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A Good Night's Sleep
25 October 2001
Contrary to popular belief everyone's current personalpre-occupation is not sex, celebrities or shopping - it's sleep! Apart fromeveryone feeling tired, looking tired and saying they're tired, over fivemillion people in the UK are really affected by some kind of sleep problem.
Part of the problem is poor 'sleep management'.We are all urged to do more and to juggle home, work, family and social life.While a 24-hour society sounds fantastic, the reality may be different. Shopsare open on Sundays and some even open 24-hours a day. You can check your bankbalance at 3am and shop all night over the internet if you want to. Even thoughwe all complain that there is nothing to watch the countless cable andsatellite television channels mean we tune in when we should be turning off.
Essentially we are no longer encouraged to slow down andrelax once the day traditionally ends - because in reality it doesn't and ofcourse this makes it harder for us to switch off, wind down and let our bodiesrelax and recharge.
A simple rule of thumb is that if you feel tired youprobably need some sleep! It may sound obvious but it is surprising how manypeople push themselves when they should really be in bed. Statistics suggestthat more than one in twelve of the population finds sleeping difficult. Forsome these conditions go undiagnosed and can have serious effects on our healthand wellbeing. Many people will be familiar with some of the adverse effectsincluding, irritability, loss of concentration and impaired performance. Aswell as making us feel so dreadful, there is some evidence that our immunesystem and physical health also suffer when we experience chronic sleepdeprivation, as well as our ability to enjoy life in general.
BUPA is taking the end of October as a focus point to helpeveryone get a good night's sleep. As the clocks go back and British summertimeends fortunately we will gain an extra hour, one hour of sleep may not soundmuch but starting a more disciplined approach now will help in the long-term.
BUPA's assistant medical director, Dr Paula Franklinexplains why sleep is so important: "The effects of lack of sleep may beeasily masked by a cup of coffee but there are real benefits to be had fromconsistently getting a good night's sleep. And it is not difficult to get intoa beneficial regular sleep pattern. If we go to bed and get up at roughly thesame time each day our bodies become used to the routine and the quality ofsleep is better. There are physical and mental benefits to getting the rightamount of sleep. Sleep is vital to re-charge our bodies allowing us to copewith modern-day life."
Paula goes on to explain that: "It is notcomplicated, the human body is like any piece of machinery and should be restedand recharged to ensure it gives its best performance. Sleep gives our bodies'organs, like the kidneys, heart and brain, time to rest and recover to be readyto work properly the following day."
If you ever needed more of an incentive to invest in somegood quality sleep you may like to consider findings from scientists recentlythat have found that a lack of sleep promotes the growth of fat rather thanmuscle.
Paula offers some tips for the perfect nights sleep:
one thing you need to learn about yourself is how muchsleep you need in order to awake refreshed and ready for the day. For mostpeople this will be between seven and eight hours. Although it might betempting to believe that we will feel better the longer we can stay in bed,there is no real added benefit to more than eight hours
don't smoke - it's not only your lungs that are damaged, smokingincreases the time it takes to get to sleep
avoid stimulants such as caffeine and alcohol before goingto bed as these will interrupt your sleep pattern
if you can't sleep, although it is difficult try not tostress yourself further by worrying that you can't sleep - try reading orsomething else relaxing to make you sleepy again
although we think a warm, snug bedroom is most welcoming,aim for your room to be about 24 degrees celcius this is the most conducive fora good nights sleep
if you do find that you struggled to get some sleep onenight, you should avoid staying in bed the following day to make up your sleeptime - this will only make it harder for you to sleep the next night
Your sleep pattern can be disrupted if you work shiftsespecially if they operate on a rolling basis with regular changes. Of coursesome people who work shifts find it suits their domestic arrangements helpingthem with childcare requirements for example. But for some people, chronictiredness, health and relationship problems are common complaints. In additionto the tips above, there are some other steps you can take to improve yoursleep whilst working shifts including:
stick to a routine of going to bed and getting up at thesame time each day and keep a regular pattern for the week, even if it is outof sync with other members of the family
try to make a concerted effort to keep regular time forfamily and friends
if you have a meal before going to bed keep it light;perhaps soup, fruit and toast
take a little time when you get in from work to wind downby doing something relaxing, like reading before trying to sleep
Some practical steps you can take include:
install black-out blinds in your bedroom and wear earplugsto reduce noise
get an answering machine to take messages while you areasleep - if you want friends and family to be able to contact you in anemergency buy a pager or separate mobile phone that only they have the numberfor
A final trick - wear sunglasses on the way home at the endof a night shift to maintain the sense of darkness - no it really works!
