1
SLEEP STRATEGIES
WHAT HAPPENS WHEN WE SLEEP?
Sleep is made up of 5 stages:




Stage 1 – This is very light sleep
Stage 2 & 3 – During this phase sleep deepens
Stage 4 – Very deep sleep
Stage 5 – This stage is known as REM sleep, which stands for
rapid eye movement Sleep. This is when most of our dreams
occur. We only remember them if we wake during this stage.
Once REM sleep is over, you go back to Stage 1 sleep. You go through this
cycle about 4 or 5 times each night.
As you get older you seem to need less deep sleep. This may be one of the
reasons why older people tend to wake more often during the night.
All the different stages are important (especially stage 4) but, like breathing,
our body takes what it needs without us having to do anything. The other good
news is that if we’re woken up in the night or have a very late night, we only
need 1/3 of what we missed (e.g. if we usually sleep for 8 hours and lose 2
hours, we only need 40 minutes to replace the missing 2 hours).
It is the concern about sleep that often causes the problem.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
2
IMPROVING YOUR SLEEP
Common difficulties include:




Taking a long time to go to sleep at night
Frequent or prolonged awakenings during the night
Waking early
Sleeping too much
The quality of sleep is often poor and sufferers will often report waking up
feeling exhausted.
If you are having sleep problems like those described above:
Complete a Sleep Diary for 2 weeks, to build up a picture of your sleep
pattern.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
3
SLEEP DIARY
PATTERN OF YOUR
SLEEP
Day
1
Day
2
Day
3
Day
4
Day
5
Day
6
Day
7
Day
1
Day
2
Day
3
Day
4
Day
5
Day
6
Day
7
Did you nap at any point
yesterday? If yes, for how
long (minutes)?
At what time did you rise from
bed this morning
What time did you finally
wake up this morning?
At what time did you go to
bed last night?
At what time did you switch
off the light intending to go to
sleep?
How long did it take you to fall
asleep (minutes)?
How long you were awake
during the night because of
these awakenings (total
minutes)?
About how long did you sleep
altogether (hours/minutes)?
How much alcohol did you
have last night?
Did you take sleeping
medication to help you sleep
last night? If so, how many?
QUALITY OF YOUR
SLEEP
How refreshed do you feel
this morning?
0
1
Not at all
2
3
4
moderately
very
How would you rate your overall
quality of sleep last night?
0
poor
1
2
3
4
very good excellent
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
4
LIFESTYLE AND ENVIRONMENTAL FACTORS THAT CONTRIBUTE
TO POOR SLEEP:
 An irregular sleep pattern can disrupt the body clock and lead to the
loss of certain cues such as feeling tired in the evening and alert in the
morning.
 Daytime inactivity can increase your feelings of fatigue and desire for
short naps.
 Sleeping in the day will lead to needing less sleep at night.
 Drinks and other substances such as caffeine containing drinks (coffee,
tea, cola), alcohol, cigarettes and certain medications may all affect
sleep by making it difficult to go to sleep or waking you up in the night.
 An uncomfortable sleeping environment such as a poor quality
mattress, being too hot/cold, a restless partner or excessive noise may
keep you awake at night. Planning or studying or other paperwork in
your bedroom may make it more difficult for you to switch off at night.
Long periods of wakefulness in your bed may lead you to associate
your room or bed with being awake, therefore making it more difficult for
you to go to sleep.
 An overly active mind or concentrating on worries at bed time can lead
to tension, restlessness and an inability to relax, making it more difficult
to fall asleep.
 Sleeping too much can make you feel constantly tired, as the sleep is
often light and non-refreshing.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
5
Improving Your Sleep Hygiene
LIFESTYLE FACTORS
There are lifestyle factors and bedroom factors associated with good sleep
hygiene:
 It is better to avoid caffeinated drinks such as tea/coffee and to avoid
having your main meal within 4 hours of going to bed. A small snack at
bedtime shouldn’t be a problem.
 Although exercise is good for our physical and psychological wellbeing,
it’s preferable not to exercise within 2 hours of going to bed, because it
tends to keep you awake.
 For those that smoke, try to cut down before bedtime and avoid
smoking during the night. Not only is nicotine a stimulant (like caffeine),
but your body may also wake you up craving a cigarette.
 Alcohol is a central nervous system depressant, although it may speed
up sleep onset, it often causes disrupted sleep later in the night when it
is metabolised. A milky drink before bed can help you to feel sleepy and
will not cause you to waken in the night.
