I found this on my Chronic Pain Hideaway Group.
What is a normal amount of sleep?
Different people need different amounts of sleep. Some people function well and are not tired during the day with just 3-4 hours' sleep a night. Most people need more than this. To need 6-9 hours per night is average. Most people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep.
So, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is ... 'difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness'.
What are the causes of poor sleep?
Poor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following:
This sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring, but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. See separate leaflet called Obstructive Sleep Apnoea for details. Note: most people who snore do not have sleep apnoea, and do sleep well.
Various illnesses keep some people awake. For example, illness causing pain, leg cramps, breathlessness, indigestion, cough, itch, hot flushes, mental health problems, etc.
Some medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants, steroids, beta-blockers, some slimming tablets, painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep.
General tips for sleeping better (often called sleep hygiene)
The following are commonly advised to help promote sleep and are often all that is necessary:
Reduce caffeine - do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped.
Do not smoke within six hours before bedtime.
Do not drink alcohol within six hours before bedtime.
Do not have a heavy meal just before bedtime (although a light snack may be helpful).
Do not do any strenuous exercise within four hours of bedtime (but exercising earlier in the day is helpful).
Body rhythms - try to get into a routine of wakefulness during the day, and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore:
No matter how tired you are, do not sleep or nap during the day.
It is best to go to bed only when sleepy-tired in the late evening.
Switch the light out as soon as you get into bed.
Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week.
The bedroom should be a quiet, relaxing place to sleep:
It should not be too hot, cold, or noisy.
Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.
Make sure the bedroom is dark with good curtains to stop early morning sunlight.
Don't use the bedroom for activities such as work, eating or television.
Consider changing your bed if it is old, or not comfortable.
Hide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep.
Mood and atmosphere - try to relax and wind down with a routine before going to bed. For example:
A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening.
Do not do anything mentally demanding within 90 minutes of going to bed - such as studying.
Go to bed when sleepy-tired.
Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.
If you cannot get off to sleep after 20-30 minutes - then get up. If you can, go into another room, and do something else such as reading or watching TV rather than brooding in bed. Go back to bed when sleepy. You can repeat this as often as necessary until you are asleep.
These aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious, but find it hard to get off to sleep. There are a number of techniques. For example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence.
Regular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days. Even a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week.
Moderate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing, and heavy housework are all moderate-intensity physical exercises. See separate leaflet called Physical Activity For Health for more details.
Behavioural and cognitive therapies
If you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave. Research studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia.
There are various types or therapy and they include the following:
This helps you to re-associate the bed and bedroom with sleep, and to re-establish a consistent sleep/wake pattern.
Sleep restriction therapy.
Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows:
First, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a sleep diary. (See separate leaflet called Sleep Diary.)
You may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours, then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am, and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am, but still get up at 7 am.
You then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.)
When 90% of the time spent in bed is spent asleep, then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am.
Adjustments are made each week until you are sleeping for a longer length most nights.
Relaxation training. This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier.
This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep).
With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension).
Briefly, cognitive therapy is based on the idea that certain ways of thinking can trigger or fuel certain health problems, such as poor sleep. The therapist helps you to understand your thought patterns. In particular, to identify any harmful or unhelpful ideas or thoughts which you have that can contribute to you not sleeping well. The aim is then to change your ways of thinking and/or behaviour to avoid these ideas. Also, to help your thoughts to be more realistic and helpful. Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called cognitive behavioural therapy (CBT).