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The real reason you’re not sleeping, and what to do about it

From Holden Cycling Collective Zwift Ride

It’s that sticky time of year when hot nights and far-too-early dawns play havoc with our sleep and even more people seem to struggle with insomnia than usual.

It is estimated that 30 percent of adults have difficulty sleeping, and this figure rises as we get older.

For the over-60s the figure is about 40-50 percent, and the picture is even worse for women —

according to the British Menopause Society, the number of peri- and postmenopausal women who struggle with insomnia could be as high as 60 percent.

When it comes to sleep, midlife has all the right ingredients for disruption. For many people, it is when careers and financial pressures intensify, allied to the stress of having teenagers in the house or facing empty-nest syndrome, all while elderly parents become increasingly infirm.

For women, the hormonal chaos of the perimenopause begins, and for both sexes, melatonin production starts to decline gently and levels of cortisol, the hormone that is responsible for waking us up, start to climb. Sleep becomes lighter, shorter, and more fragmented, and we are more likely to develop sleep-related conditions like restless legs syndrome and obstructive sleep apnoea. It can feel as if sleep issues are an inevitable part of growing older, especially for women, who are twice as likely to suffer from insomnia than men. But, I am sleeping better than I ever have before. Not by discovering the best-weighted blanket/ white noise machine/ pillow spray, but by gaining a deeper understanding of how sleep actually works and putting this new-found knowledge into practice. Here are some of the lessons I have learnt.

You may need less sleep than you think

It is widely reported that we should all be getting a minimum of eight hours’ sleep every night, but this is an average, not an ideal.

How much sleep you need is as personal to you as your shoe size or eye colour, and trying to change it is like trying to be taller.

Furthermore, we naturally get less sleep as we age — studies show that we lose approximately 30 minutes per decade starting at midlife —

so even if you got eight hours regularly in your thirties, you will probably get less than this in your fifties.

It is the quality of the sleep you get rather than the quantity that really matters.

One definition of “enough sleep” is when you have the energy to do the things you want to do most of the day, most days, so don’t worry about the hours and minutes or whether you fall short of misleading “recommendations”.

Trust that you are probably getting enough, even if it’s shorter and more broken than it used to be.

Waking up earlier — or in the middle of the night — is normal

As you reach midlife you can expect to wake up in the night more often, because sleep becomes more easily disturbed as we age.

This is normal; even the best sleepers wake up two to three times a night, but they usually don’t notice and go back to sleep.

As well as more frequent awakenings, you may start waking up earlier than you want to because we become more “larkish” as we get older.

One theory is that the part of your brain responsible for your circadian rhythm becomes less effective over time.

As Russell Foster, professor of circadian neuroscience at Oxford University, says: “Different sleep isn’t necessarily ‘bad’.”

What matters now is how you react to this new nocturnal landscape. If you become anxious about it and try to fix the “problem”,

it is likely to start a spiral of bad sleep that will lead to even more night wakings and even earlier starts.

But if you canaccept the changes relatively calmly and resign yourself to being awake a bit more,

you will go back to sleep more quickly and the sleep you do get will be more restorative. So-called sleep hygiene can make things worse

When sleep starts to go wrong, it is a natural human instinct to try to fix the problem.

In the 21st century, this means googling “how to sleep better” and following advice found online.

The more scientific-sounding guidance to be found is what is known as sleep hygiene and it implies that if you follow all the “rules” you will get a good night’s sleep

So you reduce the temperature of your bedroom to 18C, make sure you have blackout blinds, go to bed at the same time every day,

have a bath as part of your two-hour wind-down routine and switch off your devices an hour before bedtime —

but despite doing all the right things you still can’t sleep.

It’s not that the advice is wrong, it’s just that it comes with the implication that it will magically send you to sleep.

The truth is that nothing has the power to make that happen. Sleeping is a passive process and it cannot be controlled, however hard we try. A lengthy or convoluted wind-down routine can actually make things worse because it increases pressure and expectation, which lead to anxiety and frustration when we (inevitably) fail. If you ask a good sleeper what they do to get to sleep, they will look at you blankly. If you ask an insomniac, there will be a long list of rules and rituals.

Sleep works best if left to its own devices, so you need to stop trying so hard to control it.

