Monday, 29 October 2007

Sleep and "Semi-Somnia"

That'll teach her to become addicted to my blog...

I saw this in The Daily Mail while at work. Working nights I know all about sleep problems. I also know more than one acquaintance outside of work who has suffered from sleep ailments of one sort of another. This is for them!

Are you one of the millions of Britons suffering from 'semi-somnia'?
Moira Petty, Daily Mail, October 23rd 2007

The buzz of the alarm clock forces you out of bed, blearyeyed and anything but refreshed.

You snap at your partner, lose patience with the children and struggle into work with all the dynamism of a slug.

About the only thing that keeps you going through the day are sugary snacks.

Back home, even when the evening's tasks have been completed, there are 101 things to do — e-mails to check, a television programme you want to stay up for, preparation for the next day.

Millions of Britons are suffering from 'semi-somnia' - chronic tiredness caused by our hectic 24-hour lifestyle

You finally fling yourself exhausted into bed, mind racing, and wonder why you can't get to sleep.

Sounds familiar? You, like another 30 million Britons, could be suffering from semi-somnia, a term coined by leading sleep expert Dr Neil Stanley to describe persistent low-grade exhaustion due to poor sleep.

"If you put 100 people in a room and asked how many of them felt really good, energetic and full of vitality, few would raise their hands," he says.

In a report, commissioned by Horlicks, to be published next week - revealed exclusively in Good Health today - Dr Stanley reviewed 30 years of academic sleep research and discovered that huge numbers of people complain of feeling chronically tired all the time - "semi-somnia".

But because these people did not have "proper" insomnia or other serious sleep disorders, they were largely ignored by healthcare professionals.

The problem is caused by a combination of lack of sleep and poor quality sleep, and is the result of living in a culture with competing demands on our time.

"These days, we don't see sleep as an end in itself, but as a disposable thing which gets compressed," says Dr Stanley.

"As a result, we trim time off the hours of sleep we get, and when we do sleep, we sleep fitfully because our minds are buzzing."

So how is semi-somnia different from insomnia?

It's like comparing someone who eats only junk food to someone whose diet is half junk food, half nutritious food.

The symptoms of insomnia include taking longer than 30 minutes to get to sleep, and frequently waking in the night or early in the morning.

Chronic insomnia occurs most nights for more than three weeks, but often lasts for months, years or decades.

The semi-somniac may suffer milder versions of the same symptoms; or they may simply not sleep for long enough because they have too much else to do.

It may be a halfway house, but, says Dr Stanley, semi-somnia is a real health concern that should not be ignored. He suggests it is as grave a concern as the obesity crisis.

Yet while there is plenty of public health information about diet, there is almost no attention paid to how vital sleep is to our wellbeing.

The symptoms of insomnia include taking longer than 30 minutes to get to sleep
"We have lost sight of the fact that sleep is vital for good emotional, mental and physical health, and as important as exercise and a good diet," says the former director of sleep studies at the Human Psychopharmocology Research Unit, University of Surrey. (He is now manager of the Clinical Trials & Research Unit at the Norfolk and Norwich University Hospital.)

When we sleep, we experience cycles of deep sleep, in which our body and immune system are repaired, and REM (rapid eye movement) sleep, in which we dream, lay down memories and deal with stress and emotions.

If we don't sleep for long enough, our body will play catch up next time. It makes up the deep sleep first - although in extreme cases you might never achieve this completely. It may never get the chance to catch up on the REM sleep.

In the short term, poor sleep is linked to irritability, poor performance, lowered immunity and mood swings. In the longer term, it can lead to depression, obesity, type 2 diabetes, heart disease and stroke.

Poor sleep has been linked to marital problems and divorce, time off work and unemployment.

One in five car accidents is caused by tiredness - more than the number caused by drink-driving.

In his report, Dr Stanley calculates that this year alone, semi-somnia will cost the National Health Service £290million in treatment.

Intriguingly, Dr Stanley's research suggests that while many of us feel tired (75 per cent of the population admit to waking up exhausted every day), most don't realise, oddly, that it's due to poor sleep - blaming instead factors such as poor diet or lack of exercise.

Semi-somnia is not calculated on the basis of how much sleep you have, but how much you need to be really vibrant the next day – and only you can be the judge of that.

"What is important is not how you rate your sleep, but the daytime consequences of your sleep," he says.

The clue to finding out if you are suffering from semi-somnia is to ask yourself, on a scale of one to 10, how good you feel at 11am and 2pm.

"If you're a five, you're half as good as you should be," says Dr Stanley.

"Even a seven isn't there. If you're suffering from semi-somnia, you have the feeling that you are not on top of the game.

"We live in a tired society, and we have become accepting of being tired. The days when we feel really good are incredibly rare."

So why haven't doctors taken this chronic tiredness more seriously? It seems part of the problem is that we have concentrated exclusively on insomnia.

Dr Stanley, who has previously run a 24-bed laboratory monitoring sleep problems, says that just three per cent of the population suffer from medically recognised sleep disorders.

Apart from chronic insomnia, these include bruxism (clenching or grinding of the teeth), sleep apnoea (excessive snoring in which the sleeper stops breathing many times in the night), and narcolepsy (falling asleep without warning at inappropriate times).

Another problem, he says, is that doctors have so little training in the area.

One study found that half of all doctors receive no training on sleep problems, and the other half get five minutes' training in seven years of study.

"I'd like to know which bits are covered in those five minutes," says Dr Stanley.

"If you go to the doctor and say you're having sleep problems, as likely as not you'll be prescribed drugs for insomnia."

Few GPs even tell patients about the standard sleep hygiene rules devised by Peter Hauri in 1977.

