time are also important. As the 17th-century British aristocrat Lord Chesterfield once said, “A light supper, a good night’s sleep, and a fine morning have often made a hero of the same man who, by indigestion, a restless night, and a rainy morning would have proved a coward.” Certainly, indigestion and heartburn are often cited as reasons for preventing sleep. If you’re prone to either of these, try keeping a food diary, noting down everything you eat and drink, and see if you can establish which foods cause the problem. Once you know, eliminate them from your diet – or at the very least from your evening meal.
Generally, though, a healthy diet that features a range of fresh foods, including plenty of fruits and vegetables and dietary fibre, is good for the quality of your sleep. High-sugar, high-fat foods are harder for your body to digest, which means that they are much more likely to keep you awake as your gut tries to move them through your system.
One important rule of thumb for everyone is to eat at least three to four hours before you retire for the night. This way, your body has time to digest your food before you try to go to sleep.
Alcohol
Although alcohol is in theory a sedative, its soporific effects hold true only if it is drunk in moderation. More than a glass of wine shortly before bedtime has the opposite effect. This is primarily because alcohol is dehydrating and diuretic: while you might fall asleep easily, you’re likely to wake in the night feeling thirsty and needing the loo.
My husband tells me that I should eat lettuce at bedtime to help me get to sleep. Can this really be true?
The simple answer is no, unless you want to eat it in such large quantities that it would probably give you a terribly bad stomach that keeps you awake anyway. Lettuce does contain tiny traces of two chemicals – lactucarium and hyoscyamine – that do have a soporific effect on the body. However, the amounts in lettuce are so small that you would need to eat a lot of it (and ideally on its own) for them to have any effect. You’d be better to ensure that you’re getting good levels of calcium (in dairy products, as well as broccoli and spinach) in your diet, which the body uses in the manufacture of melatonin. Equally, magnesium deficiency has been linked with insomnia, so make sure you’re getting plenty of this mineral, too. You can find it in dark green leafy vegetables, as well as bananas and dried apricots. Overall, a warm cup of milk at bedtime is likely to be of far more help to you than a bowl of lettuce.
More worryingly, research in the USA in the 1980s showed that alcohol consumption can lower levels of oxygen in the blood and increase susceptibility to sleep apnoea (see pp.192–4). Oxygen levels remained lower than “normal” not only on the night after the drinking occurred, but on the following night, too. More recently, in 2011, researchers studied the relationship between alcohol and the stages of sleep. They discovered that although alcohol may induce sleep initially, overall there were fewer periods of deep and dreaming sleep during the night, and that in the morning study participants generally reported feeling as though they hadn’t slept at all. Indeed, many alcoholics say that they are also insomniacs, supporting the theory that alcohol interferes with the restorative powers of sleep.
We’re all different, and alcohol tolerance levels vary from person to person. You can be really sure whether or not alcohol has a consistently negative effect on your sleep only by becoming teetotal for, say, six weeks, and then reintroducing an evening alcoholic drink and monitoring its effects on the quality of your sleep. You may find that a single drink, or two drinks, once or twice a week a few hours before bedtime has very little effect on your sleep quality – or you may find that your good night’s sleep relies upon total abstention.
The problem with stimulants
I’m not someone who demands that my clients never let another cup of coffee pass their lips. In fact, I think a cup of coffee as a morning pick-me-up can be a good idea. Nevertheless, the simple fact is that if you want to improve the quality of your sleep, you need to steer clear of caffeine after lunchtime every day. Caffeine is found in coffee, black tea, green tea, carbonated drinks and energy drinks, and in all cocoa products, from hot chocolate drinks to bars of chocolate.
The stimulant effects of caffeine can take effect in only 15 minutes, and it can take several hours for your body to eliminate the caffeine fully. The older you are, the longer its effects are active, but on average caffeine metabolism takes between three and six hours. Caffeine disrupts your body’s use of the neuromodulator adenosine to promote drowsiness. Specific receptors in the brain perceive the caffeine molecules and think that they’re adenosine. Instead of latching on to adenosine (making you drowsy), the receptors hook up with the caffeine. The adenosine sleep-promoting signals then can’t get through, so the wakefulness-promoting parts of the brain remain active.
