Need Some Sleep?

Sleep deprivation is a problem for 30-50% of people around the world[1], occurring either because we can’t sleep when we want to or life is too busy and we simply don’t make sleep a priority. Sarah and Aaron are pretty typical:

Sarah

I’m not really sure when I started having trouble sleeping. I think perhaps when I went back to school in my 40s. Life really got complicated then. Although most of the time I could fall asleep easily, quite often I would wake up at 3 in the morning and not be able to go back to sleep. I would try but my mind would just start racing with everything I had to do. I just felt more and more wound up. A lot of nights I never did get back to sleep, or I would fall asleep an hour before I had to get up. I started sleeping later trying to make up for lost sleep. Or I would get home in the afternoon and be so tired I just had to lie down and nap. I don’t think that really helped.

Sarah is probably right that sleeping later, and napping didn’t help. In fact, it probably made the problem worse.  Aaron had a different sleep problem, but the result was the same— feeling very fatigued during the day.

Aaron

My problem is I just can’t settle down at night. I often bring work home, but I never get to it till later. We have 2 kids under the age of 3. Needless to say, my partner and I are used to getting by sleep deprived but both of them sleep through the night now. It’s us who are having problems! I know one issue for me is that I need time to myself and I just don’t get enough. Once we get the kids settled and ourselves organized for work the next day its 9 o’clock. I typically stay up till midnight puttering with things or doing some work. When I do go to bed, it’s another hour before I can wind down and go to sleep. I’m up at 7, so I’m just not getting enough sleep – maybe 6 hours most nights. I hate to give up the quiet time to myself in the later evenings just so I can sleep more. But I’m pretty tired most days and don’t have the energy to take much on or even to do the things I used to do.

For many people like Sarah and Aaron, finding solutions for sleep problems isn’t always easy. Sometimes it’s a matter of making choices and setting priorities. Aaron for example is not quite ready to let go of time to himself in order to get more sleep. He doesn’t suffer the same kind of sleep problem as Sarah does but the delay in falling asleep is certainly cutting into his sleep time and may be having more of an effect on his health than he realizes. Sarah has a more classic experience of insomnia – simply not being able to sleep when she wants to. These two patterns, delay in falling asleep, and delay in going back to sleep when you wake during the night are common ones.

Sleep deprivation has been called a serious public health hazard, with even mild levels of sleep deprivation – for example, sleeping less than 6 hours a night over a one or two-week period, or being awake for 20 hours— resulting in performance that is comparable to being intoxicated [2]. Sometimes people are sleep deprived because they don’t give themselves enough time to sleep. Perhaps there are competing demands for time or simply other priorities. Perhaps we think that we need less sleep that other people or can function well on less sleep.  Most of us can’t though[3]. The recommended sleep amount for adults is 7-9 hours; much less and our ability to function quickly deteriorates, placing us at high risk for accidents. In the longer term, there are a great many impacts of chronic sleep deprivation on our physical and mental health.

Sometimes sleep deprivation is caused by insomnia. We want to sleep but have problems going to sleep when we want and staying asleep. Or, maybe our sleep is simply not restorative, we don’t feel rested.  An occasional night like that is pretty normal. However, sleep problems that occur 3 or more nights per week and that result in daytime difficulties, like sleepiness, problems concentrating, or feeling unwell, is defined as insomnia. If it occurs for more than a few months, it is called chronic insomnia and affects about 10% of the population.

Whether or not sleep difficulties reach the level of insomnia or instead represent a lower level, but still serious problem, a large percentage of the population across countries report not sleeping well.  In a recent poll conducted by the National Sleep Foundation,[4] for example, less than one-half of people across different countries are getting sufficient sleep. In Canada, only 43% of the population, similar to the US and the UK.  About one-fourth said they rarely or never get a good night’s sleep during the work week.  In another Canadian study[5], 71% of millennials report cutting back on sleep when they are short on time.

If you have a sleep problem, there are good treatments that don’t involve drugs. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been shown to be very effective in improving sleep and daytime symptoms. Many cities have sleep centres and counsellors who offer CBT-I.  Sometimes though all that is needed is a commitment to prioritize sleep and some simple strategies that are sleep promoting. Here are some top tips that may help:

  1. Keep a regular sleep routine, going to bed and getting up at the same time every day, even weekends. Often a couple of weeks of regular bed /wake times are enough to sort out sleep problems.
  2. Plan a transition time from being awake to going to bed. Plan some relaxing, quiet activities for 1-1.5 hours before turning in and do the same thing every night,
  3. Avoid back-lit screens at least during your transition time and while in bed! Blue light from computer screens, phones, ipads, and televisions are stimulating and tell your brain to wake up. If you MUST use a screen, install an app like f.lux that blocks the blue light.
  4. Look after your sleep environment – quiet, dark, and cool is best. If your partner disturbs your sleep, consider separate beds.
  5. Try to do nothing in bed but sleep (and sex). Reading, knitting, or watching TV in bed conditions you to be awake in bed. You may be able to resume quiet activities like reading when your sleep improves, but sometimes not.
  6. If you go to bed and are still awake after 20 minutes, get up and return to your transition time activities until you feel sleepy again. This is also true if you awaken during the night. But try not to expose yourself to light during the night as it can disrupt melatonin production, which is a key hormone responsible for regulating sleep.

Sleep is essential for good health and a sense of well-being. Don’t neglect yours. If the tips offered above aren’t enough, talk to your family doctor about finding someone who offers CBT-I.

Additional Resources

Huffington, A. (2016). The Sleep Revolution: Transforming Your Life, One Night at a Time. Harmony.

Silberman, S. A. (2009). The insomnia workbook: A comprehensive guide to getting the sleep you need. New Harbinger Publications.

[1] National Sleep Foundation (2013) International Poll. Retrieved from: https://sleepfoundation.org/media-center/press-release/national-sleep-foundation-2013-international-bedroom-poll

[2] Williamson, A. M., & Feyer, A. M. (2000). Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and environmental medicine57(10), 649-655.

[3] There is a small proportion of the population who are know as “short sleepers” and do not seem to need more than 4-5 hours sleep, suffering no ill effects. According to X, this is less than 1% of the population who have a particular gene mutation.

[4] 2013, retrieved at: https://sleepfoundation.org/sites/default/files/RPT495a.pdf

[5] Canadian Sleep Study, 2016. Retrieved at: http://www.crosstowndental.com/wpcontent/uploads/2010/08/Canadian-Sleep-Review-2016.pdf