Hauri, who directed the insomnia programme at the famous American Mayo Clinic, is widely regarded as the world's foremost sleep expert.

The rules can be found in self-help books, but even then, they are really aimed at insomniacs.

Among Hauri's rules was the advice that stimulants and alcohol should be avoided in the evening, and that a light snack should be eaten at bedtime to harness the sedative effects of digestive hormones.

Stanley says this is not only an inflexible, one-size-fits-all approach, but it is often unsuited to today's world.

He favours a much less prescriptive approach, with basic principles that the individual adapts to their style and needs.

"The most important thing is that we must actively pursue sleep: we must prepare for it rather as we warm up before exercise," says Dr Stanley.

"We insist that our children 'wind down' before bedtime - and adults need to do the same, physically and mentally.

"But every person's wind down needs to be personal to them, depending on their likes and dislikes."

The first step is to understand the modern barriers to sleep - and to work out which affects you in order to fix your semi-somnia.

Dr Stanley says there are two main problems: our inability to switch off from work and the 24-hour society, and bedtime "buzz".

"We work and play hard, and time has become irrelevant. Sleep is seen as something you snatch when you are finished with everything else.

"We live in a 24-hour society, where you can even do your supermarket shopping in the middle of the night.

"Twenty to 30 years ago, there was no overnight TV or radio, and no all-night clubs, let alone the internet.

"Texting is one of the major problems of teenage sleep. Teenagers are actually woken in the night when they hear the ping announcing they have a message.

"Then there are people who sit up using the internet, thinking: 'I must stay on top and be in control.' But evolution says we should be awake in the day and sleep at night."

For some people, the problem is compounded by an inability to separate work from their home life. "You know the sort," says Dr Stanley.

"They have a BlackBerry and two mobile phones glued to their ears. They can't switch off, and are still checking their messages late at night.

"But in order to fall asleep, you have to be thinking of nothing in particular — but nowadays that's virtually impossible. No wonder so many of us can't sleep."

The other major problem is what he calls "bedtime buzz"; our habit of going to bed with the day's issues - personal, domestic or career - unresolved.

"Don't lie in bed next to your wife discussing the mortgage repayments," says Dr Stanley.

Sometimes this buzz is caused by stress over our inability to sleep.

"The more you worry about not sleeping, the harder it will be."

Dr Stanley admits that many of his techniques are simply common sense - but the key is to do what suits you.

That means that if drinking alcohol or coffee at night doesn't affect your sleep, you can avoid Hauri's strictures against such habits.

"If you have happily been drinking a cup of coffee every night for 40 years and more recently had sleep problems, in all likelihood the coffee is not the culprit," says Dr Stanley.

"People go out to dinner, have a heavy three-course meal and then order a cup of decaffeinated coffee - as if that will make any difference.

"Your body temperature needs to fall before you go to sleep, and it won't if you have taken in all those calories just before bedtime."

Nor does he believe that TV and radio should be banned from the bedroom - even though this goes counter to all the advice usually given about sleep problems.

"If having a television in the bedroom is an excuse to watch for hours more than you would if you were still up, then that is not good. But if it helps you sleep, that's fine.

"It's not the process of getting to sleep that is important, but the destination.

"My message to semi-somniacs is be nice to yourself. Wind down in a way that pleases you. Make it a pleasurable process.

"Sleep is such a good thing to have and as essential - and arguably even more so - as good diet and exercise.

"See sleep as a pleasure. Going to sleep is such bliss. If we forget that, then, as a society we must accept the consequences.

"Remember how good you feel when you've had a really good night's sleep, and think how much better you would work if you always felt like that."

Dr Stanley's report, Making Time For Sleep, will be available on from October 30.

Here are Dr Stanley's 3Rs of getting a good night's sleep:

RESOLVE: The countdown to bed, when you begin the process of putting aside the day's chores and worries. Start by turning off the computer and perhaps the radio and TV, too.

Music might provide a better background for your sleep preparation.

Think about your environment. Can you soundproof it against car alarms or noisy neighbours?

Invest in the thickest curtains or blinds you can find. Just four minutes of sunlight on the retina are enough to make you feel wide awake.

Does your partner disturb you with snoring or restlessness? Consider a bigger bed, or separate bedrooms.

Your evening meal should be three to four hours before bedtime. There's no need to avoid specific food or drink unless they interfere with your sleep.

RELAX: Use a relaxation technique. Some prefer yoga or meditation, but for most people a hot bath with your favourite oils will work.

Perhaps light a scented candle or play classical/light music in the background. Your bedroom needs to be as inviting as you can make it.

The body needs to cool down before you can sleep so make sure the bedroom is well-ventilated and turn off the heating well before you go to bed.

Women are more likely to suffer from semisomnia, partly because hormonal changes cause their temperature to rise.

Do not keep a computer in the bedroom. (Some people are online until they climb into bed.)

A TV or radio is fine if it provides a harmonious background to your bedtime ritual. Take advantage of feeling sleepy and go to bed.

A hot milky drink such as Horlicks works for some people.

It sounds obvious but with so much entertainment on offer, too many of us sit up yawning long after our body has told us it is time to sleep.

RELEASE: Develop techniques to counter "racing brain", when an overactive mind stops you sleeping.

Ideally, you need to be thinking of nothing much and allowing your mind to drift. For some people, playing a familiar, well-loved piece of music may help.

Visualisation techniques can be useful: imagine a scene of great serenity. The textbook example is a deserted, tropical beach at sunset - but an entirely different image might appeal to you.

If you are concerned about things you need to do the next day, write a list on a pad and leave it on the bedside table.

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