Sleep Therapy

Sleep therapy is used to help individuals identify what may be contributing to their sleep problem.

Traditionally GPs have prescribed sleeping medication, however now the preferred treatment is talking therapies such as iCBT – cognitive behaviour therapy for insomnia. This is starting to widen to incorporate mindfulness and Acceptance and Commitment Therapy techniques.

Holistic Assessment

Sleep itself needs to be looked at from a holistic approach. Using knowledge of our circadian rhythms and the hormones involved in sleep we can improve our sleep purely through simple measures and education.The main hormones involved in sleep are melatonin and adenosine. Melatonin can be thought of as the hormone which starts off the sleep process – this ultimately leads to the sleep/wake switch in the hypothalamus turning to off – i.e asleep.

Adenosine is considered the ‘sleep pressure hormone’ and increases throughout the day so that after 18 hours of wakefulness it powerfully induces the brain to sleep in conjunction with approximately 16 other hormones. If a person falls asleep with a lower level of melatonin and adenosine then they may not have enough sleep drive (or pressure) to maintain a sufficient number of hours sleep.

Sleep Education

A knowledge of how these hormones are influenced by light, adrenaline and caffeine to name a few, informs sleep therapy. The human eye is sensitive visible light, and this light regulates our melatonin and circadian rhythm. Visible light is that part of the electromagnetic spectrum that is seen as colours: violet, indigo, blue, green, yellow, orange and red.  Specifically, blue light has a very short wavelength, and as such suppresses the release of melatonin. This blue light is emitted by digital screens, the sun and fluorescent and LED lighting. Thus sleep hygiene practices address an individual’s bedroom environment and bedtime routines to ensure a reduction in exposure to blue light.

Modern Life

Superimposed upon these natural sleep mechanisms is modern life. Although this is now changing society does not value sleep as the essential behaviour that it is. All creatures sleep and without enough of it our health and quality of life are drastically reduced.

Conventional advice will recommend that a sleepless person gets up after 15 minutes of lying in bed – this does not address the underlying reasons behind sleeplessness and insomnia. Sleep therapy will help an individual stay in bed by addressing unhelpful sleep associations and habits. Support will be given to help an individual cope with the unpleasant process of staying in bed despite not sleeping, and ultimately retrain the brain to allow sleep to take place.

Sleep therapy may comprise of different techniques to improve sleep hygiene and support any anxieties which may result from making changes to an individual’s sleep.

Goodnight Solutions is pleased to announce they are now working in partnership with Salus Wellness Centre in Cambridge.

Visit http://www.salus-wellness.com or for more information and support visit https://www.goodnightsolutions.co.uk/contact/

 

“Sleep results from a complex cascade of hormones in the brain which initiate and maintain the state of sleep throughout the night”

One of the main hormones involved in sleep is melatonin.

Melatonin helps to regulate the timing of sleep onset but does not generate sleep by itself. Once sleep is achieved melatonin slowly decreases over the night and as sunlight enters the brain (through closed eyelids) the release of melatonin is stopped by the pineal gland.

As darkness falls at the end of the day the pineal gland no longer stops the release of melatonin and so the brain/body is primed for sleep again.

This is our circadian rhythm – the term for the body’s natural cycling of hormones – and simply put is the sleep/wake cycle. See https://www.sleepfoundation.org/articles/what-circadian-rhythm

Thus light (natural and artificial) is the biggest external control of our circadian rhythm. Other influences on our circadian rhythm are sound, meal timings, temperature and social cues – ie work/school timings.

Another important chemical involved in sleep is adenosine.

Another important chemical involved in sleep is adenosine. This builds up naturally throughout the day as a byproduct of using up our internal energy stores. For most people it creates an irresistible desire for sleep after 12-16 hours of wakefulness. This appears to be mainly related for a desire for deep sleep rather than REM sleep.

Luke Mastin (2017) describes this in much more detail in his blog https://www.howsleepworks.com/how_homeostasis.html

The combination of melatonin and adensosine creates the natural peaks and troughs of wakefulness throughout the day.

These are much more noticeable in people who are not achieving enough sleep at night. Caffeine temporarily blocks the affect of adenosine creating a boost when tired. This is useful just after lunch but not at 9 pm for example.

Temperature and sleep

Core body temperature also operates on a 24 hour rhythm. A 2 degree drop in body temperature helps initiate the sleep process. This is why vigorous exercise too close to bedtime wakes us up. It also explains why factors such as stress, which increases the ‘flight or fight’ response, therefore raising body temperature affects sleep. Likewise the temperature surges associated with the menopause has a detrimental affect on sleep.

