The effects of lack of sleep

A great article today in the Times by John-Paul Flintoff on the election and lack of sleep:

“It was the election that didn’t sleep. David Cameron campaigned throughout the night. Gordon Brown was so addled that he forgot that he was wearing a microphone. And Nick Clegg revealed that all his mother ever says after watching him on telly is: “You look so tired, dear.”… Read the rest here.

Sleep was the topic of my latest newsletter, which I’ve pasted below – sign up for monthly updates here.

Although we are now firmly into spring, sleep is still vitally important all year round and often people find it harder to sleep in the summer due to the excess light and noise. This month’s newsletter is all about sleep: how much you need, sleep disorders and tips on how to get a good night’s sleep.

You may have noticed a few changes to my website – please do get involved on facebook or twitter, and any thoughts you would like to share, go to my blog. Someone asked me for a list of all farmers markets in East Sussex, which you can also find on my blog. Finally, again a huge thank you to those referring your friends and family to me – it is an honour to treat those who are taking responsibility for their health.

Sleep disorders
Failure to get an entire night’s sleep on most nights over a one month period can be considered chronic insomnia. It affects approximately 1 in 10 of us here in the UK and approximately 30% of those over 60 years old. Insomnia can take the form of being unable to fall asleep when you first go to bed, or waking during the night and being unable to go back to sleep. While insomnia can be very frustrating it is hardly dangerous and is usually only a temporary annoyance; although in some cases, sleep-related problems can last for months or even years.

Insomnia
Chronic insomnia can be a symptom of a serious underlying medical disorder. Fifty percent of insomnia cases can be attributed to depression and psychological disorders such as anxiety, stress or grief. Insomnia can result from a wide variety of causes, including arthritis, asthma, breathing problems, hypoglycaemia, hyperthyroidism, indigestion, kidney or heart disease, muscle aches, Parkinson’s disease or physical pain. Quite a bit to keep you up at night! In addition, caffeine consumption, jetlag, the use of certain drugs like antidepressants, seizure medications, beta blockers and thyroid hormone replacement drugs can cause problems with sleep. Also, a lack of the nutrients calcium and magnesium can cause you to wake up after a few hours and not be able to return to sleep. A sedentary lifestyle can also be a major cause of sleep disorders.

While one or two sleepless nights can cause irritability and daytime sleepiness, with decreased ability to perform creative or repetitive tasks, most people can adapt to short-term periods of sleep deprivation. After more than three days, however, sleep deprivation begins to cause a more serious deterioration in overall performance and can even result in mild personality changes. If chronic, inadequate sleep compromises productivity, creates problems in relationships and can contribute to health problems.

There are no hard and fast rules about how much sleep is enough because everyone is different. Some people can function on as little as five hours sleep while others need ten hours. Most adults need about eight hours sleep in order to feel refreshed and operate at peak efficiency during the day. Children need much more. It is not uncommon for people to sleep less as they get older, especially after the age of 60 yrs old.

Restless legs syndrome
Millions of people have trouble getting to sleep due to RLS. For reasons unknown, when these people are in bed, their legs jerk, twitch, and kick involuntarily. RLS has also been linked to night-time cramps. A deficiency in magnesium and anaemia can play a role in this syndrome.

Sleep apnoea
Sleep apnoea is a serious sleep disorder. This problem is commonly associated with snoring and extremely irregular breathing through the night. In sleep apnoea, breathing actually stops for as long as two minutes at a time whilst the individual is asleep. While breathing stops, the levels of oxygen in the blood drop, resulting in oxygen deprivation. The person then wakes startled and gasping and can often wake up to 200 times a night. People with sleep apnoea tend to have higher than normal blood pressure and are more likely to have a stroke and face an increase risk of heart disease. People with sleep apnoea also seem to have a higher than normal incidence of emotional and psychotic disorders. Experts attribute this to what they call dream deficit – a lack of adequate REM sleep, the stage of sleep in which dreaming occurs.
A person with sleep apnoea often cannot settle into REM sleep for even the eight to twelve seconds it takes to have a normal healthy dream.

Often, lack of sleep is due to raised cortisol levels at night caused by stress. Our natural rhythm should be higher cortisol levels in the morning and lower at night. If you can start to unwind and destress it is possible to lower levels of night-time cortisol. Fundamentally, restorative sleep is one of the most valuable tools that we have to prevent ageing and disease.

