Sleep disorders are far more variegated and complex than you think. The causative factors are numerous and the complementary, synergistic effects they have, make this a challenging field for physicians, psychiatrists and psychologists. It is also more psychosomatic than one can imagine.
This piece is a ‘free’ translation of a booklet this writer found discarded atop a recycling bin at the bus-stop in front of the university I work at, in Karlstad, Sweden. Having been treated for a variant of insomnia — if I could say so — I found the booklet just interesting enough to pick up, in front of bystanders and take home. Available for one and all, gratis, such informative booklets are there for the asking at all healthcare centres in the country. This is a great mode of disseminating information to the populace who tend to often get hooked on to the convoluted maze of the Internet.
What I present is attributed entirely to the healthcare agency in the State of Värmland in Sweden. This writer, has however, taken the liberty to weave in some metaphors of his own to improve readability.
To state the obvious: sleep disorders are common. It is also nothing to feel anxious about. In fact, the more anxious you feel, the more you tend to reinforce the disorder. It is a case of insomnia-anxiety-more insomnia —more anxiety…ad nauseum. This is, in fact, good news. To cull a cricket analogy: when you go out to bowl and get whacked for a couple of sixes off the first two balls, getting anxious may very well end up in a 25-run over. You ought to apply the same logic to the challenge of sleeplessness and simply stop feeling anxious — you can bounce back over time, just like the said bowler by staying calm comes back and bowls a wonderful second spell, which may even be a match-winning foray.
A couple of nights without sleep are nothing to feel harried about. It will right itself, just as a thermostat starts your radiator automatically when the temperature in the living room drops. However, if this is a recurring problem, rest assured that there is help available for the asking — from experts. Note though that patience is the name of the game. Things can be rectified over time, with compliance in the methodology.
ABC OF SLEEP
Sleep rhythms are steered by our brain. When the brain readies the body for sleep, your body-temperature drops, you start yawning and your eyelids droop. If you neglect these signals and help yourself to a cup of cappuccino, you are fighting the free good advice which your brain offers you. And, if you miss the ‘sleep-bus’ voluntarily, you would need to wait for a long time for the next one to show up at the bus-stop.
Things to do. When you lie down, put off the lights and feel sleepy, your ‘degree of being awake’ dips, till you start feeling drowsy. At first, you start by sleeping light and can be easily woken up by minor disturbances — noise or vibration. Slowly, sleep entrenches itself… and, your muscles start relaxing and you are in deep sleep — sleeping like a log. Quite like a batsman struggles when he walks in to bat, but with time and endurance and patience, entrenches himself and goes on to dominate the bowling. The difference, however, is the fact that you do not need to apply yourself like a batsman does, but rather just need to go with the flow and let your body take over. However, though the night, there are recurring patterns of light sleep, deep sleep and the so-called REM [rapid eye movement] dream-characterised sleep. Those of you using app-enabled devices like wristwatches which monitor your sleep rhythms know the credo quite well.
QUALITY, NOT QUANTITY
With age, one tends to need less and less sleep at night. Adults, in general, ought to sleep for 6-8 hours every night, and with age, the required length of sleep keeps decreasing towards the minima of the range referred to. It is more the quality of the sleep which matters, not the quantity, or the total duration. Often, after a restful 6-hour slumber, you may feel much more refreshed than you would feel after an 8-hour disturbed sleep.
Never be under the wrong impression that more is better. Sleep, like all good and necessary things in life, is good in moderation. What happens when you get good-quality sleep is what matters — the blood pressure, pulse rate and body temperature drop, your breathing rate gets slower and your muscles relax. Even the brain gets its well-deserved rest [Note: The human brain consumes a good amount of the energy we get from food and drink we take in – as a percentage share, this is much more than other animals]. However, while the brain rests, and does not actively exert itself, there is energy available for such applications as storage and recording of knowledge gained and memories acquired during the day. This is why a good night’s sleep is necessary, also indispensable, before you take an examination at school, or college. Whatever you have studied before going to sleep, gets embedded in your brain’s hard-disk to be recalled the next day in the examination hall.
The wear and tear the body suffers during the day gets repaired when you are sleeping. Hormones which are necessary for good health are released, while those related to stress are suppressed. Result: your immune system gets a boost.
