The Coaching for Geeks health expert, Robert House, tackles sleep, and lack there thereof (and no, I won’t make a corny Kingdom Hearts reference mostly because I myself am too tired to think of anything clever – Robin)
In this tricky sequel article (debut: How To Beat The Carpal Tunnel Of Love) I am going to speak to you about a topic close to my heart, insomnia. Let’s not roll over and ignore this – sleep is important.
The body needs in the region of 7-9 hours a night (person dependent), and we all know what can happen when we don’t get enough! Grumpy, sleepy, dopey, sneezy, I might be thinking of something else here. But the point is clear. Insomnia can play havoc with us in a lot of different ways. As someone who helps people fall asleep for a living, I personally have lived with insomnia for 18 years now. It’s a murky world full of pseudo-science, old wife’s tales, anecdotal evidence and confusion…
So, let’s take a bit of a dive into the science and find out more about this late night pain in the bed.
What the hell is sleep?
According to The National Sleep Foundation insomnia is when a person has difficulty sleeping or staying asleep, even when they have the chance to sleep. Insomnia can be broken down a bit more as well; You can have primary or secondary, transient, acute or chronic.
- Primary is when there is no underlying reason for your insomnia but secondary is when there is something else to blame, like depression, asthma or your neighbours playing death metal at 3am.
- Transient is a passing bout of insomnia often caused by social disruption like a break up or stress.
- Acute is short term and can be anything from a night to a few weeks, with chronic meaning it is a minimum of 3 nights a week for a month or longer. It effects roughly 30% of adults at some point in their life time.
Bedtime story time – the history of sleep!
This might help you sleep, or fire up some curiosity. The word first appeared in 1623 in Henry Cockeram’s Dictionary. Interestingly this was only the third known English language dictionary and the first to actually use the word dictionary. Got to love good little bits of trivia like that. It was initially anglicised as ‘Insomnie’ with it going back to the Latin Insomnia in 1758.
Richard Caton was the first to really start to understand what sleep is, and in 1875 was the first to observe electrical impulses in the brain ultimately leading to the discovery of alpha waves, the stages of sleep and how we fall asleep. Of course once you know what sleep is you can start to work on the why it isn’t happening!
What causes lack of sleep?
Where to begin? Probably easier to list what doesn’t cause insomnia. And that’s sleep!
Psychological factors such as depression, post traumatic stress disorder, hyperarousal and anxiety, use of stimulants, some medications, physiological conditions like heart disease, asthma, menopause, general fitness, poor sleep hygiene, general life stuff like work, moving to a new house, proof reading your own Coaching for Geeks article. The list is endless.
Studies do show that people with insomnia do tend to have a higher metabolic rate at night than those who don’t suffer with insomnia, and more research is being done to figure out if this is a cause or effect of insomnia itself.
How do we diagnose Insomnia?
The most common tool, beyond keeping a sleep diary and a standard health screening, is the ‘Athens Insomnia Scale’. With it there are 8 scoring factors that are looked at and scored between 0-3. Score over six across the 8 factors and ding ding ding you win a diagnosis of insomnia!
Sleep diaries are a great tool; they can identify patterns in sleep and help specialists to make a diagnosis. They should include things like time to bed, time slept, times up in the night and how you feel in the morning.
A formal diagnosis can only come from a sleep specialist, and if you are having difficulties sleeping then it is important to have a full health screening – it could be an indicator of an underlying health issue.
As always, prevention is preferable to treatment or cure and the best way to prevent insomnia is with good sleep hygiene.
Making sure the bedroom is cool and dark (this does not refer to your DCMU posters), only use the bedroom for sleep and, erm, ‘making magic’ and try to keep to a consistent sleep schedule. Keep the coffee and coke away as well as they are stimulants and if you want to sleep you don’t want to be stimulated. Much better suited to the magic making.
This is where the topic really explodes. There are all kinds of crazy things people will do or try to help fall asleep. When a person is tired, hurting and desperate they will try all manner of ‘cures’ and sometimes wrongly attribute that zany thing to finally falling asleep. This is where a lot of pseudoscience makes its stand – In that lovely coincidence bubble.
Fear not! I am going to explain some scientifically tested treatments to help the insomnia sufferers out there.
Firstly lets look at what the NHS recommends:
- Good sleep hygiene as stated above, try to relax, exercise regularly, don’t smoke or drink a few hours before bed, no day time napping and avoid tv before bed. I can hear the cries of some of you saying things like ‘But I can only sleep with the tv on’, but remember this is generalised to the masses so not all things apply to all people.
- Alongside sleep hygiene, relaxation techniques such as meditation, controlled breathing and even colouring books are known to work well, helping the body to unwind and the mind to settle.
- Sleep restriction is a technique that seems to produce good results as well. The idea here is that you avoid your bedroom at all times except the strict to bed and out of bed times that, ideally, don’t change. For example you avoid your bedroom until say 10pm, lie down to sleep, then up at 7am, and then not go back until 10pm that following night. After a few weeks you will have a sleep routine and potentially no more insomnia.
- Drug treatments are not recommended for mild cases and change in lifestyle is always the better way to go. Over the counter medication can be beneficial to some but becoming reliant on medication in order to sleep should be avoided where possible. The sort of things you can take range from antihistamines, benzodiazepines, melatonin and other sedatives.
- Herbal remedies can be popular but vary wildly in efficacy for treating insomnia. Looking at a variety of systematic reviews lets see which work or don’t.
- Valerian; comes as tablets, tea, and tinctures. Safe, but not known to effective.
- St John’s Wort; again safe (though may reduce the effectiveness of the contraceptive pill) but this time some evidence for symptom reduction in insomnia, mainly in menopausal women.
- Chamomile tea; safe and not effective! This one did shock me and I did believe that it helped. But my own bias toward a cup of chamomile tea doesn’t beat out the scientific evidence!
- Lavender; safe but insufficient evidence at present as almost all work has been on aromatherapy.
The final part of this piece is that it is important is to treat the underlying issue – what’s causing the insomnia? Are there bigger issues you need to face?
Whether it is mental health related or physiological, see your GP, see a specialist, psychotherapist, counsellor, support group, whatever you need.
Remember there is no one more important to you than you and taking good care of yourself and getting good sleep can only ever be a positive thing.
I hope that has helped enlighten a few of you night owls or even just given you sweet dreams to sleep on. Take care of yourself!
Robert House – Operating Department Practitioner and the Coaching for Geeks health correspondent
Follow Robert on Twitter @Roberthouse1985