Tips for a good night’s sleep

1,500-2,000mg calcium and 500mg-1,000mg magnesium has a calming effect on the nervous system, particularly if taken a few hours before bed.

Melatonin – start with 1.5mg daily taken 2 hours or less before bedtime. If this is not effective gradually increase the dosage until an effective level is reached (up to 5mg daily can be used). This is a natural hormone that promotes sound sleep but should not be used in children.

Vitamin B complex helps to promote a restful state and enhances REM sleep, and niacin promotes serotonin production. Take this during the day rather than just before bed.

In the evening eat bananas, dates, figs, milk, nut butter, tuna, turkey, whole grain crackers or yoghurt. These foods are high in tryptophan, which promotes sleep.

Avoid alcohol – a small amount can help induce sleep initially but large amounts disrupt the sleep cycle.

Avoid smoking – nicotine is actually a neurostimulant and can cause sleep problems.

Avoid stimulants that contain caffeine.

Avoid heavy meals from three hours before bedtime.

Avoid bacon, cheese, chocolate, ham, potatoes, sugar, sausage, spinach, tomatoes and wine close to bedtime. These foods contain tyramine, which increases the release of nor epinephrine, a brain stimulant.

Avoid taking nasal decongestants and other cold medication late in the day, as although the ingredients in these preparations are known to cause drowsiness, they can have the opposite effect on some people.

Establish a set of habits and stick to them.

Got to bed only when you are tired.

Do not stay in bed if you are not sleepy. Get up and move to another room and read or watch TV.

Use the bedroom for sleep and sex, not for reading, working, eating or watching TV.

Set an alarm clock and get out of bed at the same time every morning, no matter how much sleep you had the night before.

Do not nap during the day if this not normal for you to do. However, if you find a cat nap/siesta suits your rhythm then that is fine.

Exercise regularly in the late afternoon or early evening but not right before bedtime.

Take a hot bath an hour before bedtime.

Keep the bedroom comfortable and quiet.

Learn to put worries out of your mind.

A few sleep myths

Eating cheese does not give you nightmares. However, a high fat meal before going to bed may be difficult to digest and therefore lead to interrupted sleep.

Sleep is not just rest. It’s an essential time for your body to perform routine maintenance and repair.

Losing an hour’s sleep is a big deal. If you get less sleep than you need, your ability to do certain cognitive and physical tasks is decreased. If the sleep loss builds over time, it can interfere with hormones that monitor appetite and increase your risk of chronic illness.

You don’t adjust to sleep changes as easily as you think. When you travel across many time zones or work night shifts, you confuse the body’s sense of time, making sleep difficult and inhibiting some necessary sleep functions. For every one- to two-hour time change, it takes your body 1 day to adjust. That means it could take your body 6 to 12 days to adjust to a trip from New York to China.

Older people don’t need less sleep. Older people need the same amount of sleep as everyone else, 7 to 9 hours per night. There is a cultural belief that as you age, you need less sleep. Unfortunately, because of this myth, many older people do not seek help for their sleep problems. Often, older people sleep less than they need to because of illness.

Extra sleep does not necessarily help fatigue. Many people assume that if they feel tired during the day, then they should sleep longer at night. This is not necessarily true. If a person is getting 7 to 9 hours of sleep each night, then he or she should seek another source for their fatigue. Some sleep disorders decrease sleep quality, even though the person is getting enough sleep. Many medical conditions can cause fatigue. If you are sleeping long enough but are still tired, try some exercise and daylight exposure during the day. If that doesn’t help, see your doctor.

Naps are not a waste of time. Naps can be a great way to catch up on lost sleep. After taking naps, people function better and do certain cognitive tasks quicker. Napping can also help you train yourself to fall asleep quicker. However, napping longer than an hour or after 3pm may make it more difficult for you to fall asleep at night.

Alcohol won’t help you sleep better. Alcohol interferes with the normal sleep cycle, especially the back end of the cycle. Four hours into sleep, alcohol wears off and leaves you in an excitable state. You will sleep lighter, wake more easily, and be hungover when you do wake. Being a muscle relaxant as well as sedative, alcohol can even create sleep apnoea symptoms in snorers who don’t otherwise have the condition.

Drugs

If things get too bad, you may need to stop the cycle and take drugs. Tranquilisers like benzodiazepines and similar medication might be suggested by your GP short term. Don’t feel guilty about taking them – it is important to stop the cycle of sleep deprivation as quickly as possible. However, this is never the answer long term and the underlying reason will need to be addressed.

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