Sleep Expert

There is so much information out there about sleep but not all of it is true. This is a problem as it leads to unrealistic expectations and myths about sleep, as well as people adopting unhelpful habits that could even damage their long-term health.

You can train yourself to need five hours of sleep or less

This is one of the most damaging sleep myths that put people at risk of long-term health problems. There is now a wealth of studies linking sleeping less than six hours with heart attacks, strokes, dementia, type two diabetes, obesity, mental health problems and reduced life expectancy.

Despite this, I regularly hear people saying they can get by on five to six hours of sleep. It’s also common for people to quote famous people who got by on very little sleep, such as Margaret Thatcher (who had dementia for at least twelve years before dying of a stroke), Donald Trump or William Churchill (who regularly napped in the day), as justification for self-imposed lack of sleep. There are some rare individuals who need less than the average amount of sleep but this is roughly one person in four million.

You might get used to feeling sleep deprived. It doesn’t mean you only need five hours of sleep just because you can get by on this.

Sleep experts recommend aiming for seven to nine hours of sleep a night. As well as the long-term benefits, there is lots of evidence to show that getting sufficient sleep leads to more focus and attention, better memory, improved reaction times and decision-making, better mood, enhanced creativity and problem-solving, and other improvements that will improve work performance and leadership skills. 

You can catch up on sleep at the weekend

If you don’t get enough sleep on weekdays, you can’t put this right with extra sleep at the weekend. You need sufficient sleep every night to repair the damage done to your brain and body when you are awake. Lying in at the weekend might partially clear a sleep “debt” and reverse the short-term effects of sleep deprivation such as drowsiness but it won’t reverse the long-term effects of not getting sufficient sleep every night.

Getting up at 5am is the key to success

Some people naturally wake early in the morning. Other people find it hard to wake early. This is not because they are lazy but because they have a genetic makeup that is different to the early risers. Your genetic tendency to sleep and wake at a certain time is called your chronotype. If you have an evening chronotype and you find it very hard to get to sleep before 10pm at the latest, you are not going to get enough sleep if you get up at 5am. Not only will you be sleep deprived which will affect your daytime performance but you will put your long-term health at risk.

It is possible to “entrain” your circadian rhythm (your internal body clock) to sleep at a different time to your chronotype but to do this successfully it is best to stick to the same bedtime and wake time every day, to give you seven to nine hours of sleep, and not change this at the weekend.

Waking at night is bad for my sleep quality

Most people wake a couple of times every night but they are not consciously aware of this. With age, people often notice they are waking in the night. It is very common to wake at the end of a period of REM sleep which occurs at the end of a sleep cycle. You might also wake in light sleep, in response to a noise or other disturbance. If you wake just a few times a night and for a brief period (less than 20 to 30 minutes in total), this is unlikely to seriously affect your sleep quality. If you are frequently awake for more than 30 minutes a night or wake multiple times and you feel it is affecting your daytime functioning, it’s worth speaking to a doctor.

Adults need less sleep with age

Older adults are still recommended to aim for seven to eight hours of sleep a night because they don’t need less sleep than younger adults. However, it’s harder to achieve this because as we age, the mechanisms in the body that drive our sleep weaken. This results in more fragmented sleep at night and often a tendency to nap in the day.

A warm bedroom is best for sleeping

In order to get to sleep, the core body temperature has to drop and this coincides with a release of melatonin in the brain. If the room temperature is too high, this process may be disrupted and you may struggle to get to sleep, stay asleep or experience poor sleep quality. It’s best to sleep in a cool room of between 16 to 18 degrees Celsius and to regulate your body temperature with layers of bedding.

Exercising at night can cause disturbed sleep

About ten years ago, the advice was to not exercise in the evening or you may have disturbed sleep. However, of all the studies that have been done on this topic, there is very little evidence that exercise in the evening is detrimental to sleep. In fact, many people find that exercising in the evening helps them to sleep.

A small number of people do report that intense, vigorous exercise close to bedtime can cause a delay in getting to sleep. You need to allow enough time for your core body temperature to cool down and to have a wind down of 30-60 minutes before attempting sleep.