The real reason many of us can’t sleep: hyperarousal

Allow me to introduce you to hyperarousal,

the state of physiological high alert triggered by the fight-or-flight response and the real villain of this piece.

As the name implies, hyperarousal is the opposite of relaxation and it is what stops you from sleeping,

even when you are completely exhausted. It is responsible for that “tired but wired” feeling at bedtime and for waking you up with an adrenaline rush in the middle of the night.

Obvious triggers of hyperarousal include work stress and daytime anxiety —fuelled by the smartphones constantly at our fingertips — and caffeine, which artificially stimulates the arousal system.

Unfortunately a lack of sleep is a trigger itself. 

Not only will hyperarousal levels stay high overnight if you sleep poorly, but the brain sees being overtired as a vulnerable state and activates yet more to help you to get through the day.

The situation is further complicated by anxiety around not sleeping — the very act of worrying about going to bed or waking in the night can trigger hyperarousal,

making it more difficult to nod off. 

Happily there are many ways physically to reduce your hyperarousal levels to let you sleep and this starts a virtuous circle:

the more you sleep, the less hyperarousal you have, the more you sleep and so on.

To beat hyperarousal, try yoga, a worry diary or ‘4-7 breathing’ for ten days

The key to reducing how much hyperarousal you take to bed with you is to find ways to handle your stress during the day or before bed. Effective exercises include slow breathing, yoga nidra, t’ai chi, progressive muscular relaxation, meditation or writing a worry diary — where you write everything preying on your mind down on paper to switch off the amygdala,

otherwise known as your brain’s worry center.

Personally, I (Mari Holden) do 5-10 minutes of “4-7 breathing” — breathe in deeply for four seconds and out for seven — in the evening while watching TV or just before I go to bed and that seems to be enough to activate the parasympathetic nervous system, which is responsible for the “rest and digest” response required for peaceful sleep. It is important to note that, due to the slippery nature of sleep, none of these exercises is guaranteed to make you nod off tonight, but if you keep them up for ten days with the intention of reducing your overall levels of hyperarousal, better sleep should be a happy consequence.

Plan activities for if you wake up in the night

I know first-hand that it isn’t always easy to be calm when you have woken up at 2.30am for the third night in a row,

so I recommend that you line up something enjoyable to read, listen to or do, as soon as it’s clear they aren’t going to fall back to sleep quickly.

Ideas include listening to audiobooks or podcasts, reading a book, looking at photos or videos on your phone, playing word games or even watching TV.

Don’t worry if what you choose to do involves a screen.

Foster believes the effect of the blue light from smartphones has been widely exaggerated and the small amount you absorb is “extremely unlikely” to affect sleep.

It’s the content and time you spend on your device that acts as a stimulant, and your anxiety about not being asleep that keeps you awake.

So stay off social media, but go ahead and look at your phone or tablet if it will make it easier to accept your new sleep pattern.

Don’t worry about what lack of sleep is doing to your health

As illogical as this sounds, there is a very important distinction to be made between getting less sleep due to insomnia

and the frightening headlines you may have read about the terrible long-term effects of sleep deprivation, such as cancer, Alzheimer’s disease and diabetes.

Insomniacs typically get the same amount of deep sleep as normal sleepers (about three hours),

as the body adapts to prioritise it at the expense of light and REM sleep, snatching it whenever it can in the night.

It is this physically restorative deep sleep that protects insomniacs from long-term health consequences.

Health anxiety drives a lot of sleeplessness, so it can be deeply reassuring for people to know this, and might stop a period of bad sleep developing into full-blown insomnia.

Yes, not getting enough sleep will leave you feeling exhausted, more anxious and possibly less cognitively competent temporarily,

but it will not shorten your life. So take that off your list of things to worry about at three o’clock in the morning.

Avoid caffeine in the afternoon and alcohol before bed

Though following most sleep hygiene rules isn’t helpful,

there are a few concerning what we drink that become more pertinent in midlife and which are therefore worth adhering to.

As we age, we become more sensitive to caffeine and the speed with which it clears our system begins to slow down —

on average it takes 65 to 70-year-olds 33 per cent longer to metabolise — so it is worth reducing your caffeine intake and restricting it to the morning if you are having trouble sleeping.

Alcohol is another renowned sleep disrupter, and its effects get worse as our ability to process it becomes less efficient in midlife.