BEDROOM FACTORS
 The bedroom factors are also important. Most of these focus on making
the bedroom suitable for sleeping.
 Limiting noise is helpful (but that does not mean you need complete
silence). Some people choose to use ear plugs at night.
 Ensure that your room is dark (but not necessarily pitch black). Consider
blinds or an eye mask.
 Make sure that you have a comfortable mattress and pillows.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
6
 Temperature is important. The ideal room temperature is around 18C
(64F) - not too hot and not too cold. If anything, sleep prefers the cool,
so you shouldn’t be too warm in bed. A hot bath immediately before
going to bed is likely to keep you awake.
 Good sleep hygiene gives you a good starting point so that you can
improve your approach to sleep.
LIFESTYLE FACTORS
Manage
exercise
Manage
diet
Limit
caffeine
Limit
alcohol
Limit
nicotine
Good
Limit
daytime
sleep
Sleep
Limit
noise
Hygiene
Improve
bed
comfort
Manage
room
temperature
Limit
Light
Manage
body
temperature
Improve air
quality
BEDROOM FACTORS
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
7
STRATEGIES TO IMPROVE SLEEP
You may find that sleep will improve once you get into more of a routine
during the day or when you slightly increase your level of activity. On the other
hand you may need to follow some of the methods described below for a few
weeks to notice any significant changes.
ESTABLISH A ROUTINE
The aim of establishing a routine is to help your body clock get used to a set
routine. Establishing a routine will help to regulate your body (circadian)
rhythms so that you begin to feel things at certain times each day and
establish a regular sleep-wake cycle. We do not recommend that you should
go to bed at the same time every evening, as you may not feel sleepy at that
time. However, you may find that when you start getting up at the same time
each day you get more tired at a particular time of the evening and, therefore,
naturally start going to bed at a similar time each night. The guidelines below
will help you to establish a routine. If your sleep pattern is erratic you may find
it difficult to put more than one or two strategies into practice at any one time.
Implementing all the guidelines at once may work for some people where as a
more gradual approach may work for others.
IN ORDER TO ESTABLISH A ROUTINE
 Get up at the same time each day even if you have not had much sleep
the previous night. It may be helpful to set your alarm clock.
 Do not nap during the day even if you feel very tired.
 Do not go to bed early even if you feel very tired, or to try to make up for
lost sleep.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
8
PREPARING FOR SLEEP
Establishing a set routine will help you to prepare both mentally and
physically for going to sleep.
 Try to wind down in the hour or so before you go to bed.
 Include relaxing activities such as watching television, but avoid this in
your bedroom. Having a warm bath (not hot) and listening to relaxing
music may be helpful to include in your schedule.
 Avoid stimulating activities that will keep you alert, for example:
work involving problem-solving, studying and decision-making.
 Develop a regular order of doing things, e.g. locking up the house,
turning out the lights, brushing your teeth etc. This will act as a signal to
your body that it is preparing for sleep.
HOW TO ASSOCIATE YOUR BED AND BEDROOM WITH SLEEP
RATHER THAN BEING AWAKE
If you have had poor sleep for a long time, you may find that when you get into
bed, instead of feeling sleepy you feel wide awake or restless which will make
it harder to fall asleep. Subconsciously, you may therefore associate your
bed/bedroom with being awake rather than asleep, which may make it harder
to fall asleep.
THE FOLLOWING GUIDELINES AIM TO HELP YOU TO ASSOCIATE
YOUR BED/BEDROOM WITH SLEEP RATHER THAN BEING
AWAKE:
 Avoid using your bedroom during the day if at all possible. If you live in
a bed-sit, try to have a separate work area in your room, so that you just
use your bed for sleep.
 Do not read, watch television, or sort out the day’s problems etc. in bed,
as these are waking activities.
 Go to bed when sleepy rather than at a time you think you should go.
For example, if you think that you should go to bed at about 11.00, but
do not feel sleepy, wait until you begin to feel drowsy.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
9
 Do not be tempted to go to bed very early, e.g. before 9.30, even if you
feel very sleepy. This may result in waking in the middle of the night or
early in the morning.
 Turn the light off straight away when you get into bed.
 If you are not asleep within 20 minutes, go to another room sit and relax
or read until you feel sleepy again.
 Repeat the previous step as often as is required. And also if you wake
up for periods of more than about 20 minutes in the night.
Try to follow the programme rigidly. It can take several weeks
to establish an efficient and regular pattern.
