Insomnia: A sleep expert offers advice
Here’s an encouraging article (from www.stuff.co.nz, Sharon Stephenson) about dealing with insomnia. I use similar tools with my clients to those described here, using NLP, with excellent results. Other techniques clients have found useful include hypnotherapy, practicing mindfulness, using apps such as white noise, and doing physical things like using earplugs, being in a dark room, or using an eye mask to get rid of the light, no coffee after noon, limiting alcohol, and more …… Read on.
“It’s 3am on Wednesday, a time when only nursing mothers, shift workers and die-hard partiers are awake. I’m none of the above, yet I am bright-eyed and bushy-tailed, staring at the bedroom ceiling instead of at the insides of my eyelids. I am a chronic insomniac, unable to fall asleep and stay asleep, both equally frustrating sides of the disrupted sleep coin.
Sleep and I have never been good friends, or even casual acquaintances.
This is what usually happens: I go to bed and toss and turn for hours worrying that I can’t get to sleep/have to get up soon/haven’t sent an important email/need to add something to the grocery list, etc. On particularly bad nights, random thoughts and worries bounce around my brain like an out-of-control game of ping pong.
I try counting sheep, listing the things I’m grateful for, regulating my breathing and meditating and when none of these work, I try to bargain with God/Buddha/Allah/Anyone that if they grant me a good night’s sleep, I’ll be a good girl from now on. Ironically, the only thing that all that worrying and bargaining does is to further stimulate my brain, ratcheting up the anxiety and making sleep even more elusive.
Eventually, annoyingly, I fall into an exhausted sleep, only to wake up a few hours later to watch daylight creep around the curtains.
If insomnia was an Olympic sport, I would have a permanent place on the podium, gold medal firmly clasped around my neck.
It’s not as though I haven’t tried to sleep: over the years I’ve taken chamomile and magnesium, fitted blackout curtains, done yoga, eaten bananas and sipped warm milk (not at the same time), exercised in morning sunlight, given up coffee and limited alcohol. I’ve tried deep-breathing exercises, listened to podcasts and gobbled melatonin tablets (and when those didn’t work, I got a prescription for sleeping tablets which do work but which I only take when I really, really need to). I’ve eaten lots of carbs and given up carbs and, once on a work trip to a health retreat in Queensland, had acupuncture from the bloke who used to stick needles into Princess Diana. Heck, I would pound my chest in a drum circle while hanging naked from a chandelier if I thought it would help.
And even though in the wee small hours, when my rock-solid sleeper husband is happily lost in dreamland and it feels as though I’m very much alone, figures show I’m anything but.
New Zealand’s National Health Survey 2013-2014, for example, revealed that 37 per cent of Kiwis aged 30-60 never, or rarely, get enough sleep. Those most at risk include women (insomnia affects twice as many women as men), shift workers, the elderly, young adults, travellers, women in menopause, drug abusers and alcoholics.
Dr Alex Bartle, director of New Zealand’s Sleep Well Clinics, believes up to 15 per cent of adult Kiwis have chronic insomnia which affects their waking lives.
“That’s a fair number of people who have disrupted sleep at least three nights a week, and have had for more than three months,” says Bartle.
“Part of the problem is that many people who can’t sleep accept it as normal and insomnia is not normal.”
Although we spend about 24 to 26 years of our lives asleep, how much we really need varies from person to person. The gold standard for an average night’s sleep, set by the US Sleep Foundation, is 6½ hours.
“Any less than six hours and we don’t compute very well,” says Bartle.
He’s right: when we’re sleep deprived we tend to be grumpy, unproductive and often unable to think straight. Research from the University College London Medical School revealed that people who fail to get a full night’s sleep score significantly lower on tests of logic and vocabulary and, more worryingly, have slower reaction times which can impact on everything from operating machinery to driving.
The grim news doesn’t stop there: chronic insomnia can lead to a laundry list of illnesses, from high blood pressure and diabetes to an increased risk of heart attack, Alzheimer’s disease, problems with the immune and lymphatic systems and even death (such as the 24-year-old Indonesian woman who died in 2013 after prolonged sleep deprivation).