But you don’t haveto give up drinking completely, just stop earlier.

Having your last drink two to four hours before bed will give your body a chance to process it,

reducing the likelihood of those awful, angst-ridden awakenings that alcohol can induce.

Nocturnal urination increases with age, so it makes sense generally to drink less liquid in the evening if you find yourself waking to pee more than once a night.

And maybe forgo that cup of camomile tea just before bed if you want to make it through until dawn.

What to eat for a good night’s sleep

Take a vitamin D tablet. There is growing evidence that vitamin D is involved in sleep regulation

and low levels of the vitamin are associated with poorer sleep quality and duration.

“Quite how it might work is uncertain, but a lot of studies have reached the same conclusion,” Marber says.

“Getting outside in the summer months is important to boost the body’s natural production of vitamin D,

and including oily fish and egg yolks in the diet will help, but the best way to ensure a consistent intake is with a supplement.”

Have a glass of milk

Your grandmother was right — a glass of milk before bed could help you get to sleep.

Milk is a source of tryptophan, an amino acid that is believed to have sedative effects (although evidence for its specific sleep effects is lacking).

“Any food that contains protein — milk and yoghurt included —

will provide the body with building blocks needed for the production of the sleep-inducing hormone melatonin, so might help,” the consultant sleep scientist Dr Neil Stanley says.

Milk also contains a cocktail of milk peptides, called casein tryptic hydrolysate (CTH),

that researchers reporting in the Journal of Agricultural and Food Chemistry suggested have more specific anti-anxiety and sleep-enhancing effects.

Eat more magnesium-rich food — brown rice and pumpkin seeds

Magnesium, found in quinoa, spinach, brown rice and pumpkin seeds, may help to promote healthy sleep.

Some studies have shown that a deficiency of the mineral disrupts nerve signalling so that production of sleep-inducing hormones is reduced.

“In addition to encouraging muscle relaxation, magnesium is a key component of a neurotransmitter called gamma-aminobutyric acid [GABA]

that carries messages from the brain to the nervous system,” the nutrition therapist Ian Marber says.

“It has a very mild sedative effect that helps to offset symptoms of anxiety, one of which is insomnia.”

Try eating more magnesium-rich foods — and if a deficiency is diagnosed you may need a supplement.

“I recommend trying a 100mg dose half an hour before bed for a few nights to see if it begins to make a difference,” Marber says.

Choose romaine lettuce for your salad

Lettuce contains the compound lactucarium, which has been shown to have sleep-inducing effects.

The best source of this natural sedative is romaine lettuce, which has higher concentrations than other lettuce varieties.

Recent studies have shown that lettuce-seed extract and lettuce-seed syrup improve quality of sleep during pregnancy and in cancer patients respectively.

Have a cherry shot to boost melatonin

Tart Montmorency cherry juice is known to contain large quantities of beneficial polyphenols and anthocyanins,

which have important anti-inflammatory and antioxidative effects, but drinking a shot of it could also enhance sleep, research has shown.

Glynn Howatson, professor of sport, exercise and rehabilitation found that consuming tart cherry juice concentrate boosted the production of melatonin in a group of volunteers,

improving both the quality and duration of their sleep over seven days.

Try sedative herbs such as valerian

Tea made from the root of the herbal valerian plant has long been used as a sedative in traditional and alternative medicine.

There’s conflicting evidence about its benefits, although a review of 60 scientific papers involving 6,894 people suggested that it may help to promote sleep.

“Some researchers suggest that long-term use of valerian boosts the action of the neurotransmitter GABA and increases the time it takes to drop off and the duration of sleep,” Marber says.

Avoid eating at least an hour before bedtime

The closer to bedtime you eat your last meal, the more likely it is that your sleep pattern could be disrupted.

“If you have a snack, keep it small to avoid taxing your digestive system,” Marber advises.

Studies have shown that carbohydrates can boost the uptake of tryptophan — the amino acid thought to have sedative effects — from your diet by the brain.

However, “for some people the spike in blood sugar that comes with carb consumption results in a burst of energy that outplays the soporific effects of tryptophan,” Marber warns.

Avoid sugary and refined carbs, which will result in the sharpest sugar rise, and opt for healthy whole grains that are high in fiber.

Now get some good sleep and as always

Be Kind, Do Fearless

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