If you feel that you have a serious problem with sleep,you should make an appointment with your GP and discuss your symptoms.
Problems associated with sleep:
Sleepwalking, night terrors and nightmares
About one percent of us sleep-walk and five percent of usreport that we experience night terrors.
Someone who sleepwalks will appear to wake from a deepsleep, get up and often walk around the house. This could lead to someembarrassing situations and you may need to protect them from injuringthemselves. If necessary, lock doors and windows and make sure the sleepwalkercan't get access to sharp objects like knives and tools! A sleepwalker shouldbe guided gently back to bed and should not be woken up.
Someone experiencing a night terror may shout out orscream and wake suddenly from a deep sleep, in a state of distress, but mayappear only half-awake. They are likely to be very frightened but will oftensettle down to sleep again without waking up completely. People who suffernight terrors cannot recall vivid dreams and often don't remember much aboutthe night terror the next day.
Most people experience nightmares now and again. Theyusually happen in the later part of the night when we have our most vivid andmemorable dreams. They do not normally cause problems unless they arerecurring, which can be a sign of emotional difficulties. Nightmares may followa distressing event, such as bereavement, a disaster or a physical trauma such asa violent attack.
Sleep apnoea
Dr Paula Franklin, BUPA's assistant medical director,explains: "Sleep apnoea is a rare condition in which you stop breathingfor short periods while you're sleeping. These interruptions in your breathing,which can last 10 seconds or longer, occur when the muscles in your soft palateand tongue relax during sleep. This is the same process involved with snoring,but with sleep apnoea, the airway narrows so much that it closes. Yourbreathing stops, cutting off the flow of oxygen into your body and reducing theelimination of carbon dioxide (CO2) from the blood. Your braindetects this rise in CO2 and stimulates the body, re-opening yourairways and re-starting your breathing. This process can be repeated severaltimes during the night. Proper sleep may become impossible, resulting in severefatigue and a decreased quality of life.
Sleep apnoea in adults can increase the risk of serioushealth problems such as heart failure, because it deprives the sufferer ofadequate levels of oxygen, making the heart work harder than normal.
"If you think that you or a member of your family mayhave sleep apnoea you should see your doctor. Your doctor will ask you aboutdisturbed sleep, excessive daytime sleepiness, loud snoring and/or long pausesin breathing reported by a bed partner. These signs are strongly suggestive ofsleep apnoea but your doctor will need to refer you for further investigationsbefore treatment can be started."
Usually, these investigations are performed in a sleeplaboratory and include:
visual observation of sleep, to detect laboured breathing,with long pauses, followed by arousal from sleep
pulse oximetry, to measure the amount of oxygen in theblood and the pulse rate. The recording is taken for at least eight hoursovernight, and can be carried out at home. Multiple dips in oxygen level andpeaks in pulse rate are found in people with sleep apnoea
polysomnography, which involves many measures of sleep,including eye movements and chin tone to define sleep stages, flow of airthrough the nose and mouth, movement of the chest wall, oxygen levels in theblood, and ECG (electrocardiography) to measure any abnormal heart rhythms
Some advice on a self-care action plan:
One of the things you can do is to try to maintain ahealthy weight by having a healthy diet. This means eating a wide variety offoods from four main food groups:
bread, other cereals and potatoes
fruit and vegetables
milk and dairy foods
meat, fish and alternatives
You should aim to eat five servings of fresh, frozen orcanned fruits and vegetables in your daily diet. You can also prepare meals ina more healthy way, for example baking or grilling foods instead of frying.This will not only reduce the fat in your throat tissues, but will also helpimprove your general health.
