Putting our bad bedtime habits to bed

Sleep, exercise and nutritious food are the three basics to aim for to keep your mind, body and spirit in good shape. And, while we have a pretty good idea about how much exercise we need and what food is healthy for us, many of us don’t foster good sleep habits or ignore possible sleep problems – but we do this at our peril.

About one in five people in Ireland suffers from insomnia at some stage in their life and this figure doesn’t include transient bouts of insomnia linked to bereavement or other highly stressful life events.

Deirdre McSwiney is a sleep technician and cognitive behaviour therapist for Insomnia at the Mater Private Sleep Disorders Clinic in Dublin.

She explains how about a decade ago, insomnia was given its own international scientific definition – separate to being a symptom of depression or anxiety.

Insomnia is thus defined as a condition where the person has difficulty initiating or maintaining sleep that has become persistent. “We would see people at the clinic who suffer from sleeplessness four nights out of seven for four to six months,” explains McSwiney.

Distress in the dark
The key symptom that should encourage people to seek treatment is distress.

"Our thoughts are darker and more
distressing at night and people do a lot of
catastrophising at night. A true insomniac will have both psychological and physiological symptoms.

“They will have a high rate of muscle tension and be very tense going to bed. They will be going to bed with the extra burden in their head from layers of maladapted thinking and behaviours,” says McSwiney.

McSwiney believes many of us have developed very poor habits around sleep. “Sleep is one of the most natural biological signals that many of us have over-ridden with our busy lives. I’d like to ban televisions, laptops and mobile phones from bedrooms.”

Sleep expert Michael Perlis says that many people go to bed before they are sleepy to order online, watch TV or use their phone. He calls this "the nesting syndrome".

Beds are best kept for sleep, for when you’re sick and for sex if you’re an adult,” says McSwiney.

When dealing with her patients, McSwiney says, “What I try to do is to lift the distress, worry and frustration out of the problem.

“I also ban clock watching and encourage people to re-learn their ability to recognise when it’s time for sleep rather than hooking themselves to a bedtime.”

Sometimes, she even puts people on a reduced amount of sleep to encourage their bodies to re-set their sleep patterns.

Dump the day
McSwiney also encourages her patients to "dump the day" so that they can let go of stressful meetings and to-do lists before they go to bed. Relaxation techniques are also part of the treatment.

She says that medication has a role to play – especially for people who are extremely distressed. In these cases, people can’t start thinking rationally about the problem until some of their sleep is restored.

The most common physiological sleep condition is sleep apnoea, which affects about one in 25 men and one in 50 women in Ireland. Some suggest that 5-10 per cent of the population have some degree of sleep apnoea and this percentage is increasing due to rising obesity levels. Some experts say that 90 per cent of sufferers remain undiagnosed.

Sleep apnoea is a respiratory disorder which occurs during sleep. Essentially, there is a narrowing of the throat muscles to such an extent that the person experiences a transient choking spell.

When this happens, the brain is immediately aroused, stimulating the throat muscles to re-open and allow breathing.

"Many people with sleep apnoea will stop breathing for between 10-30 seconds 50 times a night," says Prof Walter McNicholas at the Sleep Clinic in St Vincent's Hospital, Dublin.

Sufferers of sleep apnoea snore but snoring in itself isn’t always an indicator of sleep apnoea.

Up to 50 per cent of sufferers of sleep apnoea also have high blood pressure and are at a higher risk of stroke, heart attack and diabetes. The condition runs in families but being overweight and unfit are also causal factors.

Most people with sleep apnoea will complain about being chronically fatigued during the day. They will also talk about the poor quality of their sleep at night.

“There are performance and safety consequences for people with undiagnosed and untreated sleep apnoea and at the extreme end of the problem, sufferers are taking a risk when driving,” says McNicholas.

In fact, sleep apnoea became a specifiable condition on driving licences earlier this year and those with the condition not receiving treatment need a doctor's certificate to say they are fit to drive.

Knock-on effects
The good news is that once diagnosed (either during overnight monitoring in a sleep clinic or with specialised portable sleep- monitoring devices), sleep apnoea is relatively easy to treat and has knock-on effects of reducing the amount of high blood pressure medications some patients require.

The treatment of choice, according to McNicholas, is the use of a Continuous Positive Airway Pressure (CPAP) device which is worn by the patient every night.

“I have thousands of patients wearing CPAPs and the typical response is that they wouldn’t go to bed without them. The masks are linked by tubing to a small airway pressure device which transmits air throughout the night. “Once a patient adapts to the treatment, it works straight away,” according to McNicholas.