As a GP I see patients daily with sleep problems. Many people come to their doctors in desperation about their sleep. Chronic insomnia (meaning difficulty sleeping despite trying for more than 3 months) is very common and affects 1 in 10 adults. More common are short days or a few weeks of insomnia due to an acute stress such as an exam or a bereavement. Short term insomnia will often get better when the acute stressor has gone away. Chronic Insomnia can be harder to manage and is often associated with long term medical conditions particularly anxiety or depression. It is important that these are treated alongside the insomnia otherwise it will not improve.

If you aren’t sure if you have a sleep problem, visit https://www.nhs.uk/conditions/insomnia/to complete a Sleep Self-Assessment.

Why is sleep important?

Sleep is essential for repair, learning and maintenance of our physical and emotional health. Without sleep we quickly loose ability to learn new skills, our memory worsens, we begin to feel unwell and disease can develop. Given the appropriate amount of sleep we can repair the damage during our awake hours and process difficult emotional experiences we may have during the day.

How can I improve my sleep?

In trials doing the following 12 things are the most effective way to improve your sleep. They are more effective than sleeping tablets and have a longer lasting effect. They will increase the chance that you get into deep restorative Rapid Eye Movement or REM sleep. Some studies even show that REM sleep can help prevent depression and dementia.

Most of these tips are targeted at two hormones – Melatonin and Cortisol. Melatonin is a sleep-inducing hormone; the aim is to get this as high as possible at bedtime to help you get to sleep. Cortisol is a stress hormone and it is essential for our general wellbeing, but especially for sleep, that we lower it as we approach the evening to allow our bodies to get to sleep. If cortisol is high and melatonin low, we are in a stressed state and this is not conducive to sleep.

12 Self-help Tips:

1. Keep to the same bedtime and waking up time, changing these times will affect your bodies normal day/night rhythm and as such will stop you from sleeping. Try to have at least 8 hours between your sleep time and wake time to give yourself the best opportunity of a refreshing night’s sleep

2. Keep your bedroom just for sleeping, keep it pitch black and cool. Ideally 18c. Most of us have our rooms far too warm. It’s fine to have a nice warm duvet instead!

3. Stop any screen time and bright lights at least 90mins before bed. Blue light emitted from bright LED lights, computers, phones etc. should be turned off or wear blue light blocking glasses.

4. Use low lighting, warm lighting or red light in the evening to remind your brain that bedtime is approaching. Avoid turning on the bright LED bathroom lights when you brush your teeth!

5. Do exercise daily in the morning (or at least before 6pm) this again makes you physically tired and helps you sleep better.

6. Cut caffeine down to a minimum or stop completely for a short period of time. Caffeine stays in some people’s systems for 12 hours. So a cup of coffee at lunch will still be in your system at 1am! Don’t forget there is some caffeine in decaffeinated drinks and fizzy drinks like coke often have caffeine in.

7. Avoid alcohol or other drugs, including nicotine, to help you sleep. These may help you get off to sleep but they will stop you getting into the deep restorative sleep and may disturb your night later on.

8. Avoid napping if possible. Short naps up to 90 minutes can be really useful if you can’t give yourself the opportunity for 8 hours sleep at night; however, they can upset your daytime rhythm and as such make it more difficult for you to sleep at night. When first trying to restore your sleep, I would recommend not napping.

9. Get out and about in daylight for at least 20-30mins each morning. This sets your body clock to be awake during the day, which helps you sleep at night. Daylight is much brighter than the majority of lights we have inside, even when it’s overcast.

10. Avoid large meals in the evening as these can keep you up at night digesting the food. Especially avoid high sugar meals as this will stimulate your brain.

11. Try to wind down before bed, with the lights dimmed try to forget about work, pack away any emails early in the night and write a to-do list for the next day so that you can forget about the things you have to do and try to relax. A warm bath can help to lower our core body temperature which promotes sleepiness. Focusing too much on your sleep will make the problem worse, you need to find a way to switch of your body and mind. Try some meditation with the Calm or Headspace Apps.

12. If you are struggling to get to sleep or stay asleep, leave your bedroom, go into another room and do something repetitive or sleep inducing such as read a book. Do not look at your phone, TV or Tablet.

Why Don’t I Just Take Some Sleeping Tablets?

Occasionally your doctor may prescribe a short course of sleeping tablets if you have a short-term stressor such as a bereavement. Really people should not be taking more than 7 days of tablets.

Often people want sleeping tablets to help with their chronic insomnia but unfortunately, they aren’t the magic cure we are all hoping for.

Sleeping tablets give you the impression of sleeping longer but actually recent reviews show they don’t increase the amount you sleep. Importantly they will stop you falling into deep, restorative REM sleep. This is the sleep which helps us lay down memory, cement new learning and make us emotionally resilient.

The other big issue with sleeping tablets is that they can often increase the risk of having an accident the next day or being unable to work because of ongoing sleepiness. They are more dangerous than just being sleepy as they help to remove the feeling of sleepiness but not the slowness that people experience when they are tired ie. speed to hit the brake in an emergency. In the elderly they will increase the chance of having a fall with the risk of causing serious injury and they have been linked to increasing your chance of infection.

Shift Workers

Shift working plays havoc with Cortisol and Melatonin and most of us who have had experience of shift work know that we use coffee and sweet treats to get us through those long nights! It is really important to try and keep your body clock as normal as possible. For instance, if you are doing nights, I would recommend waking up mid-afternoon, trying to get some daylight, eat your largest meal of the day and have coffee (if you need it). Slowly reduce the amount you eat through the night shift, trying to keep to unprocessed, low sugar foods (this will help you prevent a sugar crash). Ideally wear sunglasses on your drive home to avoid the sunlight reducing your melatonin. Then get to bed as soon as you can in a cold/dark/quiet room.

What If These Tips Don’t Help?

If the above self-help tips don’t work the most effective treatment for Insomnia is Cognitive Behaviour Therapy – Insomnia (CBT-i). This involves a face to face or app based programme to help re-programme your sleep schedule. It is important you continue to do all of the above alongside CBT-i.

Prolonged released Melatonin can be a helpful medication for Chronic Insomnia however in many areas of the UK your doctor is unable to prescribe this and so don’t be surprised if they can’t help you with this.

If you want to find out more about CBT-i visit the Sleep Station website, download CBT-I Coach or Sleepio.

Other resources include:

- The Sleep Book: How to sleep well every night by Guy Meadows.

- A great download is a music track called Sleep by Max Richter including 8.5hrs of music which has been proven scientifically to improve insomnia for some people.

Visit your doctor if your lack of sleep is beginning to affect your physical or mental health and the above tips haven’t helped.

Don’t’ forget: If you feel sleepy, it is important that you do not drive.  Sleepiness causes more accidents that drink driving.