Regular exercise will also help with weight management aswell as improving muscle strength. If you are not a regular exerciser, beginwith a 10-minute period of light exercise and gradually build from there. Whenyou are ready, it is recommended that you exercise at least three to four timesa week. Try to do 20-30 minutes a session. Those 30 minutes don't have to becontinuous: we know that three 10-minute sessions of exercise each day is justas good. Occasional vigorous activity is unwise and possibly dangerous if youare out of shape."
Other measures include:
always try to sleep on your side, instead of your back
avoid alcohol before bedtime
keeping the body in alignment, which could include raisingthe head of the bed, may help reduce snoring. This should be done by raisingthe head of the bed itself or by making sure that your pillow is at the correctheight.
Medicines
If you have allergies that cause nasal congestion, try anoral or spray decongestant available from your chemist. Be careful not to usethese over-the-counter (OTC) products on a long-term basis. If your nasalcongestion doesn't clear up in a few days, see your doctor as you may needstronger medication, or other measures to clear your nasal passages. If yournasal congestion is caused by a structural problem in the nose such as adeviated septum, there are surgical techniques that can correct it.
If your doctor diagnoses sleep apnoea and none of thesimple remedies are successful, he or she may recommend wearing an oxygen maskover your face while you sleep, to force air through your airway so that itwon't close. This treatment is called continuous positive airway pressure(CPAP). However, this form of treatment may need to continue for months oryears and some people find wearing a mask in bed every night difficult totolerate.
Surgery
While making lifestyle changes should be the first step intreating your snoring, these measures are not always effective. If that is thecase, you might want to consider a form of surgery called laser-assisteduvulopalatoplasty (LAUP). This relatively new procedure has been found to stopor reduce snoring in most people.
LAUP involves removal of excess tissue from your softpalate and uvula with a small, hand-held laser. The operation makes your airwaylarger, so vibrations are decreased. The procedure is performed under a localanaesthetic and takes about 30 minutes. Depending on the severity of yoursnoring, you may need more than one session - some people may need up to fiveor six sessions before their snoring is improved. If you need multipletreatments, they will likely be spaced four to six weeks apart.
In general, this surgery does not have serious sideeffects and you can continue your regular activities immediately after theprocedure. Some people may have a sore throat for about one week. In a very fewcases, laser surgery can raise or lower the pitch of the voice. Before youdecide on laser surgery, talk it over with your doctor.
There are several other surgical options for sleep apnoea,depending on the cause:
if your sleep apnoea is caused by a jaw deformity, anoperation to correct the deformity (which usually involves lengthening of thejaw bone) will be performed - this is successful in most people
if your sleep apnoea is caused by large tonsils and/oradenoids, these can be removed in a simple operation called a tonsillectomy oradenoidectomy
if no cause can be found for your sleep apnoea and it isnot considered to be life-threatening, a procedure called auvulopalatopharyngoplasty (UPPP) can be performed, where a surgeon trims andtightens throat tissues while you are under a general anaesthetic. However,this procedure has only a 30-50 percent success rate and can affect yourability to have CPAP therapy at a later date
Insomnia
Insomnia is an inability to fall or to stay asleep. It canbe caused by anxiety, depression, alcohol and drug abuse, jet lag, and chronicpainful medical conditions. These and other causes are set out in greater detailbelow. Insomnia is very common. As many as one in three adults will sufferinsomnia at some time or other in their lives.
Causes of insomnia include:
Anxiety - is characterised byincreased alertness and an unpleasant sensation of fear and apprehension. Oftenanxious people will lie in bed for hours attempting to get to sleep. Theinability to get to sleep generates more anxiety, making the problemself-perpetuating. Other symptoms of anxiety include trouble staying asleep,poor concentration, feeling wound up, irritability, muscular aches,distractibility, being easily tired, palpitations, dizziness and nausea. Theanxiety may be the result of stressful life events which may include illness,difficulties with work, problems with family life or some sort of lossincluding bereavement.
Depression - Disturbance ofsleep rhythm is very common in people suffering from depression.In severe depression, waking early in the morning is common, typically in thevery early hours, often at 4 or 5am with great difficulty getting back tosleep. This results in chronic tiredness.