Hitting the snooze button helps me to wake up

While this might feel like a good way to ease you out of bed, you get very little benefit from the sleep this provides. Hitting the snooze button every five or ten minutes gives you fragmented sleep which is unlikely to be restorative. Waking up this way is not going to make you feel more refreshed. It’s better to set the alarm for when you actually intend to get out of bed, sleep up until this point without snoozing, then get straight up. It can be helpful to put the alarm out of reach so you have to get out of bed to turn it off and put the lights on straight away.

Christabel Majendie January 2023.

Christabel is a Bristol based sleep therapist and consultant, specialising in helping individuals experiencing a wide range of sleep problems. For more information on her work you can visit her website.

Christabel is not a brand ambassador and does not endorse any product of Sleep Well Drinks Limited.

If I didn’t know better, I would think I rarely dream. But everyone dreams every night; I just don’t remember them.

Sleep scientists have shown that most of our dreams, at least the really vivid ones, occur during Rapid Eye Movement (REM) sleep. Dreaming can also occur in other non-REM stages of sleep. It is not so vivid and less bizarre, with more coherent content, resembling thoughts more closely.

During REM sleep, brain waves are markedly different to other stages (non-REM sleep) and closely resemble those of wakefulness. All voluntary muscles in the body are paralysed to prevent acting out of the dreams, and the eyes move rapidly back and forth. Brain waves can be measured in a sleep laboratory, together with muscle tone and eye movements during a procedure called polysomnography (PSG), then interpreted by a sleep technician to find out the different stages of sleep across the night. This data consistently shows that when someone is woken in REM sleep, vivid dreaming is always reported. The episodes of REM sleep occur systematically, around four to six times a night. The intervals becoming longer as the night goes on. REM sleep makes up about 20-25% of total sleep time but the majority is in the second half of the night.

Why do we dream?

Since Freud’s work on The Interprepation of Dreams, there has been much debate about the function of dreams.

Freud believed dreams were a gateway into the unconscious mind and could be interpreted as unconscious wishes that had not been fulfilled. This theory dominated the field of mental health for almost a century. However, later research showed that Freudian psychoanalysts gave widely different interpretations of the same dream from the same individual. For this reason, it has been rejected by modern day science. And the fact that the theory cannot make clear predictions that can be tested.

Following this, dreams were not considered to have any function but to a by-product of REM sleep. Sleep researchers Matthew Walker and Murray Raskind have demonstrated that dreams do actually have a function above and beyond those of REM sleep.

Emotion regulation

Dreams appear to act as a form of psychological resolution. By detaching the emotion from difficult events they can be remembered without reliving the feelings that come with them. During REM sleep, noradrenaline (the neurotransmitter in the brain which triggers anxiety) is inhibited. Simultaneously, emotional and memory circuit are stimulated during dreaming. In this way, painful, emotional experiences can be reprocessed in the absence of anxiety in the sleeping brain. This means we can learn from these experiences without being debilitated by anxiety. With the anxiety disorder post-traumatic stress disorder (PTSD), noradrenaline levels in the brain are too high to allow REM sleep to be maintained. Therefore, the process of stripping away the emotion from traumatic events cannot occur. This leads to the common symptoms of PTSD such as intrusive memories, flashbacks and nightmares.

Decoding emotional expression

Humans rely on the ability to read facial expressions to understand other’s emotions and intentions. Used in order to navigate the social world around them. This ability gives humans a survival advantage as they can direct their own behaviour accordingly. There are specific areas in the brain that read and interpret these emotional cues from faces. However, without REM sleep, these circuits lose their ability to decode these signals. REM sleep acts to reset the circuits so they are able to work efficiently each morning. Studies have demonstrated that when participants were deliberately sleep deprived, they lost their ability to accurately read emotional expressions from a set of pictures. Faces were more likely to be perceived as threatening or menacing. Even the pictures which the same individuals had classified as friendly when they were not sleep deprived.

