How to get a great night's sleep
It was like a thief in the night. At first I battled to fall asleep, so a few hours were lopped off my usual eight. This wasn’t too bad because I could find something to keep me busy until my brain felt tired enough to shut down,’ says Tracey*, a 30-something journalist. ‘It got more troublesome when the alarm clock in my head went off every morning at 3am or 4am. I realised it was out of control when I was having a conversation with someone I’ve known for years but couldn’t remember [a thing about it].’
Most people have experienced some sleeplessness at one time or another. About 30–40% of adults indicate some level of insomnia within a year, and 10–15% indicate that insomnia is chronic and/or severe, says Dr Irshaad Ebrahim, specialist neuropsychiatrist in sleep disorders at the London Sleep Centre (Harley Street, UK) and The Constantia Sleep Centre (SA).
When we talk about getting ‘enough sleep’, we consider the quantity of sleep required, thought to be between seven and eight hours a night, says Dr Ebrahim. But, he says, ‘it’s the quality of sleep that’s probably more important’.
So, what counts as quality sleep? Sleep is divided into five cycles, stages 1 to 4, or non-REM sleep, followed by REM sleep. Stages 1 and 2 are light enough for us to be woken up by a knock on the door. Stages 3 and 4 are considered deep or slow-wave sleep, and are essential to waking up feeling like we’ve had a good rest. But to get to REM, the last stage, you have to go through the full cycle of non-REM. If you’re interrupted at any stage, by a poke in the ribs, for example, the cycle loops back to Stage 1. If you’re feeling wiped out in the morning, chances are you haven’t had enough or haven’t had a chance to get to Stages 3 and 4. Too little REM and your mind starts to play tricks on you.
In That Memory Book, Cathryn Jakobson Ramin describes slow-wave sleep as a time when the brain extracts meaning from the information that comes at it during the day. ‘Because the brain is able to run through events that occurred during the day and look for interesting juxtapositions, slow-wave sleep enhances creativity,’ she says.
‘REM sleep is the cleanup crew, brought in to sweep up the detritus after slow-wave has finished its gig. In REM sleep, the brain examines the just-processed material, deciding what to keep and what to toss. If there’s been little or no slow-wave sleep, the cleaners can make a bad mistake, carting tomorrow’s carefully prepared speech off in a dustbin.’
It’s no coincidence that Tracey’s insomnia coincided with a traumatic death in her family. According to Elise Beeby, a Cape Town clinical psychologist and hypnotherapist, poor sleep is usually a symptom of a psychological problem often related to trauma, severe stress, burnout or depression, among other conditions. ‘The main symptom to treat is the anxiety. Underlying the anxiety is anger or fear, that causes a feeling of powerlessness or helplessness. ‘If this is the case, you have to accept that these feelings have become unmanageable. Seek help, go for counselling, address your problems and don’t avoid them,’ she advises. Once you’ve unlocked the deeper issues and diffused them, better sleep should soon follow.
When Liz*, a health-care professional, went into private practice, she was ‘extremely anxious’ about making ends meet. ‘The tipping point came when a relationship started having problems too. I would wake up at 1am or 2am and battle to go back to sleep. I felt exhausted by morning. I was subsequently diagnosed with depression and started taking antidepressants. About six weeks later, my sleep problem resolved itself. If I hadn’t dealt with my depression, my sleeping problem would have become more difficult to resolve.’
‘Last week I probably slept an average of two hours per night,’ Heath Ledger told The New York Times in one of his last interviews. ‘I couldn’t stop thinking. My body was exhausted and my mind was still going.’ ‘One night he took an Ambien [a sleeping pill], which didn’t work,’ the Times continues. ‘He took a second one and fell into a stupor, only to wake up an hour later, his mind still racing.’
A toxicology report released after Ledger’s autopsy cited the cause of death as ‘accidental’, because none of the drugs was taken in excess. It was the combination of drugs that dealt the lethal blow. Ambien is not available here, but the substance it contains is. Zolpidem is found in Adco-Zolpidem, Stilnox, Zolpihexal and Merck-Zolpidem among others. These ‘Z-drugs’ link with the neurotransmitter GABA to ‘shorten’ the period just before you fall asleep by inducing amnesia so you forget how long it takes. Zolpidem works fast: usually within 15 to 20 minutes you’re lights out. But, while Zolpidem may help insomnia, its ability to induce amnesia is problematic. The package insert warns that amnesia occurs several hours after taking the pill, so if you’re taking a Z-drug to sleep, you should go straight to bed. Don’t do Internet shopping (you’ll spend millions you don’t have), and don’t invite all your friends to Mexico (yes, someone really did). These types of drugs are only supposed to act for about four hours, so they should get you through the midnight hours and you shouldn’t wake up feeling fuggy. But there’s a danger that you could ‘wake up’ before the effect has waned, and get up to high jinks – and not remember a thing.
Raiding the fridge is common. Night driving is also a side effect: one man woke up in his car with the bumper on the seat next to him. Another woman woke to find all the containers for her allergy medication empty: she’d accidentally taken it all. She was lucky; Ledger wasn’t. Though sleeping pills can help you through a bad patch, they’re not a good idea in the long-term. One of the side effects of coming off them is a rebound of insomnia, so seek professional help before you stop them.
Hanan Bushkin, a psychologist at the Anxiety and Trauma Clinic in Johannesburg, believes that cognitive behavioural therapy (CBT), though not a quick fix, is so effective that for most people it works better than sleeping pills – with no side effects. ‘The success of CBT is based on the central theme that sleep problems can only be treated by addressing the underlying causes which, in most cases, are negative thoughts and/or habits. Both of these are learned and can therefore, with the aid of specialised techniques, be unlearned.’
- Go to bed only when you think you can fall asleep. if you haven’t fallen asleep within 20 minutes, get up and do something else until you feel tired.
- Wind down in the evening. Rather than watching television, take a relaxing bath.
- Don’t put a TV in your bedroom and never work in bed.
- Avoid caffeine, nicotine, sugar and alcohol before bedtime. If you want a snack, eat protein and not carbohydrates.
- Try breathing, visualisation and other relaxation techniques to calm yourself.
- It’s worth trying homeopathic remedies; they might just work for you.
- Go to bed and get up at about the same time every day, including weekends, to establish a rhythm.
- Switch off electrical appliances in your room at the wall.
- Get sufficient daylight. Go outside for a walk at lunchtime and make sure your room is sufficiently darkened so that sunlight won’t wake you before you need to.
- Don’t nap during the day. According to marlene Gounder at the Sleep Clinic, Life Vincent Pallotti hospital, no adult should nap in the day unless they had a bad night.
- Get regular exercise: yoga is particularly good for relaxation.
According to Marlene Gounder, this is when the muscles in the back of the throat collapse, the airway is blocked and you stop breathing. ‘The brain reacts to a lack of oxygen by alerting your body to wake up,’ she says. ‘This can occur a number of times a night, so you wake up exhausted.’ Recent research shows that almost 70% of people who have had a stroke have sleep apnoea. Marlene has had positive feedback from patients who have bought a CPAP machine. Overnight monitoring at a sleep lab will establish whether you have OSA. If your doctor chooses CPAP as treatment then a follow-up session is done to obtain the pressure required to keep the airways open. Call Life Vincent Pallotti Hospital on (021) 506 5111.
This article was published in Fairlady (www.fairlady.com) - June 2008