Trouble sleeping? You need to read this before bed

"There are few health issues that cause more stress and anxiety than sleep problems and few that are as innocuous and treatable." So writes sleep expert Dr Chris Winter in the opening chapter of his new book, The Sleep Solution: Why Your Sleep is Broken and How to Fix It (Scribe Publications).

Dubbed as the sleep whisperer by US writer and entrepreneur Arianna Huffington, Dr Winter works with athletes and sports teams around the world to improve their performance.

He says he set out to write a primer on sleep – in contrast to all the technical, fact-driven books on sleep or the ones that offer you a hundred tips on how to sleep better.

But starting by calling sleep problems “innocuous and treatable” sounds rather unsympathetic albeit hopeful to people who struggle with sleep problems for years.

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Speaking from his neurology and sleep medicine clinic in Charlottesville, Virginia, Dr Winter says: “I wanted to take people on a sleep journey with this book but also to help readers understand that people’s perceptions of their sleep and the reality of how much they sleep are often two very different things.”

It's important to differentiate between sleep deprivation and insomnia

The book is written just like Dr Winter speaks: in a humorous, conversational style. He sprinkles patient anecdotes and personal remarks through the facts he relays and says that he doesn’t wear a white physician’s coat in his clinic as he believes the doctor/patient relationship is one of teamwork rather than expert-driven. One of his favourite analogies is to compare the importance of sleep to the importance of eating, reminding us that if we really need to sleep or eat, we will.

Sleep deprivation

“It’s important to differentiate between sleep deprivation and insomnia. An ER nurse who’s worked full time all her life and works a second job as a sitter and has a child is sleep deprived. She will fall asleep in 20 seconds. But a lot of people who say they can’t sleep are sleeping much more than they think,” he says.

“For example, I deal with many people in my clinic who tell me they haven’t slept for years or that they wake up at 2am every night and they can’t get back to sleep yet when we do sleep studies on them, we find that they’ve slept, maybe six hours.”

Not sleeping well can become central to the way some people identify themselves

According to Dr Winter, people who suffer from insomnia often define themselves by their sleep problems. “I’m interested in reading the consumer online reviews of my book – particularly the negative ones – because it helps me understand my patients better. Not sleeping well can become central to the way some people identify themselves and that can’t help them sleep [better],” he says.

And while eating and drinking alcohol or coffee late at night, certain medications and over-stimulation from electronic gadgets in the bedroom affect sleep, Dr Winter firmly believes that fear and anxiety are the root causes of insomnia for many people.

“Insomnia is about people not sleeping when they want to.  There is an emotional response in this. If someone takes time to fall asleep but spends that time reviewing their day, happy to have the quiet personal time and space to rest, it can be nice but if they tell themselves that they can’t go asleep, they are putting themselves under pressure to go asleep.”

It's important to remember that resting even without sleeping is good for you

Dr Winter believes that this “performance anxiety” about sleep is what’s causing sleep problems for many people. “What I want to do is to extract the fear or anxiety out of the situation. I work with a lot of athletes with sleep problems and many of them see resting and meditating as a waste of time. But, rest can be restorative and if you’re not sleepy, you need to tell yourself you’re okay,” he says.

Quiet activity

He also doesn’t agree with the oft cited advice that if you can’t fall asleep within 20 minutes, you should get up and do some quiet activity until you feel sleepier.  “If you’re not too bothered by being awake, I recommend simply lying there and resting. It’s important to remember that resting even without sleeping is good for you too,” he writes.

He also says that if you’re regularly awake for 20 minutes or more, then you’re simply going to bed too early and it’s worth staying up a little longer. This is advice that some parents might also take on board when it comes to children who can’t fall asleep at night time.

According to Dr Winters, many people have become preoccupied with getting enough sleep – often without knowing what’s constitutes enough sleep for them. And, this often leads them to take sleeping pills to help them go to sleep.   “People say to me I really need to function the next day so I take sleeping pills but there isn’t any research that shows that taking sleeping pills leads to improved performance,” he says.

So, what is the solution then for anxiety-filled insomniacs?  Well, getting your sleep “hygiene” sorted out is a good starting point. Dr Winter dedicates a chapter to preparing yourself and your bedroom for ideal sleeping conditions but says that “sleep hygiene only accounts for about 25 per cent of sorting out sleep problems”.

So, for those who are still struggling with sleep problems – and haven’t been diagnosed with more complex medical sleep disorders such as sleep apnoea or narcolepsy, what does he suggest?

