In the aftermath of major stress and exposure to traumatic events most adults will experience sleep disturbance of some kind. This may include difficulty in falling asleep when first going to bed, often accompanied by repetitive, intrusive thoughts that can’t be ‘turned off’, more frequent waking during the night with difficulty resuming sleep, and waking early in the morning. In addition, people may have nightmares and anxious dreams – normal-content dreams that are accompanied by a feeling of anxiety and apprehension. For many folk, these sleep disturbances will fade away over a few weeks, but nightmares and anxious dreams may continue for much longer; for a minority, their disturbed sleep may persist and become chronic.
The great majority of adults need to have between seven and nine hours of sleep every night. This is not optional: our brains need to sleep regularly for long enough for us to complete the full set of normal cycles of sleep (known as REM and nREM sleep) during which the brain processes memories, consolidates learning, and does essential metabolic housekeeping, and lack of sleep is associated with many adverse mental and physical health effects. Furthermore, we do not compensate for chronic lack of sleep during the working week by longer sleep at the weekend.
Unfortunately, in contemporary societies, many people live in a state of chronic sleep deficit and the sleep disturbances following stress or trauma make this sleep deficit worse. Individuals wake up feeling that they have not had enough sleep, they feel tired throughout the day and often resort to high consumption of stimulants, such as coffee, to maintain functional levels of alertness. Even so, concentration, memory, mood, and performance levels may deteriorate during the day, and chronically sleep-deprived individuals may experience micro-sleeps, where the brain enters the early stages of sleep for a few seconds or more. This can be extremely dangerous if driving, using machinery, or doing delicate manual work.
What can affected individuals do to restore healthy, normal sleep?
There are a number of steps anybody can do on their own, and/or with the cooperation of their partner and family, to make it more likely that they regularly will get a good night’s sleep.
Step 1: Do a sleep hygiene check, and fix any problems with the bed and bedroom environment and bedtime routines that the check reveals. Sleep hygiene involves a set of standard conditions and routines that optimise our chances of sleeping well. See below for the sleep hygiene checklist.
Step 2: Good nutrition promotes good sleep [see advice by Professor Julia Rucklidge here]. As part of sleep-promoting nutrition, limit caffeine consumption, especially in the afternoon and evening. This includes coffee and also the many high-caffeine soft drinks and so-called sports drinks, and may also include ‘comfort foods’ like chocolate.
Step 3: Meditation or relaxation: In addition to improving nutrition and doing the sleep hygiene check, or if sleep disturbance persists for several weeks despite improvements in sleep hygiene and nutrition, then it is worth beginning the regular practice of meditation or relaxation in the hour prior to going to bed. Meditation and relaxation can also be used to help us go back to sleep following night wakings.
There are many books and on-line resources to guide people in meditation or relaxation practice; if you don’t already have a favoured routine, then select one that you find congenial and begin to practice. You will need to be patient – meditation and relaxation are skills that it takes time and practice to become good at. Join a class if you are not making progress on your own.
Further Steps
If, after a month or two of improved nutrition, sleep hygiene and meditation/relaxation practice, sleep disturbance of one sort or another persists, then you probably need to see a professional, ideally a medical practitioner or psychologist with some expertise in treating insomnia. There is excellent evidence that a form of therapy called Cognitive-Behaviour Therapy – Insomnia (CBT-I) is generally quickly effective. In addition to sleep hygiene and meditation/relaxation, CBT-I focusses on those core beliefs and their emotional concomitants that interfere with sleep and will assist the client to restructure these beliefs. If persistent nightmares and/or anxious dreams are an ongoing problem there are special techniques within CBT-I that specifically address that problem.
What about sleeping pills and alcohol?
Sleeping pills should be regarded as a last resort. It is very important to understand that sleeping pills, although they produce hours of unconsciousness that simulate sleep, do not give us normal sleep. In fact, they seriously disrupt the brain patterns characteristic of normal sleep. If taken, they should be used for no more than 3 – 5 nights, with a break of several days to see if natural sleep can be re-attained, before any further consumption.
Unfortunately, if sleeping pills are taken for long periods, when the individual stops taking them there is a period of several nights during which the brain is trying to adjust back to normal REM/nREM sleep patterns and this is often experienced as highly disrupted sleep, so the affected individual resumes the use of sleeping pills. This creates a vicious cycle that perpetuates drug consumption. Self-medication with alcohol is also to be avoided; it will make insomnia worse, not better, in the long-term.
Is there any data on using micronutrients to help with restoring good sleep?
Yes there is! We have conducted two studies in the Mental Health and Nutrition lab documenting that taking micronutrients at appropriate doses can significantly improve sleep and sleep quality. Email mentalhealthnutrition@canterbury.ac.nz for more information. Just don’t take B vitamins too close to bedtime as they can activate your mind rather than quieting it down.
The sleep hygiene checklist – here is a list of some great sleep hygiene advice. For instance,
- Check that the bedroom is dark, quiet and not too warm or too cold
- Remove sources of stimulation such as televisions from the bedroom
- Put devices such as mobile phones, tablets, computers etc away in a drawer or outside the bedroom – the light they emit turns on the wake-up part of the sleep-wake cycle
- As much as possible, have a set routine time to go to bed and to get up in the morning
- When you get up in the morning try and expose yourself to natural light from the sky
- Avoid highly stimulating activities and social interactions in the hour or so before bed
- If you can’t fall asleep within about 20 mins of lights-out, then get up and leave the bedroom. Find a place to engage in quiet pleasant activities – e.g., read, listen to music – until you feel sleepy again. Repeat this as often as necessary until you fall asleep. Above all, break any connection between lying awake in bed and feeling agitated, anxious, or preoccupied with being unable to sleep.