Interestingly, in 2012 research students at Stanford University in the USA experimented to see if larks or owls were more susceptible to the effects of caffeine in relation to the quality of their sleep. They discovered that the owls (those who like to stay up late at night; see box, p.18) in their group were far less likely to suffer the stimulant effects of caffeine during their sleeping hours than were the larks. However, the trial was conducted only on students, who tend to anyway have erratic sleeping patterns. We’d need a more representative cross-section of the population to claim for certain that the discoveries are true.
AMPHETAMINES
Amphetamines (or alpha-methylphenethylamines to give them their full name) are drugs that primarily promote wakefulness, reduce fatigue and can induce feelings of euphoria and sociability. They may also be prescribed to treat narcolepsy – a condition that causes its sufferer to fall asleep at inappropriate times (see pp.174–177). However, in their illegal, “recreational” form, they appear on the market as speed, crystal meth, uppers, whiz and so on.
Apart from the fact that the law strictly prohibits the use of amphetamines outside clinical practice, these drugs have absolutely no place in the life of someone who is trying to improve the quality of their sleep. They increase heart and breathing rate, alertness and restlessness. Long-term use not only leads to insomnia, but possibly to permanent damage of the brain’s cells.
If you do need to cut down on your caffeine intake, do so gradually, reducing the number of cups you have each day by one until your intake is no longer affecting your sleep. Going “cold turkey” (stopping suddenly) can cause withdrawal symptoms – including insomnia.
Caffeine is not the only stimulant in common circulation. It’s estimated that around 20 per cent of adult Americans smoke tobacco. The nicotine in tobacco is a powerful stimulant with an effect similar to alcohol: it reduces the amount of restorative deep sleep we get during the night. Deep sleep, REM sleep and overall sleep time are all reduced in regular smokers. This is not least because after several hours the brain starts craving nicotine to feed its addiction.
Also, rather like alcohol, nicotine increases susceptibility to sleep apnoea, with some reports claiming that smokers are three times more likely to suffer this condition than non-smokers. If you’re a smoker and you think you have poor-quality sleep, you should do your utmost to quit. Although quitting might hamper your sleep initially (because of the withdrawal symptoms), persevere because in the long term your sleep quality (and other aspects of your health) will certainly improve.
Stress and relaxation
The more stressed you are and the greater the number of worries you go to bed with, the poorer the quality of your sleep. Easing the physical effects of stress and quietening anxiety are essential to a restful night.
During times of stress, a sharp rise in adrenaline pumps your muscles full of energy to prepare you to fight or flee from danger. In times gone by, you would use up this energy doing just that. Today, your body releases adrenaline when it perceives threat in just the same way – but the threat tends to require far less physical action. You wouldn’t, for example, get physical when your boss tells you at 5pm one afternoon that she needs you to prepare a 30-minute presentation for the Board by 9am the following morning. In the modern world, stress tends to be more psychological – time management, the pressure of organizing an event, a vacation, a family and so on. With emotional and mental stress, adrenaline doesn’t get burned off. Instead, it’s stored as muscle tension, which is as bad news for your sleep as the mental chatter.
YOUR TIMETABLE FOR STRESS-FREE SLEEP
Try implementing the following tips every evening, so that you can go to bed without carrying your worries with you. If you like, you can make them a part of your bedtime routine (see pp.78–80).
During the evening:
1. Make a list of any meetings or engagements you have tomorrow and prepare everything you need – from your keys and wallet to any documentation or papers you need for the day.
2. Prepare your clothes for tomorrow, as well as your packed lunch or other necessities. If you have school-age children, prepare their school clothes, lunches and bags, too.
One to two hours before you intend to go to bed:
1. Make a list of any items that you meant to do today, but didn’t get round to. These will be your top priorities for tomorrow. Then, add anything else that you’d like to achieve if you have time. Put the list in your work bag and clear it from your mind.
2. Turn off your TV and do something calming. Don’t begin any contentious discussions with other household members!
30 minutes before you intend to go to bed:
1. Spend ten minutes doing a quiet breathing relaxation. For example, you could try the yoga Humming Bee (see p.81) Breath exercise. Or, you could make your body the focus of your relaxation (see box, p.70).
There are many excellent books available on stress relief. As far as your sleep is concerned, they tend to offer two important messages:
• Every day set aside time to let go of as much of your daytime stress as possible, so that you can go to sleep with a quiet mind. Even if you can’t be worry-free, aim to press the pause button on your anxiety. Take a look at the box on the previous page for some ideas that you can work into your bedtime routine to help you shelve your worries overnight.