Alcohol - abuse is often relatedto anxiety and depression; disturbance of sleep may occur as a result of theseconditions. Alcohol taken in large quantities by people who do not abusealcohol also frequently leads to disturbed sleep, often in the early hours ofthe following morning. This is due to the declining alcohol levels in the bodyleading to increased wakefulness.
Drugs - that stimulate the brainfrequently lead to disturbed sleep patterns. These include cocaine,amphetamines and ecstasy. When taken in large amounts, it may be impossible toget to sleep for many hours. This is followed by long periods of sleep when theeffects of the drug have worn off.
Jet-lag- This is a particular problem among business men and women whose work involvesinternational travel. The susceptibility to developing jet-lag varies greatlybetween individuals. Some people are completely unaffected by jet-lag, whereasfor others the effect is particularly marked and will interfere with normalfunctioning of everyday life.
Most people develop some degreeof jet-lag when travelling East or West to a time zone five or more hoursdifferent from home. On travelling East, the effect will be of one of inabilityto get to sleep at the normal retiring time of the time zone travelled to. Ontravelling West, the problem is one of drowsiness very early in the evening andthen waking in the early hours of the morning.
Other medical conditions leadingto insomnia - Any painful long-term medical condition will affect sleep (eg,arthritis). Medical conditions that cause shortness of breath may be worse whenlying flat, and therefore cause waking in the middle of the night. Theseinclude heart failure and chronic bronchitis. Parkinson'sdisease, which is a common condition in elderly people, often interfereswith normal sleep patterns due to an inability to move adequately in bed atnight during sleep.
Poor sleep hygiene - Individualswho take 'cat naps' during the day will require less sleep at night and may saythey have insomnia. This phenomenon is known as 'poor sleep hygiene'. Therequirement for sleep during any 24-hour cycle varies greatly betweenindividuals.
A small proportion of thepopulation will require only five or six hours sleep at night, whereas otherindividuals require between nine and 10 hours. The average amount of sleeprequired is about eight hours. This amount also varies with age. Often youngchildren require less sleep at night and the need for sleep often increasesgreatly during adolescence. With increasing age, the requirement for sleepgradually diminishes. Many people who say they have insomnia often haveunrealistic expectations of the amount of sleep required.
What is the treatment for insomnia?
Self-care action plan:
often identifying stressful events and eliminating them orreducing them may improve sleep patterns
jet-lag may be managed by attempting to switch sleeppatterns to the new time zone before travelling
for poor sleep hygiene, advice about healthy sleeppatterns is often all that is required to treat the condition. Stopping catnaps in the day is often beneficial
Medicines
Depression may need to be treated with anti-depressantmedication. Similarly, long-term anxiety states may need to be treated withmedication to reduce the level of anxiety. Occasionally, behaviouralpsychotherapy may be of benefit in chronic anxiety states. Alcohol or drugabuse may require a systematic and planned treatment programme allowing gradualwithdrawal of the drug of abuse. A hormonal therapy known as melatonin is currentlybeing evaluated for jet-lag. This hormone is produced naturally by the brainduring sleep and is responsible for the initiation and maintenance of sleep.
Disturbances in its secretion from the brain are thoughtpossibly to be related to jet-lag. For the frequent traveller taking artificialmelatonin is often highly successful. This drug is not yet available in the UK,but may be so in the near future.
Complementary therapy
Relaxation therapy, reflexology, Alexander technique, yogaand tai chi may all help promote a sense of well-being, relieve anxiety and mayimprove sleep patterns at night.
Improvement of symptoms is dependent on the underlyingmedical condition. Depressive and anxiety states frequently improve with acombination of drug treatment and some form of psychotherapy. Drug abuse mayrespond to a detoxification programme but often the behaviour is entrenched anddifficult to treat. For the majority of people, identifying stressful factorsaffecting their lives and removing them is all that is required to restoresleep patterns to normal.
- - -ENDS - - -
For further information contact:
Gayle Siblock/Camilla Saunders
BUPA Corporate Communications
0207 656 2292/2545
siblockg@bupa.com