Your Sleep and You

by Liz McKeon, Dublin City University

Sleep problems

Have you ever had a bad night’s sleep—not being able to get to sleep, trouble staying asleep or indeed sleeping too much? If so, you may have a sleep problem and this may be caused by a variety of sleep disorders. Some common sleep disorders include sleepwalking, talking in your sleep, nightmares or clenching or grinding your teeth. Other disorders that may cause sleep problems include sleep apnoea or narcolepsy (which is an overwhelming urge to sleep without warning and sleep deprivation). Whatever is causing sleep problems needs to be dealt with as soon as possible. Certain medical conditions may interfere with sleep—such as epilepsy, or if a person has some difficulty breathing due to chest infections.

Sleep problems may be caused by a number of factors such as being anxious about something and not being able to discuss it with someone. Alcohol and certain drugs may interfere with sleep. It may be difficult to sleep in a strange environment, such as when on holidays. If a person does not get enough sleep it may cause them to become emotionally irritable, have poor concentration, and experience difficulty in making decisions. Too much sleep, particularly during the day, will interfere with a person’s sleep pattern.
Telltales signs that suggest not getting enough sleep include darkened areas around the eyes, puffy eyelids, glazed or dull eyes, yawning continuously, being very restless, rubbing eyes, and feeling very tired a lot of the time.

So what can be done about sleep problems?

If a person is having problems with sleeping, a visit to the doctor is necessary to discuss these concerns. The doctor will be able to carry out a physical examination and perhaps have some tests carried out to determine if the sleep problem is related to a physical condition. If necessary, he can then make a plan with the person on how to treat the condition.

Sleep history

The doctor may need to get a sleep history, which includes the person’s usual sleeping pattern, specifically sleeping and waking times, hours of undisturbed sleep, quality of or satisfaction with sleep, and time and duration of naps. Another piece of information that may be needed would include any bedtime ritual that helps the person to fall asleep, such as taking hot drinks, relaxation, positioning aids. As already mentioned, drugs may affect sleeping pattern so it is important that the doctor is aware what medications are being taking. Stimulants such as alcohol, caffeine drinks like coffee and tea, if taken too close to bedtime, may interfere with sleep. The environment where a person sleeps can affect sleep—for example, a dark room or a brightly lit room—so this information should also be included in the sleep history. Any recent changes in sleep patterns or difficulties in sleeping should be given so that the doctor can make a full assessment.

Sleep diary

Another helpful thing in addressing a person’s sleep problems is to keep a sleep diary for a few days before going to the doctor. A sleep diary is a written record of a person’s sleep pattern and whatever habits are associated with it. It should include—the total number of sleep hours both at night and during the day, activities performed 2 to 3 hours before bedtime, bedtime rituals that are carried out before going to bed such as having a warm drink, talking to someone or relaxing. The diary should include the time of going to bed, any problems trying to fall asleep, and any known reasons for not being able to sleep.

Sleep hygiene

Poor sleep habits (referred to as hygiene) are very common occurrences for us all. We stay up too late or get up too early. We interrupt our sleep with drugs, chemicals and work, and we over-stimulate ourselves with late-night activities such as watching television. Below are some essentials of good sleeping habits. While many of these points will seem like common sense, it is surprising how many of them are ignored. Also, looking at things that should be avoided may be helpful when working out why a person may not be sleeping well.

A good sleeping environment should be

  • Familiar setting
  • Non-stimulating environment
  • Comfortable bed
  • No negative associations (e.g. punishment)
  • Correct temperature
  • Darkened, quiet room

To be encouraged Thumbs UP

  • Bedtime routines
  • Consistent bedtime and waking up times (weekdays, weekends, holidays)
  • Going to bed only when tired
  • Thinking about problems and plans before going to bed
  • Falling asleep without parents (younger children)
  • Regular daily exercise, exposure to sunlight, and general fitness

To be avoided Thumbs DOWN

  • Excessive or late napping during the day
  • Overexcitement near bedtime
  • Late evening exercise
  • Caffeine-containing drinks late in the day
  • Smoking and alcohol
  • Large meals at night
  • Too much time awake in bed (especially if distressed)

There are a lot of things that need to be considered if someone is having sleep problems, but there are some techniques that can be of some benefit. The effect of not sleeping does not just affect the person with the sleep problem, but also their family / carers / friends, so it is important for everyone that all sleeping problems are addressed.