Problem solving and creativity

While deep non-REM sleep is involved in memory consolidation, during dreaming these memories are blended together in extremely novel ways. During REM sleep, solutions are often found to problems that may have seemed unsolvable during the waking hours and creative content is often constructed. Research has shown that participants are significantly better at creative problem solving when woken from REM sleep compared to when woken from non-REM sleep and when they were awake, with reports that the solutions just “popped out” effortlessly. During dreaming, connections are made between distantly related information in the brain that is simply not obvious in the waking brain. REM sleep appears to turn our knowledge into wisdom.

Evidence for this problem-solving and creativity function of dreaming has not just come from sleep laboratories; history has provided wonderful examples: Mendeleev came up with the formulation for the periodic table in a dream; Michael Faraday proposed the benzene ring structure after he dreamt of a snake biting its own tail; Mary Shelley was inspired to write “Frankenstein” following a dream; Keith Richards reported composing the opening bars of “Satisfaction” in his sleep; Paul McCartney cited dreaming as the origins of both “Yesterday” and “Let it Be.”

Lucid dreaming

Lucid dreaming is when individuals know they are dreaming and are able to manipulate the experience. Using MRI scanners, the validity of lucid dreaming was established, with participants able to signal to researchers through eye movements during REM sleep that they were about to move their hand in a dream. The areas that then lit up in the brain using the MRI scanner were the same as those that lit up when participants moved their hand when awake. This opens up the possibility that lucid dreaming may be used for creative problem solving to harness dreams’ full potential.

Christabel Majendie December 2022.

Christabel is a Bristol based sleep therapist and consultant, specialising in helping individuals experiencing a wide range of sleep problems. For more information on her work you can visit her website.

Christabel is not a brand ambassador and does not endorse any product of Sleep Well Drinks Limited.

Chronotypes: night owls, early birds and social jetlag.

Often it seems there is a moral judgement made about bedtime and risetime. There is that old English proverb that says “Early to bed and early to rise makes a man healthy, wealthy and wise.” Recently there has been a lot of hype promoting getting up at 5am as being the answer to success but how true is this claim?

The truth is that going to bed early and waking early may suit some people, but others struggle to do this. While it might feel like you choose your bedtime and risetime, there is actually a strong biological drive behind this choice. This refers to your chronotype: your body’s natural inclination to sleep at a certain time. Recent research shows that chronotype is strongly influenced by genetics with morningness and eveningness characteristics linked to specific genes. For this reason, it is very hard to change your chronotype, although it will alter across the lifespan, going from a tendency towards morningness in childhood, to eveningness in teenagers, then slowly advancing in the adult years back to morningness in later adulthood.

The chronotype is closely linked to the circadian rhythm. This is the internal body clock that regulates the timing of sleep and other bodily processes (for more info click the following link, why teens sleep later). The circadian rhythm can be shifted by light and following a strict sleep schedule. So, it is possible for someone who is naturally a night owl to eventually get to sleep and wake up earlier than their natural inclination if they regularly follow this routine. However, they may not feel they are at their best until later in the day.

What is your chronotype?

You probably already have a sense of your chronotype. If you are not sure, think about when you would wake or go to bed on a day you are completely free to plan, with no work or other commitments. This might be at the weekend or on holiday. There are several online questionnaires to help you determine your chronotype, the most reliable being the Morningness-Eveningness Questionnaire and the Munich Chronotype Questionnaire.

Night owls represent evening types and early birds or larks describe morning types. However, chronotypes exist on a spectrum, similar to height, with most people falling between these two extremes. The morningness-eveningness questionnaire refers to extreme morning types, moderate morning types, intermediates, moderate evening types and extreme evening types.

Variation in chronotype is thought to have occurred through natural selection to reduce the dangers that come with sleeping, such as risks from predators or environmental dangers. Hunter-gatherers shared the task of staying watch during the night to reduce this risk.

While differing chronotypes may be an advantage in hunter-gatherer populations, modern life tends to have social schedules that interfere with individual sleep preferences for many people, with early starts for school and work.