• Try to do something physical every day to release some pent-up adrenaline and free the tension in your muscles. A 15-minute brisk walk, a short cycle ride, ten minutes using a skipping rope in the garden or 10 minutes spent gently stretching are all you need to get the adrenaline out. Do whatever suits you and your lifestyle, but do it daily. (See over.)
Self-fulfilling stress
I often meet people who can’t sleep because they tell themselves they can’t sleep. It’s often that several months or even years beforehand they suffered a stressful period in their lives that resulted in insomnia. Although they may have in all other ways moved on from what happened, the insomnia remains. Then, they’ve become so stressed at being unable to sleep, sleep has slipped further from their grasp.
I recommend a system called autogenic training to deal with this problem. Rather like progressive muscle relaxation (see box, p.71), you take parts of your body in turn, but this time repeat in your head a calming phrase, such as “My head feels heavy; my head feels heavy and warm; my head is resting.”
HUMMING BEE BREATH
This yoga breathing meditation helps to fully absorb the mind in the act of breathing and in the vibrations of the hum as it resonates through your body. It helps to relieve tension and stress, and to generate an all-pervading sense of calm.
1. Sit in a comfortable position on the floor. Rest your hands loosely in your lap. Close your eyes, drop your shoulders and become aware of your breath.
2. Relax your jaw, but keep your mouth gently closed. Breathe in through your nose as deeply as is comfortable, bearing in mind that your abdomen should rise on each inbreath, not your chest.
3. Breathe out gently through your mouth, but with your lips together so that you can make a humming sound as you do so. Try to keep the hum going for the duration of the outbreath. You can choose whatever pitch feels most comfortable and relaxing for you. During the outbreath, notice how the hum vibrates in your chest. Focus fully on this vibration.
4. Breathe in again and repeat the hum on the outbreath. Do this for six full breaths. Then, sit quietly for a few moments. Tell yourself “I am ready for sleep”, then get up slowly and go to bed.
From your head, you move to left arm, left hand, right arm, right hand, chest, abdomen, left leg, left foot, right leg, right foot – each time repeating the phrase with the appropriate body part. To finish, repeat three times “I’m ready for sleep.”
I’ve never been to a gym or for a run; exercise fills me with dread. How much do I need to do to sleep better?
If you’re otherwise healthy, aim for three 30-minute exercise sessions a week doing an activity that raises your heart rate so that you feel a little breathless. If running isn’t for you, try swimming, cycling or power walking. Improving your circulation, your breathing and your overall fitness will in turn improve your sleep.
However, if you suffer from stress (or if you also suffer from stress), and you feel uncomfortable and restless when you lie in bed, it’s possible that adrenaline has built up in your muscles and you need to set it free. In this case, try just a ten-minute burst of physical activity every day (such as a ten-minute power walk), as well as an exercise to relieve muscle tension (see e.g. p.71).
In time, your mindset should shift from one of “I can’t sleep!” to “I’m ready for sleep” – and sleep should follow. How long it takes for the shift to happen will be unique to you (allow four weeks), but the positive self-talk will work once you’ve broken the habit of negativity.
Fit for sleep
As I’ve already said, exercising to release pent-up energy every day is an important form of stress relief that aids sleep. However, there may be other benefits to exercise, too. Historically, scientists have claimed that exercise improves sleep for a number of reasons. First, it tires out the muscles, which means they are primed for a period of rest. Second, exercise breaks down muscle tissue, so the body wants to induce sleep (a time of growth and restoration) to build muscle back up again. Certainly, research in Minneapolis, USA, in 2011 showed that people who exercise regularly sleep longer at night and enjoy more deep, restorative sleep (and slightly less dreaming sleep). It also found that daytime energy levels were better and that participants were able to concentrate for longer periods. Most importantly, regular exercise or a brisk walk and a little weight training reduced the incidence of sleep apnoea by 25 per cent, even if the participants didn’t also lose weight.
A year earlier, in 2010, researchers in Switzerland also found that exercise could improve sleep, but only if participants believed they were doing enough. Participants in the study who exercised frequently and were physically very fit, but who felt they needed to do more, slept more fitfully than those who did only moderate amounts of exercise but felt good about themselves and believed themselves to be fit.
Either way, it seems that whether it’s for psychological reasons (because it makes you feel good about yourself) or physiological reasons, regular exercise is an important activity for improving your sleep. However, that’s only if you engage in it at the right times of day. Exercise increases your body temperature and your metabolism, both of which are stimulating, so you need to leave at least four hours between any burst of exercise and your bedtime.