Understanding and Re-establishing Sleep

Why is sleep important and what is it exactly?

Sleep is one of the most important things we need to address if we want to maintain good health and mental stability. Sleep helps to consolidate memories leading to improved functioning during the day. Consider that without sleep for 20 hours your reflexes will be similar to a person with a blood alcohol reading of 0.08. As a result of poor or limited sleep, reflexes become slowed down and judgements and decisions are less well thought through. Without adequate sleep the brain begins to malfunction because the neurons are not able to regenerate. A person who is sleep-deprived is likely to become more impulsive, less attentive, irritable and intolerant and it becomes harder to keep up with daily tasks. To compensate for lack of sleep the brain takes micro-sleeps and may even have micro-dreams which can be interpreted as hallucinations.
Sleep follows 90-minute cycles during which REM (Rapid Eye Movement) occurs along with slow-wave sleep. The electric patterns of REM look similar to that of a brain that is awake. This is because the brain is active, even if we are not. Research has shown that REM sleep is very important in the processing of information and the consolidation of memories. Scientists now realise that both cycles of sleep (slow-wave and REM) are important. Sleep makes memory more robust and resilient, particularly for emotionally evocative memories. Skimping on sleep interrupts the processing and consolidation of information and memories. Indeed, there is evidence that the amount of sleep for our brains to help us function optimally is a minimum of six hours.
When we become stressed, anxious or depressed one of the first things to be affected is our sleep – wake cycle. People typically find it difficult to fall asleep, to stay asleep or tend to be wakeful. This is why the ability to think straight, to concentrate and to remember things, are common complaints of the depressed person. When we can’t sleep we become agitated and anxious. Therefore our ability to concentrate and attend to what is happening is also affected. If we can’t concentrate and attend, we can’t hold onto the information to enable the laying down of memory. One becomes caught in a cycle of impoverished sleep and poor performance. In order to get a good night’s sleep, we need to go to sleep in a relaxed state. Some people who have depression sleep very deeply but wake up unrefreshed and tired. They often comment on the lack of dreams which raises the question about whether they are getting the right mix of slow-wave and REM sleep.
Sleep deprived people often try to solve the problem in one of two ways: go to bed as soon as they can and then lie in bed being frustrated because they can’t fall asleep or become sleep avoidant and delay going to bed because they don’t want to lie in bed thinking all the time. Neither of these solutions is helpful.
Re-establishing Healthy Sleep

David Morawetz in his program that teaches how to improve sleep suggests that sleep comes in waves, usually every 45 – 90 minutes. A trick to getting sleep back in order is to recognise when the waves are likely to arrive and be in a position to surf into a refreshing sleep. No surfer sits on the beach waiting for the wave. A surfer waits out in the surf in preparation to catch the wave. Like a surfer you too must be ready. Develop a routine to assist you. If you still have to do all your toileting when the wave arrives, you will miss it. Learn about your sleep pattern. Keep a check on yourself. When do you start feeling drowsy? Then decide how many hours you need for a good night’s sleep. In other words, think back to a time when you were sleeping well and remember how many hours you were sleeping then. When you have worked this out, think of when you wish to get up in the morning. That will tell you what wave to catch and therefore when is the best time to go to bed. It is no use going to bed at 7 p.m (21.00 hours) if you want 8 hours sleep and to get up at 7.00 a.m.. If your pattern is 8 hours and you go to bed at 7 o’clock then you will wake up at 4 o’clock because you will have slept the hours you need. This is something that people often become very confused about and then complain that are wakeful from 4 o’clock onwards. If you want to wake up at 7 o’clock then be prepared to be ready for bed at about 10.30 p.m (22.30 hours). Wait for your wave in bed. Do a relaxation exercise or read, although some sleep experts suggest that bed is only for sleeping and love-making. If you use a relaxation strategy, give yourself permission to drift into sleep. This will help to ensure that you fall asleep in a relaxed state that will give you a refreshing sleep. Whatever you do, do not watch the clock or try to go to sleep. Such activities ensure staying awake. If you can’t get to sleep you have obviously missed the wave and must get ready for the next, so go back to relaxation or reading. However, if you are reading you have to be prepared to close the book, no matter how exciting or where you are in the chapter as soon as your eyes start getting heavy and droopy. If you don’t, you’ll miss the wave ad have to wait for the next one.

If you wake up during the night, do not check the clock. Relieve yourself, relax and drift back to sleep. If something is worrying you, write the worry down or just acknowledge that you are thinking about whatever you are thinking about, resolve to deal with it in the morning when you are refreshed and relaxed. The reality is that few problems are solved at the witching hour of 3.00 in the morning.

In summary, to start redeveloping a healthy sleep pattern these are the following steps:

• Decide how many hours you have needed in the past in order to get a good night’s sleep.
• Learn about the frequency and pattern of your sleep wave. A sleep diary may be useful.
• Know when to be in bed so you can catch the wave and get the sleep you need to wake up at the preferred time in the morning.
• Make sure that you are ready in bed in order to catch the wave.
• Be prepared to wait in a relaxed state. Relaxation is very helpful in the preparation for a good night’s sleep.
• Have a note book and pen available so that if you have thoughts or ideas that you can’t let go of during the night, you can write them down and go back to sleep.
• Do not have a clock alongside the bed to remind you of the time.
• Do not sleep in while you are re-establishing your sleep pattern even if you feel tired. The tiredness is likely to reflect depression and will eat into your activity time, which you need to become properly tired.
• Do not nap during the day. If you feel tired, do some relaxation but don’t go to sleep or, alternatively, do something that reinvigorates you e.g., go for a walk, phone a friend.

Other things to consider are:

• Your caffeine intake:
o Know how caffeine affects you and limit your intake. Do not have a caffeinated drink after 4 p.m (16.00 hours) and this includes high sugar, carbonated and energy drinks.
o If you take tea in the evening consider a herbal brew instead. Tea does contain caffeine.
o A warm milky drink with honey can be helpful as warm milk releases amino acids that enable sleep. Be aware that drinking chocolate can contain caffeine.
• Alcohol can affect sleep. It may put you to sleep but it also causes wakefulness.
• Allow a couple of hours between your evening meal and bedtime.
• Consider switching the television off 30 minutes before going to bed as the television can stimulate the brain rather than relax it.
• In the hour or so before bed, do something relaxing: work, study, accounts etc. are not relaxing and are likely to stimulate unhelpful thinking that is not conducive to sleep.
• Regular exercise, for instance a late afternoon or early evening walk or gym workout will help you not only to tire the body but also to stimulate dopamine and serotonin. If you are sluggish in the morning, exercise will help you to energise yourself.