Well, it seems there are two parts to the solution. The first one involves changing your mental attitude to sleep. This is defined by Dr Winter as “the controlling your mind exercise”. And the second part is setting yourself a set wake-up time and working back from that to find your correct bedtime.

Mind exercise

The controlling your mind exercise set out in The Sleep Solution includes not talking about how you sleep for a month and if anyone asks you, just saying that you slept fine. During this time, you practise a goal-directed activity when you are in bed awake.

Dr Winter suggests meditation, relaxation and  visualisation.  “I’ve got a patient who likes to visualise himself playing golf during this time while his wife likes to imagine herself baking banana bread,” says Dr Winter.

The second part of the solution is to pick a wake-up time and stick to it. Dr Winter says you then work backwards from your wake-up time five and a half hours.

“If you’re not cheating, your brain will begin to exhibit a stronger and stronger drive to sleep upon going to bed because . . . those precious five and a half hours are the only time to get it,” he writes.

Ninety-eight per cent of children's sleep problems are actually parents' sleep problems

Over time following this sleep-restriction approach, the individual is allowed to go to bed a little earlier but not to adjust the wake-up time.

And while this approach might work for adults, what about children with sleep problems?  “Ninety-eight per cent of children’s sleep problems are actually parents’ sleep problems. The way parents respond to their children’s sleep dictates children’s sleep,” he says.

And, if you want more advice where this came from, you’re in luck because Dr Winter is mid-way through writing a book about the sleep solutions for children.

Tips for sleeping well

Sleep hygiene is the term used to describe how you can control your behaviour and environment to optimise your sleep. There are many things you can do during the day and in your bedroom to improve your sleep.

1. Take regular exercise, in the morning time if possible. Spending time outdoors in bright light improves your body's circadian rhythms which give signals about when it's time to be active and alert and when it's time to rest and sleep.
2. Eat regular meals and finish your dinner at least three hours before bedtime. If you need an evening time snack, have dried fruits or nuts or cereal with milk.
3. Reduce lighting in your home as the sun goes down to signal that it's getting closer to bedtime.
4. If you've a very active mind and/or are a list-maker, finish your to-do list an hour before bedtime.
5. Children get a bedtime routine so why not adults? To help you wind down, do some light exercise (such as an evening stroll), take a bath and read a print book until you feel sleepy. A 2014 study found that people using e-readers took 10 minutes longer to fall asleep and had less deep sleep.
6. Turn out the light and settle down into a cool, quiet, darkened bedroom environment. Sleep experts specifically recommend blocking all light sources in bedrooms and that includes light from clock radios, mobile phones, laptops and televisions. They also suggest all these gadgets should be kept out of bedrooms and bedroom walls should be painted soothing, not stimulating, colours.
7. Make sure your bed is comfortable and clean. This means having a mattress and pillows that suit you, dressing lightly and comfortably and having clean bed linen.
8. If you sleep next to someone who snores, grinds their teeth, talks or moans in their sleep or suffers from sleep apnoea or another serious sleep disorder, convince him/her to seek help. Sex, on the other hand, relaxes the mind and body, and promotes sleep.
9. Don't allow your pets – or your children – to sleep in your bedroom. Views differ on this one but generally speaking, children who regularly sleep in their parents' bed aren't developing good sleep hygiene for themselves. And, pets, well that's a personal matter but if you're not sleeping well and there's a pet in the room, see if you sleep better in its absence.
10. Finally and perhaps most obvious of all – caffeine, alcohol and nicotine worsen sleep so if you're having trouble sleeping and these stimulants are a regular part of your life, go figure.

Will nasal breathing help you sleep better?

Patrick McKeon teaches the Buteyko Method, a form of nose-breathing first developed in Russia. McKeon, who runs the Buteyko Clinic in Galway, says that nose breathing during sleep promotes calm, restful, uninterrupted sleep with the wake-up feeling of being rested, clear headed and energised. He also recommends 20 minutes of meditation during the day for better sleep.

In his self-published book, Sleep With Buteyko, McKeon explains how taping up your mouth at night prevents involuntary mouth breathing during sleep.

"Though it might feel strange at first, wearing tape while you sleep quickly becomes a comfortable habit that helps you get a good night's sleep," says McKeon. He also recommends it as a way of dealing with snoring and sleep apnoea.  See also buteykoclinic.com