Social jetlag

Social jetlag occurs when someone’s social clock is misaligned to the circadian rhythm. This can lead to feelings of jetlag such as tiredness, dysregulation of appetite, problems sleeping, lack of concentration and sleepiness during the day. Social jetlag is seen when there is a difference in sleep timing between work or school days and free days. This leads to a large sleep debt building up during the week followed by catching up on sleep on weekends, with the latter sleep being at a time more dictated by chronotype than social schedule. This discrepancy is normally more extreme with late chronotypes.

Chronotypes, social jetlag and health

Various studies have looked at chronotype, performance, physical and mental health. Findings suggest morning types perform better academically, most likely due to the fact they get more sleep, experience less social jetlag, feel more alert in the morning when school starts and show higher attendance.

Eveningness is associated with a higher risk of mental health issues such as anxiety, depression, impulsivity, anger and substance use such as nicotine, caffeine and alcohol. In addition, this chronotype is associated with increased risk of type 2 diabetes, obesity, sleep apnea, and metabolic syndrome. These associations are very similar to those seen with sleep deprivation and are therefore likely to be due to irregular and insufficient sleep caused by wake times not suited to late chronotypes, rather than the chronotype itself.

This has led to scientists suggesting work and school schedules should be adapted to chronotype as much as possible, in order to improve workers and adolescent health. While there has been a shift towards flexible working hours, a UK feasibility study found moving school start times to be unpractical, although there has been some success in America, with late school start times leading to improved academic performance and attendance.

How to minimize social jetlag

If you have a tendency towards extreme eveningness be aware that certain behaviours can enhance this effect and worsen social jetlag. Try to stick to fairly regular sleep and wake times, seven days a week while also aiming for seven to nine hours of sleep (eight to ten hours for teenagers); get outside in natural daylight soon after waking; eat some breakfast; aim to exercise in the first half of the day and not in the evening; avoid naps after 3pm; don’t eat too late in the evening, avoid bright lights and light emitting devices in the hour or two before bed; avoid caffeine eight to ten hours before sleep; and avoid stimulating activities such as work or computer games in the hours before bed.

Christabel Majendie November 2022.

Christabel is a Bristol based sleep therapist and consultant, specialising in helping individuals experiencing a wide range of sleep problems. For more information on her work you can visit her website.

Christabel is not a brand ambassador and does not endorse any product of Sleep Well Drinks Limited.

How to manage your racing mind and get a good night’s sleep

Most people can remember a time when they have struggled to sleep because of a racing mind. This classic symptom of insomnia, referred to as hyperarousal, is common during times of stress. It may even be accompanied by the frustrating experience of feeling tired before going to bed but then feeling wired when your head hits the pillow.

A racing mind can be due to stress or anxiety but it is more likely to occur if you have not prepared well for sleep. You may need to make some changes to your usual bedtime routine to calm your mind as well as manage any stress you may be holding.

Worry Time

Scheduling worry time teaches your brain to deal with your stressors during your waking hours so you are less likely to ruminate about them in bed. Set aside 10-20 minutes in the early evening (not close to bedtime) to go through your worries. Write a list of issues then what you can do about these problems and when you will deal with them. Think about the day you have had and anything you are left worrying about. Think about what is coming up tomorrow and anything you need to add to your to do list. For big problems, break these down into manageable steps and schedule a time to deal with the next step.

Have a notebook by your bed, to capture any additional worries you think of when heading to bed. If you notice you are worrying in bed, remind yourself these thoughts are not helpful for sleep and you have a set time to go through any problems tomorrow then distract yourself with some relaxation techniques (see below).

Dim the lights

Light has the ability to suppress melatonin, the hormone that helps you to know when to go to sleep. Dimming the lights an hour before bed should be part of your bedtime routine as bright light at night can keep you alert. Use lamps instead of overhead lights and avoid light-emitting devices in this time.

Disconnect and wind down

Not only are light-emitting devices problematic because of the effect of light on the sleep systems, what you do on these devices tends to be mentally stimulating and can contribute to a racing mind. Sleep is not like turning off a light switch. You need to take time to relax before sleep. If you work up until bedtime or are racing around doing tasks, you are setting yourself up for a racing mind when you try to sleep. Reading the news, can also set off worries while social media and browsing information on your phone can keep your brain alert. Aim to finish work at a reasonable time to allow yourself to relax in the evening and have a set time, an hour before sleep, when you turn off electronics. Then stick to non-stimulating activities like reading, listening to something, meditation or a jigsaw.

