Whereas quality/lack of sleep is often not viewed as a presenting problem in counselling work, it can be a contributory factor to distress and is therefore worthy of a greater understanding. Scientific research which incorporates biology, genetics and medication, together with lifestyle choices, seems to emphasise the complexity of sleep management. Research also suggests that a lack of sleep can increase the risk of developing conditions such as high blood pressure, coronary heart disease, diabetes, obesity and dementia. Also sleep deprivation, where the body has little chance to recover, can affect parts of the brain related to learning and memory where the brain physically shrinks. This is an alarming thought. Generally, it seems that we have some sort of education about our diet, exercise, drug and alcohol use, but not so much about the importance of sleep and how these factors might be related.
An understanding of our circadian rhythm; how sleep is incorporated into a 24 hour cycle and whether regular sleep is being achieved seems important. A good night’s sleep improves attention and concentration. While we sleep, the brain begins to organise and process all the information we have taken in during the day converting short-term memories into long-term memories. This helps us to learn and means that when we wake up we often see things more clearly. How much sleep we need is subjective but as a guideline: babies need around 12 to 16 hours sleep each day; older children about 9 to 12 hours a night; adults about 7 to 9 hours each night. For those who complain of a broken nights sleep, oversleeping or waking up to an alarm clock feeling heavy headed and lethargic, it may be helpful to understand when maximum performance is achieved during the day and work back from this.
It is recognised that the single most important factor of sleep can be sticking to a schedule by trying to go to bed and waking up at the same time each day. As an example, if you are the chronotype ‘night owl’ you may experience sleep difficulties. The fact that ‘owls’ are determined by unavoidable DNA hardwiring, so not a conscious fault but rather genetic fate, seems to evidence the complexity of re-calibrating irregular, troublesome sleeping patterns. So how can this be achieved? Perhaps starting with the concept of reducing sleep time initially to say six hours – so setting an alarm for bedtime and then again for the morning. Whilst there may be inevitable tiredness in the morning, there is the potential to stay awake for longer, building up a strong sleep pressure with a greater abundance of adenosine. This may stimulate tiredness in the hope of falling asleep faster.
Melatonin releases signals that it is night. In preparation for sleep it may be helpful to consider the need to unwind, having a relaxing bath, reading or listening to music or perhaps practising relaxation techniques or listening to a podcast on guided medication. Making sure the bedroom is the right temperature, not too hot or cold, that it is dark, with thicker curtains or blackout blinds or using an eye mask. Maybe earplugs may help with noise. Remove light and stimulation from electronic devices, which can activate parts of the brain and keep you awake, along with visible clock faces from view to prevent clock watching anxiety. For those who find they are laying in bed unable to sleep because they are worrying about life challenges with ruminating anxious thoughts, it might be helpful to consider making a to-do list to help structure the following day. Alternatively a relaxing activity (as mentioned above) until sleepiness comes. Once asleep and the melatonin decreases, sunlight enters the brain through our eyelids and we are programmed to wake up. The chemical adenosine then builds in the brain, increasing in concentration until it peaks, generally after 12-16 hours when there is an urge to want to sleep. This completes the 24 hour body clock cycle.
Of course, we also need to consider lifestyle choices made during the day which could influence sleep: Coffee, for example, is a popular choice and may be seen to enhance functionality. However, caffeine can take up to 8 hours to wear off, so intake in the day could be a problem. This would also be the case with cola, some herbal teas and chocolate which also contain caffeine. Caffeine as a stimulant confuses adenosine. If more caffeine is consumed adenosine continues to build up which could result in a crash with unpleasant side effects. Smokers can wake up too early in the morning because of nicotine withdrawal and alcohol intake may impact breathing difficulties and waking in the night when the effects have worn off. Late heavy meals can result in indigestion and late drinks with the need to urinate in the night. It is also possible that some commonly prescribed heart, blood pressure, asthma medications, as well as some over the counter and herbal remedies for coughs, colds and allergies can also disrupt sleep patterns. Sleeping tablets which contain melatonin tell the body it is night time, but they do not necessarily guarantee sleep, they may cause side affects such as next day grogginess, forgetfulness and slower reaction times.
Regular exercise helps to relieve stress and anxiety that can disrupt sleep – aim to do this during the day or early evening. Try to avoid intense exercise close to bedtime as you may be overly energised and this is not good preparation for sleep. For those who regularly take a ‘power nap’ to cope with day time tiredness consideration to avoiding sleep after 3pm may help. Research suggests that being sleep-deprived changes the level of hormones that signal hunger and fullness in our body. If we are awake for longer the body needs more energy and it may be difficult to control our appetite resulting in unhealthy food choices and weight gain, especially where food is eaten later in the day.
This article has been inspired in part by Matthew Walker’s book, Why We Sleep, which I thoroughly recommend. It is also based on my professional experience of working with sleeping difficulties in client work. My hope is that elements of this article will resonate with those of you who have sleeping difficulties offering strategy for coping with your personal situation, together with an increased awareness of how sleep can impact mental health and wellbeing. If you have concerns and you feel overwhelmed with your current situation it may be helpful to seek guidance from your GP or other healthcare professional.
Written by Lesley, volunteer counsellor at Westmeria