Dr Zoe Williams
Dr Williams is a well-known and respected media medic who also has experience in health, fitness and wellbeing, alongside her role as a GP. She is a national advisor to the Office for Health Improvement and Disparities (OHID) GP clinical champion network and also leads on work to promote physical activity and healthy lifestyle with The Royal College of General Practitioners.
Sleep is a trending topic at the moment – and it seems that the whole world is waking up to recognise the importance of sleep. Sleep is essential for human survival, and good sleep is necessary to be able to enjoy good physical health and mental health. It’s a very current topic, as 30% of people do not get sufficient sleep.
Why is sleep important?
Whilst we are able to tolerate short periods of poor sleep, and even longer periods at certain stages in life – after having a baby for example, chronic sleep deprivation throughout our lives is bad news. Sleep is extremely important for brain function and that includes our mental health, and also impacts our social lives too, from relationships and productivity to sex drive and alcohol use. This is all down to the complex, and essential processes that take place during sleep, ranging from cell repair and immune system optimisation to emotional regulation, and not to forget (no pun intended) that it’s during sleep that we form memories and process what we have learnt in the day.
The Stages of Sleeping
When you sleep your body cycles through 4 different stages. Not all sleep cycles are the same length, but on average they last about 90 minutes each. The typical adult, who is getting the recommended 7-9 hours, will go through four to six full sleep cycles each night.
Stage 1, is the slowing down and “dozing off” stage, and it normally lasts just one to five minutes. During this stage someone is easily rousable, they may twitch and keep hold of a book resting in their hands for example.
Stage 2, brain activity slows, eye movements stop, breathing and pulse rate slow, muscles relax and body temperature lowers. This stage last around 10-25 minutes.
(If you like to take a daytime nap you should aim to complete your nap before entering stage 3, this will allow you to gain the refreshing benefits of a nap, without the groggy sleepy feeling)
Stage 3, is the deep sleep stage. The body relaxes and slows further, and it’s much more difficult to rouse somebody. This is thought to be the ‘restorative’ phase when the body’s cells undergo repair, the immune system is enhanced, and the body develops. It’s important for brain function too, especially for mood, creativity, storing of information and memories. You spend 20-40 minutes in this stage early in the night, but as you go through the night the length of time spent in this stage shortens, and you tend to spend more time, per cycle in stage 4, If you are woken during deep sleep then you’re likely to feel groggy and unrefreshed.
REM sleep is the final stage, REM stands for rapid eye movement. If you look at someone sleeping, during this stage, you can see their eyes moving underneath their eyelids. This is where brain activity picks up again and when the most vivid dreaming occurs. Whilst the eyes are moving there is temporary paralysis of most muscles – an important factor that stops you from acting out your dreams. Breathing and heart rate are quicker, and men may experience penile erections. REM sleep is thought to be essential for learning, memory and creativity. As the night goes on we spend more time, per cycle, in REM sleep. So in the first cycle it can be just a few minutes, and closer to an hour by the final cycle.
How Many Hours of Sleep Do You Need?
For children ages 6 to 12, the NHS recommends between 9 to 12 hours of sleep each night. For younger children, more than 10 hours of sleep each night are recommended.
It is a common misconception that older adults need less sleep than when they were younger. Many older adults have a hard time getting , but that does not mean they need less sleep. In general, most adults should aim to get between seven and nine hours of sleep each night. It is true, though, that as we get older we tend to go to sleep earlier and get up earlier than we used to. This is due to changes in our body’s circadian rhythm (internal clock), that actually shift forward in time as we get older. The part of the brain that controls our body clock receives information from the eyes, and light is one of the most powerful cues for maintaining circadian rhythms. Therefore, ensuring that we are exposed to sufficient amounts of natural daylight during the day is really important. Spending time outdoors, whether a lovely long walk in the park, or even if it is just standing on the doorstep is an important regulator of sleep.
Other sleep thieves include chronic diseases, pain, needing to pee during the night, and medication – all of which are more likely as we get older. Almost 40% of adults over the age of 65 take five or more medications.
5 Tips for Better Sleep
Put in the work to improve your sleep
If poor sleep is affecting a person’s health, it is important to address it. Fixing the issue is not as simple as just taking sleeping tablets, because whilst hypnotic medication may get you unconscious and keep you unconscious, you don’t necessarily get the same benefits as moving naturally through the various stages of sleep. People should be aware that fixing a sleep issue can take some time, some work and some effort, but it is worth putting in the graft. It’s important to work on developing habits that encourage quality sleep.
Work on your sleep hygiene
Sleep hygiene measures and a consistent bedtime routine are the first things to address. If you have consistent activities that you do immediately before bed, such as reading, having a bath, or a hot milky drink, you can train the brain to associate these activities with getting ready for sleep, and this effectively is training the brain to be better at sleeping. The next thing to consider is the environment that you sleep in. A bedroom should be cool (an ideal temperature is 18 degrees Celsius), dark, and quiet – like a cave. It’s important to reduce bedroom distractions – such as TV, phones and tablets, and ideally the bedroom should not be used for work or leisure activities. Sleep scientists often remind us that the bedroom should only be for sleep and sex.
Focus your lifestyle habits
In addition to daylight exposure, regular exercise can help you fall asleep faster, sleep longer, and have better quality sleep and minimise substances that can affect sleep, such as caffeine, alcohol and even large meals late in the day can make sleep more challenging, so aim to eat dinner at least four hours before bedtime. If stress is affecting sleep, then practicing mindfulness, sleep stories or meditation before bed can help.
Don’t force yourself to stay in bed
Insomnia is an extremely unpleasant thing to experience. Whether it’s getting off to sleep that is a problem, or waking during the night and not being able to get back to sleep, it is not a good idea to lay in bed awake as this can start to build negative associations around being in the bedroom. So, if you think it’s been 20 minutes or more you should get up out of bed, go to a different room and do a restful activity like read a book or listen to a relaxing podcast. When you feel sleepy go back to bed.
Speak to your GP if needed
If all of these measures do not improve things over time, and sleep remains an issue it is important to see your GP, who may want to investigate for medical issues that can affect sleep and may be able to support with individualised advice. There is a special form of talking therapy called CBTi, which can be helpful, and there is an app available to download called CBT-I coach and promising research is currently looking at shorter forms of interventional therapy that can help.