It is estimated that a third of the UK population have problems sleeping and that we are sleeping an average of 90 minutes less than the 1920’s (https://www.mentalhealth.org.uk/a-to-z/s/sleep)
Insomnia is struggling to get to sleep, difficulty staying asleep, waking early, 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 as reported by the National Institute of Clinical Evidence (NICE 2015).
There isn’t a definition of ‘normal sleep’ but it is estimated that most healthy adults will sleep between 7 and 9 hours a night. As a rule of thumb if there is no impact on your ability to function day to day then you don’t need to be overly worried.
According to the NICE guidelines Acute or Primary insomnia lasts for between 1-4 weeks and accounts for 5-20% of chronic/long term insomnia. Acute insomnia may occur as a result of a stressful event. Medication may be prescribed if insomnia is having a significant effect on your day to day functioning.
Chronic insomnia lasts for 4 weeks or longer. Initially medication may be prescribed, however other treatments will be considered including cognitive and behavioural interventions.
In addition, Comorbid or Secondary insomnia is when insomnia occurs as a result of another condition. Secondary insomnia may be caused by:
- Sleep apnoea- https://www.nhs.uk/conditions/sleep-apnoea/
- Shift work, jet lag, advanced sleep phase syndrome; falling asleep early and waking early, outside of what is deemed a ‘normal time to sleep’ and delayed sleep phase syndrome; sleep is delayed more than 2 hours past a conventional bedtime. The delay causes difficulty waking up.
- Restless leg syndrome - https://www.nhs.uk/conditions/restless-legs-syndrome/
- Sleep walking - https://www.nhs.uk/conditions/sleepwalking/
- Sleep talking
- Teeth grinding
- Narcolepsy - https://www.nhs.uk/conditions/narcolepsy/
- Stress; work, relationships, noise, financial, academic, medical
- Mood disorder; depression, bi-polar
- Anxiety disorders; generalised anxiety disorder, panic disorder, post-traumatic stress disorder
- Psychotic disorders; paranoia, schizophrenia
- Medical conditions (including a combination of conditions) that may affect your sleep.
- Cardiovascular: angina, congestive heart failure.
- Respiratory: chronic obstructive pulmonary disease, asthma.
- Neurological: Alzheimer's disease, Parkinson's disease.
- Endocrine: thyroid dysfunction.
- Rheumatological: fibromyalgia, chronic fatigue syndrome, osteoarthritis, rheumatoid arthritis.
- Gastrointestinal: gastroesophageal reflux disease, irritable bowel syndrome.
- Genito-urinary: incontinence, benign prostatic hypertrophy, nocturia.
- Chronic pain.
- Drug and substance misuse can also affect sleep, these include
- Recreational drugs.
- Some prescription medications can also affect sleep –Antidepressants: selective serotonin reuptake inhibitors, venlafaxine, bupropion, duloxetine, monoamine oxidase inhibitors. Antiepileptics: lamotrigine, phenytoin. Antihypertensives: beta-blockers, calcium-channel blockers. Hormones: corticosteroids, thyroid hormones. Nonsteroidal anti-inflammatory drugs. Stimulants: methylphenidate, modafinil. Sympathomimetics: salbutamol, salmeterol, theophylline, pseudoephedrine
Incontinence or waking to go the toilet – if you or your partner are experiencing incontinence or waking to use the toilet if maybe advisable to speak to your GP as they will be able to offer support, advice, treatment to improve your continence.
There are many continence products that can help and may improve yours or your partners sleep. These include – waterproof sheets, continence pads, sheets, pants.
You could consider using a urine bottle or have a commode next to the bed as this will prevent the need to walk to the bathroom and potentially reduce your risk of falls. The disturbance to a partner may also be reduced.
Additionally, irritable bowel syndrome may be a reason for you waking during the night, advice would be to discuss this with your GP.
Difficulty getting in and out of bed – some people may not be going to bed which will affect their sleep routine and patterns because they struggle to get in and out of bed, this could be due to fibromyalgia, chronic fatigue syndrome, osteoarthritis, rheumatoid arthritis reduced mobility/ability, pain or oedema. There are several aids that may help from a simple bed lever to an adjustable bed.
Top tips to help improve your sleep
- go to bed and wake up at the same time every day – only go to bed when you feel tired try to avoid sleeping in after a poor night's sleep.
- relax at least 1 hour before bed – take a bath or read a book
- make sure your bedroom is not to hot or cold, is dark and quiet – use thick curtains, blinds, an eye mask or ear plugs
- exercise regularly during the day
- make sure your mattress, pillows and covers are comfortable
- do not smoke or drink alcohol, tea or coffee at least 6 hours before going to bed
- do not eat a big meal late at night
- do not exercise at least 4 hours before bed
- do not watch television or use devices right before going to bed – the bright light makes you more awake
- do not nap during the day do not drive when you feel sleepy
- do not keep watching/checking the time during the night