What really goes on when we close our eyes at night?

Having spent several years as a GP, sleep was something I was aware I knew very little about?until a few years ago when I studied Sleep Medicine with The University of Edinburgh. I felt “Sleep”?was an area of specialist medicine that was beyond the scope of my generalist knowledge, a bit like genetics or virology. Except we all sleep and lots of us feel tired a lot of the time. We live with the consequences of our sleep patterns every single day and many of us suffer as a result.?

With more research pointing to the importance of sleep for physical health and risk of Alzheimer's Dementia in later life, I wanted to try to begin to get my head around what happens when we sleep and why so many of us feel so bloody tired. With the words of a wise Psychiatrist I was fortunate to work for ringing in my ears ‘ it’s impossible to have good mental health without good sleep’, I was also acutely aware of how sleep and mental health go hand in hand.?

Immersing myself in the world of Sleep Medicine I was truly fascinated by what I learned.?

Here’s my top 5 ‘oh wow’ moments:

REM isn’t the main event.Most of us have heard of REM sleep- rapid eye movement- which is when we have crazy dreams and are in a relatively light sleep. But we actually go through 5 stages of sleep when we go to bed at night, and we go in and out of these stages of sleep several times. In fact 75% of our sleep is in NREM - non rapid eye movement sleep - and each stage of sleep can be monitored by monitoring our brain activity AND serves a different purpose for our body and brain. We spend about 50% of our night in stage 2 NREM which is neither the lightest, nor deepest stage of sleep. In stage 2 our brain works to keep us asleep and resistant to the sudden wakening that can result from an outside noise?

Insomnia or insomniac??Many words that carry heavy weight are part of our everyday lexicon now. Stress, Anxiety, Depressed for example. You can experience feelings of stress, anxiety and depression without having a formal diagnosis of these. Insomnia can also fit in this category of being both a symptom and a diagnosis. Why does this matter? Having difficulty sleeping can be normal due to what is going on around or within you. Some may call this having insomnia. The key is that this should be transient and you should be able to revert to your normal sleep pattern once the external stressor has passed. But if the sleep challenges become pervasive and consistent, this may warrant a diagnosis of insomnia and require a different approach beyond early nights and chamomile tea.

Life vs Sleep Do you have Circadian Rhythm Sleep Wake Disorder? Lots of words for a diagnosis that means effectively there is a mismatch between your desire and drive to sleep and the external circumstances that are present in your life that prevent you from doing so. There are two reasons we sleep at night ; 1) A ‘Homeostatic’ process which is our inbuilt drive to sleep and 2) A Circadian process which is our natural rhythm triggered by our routines incorporating exposure to light, food and movement.?Altering these rhythms can disrupt our sleep as anyone who has ever flown long haul or had a baby can attest to. The most common reason for ongoing disruption to our natural rhythm is shift work and there is clear evidence that being a shift worker alters your natural rhythms in a way that can in impact the restorative nature of your sleep.?

You can’t thrive or even survive without sleep In the deepest stage of our sleep, known as slow wave or stage 3 sleep, our bodies are recovering. This includes the physical systems that keep us going, primarily our immune system.A minimal amount of sleep deprivation can activate our immune system and kick this into defense mode. You know that feeling of coming down with something and all you want to do is sleep? This is our immune system telling us we need to shut down and to help ourselves recover from attack. But if we are not actually coming down with something and sleep deprived, our immune systems will also be activated as if we are under threat. This can result in an autoimmune response. Our Professor even advised us that on studying the immune system responses of those suffering from sleep deprivation, there was a parallel to those who are seroconverting to HIV. Without immune systems and hormones out of kilter, there is little wonder why we can feel unwell and impaired when we are deprived of sleep?

Don’t suffer in sleepiness?The commonest cause of sleepiness in our communities is sleep deprivation or insufficiency. What works when you are not sleeping well? The first thing is to look at your routines in the run up to bedtime, during the afternoon and how long this has been affecting you for. Sleep Hygiene techniques are critical for helping improve sleep duration and quality however this may not be enough if you are suffering from a sleep disorder. These can take different forms of which circadian rhythm problems are only two from a category of seven so don’t ignore persistent poor sleep. CBTI- a specialised form or cognitive behavior therapy- is a proven treatment for insomnia that I was not even aware of until I did this course. Depending on the root cause of your sleep disturbance there are treatments and options available beyond a short course of sleeping tablets or a lifetime of exhaustion.?

?“I’ve never slept well, I’m just used to it” ’ was a sentence I used to hear regularly from patients and in the same way we might need help with gut problems or a bad chest, good quality sleep is essential for a healthy and happy life. Keep a sleep diary, research reputable sources if you can and ask for help.?

What works:

For sleep issues that are a result of environmental factors, sleep hygiene may be enough to solve the problem

These include:

• Avoiding caffeine after 1pm
• Exposure to light in the early part of the day
• Eating 2 hours before bed and avoiding alcohol as a pre bed relaxant
• Ensuring your bedroom is cool and dark?
• Switching off all devices 2 hours before bedtime
• Set bedtimes and wake up time