NOT AS BAD AS YOU MAY THINK
As explained before, you oscillate from light sleep to deep sleep to REM sleep and back, throughout the night. In-between these oscillations, you are also awake for some time. However, it is only if you are awake for a significant number of minutes, that you realise that you are awake. That means, you may actually be awake for a minute many times over a 7-hour period, and you may still wake up feeling refreshed. And, there may be occasions when you feel groggy on waking up — your alarm clock may have gone up when you would have been in real deep sleep. However, that need not make you feel that you slept badly. Wait till well after afternoon and see how you feel — if you are energetic and focused, that is a sure indicator of good-quality sleep.
If you have not slept well for a couple of nights, do not try to compensate for it by taking long naps on the third day. Naps ought not to be longer than 20 minutes [the so-called siestas, or power naps]. This will ensure that sleep sets in automatically on the third night. Of course, as mentioned earlier, if sleeplessness is a recurring problem, medical advice is necessary. And, it certainly helps.
It is always good to introspect and investigate, as detectives and scientists do, to link effects to causes, or combinations of causes, and determine cause-effect correlations, while also remembering that correlation may not be causation. Make a note of your activities during the day, your meals and mealtimes, intake of caffeine-drinks, alcohol, tobacco, sleeping pills, etc., your thought processes and experiences, and assess the quality of your sleep [This can be done easily using the app-enabled devices which are available on the market], and also how you feel the day-after — disturbed/calm, unfocussed/focused, tired/energetic...
CBT VERSUS SLEEPING PILLS
CBT [cognitive behaviour therapy] is quite like homeopathy. It takes time, but delivers the goods eventually; it is all about patience and persistence. However, sleeping pills may have immediate effects, letting you sleep half-an-hour longer and not waking up often during the night. But, they are classified as narcotics; this means one may often get addicted to them. The effectiveness of the starting-dose wears off, prompting an increase in the dosage to achieve the same results. Once you get hooked on to sleeping pills and decide not to stop using them, the side-effects kick in — forgetfulness, confusion, and tiredness during the daytime, for instance. Driving your car the ‘day-after’ you take your sleeping pills to get a ‘good’ night’s sleep, can be dangerous, especially for the aged.
Go to bed every night at the same time, and wake up at approximately the same time every morning
Try to avoid napping in the daytime…no matter what
Try to get as much natural sunlight as possible during the day time [vitamin D, in other words]. Take walks through woods or in parks / gardens
Use ear-plugs and eye-shades, if you are easily disturbed by light and sound
Physical activity is the elixir. Walk or jog, or work out, or swim, or bike, or do some gardening… In short, be active as much as you can, during the day time. Research has shown that physical activity is good at fighting stress, anxiety and depression
Do not overeat or go to bed hungry. Do not eat close to bedtime
Snoring may hinder good-quality sleep both for the snorer and the one exposed to the sound of snoring. Sleeping on one’s tummy, or on your sides [left or right] may help in diminishing snoring a little. Snoring may be caused by excessive tiredness, consumption of alcohol or a phlegm-choked nasal passage, among other things
Alcohol, caffeine and nicotine are strict no-no’s if you are keen on getting regular restful sleep
Reduce and progressively avoid exposure to television, laptop and smartphone screens. The radiations therefrom hinder the sleep-signals generated by the brain [The brain gets activated, just as sugary foods make little kids hyperactive at night]
Keep your alarm clock far away from you. This helps you to avoid staring into the alarm clock from time to time, and checking the time. Trying to find out how many more hours you have before the alarm goes off is stressful. And, even if you find out that there is enough time, you are often not able to go to sleep after that
Reading a book often helps…in lieu of watching TV [which must be avoided]. A warm bath, and/or relaxant music and/or a glass of warm milk tend to make you naturally soporific
If you are not getting sleep, do not keep lying down staring at the ceiling and wondering. Stand up…walk up and down for some time, switch on some music, wash your face and read some pages from a book…and, the brain will be motivated to send its sleep-signals again
Try thinking about the good things which have happened during the day. Think about an image or a picture from your childhood days which used to make you happy. Keep focusing on it and, slowly, your muscles will automatically relax
Take deep breaths — and also breathe with your ‘tummy,’ not chest. Place a hand on your chest and another on your stomach. Take deep breaths making sure that when you inhale, the hand you have placed on your tummy is raised much higher than that on the chest — for 10 minutes.