Relaxation techniques

As well as helping to relax the body, relaxation exercises can help with a racing mind. Deep or diaphragmatic breathing involves a slow, regular breath from the belly. Progressive muscle relaxation is a sequence of tensing then relaxing different muscle groups around the body while working with your breath. Visit our previous post, ‘relaxation techniques to help you sleep‘ for more information on these techniques.

Going to bed when you are sleepy

Sometimes people may experience a racing mind because they are not ready to go to sleep. The timing of sleep is controlled in the body by two biological systems, the circadian rhythm which is your internal body clock, and the sleep homeostat which balances wakefulness with sleep. If you go to bed too early, these systems may not allow you to sleep. By going to bed when you feel sleepy -tired (eyes feel heavy and you feel you might nod off), you are less likely to have a racing mind and are more likely to get to sleep. This may be later than your usual time so continue to wind down in dim lights.

No clock watching

It’s tempting to check the time when you can’t sleep but this can enhance the racing mind. Clock watching leads to thoughts about how long you have been awake, how many hours you have left to sleep and how you must get to sleep soon. These thoughts can cause anxiety and frustration, emotions that don’t pair well with sleep. If you really can’t keep the phone out of the bedroom, at least keep it out of reach so you can’t check the time. Position clocks so you can’t see them in bed or remove them from the bedroom completely.

Caffeine

Caffeine is a stimulant; it suppresses sleepiness and keeps you alert. It has a long half-life so it takes a while for it to be broken down in the body. If you are experiencing a racing mind at night, try cutting out caffeine ten hours before bedtime.

Keep the bed for sleep

If you do lots of things in bed like browsing on the phone, checking emails, watching TV, drinking cups of tea, the purpose of the bed becomes confused in your brain. You want to keep the bed for sleep (sex is the only exception) so these things become associated together.

For this reason, it’s also a good idea to get out of bed if you are struggling to sleep for more than an estimated 20 minutes (remember no clock watching). Do something relaxing, in dim lights until you feel sleepy then head back to bed.

Christabel Majendie November 2022.

Christabel is a Bristol based sleep therapist and consultant, specialising in helping individuals experiencing a wide range of sleep problems. For more information on her work you can visit her website.

Christabel Majendie is not a brand ambassador and does not endorse any product of Sleep Well Drinks Limited.

Complaints about sleep quality are one of the most common symptoms of the menopause, affecting 39-45% of women perimenopausal and 35- 60% postmenopausal.

Women report more sleep complaints and are more likely to have insomnia compared to men at all stages in their lives. One of the major influences on women’s sleep is hormones. Hormones affect sleep during puberty, the menstrual cycle, pregnancy and in the menopause transition. In the perimenopausal years, huge changes in hormones start to occur, together with a change in neurotransmitters, the chemicals that transmit messages in the brain.

Changes to estrogen

The level of reproductive hormone, estrogen, fluctuates then reduces from the perimenopausal years onwards, which leads to hot flashes. In order to get to sleep and stay asleep, your core body temperature drops and this triggers a release of melatonin, the hormone that tells your body it’s time to sleep. For this reason, sleep hygiene advice suggests sleeping in a cool room. When hot flashes happen at night, the increase in temperature can cause an awakening as well as making it very hard to get back to sleep.

Changes to progesterone

Progesterone, is another reproductive hormone that plays a role in initiating and maintaining sleep. Progesterone promotes sleep by its effect on GABA, a neurotransmitter that reduces activity in the brain and nervous system. The change in levels of progesterone that starts in the perimenopausal years leads to problems inhibiting brain activity that is essential for sleep.

Changes to neurotransmitters

There are many chemicals in the brain that influence mood. When estrogen levels are low, this affects the production of serotonin which can lead to feelings of depression. The level of neurotransmitters, dopamine and norepinephrine, are also affected by changes in estrogen. An imbalance in these hormones can lead to anxiety, commonly seen during the menopause.

