What's keeping you awake?

World Sleep Day - Friday 13th March 2015

Dr Carmel Harrington answers frequently-asked questions about insomnia


What are the main causes of sleep problems among Australians today?

We often think that sleep problems are a consequence of poor sleep habits, like drinking coffee too late in the day. However, research indicates that the reasons are more varied than this and while poor quality sleep may well be a result of poor sleep behaviour, it’s frequently associated with another underlying problem such as depression, anxiety or sleep apnoea. Abuse of alcohol or substances is another cause.

Are more people experiencing sleep problems today?

Definitely, yes. The fact that the use of sleeping aids has increased dramatically in the last decade indicates that more people today are identifying problems sleeping than in our parents' day.

Research from the US indicates that annually, about one in three adults suffer problems sleeping. An estimated one in every ten adults takes prescribed sleeping pills and a further one in ten take an over-the-counter sleeping aid. More worryingly, while sleeping pills used to be mostly the domain of the elderly, this is no longer the case and there has been a twofold increase in the use of sleeping pills by people in the 20–45 age group in the last 10 years.

What are the emotional consequences of not getting enough sleep?

When we do not sleep well our mood is affected – and not to our advantage. A bad night of sleep will invariably result in a poor mood state which can manifest as grumpiness, a short temper, intolerance and a general lack of motivation.

How does sleeplessness affect other aspects of our lives?

Not only are we generally in a bad mood after poor sleep but we are also less inclined to want to exercise and to participate in general activities. This lack of energy directly affects our sex drive, which also decreases as a consequence of sleeplessness. Sleep also directly affects our ability to learn and to think. In a sleep-deprived state it has been shown time and again that we become poor decision-makers, we are much more likely to make mistakes and our ability to learn is seriously impaired. An interesting and important study in this regard, involving over 1500 full-time university students aged 17 to 25 years of age, found that sleep quality and duration were among the main predictors of academic performance – the better the sleep the better the performance.

Are there more serious consequences?

Yes. While the negative impacts on mood and thinking are considerable, a far greater and more serious problem of sleeplessness is the increased likelihood of a work or motor vehicle accident. Studies show that people with sleeping problems are seven times more likely to be involved in such accidents. Indeed, some of the more well-known occupational disasters such as the Air France crash in 2009, the Chernobyl Nuclear Plant disaster, the Exxon Valdez oil spill and the Space Shuttle Challenger explosion have been found to be a direct result of operator fatigue.

What about the long-term effects?

While the short-term consequences of sleeplessness are well recognised by anyone who suffers from them, the long-term effects of on-going sleep deprivation may come as a surprise. People suffering from chronic sleeplessness are far more likely to develop depression; certain types of cancer; high blood pressure and heart disease; and metabolic diseases, such as Type II diabetes and obesity.

What should I do to prepare for a good night’s sleep?

Research indicates that one of the major causes of sleeplessness is anxiety. This doesn’t necessarily mean you have an anxiety disorder; it could just be that you are worried about something. When you have a busy day, you often don't have time to deal with some of the stresses and worries that occur. But if you don't deal with these during the day, when you go to bed and try to sleep, your mind will immediately go to these issues. As soon as you do this, your mind becomes alert and you cannot get to sleep. On the other hand, it may be that you are so tired that you will actually fall asleep quite quickly, only to wake up a few hours later to immediately start thinking about these issues.

Is there anything I can do to prepare for a good night’s sleep?

Happily, implementing some simple steps may significantly improve the ability to sleep for many of us. If you have had a busy and stressful day, make sure you set aside some time to exercise –maybe walk the dog, or get off the bus one stop earlier. When you get home, devote some time, no longer than 30 minutes, to thinking about the issues of the day and perhaps write them down, along with any potential solutions, in a book. Importantly, when you finish, close the book and put it away. Not only are you physically putting aside your worries, but you have now managed to deal with your concerns, rather than waiting until going to sleep. And, as always, good sleep practices are a must for good sleep.

What should I do when I have problems getting to sleep, or if I wake in the night and find it hard to return to sleep?

Discovering exactly what is causing your sleeping difficulties can sometimes take a bit of time. Ensuring good sleep habits, like not having caffeine after midday, refraining from alcohol and switching off all technology at least one hour before bedtime will enhance your ability to sleep and is a good first step to improving sleep.

Practising a relaxation or meditation exercise is also a great way to prepare the body and mind for sleep and will often assist with initiating and maintaining sleep.

What should I do if I just can’t get to sleep?

If you find yourself lying in bed unable to get to sleep after about 30 minutes – whether it be at sleep onset or in the middle of the night – it’s better to get up, sit in a dimly lit room and do something relaxing, like reading a magazine or maybe even doing a breathing exercise to relax. Don’t go back to bed until you feel sleepy again. Once in bed, if you are not asleep within about 30 minutes (this is an approximation as clock watching is definitely not recommended) get up again and repeat the process. By doing this, you are teaching your mind and body that bed is for sleeping and you will find that over time you develop the ability to fall asleep and stay asleep on a nightly basis.

How do I know when to see the doctor?

The primary indicator that you may need help with sleep is that despite your best efforts you feel tired and unmotivated most of the time. It may be that no matter how much you sleep, you still feel exhausted, or it may be that you struggle to get the sleep you so desperately want. Either way it’s important that you speak to your doctor.

It is essential that we recognise that sleep is fundamental to our physical and mental well-being. It is as important to our health and well-being as nutrition and exercise and we need to start thinking of it as our third pillar of health and give it the respect it deserves.

Dr Carmel Harrington, Sleep Scientist and author of "The Complete Guide to a Good Night's Sleep"