Dealing With Sleep Issues

By Dr Katharina Lederle

Dealing With Sleep Issues
Feeling tired? Human sleep and fatigue specialist Dr Katharina Lederle shares her top tips for managing sleep issues.

In this edited extract from Sleep Sense by Katharina Lederle, discover some natural ways to deal with issues such as a racing mind and the afternoon slump, as well as showing you how to identify the signs of tiredness.

What to do when the mind starts racing

A racing mind that goes over the events of the day again and again, or worries about the next day, is the last thing you want when you are trying to fall asleep. And when you feel stressed, anxious or tense, sleep is nowhere to be seen. Naturally, you’ll want to get rid of these thoughts, emotions and body sensations so you can fall asleep and get that peaceful sleep.

There are many different strategies on how to cope with these ‘private events’ (as research collectively refers to thoughts, emotions and body sensations) including cognitive behaviour therapy (CBT), relaxation and breathing techniques. Instead of reviewing each of them (you can find more information on these and other techniques online) I want to share with you a key element of the approach I teach all my clients and which they find very helpful.

The approach itself is called Acceptance and Commitment Therapy (ACT). I mentioned it on p. 147, and here’s what I suggest you try. Observe the thoughts that go through your mind and the emotions and sensations that show up in your body. Rather than trying to get rid of them by distracting yourself or challenging the relevance of the thoughts, accept them. Allow them to come and go and to be just as they are without fighting them. It’s almost like sitting in an armchair and noticing whoever is coming into the room. You don’t talk or engage with them; you simply acknowledge them and then let them be. You don’t get annoyed with yourself for thinking this way or feeling that way, you accept that what is there is there for now. You can practise this approach both during the day and if you wake up at night with worries or ruminations

If you continue to follow this approach, then over time you’ll become less bothered by your thoughts and emotions, and will fall asleep much more quickly and will be able to return to sleep more quickly during the night if you wake up. Adopting an accepting attitude, rather than getting annoyed with yourself or frustrated with the situation, will help you save energy at night which you will then have for the next day.

I know this isn’t easy when you first try it, because accepting something we don’t like is a very different response to how we usually respond to a problem. I teach my clients mindfulness exercises to help them rebuild this capacity to just observe rather than judge. Maybe this is something you might find helpful, too. There’s a lot of free content available online or — and this is what I would suggest — you can attend a mindfulness course in your local area. Gentle and yoga during the day or early evening (not at night!) are nice accompaniments to a mindful way of living your life.

If you need an afternoon alertness boost

Sometimes you’re at work and feel tired but need to be awake and present for an afternoon meeting. Or perhaps you’ve had a run of poor nights, and getting through the day feels like a hard slog. What’s the best way to get through the day?

Caffeine: One option is to consume caffeine, for example coffee or black tea. Caffeine, a stimulant that keeps you awake, is the antagonist of adenosine. I discussed this in Chapter 1 but I think it’s important to quickly recap. Adenosine is a biological indicator of your sleep pressure or sleep drive; the longer you’re awake the higher the pressure and the more adenosine is in your brain attached to brain cells. Unless caffeine has been consumed. By binding to the same cells, caffeine prevents adenosine from binding and its ‘sleepiness message’ doesn’t reach the cells (i.e. adenosine cannot signal the cells to slow down). Be aware that the levels of adenosine continue to increase while we stay awake, and the number of receptors on the brain cells also increases, which is why over time you need to drink more coffee to block these, too. Once the caffeine has finally been metabolized, all the accumulated adenosine binds to the free receptors, making us tired very quickly. In this way, caffeine is a bit of a cover-up, so to speak.

Caffeine also works as a stimulator. For example, it activates certain brain areas to trigger the secretion of cortisol and adrenaline by the adrenal glands. (I discussed cortisol in Chapter 5 when talking about sleep and diabetes.) Both hormones are involved in the fight or flight response and they increase your alertness and energy levels. You won’t feel the effects of caffeine instantly; it takes about 20 minutes for caffeine to take effect. And, as mentioned, it takes about six to nine hours for the effects to completely wear off. So plan when to have your coffee so that it alerts you when you need it during the day (most likely in the early afternoon) but doesn’t stop you from sleeping at night.

Take a nap: Take a nap of no more than 30 minutes, and make sure it’s no later than 3 p.m. Why these two restrictions? Firstly, to prevent you entering deep sleep — remember, it’s easier to wake up from light sleep, which takes about 20 minutes (plus a few minutes to fall asleep). Secondly, regardless of when you do it, napping reduces your sleep pressure (the drive to sleep) while being awake increases it (see Chapter 1). If you nap too close to your normal bedtime (or nap too long, for that matter) you won’t have enough time to achieve the right amount of sleep pressure so that you can go to sleep at your normal bedtime. Instead, you might stay up longer but because you still have to get up at the normal time in the morning you then don’t sleep enough. (This is a good example of just how easy it is to experience sleep loss.)

Daylight: Another way to help increase your alertness in the afternoon is to expose yourself to some strong light. Remember, from influencing the internal clock (see Chapter 2), light has strong alerting effects. Try to go outside even if it’s an overcast day, as the natural light outdoors will be far brighter than the office light you usually spend your day in.

The best booster of all is a combination of all three. Have a cup of coffee, nap for 20 to 30 minutes and then go for a brisk walk outside. And then interact with people to help improve your mood. As we know, your mood can suffer from a lack of sleep and make everything seem like a hard slog. Withdrawing from everyone might seem the best way forward, but it isn’t. You’ll just feel even more isolated. So do the opposite and chat with someone.

How to spot tiredness

While (almost) everyone is aware of the dangers of drinking and driving, and thus follows the law to stay safe and keep others safe, the attitude towards not sleeping (enough) and driving is entirely different. The National Highway Safety Administration in the United States reports that 846 fatal driving accidents in 2014 were sleep related. Other research suggests that this is an underestimation and actual numbers are much higher. (This is probably similar for other countries, too.)

There are some warning signs that ‘advertise’ that you are tired or even fatigued, and that your performance is impaired. Some of these signs relate to cognitive performance, while others are physical signs, and again others relate to your emotional state.

In the table above I have listed the most important signs and symptoms and roughly order them by the severity of tiredness (from top to bottom). Please note that the progress from being alert to being tired to being fatigued is a fluid one and these signs and symptoms do not all have to appear, and not always in this order.

Being aware of these symptoms of tiredness and fatigue is important in all areas in your life. They signal that you haven’t had enough sleep or have been awake for too long. Eventually, the body will just take the sleep it needs and you start to experience micro-sleeps, brief moments where you unwillingly and unknowingly nod off. This is extremely dangerous when driving as you lose all awareness of the road and the ability to control your car. In a normal daily setting, such as at work or home, the risk to you and others is of course much lower, but nevertheless, it would be embarrassing to just nod off in a conversation or meeting.

Knowing the different symptoms of fatigue can help you to perform better and be safer in both your professional and private life. And once you know the warning signs you are able to spot them in others and can hint to them that they would benefit from some extra zzzz’s.

Extract from Sleep Sense by Dr Katharina Lederle, published by Exisle Publishing. NZD $29.99. 

Dr Katharina Lederle, MSc PhD, is a human sleep and fatigue specialist living in London. She is co-founder of Somnia, an organization that raises awareness about the importance of healthy sleep and which provides one-to-one sessions, sleep workshops and educational talks helping people sleep well and feel good.


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