August 11, 2014

How to Get A Better Night’s Sleep

Good sleep is one of life’s pleasures. Most people can think of a time when they slept well and sleeping really wasn’t an issue. Unfortunately for many, sleep is a problem and complaints of poor sleep are common. This is particularly the case for those with lung disease. Reports of insomnia occur in 25-48% of those with COPD. These statistics are even more striking given that poor sleep is correlated with increased emergency healthcare utilisation, reduced quality and length of life.

Mechanisms of these associations may be related to impaired immune function, memory impairment resulting in suboptimal self-care and low oxygen levels due to breathing disorders. Oxygen levels can fall due to sleep apneoa and shallow breathing. These breathing abnormalities can also result in reports of poor sleep in some, whilst others may demonstrate any of a variety of issues such as snoring, irregular breathing and gasping in sleep, headaches, trips to the toilet at night and waking unrefreshed. A sleep test organised by your doctor may be necessary to determine if a significant breathing issue exists. For many though, a good starting point is to concentrate on changing their habits, behaviours and thought processes related to sleep.

Knowledge of the factors that promote normal sleep can help one better understand why and how behavioural change needs to occur. This understanding also allows one to accept that improvements are not going to just materialise overnight. This knowledge includes two important factors that promote better sleep:

  1. Homeostatic drive is the drive to sleep resulting from increasing the length of time we are awake e.g. if you only sleep for two hours on a given night you are likely to be more tired the following day.
  2. The circadian cycle is the body’s natural rhythm of rest and activity which is dictated by the secretion of hormones. Although this secretion is controlled by an “internal clock” within a part of the brain (suprachiasmatic nucleus) it can be modified by a number of factors, the most important of which is light exposure.

The process of modifying these factors can be achieved by participating in a program of Cognitive Behavioural Therapy (CBT). Programs can be undertaken with a psychologist face-to-face, using a self-help book, or more frequently these days via an online course.

For others, adherence to some basic principles of “good sleeping” can help improve and maintain better sleep. Check with your doctor or a healthcare professional about what approach is best for you but some basic principles might include:

  1. Do not worry if you don’t sleep. Worrying about a lack of sleep will not make you sleep longer. Indeed, lying in bed trying to induce sleep or worrying about a lack of sleep usually promotes wakefulness. Sleep is not a state of mind that can be induced, instead we must surrender ourselves and sleep comes over us. One way you should demonstrate your new found relaxed state of mind in regards to sleep is to refrain from looking at the clock throughout the night (knowing the time will not make you sleep any better).
  2. Maintain the same waking time each morning. Do not over sleep. Sleeping-in weakens the body’s sleep rhythm (circadian rhythm). If you really want a sleep-in, have no more than 20 minutes. Avoid the temptation to sleep late even if you have had a bad night’s sleep as this just weakens the sleep rhythm.
  3. Avoid napping in the day. Your body needs to develop a predictable and sustainable sleep pattern. Daytime napping tends to decrease the quality of night time sleep and confuses the body clock. If you are exhausted and can’t follow this recommendation then a 20 minute nap preferably in the early afternoon is acceptable. If you are sleepy, resist the urge to sleep by staying active, for example by getting up and moving about.
  4. Go to bed when you feel relaxed, comfortable and ready to sleep. Go to bed at approximately the same time each night, but if you are sleeping poorly, avoid the temptation to go to bed early. Have a bedtime routine that is relaxing and does not involve using a computer or watching TV as these devices emit the light that weakens your circadian cycle.

After over 20 years of working with patients with sleep problems, I know that improving sleep can be complex. However, I have also seen so many people improve with adherence to basic principles based on the physiology of normal sleep. For more information on sleep disorders see the wealth of information at www.sleephealthfoundation.org.au. The resources on this website regarding Insomnia contain links to an online CBT program. Alternatively, you can download Dr Willson’s Better Sleep Guide at
www.sleepandlifestyle.com.au.