How to get a good night's sleep

A night spent tossing and turning leaves us grumpy, less able to work and detracts from our family life. For some, a bad night's rest can leave them in pain. Sylvia Thompson explores what can be done

Together with adequate exercise and a balanced diet, sufficient, good quality sleep is crucial to good mental and physical health. Yet, one in four people have trouble sleeping and one in 10 consider their sleep difficulties to be a major health problem.

With these figures in mind, last month, the Chartered Society of Physiotherapists in Britain added an online guide to good sleep to its website (www.csp.org.uk). While opinions vary on what amounts to adequate sleep (somewhere between six and nine hours), there is widespread consensus that frequently interrupted sleep is what causes a decreased ability to work effectively and a reduced ability to enjoy being with family and friends.

The CSP's guide to good sleep concentrates on how to achieve the perfect night's sleep through optimal sleeping posture. Dublin-based physiotherapist, Louise Keating concurs with a lot of the advice given and says that showing patients with acute pain how to achieve good sleeping postures is a key component of their pain management.

"Poor sleep turns up the levels of pain and what you're really trying to do is align the person's body into a neutral midline position which places the least amount of stress on painful tissues which will then result in less pain and better quality sleep," says Keating who specialises in muscular-skeletal problems. "There is a huge vicious cycle of pain and poor sleep," she adds.

Agreeing that it is impossible to recommend an ideal sleeping posture for the entire population, Keating says that there is very specific advice for those suffering from pain in certain areas. For example, those with neck pain should not sleep on their stomach as having to turn your head to the side while sleeping will place a strain on the neck muscles and therefore increase pain.

Similarly, sufferers of lower back pain should consider sleeping on their side with a pillow between their bent knees as this will reduce the weight bearing down on the lower back muscles.

"Anyone who suffers from frozen shoulder can get horrific pain at night so the advice here is to sleep on the non-painful side with a large pillow placed against the chest and stomach on which the bent arm from the painful side rests. This takes the weight off the arm and puts the shoulder into an optimal position," says Keating.

Some physiotherapists also recommend the use of an orthopaedic pillow to allieviate neck pain. A simple way to see if such an aid would help is to roll up a hand towel and place it at the bottom of your pillow case.

This supports the neck in much the same way and will be a good indicator of whether an orthopaedic pillow would be of value.

The CSP's Guide to Good Sleep also highlights the importance of choosing the right mattress to aid restful sleep, advising people to opt for a mixture of support and comfort. For instance, the more springs a mattress has, the better the support to all parts of the body. Also, those sharing a bed should consider differences in body weight as different levels of support may be required. Therefore purchasing two single mattresses for a double bed may help to accomodate different needs and levels of support.

However, having a comfortable bed and adopting a good sleeping posture may not be enough for some people whose sleeping difficulties are linked to more complex personal problems, lifestyle factors (eating late at night, drinking coffee in the evenings, not exercising enough, being overweight) or particularly for women - hormonal changes. According to Chris Idzikowski, an expert on sleep-related disorders and author of Beating Insomnia - how to get a good night's sleep, women suffer from disturbed sleep more than men and it is well known that nocturnal wakefulness can be a symptom of premenstrual tension, the menopause and of course, during pregnancy and breastfeeding.

Although limited in duration, these phases of many women's lives can provide a background of sleep disturbance that can become a long term problem.

Drinking alcohol to excess and/or taking certain prescription medicines or illegal drugs are other causes of disturbed sleep.

Idzikowski who runs a sleep advisory clinic in Lisburn, Co Down states that 6 per cent of Americans use alcohol to promote sleep and shockingly he adds that the rate of alcoholism in insomniacs is twice that of good sleepers and 60 per cent of alcoholics use alcohol as a sleep aid.

"There is evidence that a sleep disorder usually exists prior to the development of alcoholism," he writes. And, just in case you thought he might suggest taking sleeping pills instead, he doesn't.

"Generally, the advice on taking sleeping pills to cope with life stresses is - don't. It is a definite do not if the stress is likely to be chronic and recurring. There is also doubt about whether sleeping pills are useful for a stress such as bereavement, as there is evidence that it only delays the necessary bereavement process," he writes.

Unsurprisingly, moderate exercise has a beneficial effect on sleep and one study of the over 65s (an age group in which disturbed sleep is common) found that four 30 to 40 minute sessions of brisk walking per week was enough to improve sleep quality, the time taken to go asleep and sleep duration.

Other time-honoured techniques to aid sleep include drinking camomile tea at bedtime, practising yoga or meditation routines in the evening, having a bedtime ritual which allows you to wind down slowly and ensuring your room is airy yet without draughts.

However, perhaps the best sleep aid of all is, to paraphrase a German proverb (which translates as the best pillow is a clear conscience), to go to bed with a clear conscience, leaving the concerns and worries of the day behind you.