Groggy in the mornings?

Sleep inertia which is the feeling of grogginess in the first 30 minutes after your alarm goes off in the morning. This is more likely to occur if you are wakened from the short period of deep sleep occurring after around 6 hours of sleep. See previous blog https://www.goodnightsolutions.co.uk/need-to-know-about-your-childs-sleep

Quick recap!

Regular sleep and wake times to help our circadian rhythm. Cool and dark bedrooms help the hormone cascade initiate sleep. Try to reduce worries and anxieties which can affect sleep. Prioritise as much sleep as possible to reduce sleep inertia and sleep deprivation.

Need help?

Contact me at https://www.goodnightsolutions.co.uk/contact/

What are your thoughts about sleep?

Insomnia or sleep deprivation? Part 2. In the first part of this blog we looked at some tweaks parents could make to give themselves more time in bed. We also discussed the quality of our sleep and our priorities as adults. Is there an accidental sleep deprivation or a real problem with insomnia?

The Great British Sleep Survey 2017 identified that as a whole we were following conventional sleep advice regarding screens and sleep hygiene. The survey found more people than ever were using music and mediation to help them sleep and yet the amount of hours slept was overall lower than 4 years previously.

https://sleepcouncil.org.uk/wp-content/uploads/2018/04/The-Great-British-Bedtime-Report-2017.pdf

Therefore awareness of sleep hygiene and the importance of sleep does not necessarily mean we are achieving a good nights sleep.

Why is this?

Consider how our brain works – it is designed to learn from experience, to extrapolate from previous situations and help us change our behavior to avoid repeating mistakes. Our brains are also very good at ruminating and worrying about the ‘what ifs’. As an example, if a person who generally sleeps well has a bad nights sleep – they may shrug it off as a ‘one off’ and continue as normal. If that person then has 2 or 3 bad nights sleep then their brain may well start to forecast and predict that they will ‘never sleep again’.

This may start a cascade of worrisome thoughts and feelings regarding sleep. This person is now giving much more attention and weight to this problem and will naturally try to solve it. Conventional advice regarding insomnia looks at sleep restriction, getting up after 15 minutes of sleeplessness and other techniques including lifestyle improvements and possibly CBT for Insomnia. This advice is helpful in the short term and will most likely help resolve intermittent periods of insomnia.

But I’ve tried all that you say!

Let’s look at advice previously given by Goodnight Solutions regarding children’s sleep. In past blogs I have discussed sleep environment, bedtime routine and falling asleep where you want your child to sleep all night.

This advice all relates to sleep associations i.e feeding to sleep, dummies or a parent present. It also links to the normal cascade of hormones needed for sleep initiation, i.e bedtime routine to regulate the melatonin release needed for continual sleep. Adults (and teenagers!) are no different. We also need that strong regular release of melatonin which is promoted by a short calming bedtime routine and consistent sleep and wake times. Remember we all run on a circadian rhythm.

Now consider looking at the clock every evening to see if you have been awake for 15 minutes or more knowing that perhaps you then need to get up. Is that relaxing? Think also of those worries and anxieties which pop into your brain as you lie there. It is is not an easy task to lie with troublesome thoughts and the emotions that accompany them. But these thoughts are just that – thoughts and feelings – and not actual events happening at the time.

We need to stay in bed!

To achieve better sleep we need to stay in bed, falling asleep anywhere else is a poor sleep association and will not maintain long term good sleep. We need to rid ourselves of the negative association of bedtime and our beds by accepting that we probably will lie awake! However lying awake in bed is still more restful than marching around the house and will result in a more rested next day regardless of whether we fell asleep. As a sleep practitioner I always tell parents to reward their children for lying still in bed and NOT for falling asleep as this is beyond their control. Likewise for an adult – we cannot control when we fall asleep – it is a complex hormonal cascade.

Conversely however our brains are very good at preventing us from falling asleep. The more we try to fix this the harder it becomes, as our brain is now far too active and engaged. In fact our brain is most likely activating the ‘fight or flight’ stress response as we get into bed as that is what it has become conditioned to do. It is not easy to change the way we see our insomnia. However by changing our attitude to lying in bed awake we will start to see small improvements in our nights. This allows us to make more positive changes during the day and starts us on an uphill spiral again.

For help and support with your family’s sleep or for help in the workplace please contact https://www.goodnightsolutions.co.uk/