It’s why I take myself to Bartle’s Wellington clinic on yet another day when I need pegs to prop open my eyes. I’m clearly not the only one, because I’ve had to wait three weeks for an appointment with the Auckland-based doctor who made the switch from general medicine 10 years ago when he realised the extent of New Zealand’s insomnia problem.
“Insomnia isn’t just a case of not sleeping, it’s also about fear, an overwhelming but common anxiety that can paralyse your sleep,” says Bartle.
We talk about my history with disrupted sleep, how fatigued I am during the day (very) and how I manage to muddle along with around four to five hours shut-eye a night (not always successfully). We discuss my current sleeping situation – blackout curtains (good), dog sleeping on the bed, not so much – and if I watch TV, read emails and scan the internet while in bed (yes, yes and yes).
“You’re a classic chronic insomniac, someone who’s tired and wired and can’t turn off the internal dialogue or to-do lists,” Bartle tells me.
It is, apparently, possible to rewire my brain to give me the confidence I need to fall asleep and stay that way using cognitive behavioural therapy for insomnia (CBTI), which helps to manage the underlying stress that interferes with sleep. CBTI, which numerous studies have shown to be more effective than sleeping pills, pivots on a simple concept – that insomnia is caused by learned thoughts and behaviours which can be unlearned or changed.
We start with sleep hygiene, a slightly icky term which basically describes the routines and rituals around bedtime that let the brain know it’s moving into the sleep phase.
These include environmental factors such as dimming the lights, taking a hot shower or bath an hour before bed, avoiding exercise and snacks before lights out and, most importantly, not doing anything in the bedroom except sleeping and sex. Which means no watching TV or mindlessly scrolling through my phone while in bed.
Bartle says my sleep efficiency is also something that needs to be tackled.
“You’re currently going to bed at 11pm, getting up at 7.30am and sleeping for around four to five hours, which is only a 50 per cent sleep efficiency rate.”
He suggests I restrict the time I spend in bed by going to bed at midnight, which should help to consolidate my sleep. “Turn off all electronic devices around 11pm and read a book until it’s time to go to bed.”
So far, so doable. What doesn’t sound so easy is dragging myself out of bed if I can’t fall asleep within 10 minutes of retiring (or after waking during the night). The CBTI tough-love approach is to get out of bed, go to another room and read a magazine for 20 minutes before returning to bed.
“You can’t make yourself sleep, so the trick is to relax enough in order to allow sleep to happen,” says Bartle. That includes progressive muscle relaxation which, as the name suggests, involves working up or down the body relaxing various muscle groups. That old chestnut – mindfulness – and visualisation, taking my mind to a happy place (currently a deserted beach in Fiji), can also help.
“Some people pray, do self hypnosis or have mantras they repeat, basically whatever relaxation technique works for you.”
It’s probably nothing I didn’t already know but it helps to have someone of Bartle’s experience put it in practical, easy-to-follow terms. I leave the clinic feeling more confident about sleeping than I have in a long time.
“Just remember, it takes time to retrain your brain,” he says kindly as I leave.
One month down the track and although I haven’t quite nailed this sleeping six hours a night thing, it definitely feels more manageable. I’m going to bed later, switching off the electronic distractions earlier and reading more books than I have for ages. Thankfully, I’m also sleeping for longer stretches and seldom waking before the alarm. But, best of all, I’ve almost forgotten what 3am looks like.
DR ALEX BARTLE’S TOP 5 TIPS FOR BETTER SLEEP
– Stop screen time (including smartphones, computers and TV) for at least one hour, and preferably two hours, before bed.
– Stop “clock watching” overnight by ensuring clocks and cell phones are out of sight and out of reach.
– Spend more time outside, especially in the morning.
– Go to bed later when you’re more likely to be able to go to bed and sleep. Then slowly advance bedtime every two to three nights.-
– If you’re unable to sleep, get up within 20 minutes. You may only need to be up for 15 minutes before returning to bed to try again.
Article from SHARON STEPHENSON Stuff October 14th 2017