Suffering from Insomnia? Probably not…

I get a lot of clients who tell me they suffer from insomnia. They can get to sleep but wake up in the middle of the night and lie awake for what seems like an age before they finally nod off again. They want me to hypnotise them to sleep right through. This I cannot do, and neither should I try. This is why…

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Last year, GP’s wrote out more than nine million prescriptions for sleeping pills and equal amounts were bought over the counter. But sleeping pills can be addictive, and in any case, they can only provide a short-term solution to a long-term problem.

Part of that problem is that natural sleep patterns are misunderstood. As we get older, our sleep patterns change. Many people sleep for three of four hours and then wake up, often for a prolonged period, before falling asleep again. This is called biphasic or segmented sleep (as opposed to monophasic sleep, sleeping right through) and people often confuse it with insomnia.

The good news however, is that biphasic sleep is not only perfectly normal – it’s also very healthy.

Roger Ekirch is professor of social history at Virginia Tech who has studied diaries, novels and medical textbooks from the last three centuries. He has discovered that in pre-industrial times sleep patterns were very different! Soon after sunset, people would go to bed and sleep for four or five hours (the first sleep) and then get up. They would stay awake for an hour or so and do household chores or even visit friends before going back to bed (the second sleep.) Members of some hunter-gatherer societies still do this.

So what has caused our sleep patterns and the way we sleep to change?

Professor Ekirch believes that the social changes of the industrial age together with the arrival of gas and electric light in the late 19th and early 20th centuries meant people no longer had to go to bed so early. Instead, they began to stay up longer after nightfall. The advent of radio and later, television, contributed to this change in people’s sleeping habits and encouraged them to stay up even longer. So the habit of first and second sleep disappeared, and sleeping continuously became standard practice.

Evidence that biphasic sleeping may be more natural can be found in earlier studies conducted by Thomas Wehr, a sleep researcher at the National Institute of Mental Health in Bethesda, Maryland.

In one study, Wehr recruited eight healthy young male volunteers, housing them in rooms that were lit for ten hours a day but then dark for 14 hours. These regular cycles of light and dark were designed to mimic the patterns of early winter in a world without artificial light. The men quickly fell into a pattern of four hours sleep, followed by a couple of hours of quiet wakefulness, followed by another four or five hours of sleep. While asleep, they were wired up with electrodes so the scientists could monitor their brain activity.

The volunteer’s first sleep consisted mainly of deep sleep. This is the time the brain is busy moving memories from short-term to long- term storage in order to create more short-term memory space for the following day and discarding trivial or irrelevant information. Too much deep sleep deprivation has a significant and detrimental impact on your memory. Other studies have found that students who cut down on sleep and try to do lots of last minute cramming actually do worse in exams.

Entering their lighter second sleep, the volunteers experienced less deep sleep and much more REM (rapid eye movement) sleep. REM sleep is the only time when production of noradrenaline, a stress-related chemical in the brain, is switched off. This is so we remain calm and still while our brains process the experiences of the day. If you don’t get enough REM sleep, your brain won’t have time to process your emotions. This could explain why tiredness caused by sleep deprivation leaves us feeling stressed, anxious and sometimes short-tempered.

This study is important not just because the volunteers slept in a biphasic pattern, but also because they slept much longer than normal – a total of nearly nine hours every night.

In studies where people have been severely sleep deprived, participants often fall asleep in less than a minute, given the chance. Even at bedtime, if you drift off as soon as your head hits the pillow, it’s a strong indicator that you are not getting enough sleep.

So if your sleep patterns follow a diphasic pattern, it might be that you are confusing this natural cycle with insomnia. It might be better to accept that your body wants to sleep that way and that you will probably wake up in the night – so start planning accordingly.

If you know you have to to get up at 7am, it might be a good idea to make sure you’re in bed by around 10.30pm. That will allow you a block of four hours for your first sleep, followed by about an hour or so of wakefulness, and then a further three hours or more of second sleep. When you wake up in the night, rather than lie there struggling to get back to sleep, get up quietly and do something constructive – read a book or maybe bring those accounts up to date. When you start feeling sleepy again, which will normally be after an hour or so, go back to bed and you will soon fall asleep.

However, don’t make the mistake of watching TV or checking your emails – the blue light your screen emits will almost certainly interfere with your body’s production of melatonin, and that will just make you feel more awake.

I can tell you that there is rarely a night when I don’t get up for an hour – usually between 2.30 am and 4am – and potter about doing various bits and pieces or reading. Once I learned to get used to this pattern, I also started to feel better.

If you can embrace this new way of sleeping, you will feel less tired during the day and less likely to fall asleep in the early evening, or worse, in company! You will also find that the quality of your sleep is better. Instead of drifting in and out of sleep during the second part of the night, your sleep will be more continuous.

There are lots of people who sleep this way! Some take biphasic sleeping to a whole new level – I have known clients who use the time for exercise or hobbies such as astronomy. Some take the opportunity to walk the dog, or even go for a walk on their own, although if you do this, I would avoid cemeteries or red light areas.

One more thing… using your smartphone or tablet before bed can put the quality of your sleep at risk.

As smartphones have become more a part of our lives, so the incidence of insomnia and sleep deprivation has increased. Over two thirds of adults sleep with their phones by their bed and younger users in particular spent more time on the devices and reported having more disturbed sleep.

Light in the blue spectrum, such as that produced by smartphones and tablets, can suppress the production of melatonin, leading to decreased drowsiness and thus difficulty getting to sleep. Engrossing activities during smartphone use may also result in stimulation that stymies sleep.

Poor sleep affects schooling and work performance, it’s linked to depression, and it’s a risk factor for obesity, cardiovascular disease, stroke, and early mortality. Previous studies have shown that hospital patients who used eReaders took longer to fall asleep and had reduced quality of sleep than those who read a traditional book. Those who used screens late at night were the worst affected. Of course it is also possible that the content of what they were viewing was stimulating.

Researchers at the University of California, San Francisco, have found devices that emit blue light – which is most of them – are responsible for negative impact on sleep. Their study, published in the journal PLOS ONE involved the analysis of data from 653 US adult participants. The researchers tested the hypothesis that increased screen-time may be associated with less sleep.

Participants installed a smartphone App that recorded their screen-time (defined as the number of minutes in each hour that the screen was turned on) over a 30-day period. They also recorded their sleeping hours and sleep quality. Longer average screen-time was associated with shorter duration of sleep and reduced sleep effectiveness.

However, this does not necessarily mean you will have to stop looking at your phone because there are now Apps that block this light from devices. Apple have recently added a night setting to its software so iPhone and iPad users can avoid blue light at night. Night Shift changes the colour of the screen to a warmer, yellow/red shade at night, the idea being that it will be easier to sleep after using the device. I’ve just installed it on my phone. It is easier on the eye, but time will tell if it does what it says on the box.

 

Copyright Andrew Newton 2016. All rights reserved.