There is a bi-directional relationship between mood and sleep, with low mood and anxiety affecting sleep, and sleep problems affecting emotion regulation. 

Furthermore, estrogen affects the level of cortisol, a stress hormone that influences mood and sleep. When estrogen drops, cortisol levels increase, leading to problems with anxiety. When we sleep, cortisol levels drop so sleep is directly affected by the change in this stress hormone. But all the neurotransmitters mentioned above also play a role in sleep.

Other factors

There are some differences seen in the mechanisms that drive sleep in women compared to men. The circadian rhythm, the internal body clock, is a bit more variable in women and often the circadian period is slightly shorter, so this could make them more vulnerable to sleep issues. During the menopause, problems with circadian rhythm disruption occur, possibly due to changes in melatonin, causing problems with the timing of sleep.

Age is a major factor. Sleep problems unfortunately increase as we get older for both men and women. This is because the systems that regulate our sleep weaken and melatonin production reduces, resulting in more fragmented sleep and more problems initiating and maintaining sleep.

During the menopause changes in hormones and neurotransmitters lead to higher risk of developing the sleep disorders obstructive sleep apnea and restless leg syndrome. These both can significantly disrupt sleep, the former by interfering with breathing during sleep and the latter with uncomfortable sensations in the legs at nighttime that can only be relieved by movement.

What can women do to help prevent sleep disturbance?

There are several medical options that may help but also several behavioural influences that can make a big difference. It’s helpful to remember that, although there are clear biological changes occurring in the menopause transition, our behaviours influence our neurotransmitters which then influence how we feel and our ability to relax and sleep.

Hormone replacement therapy, antidepressants and sleep medication can reduce symptoms of menopause, reduce hot flashes and sleep disruption. If you want to explore these options, speak to your doctor about risks and benefits.

There is growing evidence that soy-based foods can reduce menopausal symptoms and improve sleep quality as they contain phytoestrogens. Try out soya milk and yogurt, tofu and edamame beans. For supplements containing phytoestrogen, there is some evidence that ginseng and black cohosh can help, but more research is really needed for conclusive evidence.

There is good evidence that yoga helps to reduce menopausal symptoms and improve sleep quality. The evidence for acupuncture is promising but is limited and more research is needed.

Lifestyle factors

Lifestyle factors can make a huge difference. Avoid caffeine eight to ten hours before sleep and nicotine one hour before bedtime, limit alcohol and avoid heavy meals two hours before bed. Be aware of spicy or acidic foods which can trigger hot flashes. Reduce fluid intake in the few hours before bed to avoid trips to the bathroom at night.

Regular exercise can benefit sleep but avoid intense exercise two hours before bed to allow your body temperature to cool down for sleep. Gentle stretching completed two hours before bedtime may help as can a warm bath as both these can gently increase the body temperature which leads to a drop prior to bedtime.

Sleep in a cool room (16-18 degrees) and use layers of bedding, made from natural fibres, to regulate body temperature at night. Use “sweat management” bed clothes or none at all and have a change of clothing by the bed with a glass of water to prepare for hot flashes.

Avoid using your bedroom excessively to relax in the evening or during the day and avoid working in the bedroom. Electronics are best kept out of the bedroom to reduce cognitive arousal and light, both which can negatively affect sleep. For more tips on how to improve your sleep routine, click here.

If you struggle with a racing mind or anxiety, try writing down your thoughts in a worry journal in the early evening but then make sure you wind down for at least an hour before sleep with some relaxing, non-stimulating, activities.  

If you are still struggling to sleep despite all of this, you could try a course of Cognitive Behavioural Therapy for Insomnia (CBT-i). A wealth of research shows that this treatment improves sleep in most adults, including women going through the menopause transition.

Christabel Majendie October 2022.

Christabel is a Bristol based sleep therapist and consultant, specialising in helping individuals experiencing a wide range of sleep problems. For more information on her work you can visit her website.

Christabel Majendie is not a brand ambassador and does not endorse any product of Sleep Well Drinks Limited.