Methought I heard a voice cry ‘Sleep no more!
Macbeth does murder sleep’, the innocent sleep,
Sleep that knits up the ravell’d sleeve of care,
The death of each day’s life, sore labour’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast,

Macbeth, Act 2, Scene 2.

It is said that when Margaret Thatcher was Prime Minister of the UK she was very dismissive of the need for sleep. Allegedly she once told her cabinet that “Sleep is for wimps”. Of course she was very wrong about this but the question still remains: why do we need to sleep? Why is it so important that we learn to sleep well?

Sleep is actually a crucial part of our lives. Few of us pay sufficient attention to it. On average we spend about a third of each day sleeping. If we were to live ‘till we were ninety we would have spent at least 30 years asleep. A behaviour that occupies so much of our time has to be significant. Sleep deserves respect.

The truth is that we all need sleep. While no one knows exactly why, it’s clear that we need to sleep. And its not for wimps. For one thing without sleep our mental and physical health inevitably deteriorates. It seems that sleep is necessary to allow our body time for repair. There is plenty of experimental evidence to support this view. Resting is restorative and sleep is the most restorative restful experience you can have.

Some key biological processes take place when we are asleep, and sleep seems to be a necessary condition for the body and brain to get this important chemical work done. Sleep is not a waste of time. In fact, when we are asleep our bodies and our brains are very busy.

What is normal sleep? The average adult needs about 8 hours sleep per night but this varies. Young people need more sleep than adults and some adults need more sleep than others of the same age. The amount of sleep we need is an individual thing and so variation is normal.

The commonest explanation for loss of sleep is stress. Any personal crisis can disturb sleep if it is sufficiently stressful. Common challenges include bereavement and loss, marriage breakdown or loss of employment, as well as trauma or personal injury. Any of these may be associated with temporary sleep loss. In most cases as the stress resolves so does the sleep disturbance.

Many other people have enduring difficulty with sleeping and this may be for very practical reasons. Shift workers for example can find sleep very problematic. They represent at least one fifth of our work force. The challenge for those who work at night is to overcome the body’s natural daily rhythm which tends to promote night time sleep and day time wakefulness. Many groups of employees find this particularly difficult.

The problem is that wakeful performance is hindered by sleep deprivation. There is no doubt about this. This is true for truck drivers, shift workers and junior doctors alike. The hazards affect us all. One common result is road traffic accidents many of which are caused by the problem of the driver falling asleep at the wheel. International estimates suggest that this is a factor in many thousands of road deaths every year.

Many physical illnesses or general health problems are associated with sleep loss. Amongst these is sleep apnoea associated with morbid obesity. Sleep loss is also associated with some treatments for common conditions for example systemic steroids used in the treatment of arthritis or other inflammatory conditions. In these cases the management of sleep disturbance is the management of the underlying condition. The best way to solve the problem of sleep disturbance in depression is to that the depression. Sleep can tell us a lot about our health and what we need to do to be well.

So what happens if we don’t get enough sleep? The evidence confirms that impulse control, performance of tasks, and judgment all deteriorate when we are sleep deprived. In addition there is a strong association between chronic sleep disturbance and a host of other mental health difficulties such as anxiety and depression and other major mental health problems. For most people sleep comes naturally, but when sleep is persistently lost the experience can be very distressing. The resulting anxiety may lead to a further deterioration in sleep and a vicious cycle of insomnia and mental distress begins.

There are many myths and superstitions about sleep but the facts are plain enough. Going to bed at a regular time is helpful. Restful sleep is more likely in a darkened room and more easily achieved at a slightly cool temperature. Sleep is inevitably broken by alcohol and limited by caffeine and by nicotine. We are more likely to get off to sleep if we have taken some time to wind down, to shut off the flat screen, and to be quiet. A good bed is important. Recovery of good sleep can be the start of a recovery health in general including mental health.

So what can we do for ourselves to restore our sleep. We could start by giving sleep the priority it deserves in our life. Instead of rising to an alarm we could try to set the alarm clock for the beginning of sleep. Try setting your alarm clock to remind you when to go to bed rather than setting one to tell you when to get up. Take care to avoid caffeine in the afternoon or late evening, try to take exercise earlier in the day and to avoid eating late at night. Try going to bed ten minutes earlier each evening for a week. Go to bed in a darkened room and make sure that it is not too warm. Wind down before you go to sleep. Bright lights and flat screens signal wakefulness and the brain is likely to respond accordingly. On the other hand having a mindful and restful approach to sleep will signal to the brain that it is in for a much needed rest. Our brain and body could be crying out for that balm. With a little help and some simple practical steps we can give our minds the rest we need so much.

For more information why not check out these useful sites. All the data used in this blog has been sourced with reference to these and similar data sets.

There is an extremely useful reference on the HSE website with a comprehensive guide to management sleep problems.

You will also find useful information in the American Psychological Association sleep pages.

Perhaps the most enjoyable and informative media source about sleep is Russell Foster’s presentation on Ted Talks.

The sleep foundation is also a very helpful resource.

If you would like to discuss this or any other mental health issue why not call our support and Information line @ (01) 2493614 or our Young Persons Support line on (01)2493555. The calls are answered by qualified mental health professionals and the information and support is given free of charge.

By Prof. Jim Lucey MD PhD, Clinical Professor of Psychiatry at TCD and Medical Director at St. Patricks Mental Health Services

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