ESTABLISH AN OPTIMAL SLEEP PATTERN
An optimal sleep pattern is one that provides you with good quality
sleep, few wakeful periods and a short time to fall asleep.
Your sleep pattern is optimal when it is both efficient and regular. By
efficient, we mean that the more time you are asleep when in bed, the more
efficient your sleep is.
The following guidelines will help to achieve an optimal sleep pattern:
 Calculate your total time asleep on an average night.
 Stay in bed for the time that you are usually asleep only.
For example: If you are usually in bed for 10 hours a night, but are only
asleep for 6 hours in total, you should only stay in bed for 6 hours. You
may feel more tired for a while, but the slight sleep deprivation you may
experience will in turn produce faster sleep onset, reduce broken sleep
and result in a deeper sleep.
 The time in bed can be gradually increased as your sleep efficiency
improves.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
10
REDUCE YOUR SLEEP AT NIGHT, IF YOU SLEEP TOO MUCH
Sleeping for longer than you used to may contribute to feelings of exhaustion
in the morning. If you sleep for more than about an hour longer, then you may
feel better if you reduce the amount of time you sleep at night.
 Cut down your sleep time gradually, either by going to bed ½ hour later,
or getting up ½ hour earlier.
 Establish a set waking up time and time to go to bed.
 Be consistent in either getting up earlier, or going to bed later.
 Review your sleep pattern weekly and continue to reduce your sleep
time gradually until you are more refreshed on waking.
You may feel more tired for the first few weeks after changing your sleep
routine, but in the long term you can expect the quality of your sleep to
increase as the quantity of your sleep decreases.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
11
PROBLEM SOLVING STRATEGIES FOR REDUCING WORRIES AT
NIGHT
Lying in bed at night worrying about problems can make you feel tense
and prevent you from going to sleep. The strategies described below
may help you to reduce worries at night, therefore helping you to feel
more relaxed and allowing you to get to sleep more quickly:
 Set aside 20 minutes in the early evening.
 Write down problems or things that you have not dealt with during
the day.
 Write down possible steps to resolve the problems, or tie up
unfinished business.
 Allocate time to do the actual work.
 Consider other longer term problems which may intrude on your
sleep, for example, emotional, financial or other worries.
 Write down the first or next positive step of action to take and
when you will take it.
 If you cannot go to sleep or wake up worrying about a problem,
remind yourself that you have the matter in hand and that
worrying about it now will not help.
 If new worries occur to you in the night, write them down on a
notepad or a piece of paper and deal with them the next day after
breakfast.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
12
HOW TO DEAL WITH FRUSTRATION ABOUT NOT BEING ABLE TO
SLEEP
 If you become frustrated about not being able to fall asleep and
worry about the possible ‘negative’ consequences the next day, it
is likely that you will inhibit sleep further by trying harder to fall
asleep. This may result in increasing tension levels.
 Do not try too hard to fall asleep.
 Tell yourself that ‘sleep will come when it’s ready’ and that
‘relaxing in bed is almost as good.’
 Try to keep your eyes open in the darkened room and as they
naturally try to close tell yourself to ‘resist closing them for a
few seconds.’ This procedure tempts sleep to take over.
 Visualise a pleasing scene or try repeating a neutral word (such
as “the”) every few seconds.
 Relaxation, e.g. It may be helpful to focus on a formal relaxation
technique, or breathing technique. This may be carried out in bed
at night. It can also be practised at other times of the day.
 Concentrate on your breathing
 Try to breathe slowly
 Repeat silently the words ‘in’ and ‘out’ in time to your breathing.
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14
13
THE FOLLOWING ORGANIZATIONS OFFER HELP AND ADVICE ON
SLEEP PROBLEMS AND YOU MAY FIND THEM A USEFUL SOURCE
OF INFORMATION
British Sleep Society
Provides useful information about sleep and sleep disorders and contact
details for sleep centres and specialists.
Website: www.sleeping.org.uk
Email enquiries: [email protected]
Sleepio
Is an organization that is trying to find new ways to help people sleep well.
They provide online assessment and treatment services and they also have a
free relaxation MP3 to download.
Website: www.sleepio.com
Email: [email protected]
Mind
The leading mental health charity in England and Wales.
Website: www.mind.org.uk
Tel: 08457 660163
REFERENCE
Information for this fact sheet has been taken from:
‘An Introduction to Coping with Insomnia and Sleep problems’
By Colin A. Espie
Torbay and Southern Devon Healthcare Trust, Sentinel South West CIC Plymouth
with thanks to Northern Devon Healthcare NHS Trust
08/01/14