Sleep is a daily topic in my practice. Whether my patient has struggles with their marriage or mood or just life in general, sleep gets affected.
There is so much pressure around sleep. Arianna Huffington leads a “Sleep Revolution” and claims that lack of sleep will make us seriously ill and not functioning at our best. Research has shown that people with insomnia function as well as people without insomnia. We somehow manage to pool our resources when we need it most.
There is a big difference between insomnia and sleep deprivation. You are sleep deprived when you desperately need sleep, and will easily sleep well, but are being denied that right. Like in torture camps or by a new baby.
The Z-dorms (sleeping pills) have made millions with the message that a night with sleeping tablets is better than poor sleep. Exactly the opposite is true. People who use sleeping tablets are more likely to function poorly the next day than those who don’t. Chronic use of sleeping tablets cause more sleep problems than they help.
The cruel irony about sleep is that you can’t “force sleep”, you can only “fall asleep”.
We all know how delicious a good night’s rest is. What sweet relief it is to shut down from your problems. I have come to realise that “perfect sleep” is just one variant of normal sleep.
To understand what is normal, we first need to understand how sleep works.
The sleep graph or hypnogram can look intimidating, but is simple if we go step by step.
The first thing to realise is that there is a bit of time between being awake and the beginning of stage one sleep. This is called “sleep onset latency” and is the time needed to fall asleep. Typically this can take about 20 minutes, but it can be normal to take 40 minutes. It is only considered a disorder if it takes more than two hours for several nights in a row.
Several things can affect sleep onset latency. Various medications, jet lag, adolescence, stress- but the biggest factor is simply not being tired. Maybe you don’t need to sleep yet. The truth is not everybody needs eight hours of sleep a night. Furthermore, our individual sleep requirements change through our lives. If we are training or studying hard, we need more sleep. As we get older, we need less sleep.
Stage one to four sleep is “non REM” sleep. In non REM sleep the body is rejuvenated and there is usually no dreaming. Stage one is light sleep where you are typically still aware of your environment. Stage two is the stage between light and deep sleep. Muscle jerks are common here, the heart slows and body temperature drops. Stage three and four is deep sleep. If you get woken in stage four sleep you may well be very disorientated and out of sorts.
After about 90 minutes REM sleep occurs. In REM (rapid eye movement) sleep the main things that happen is paralysis and dreaming. Through the night the REM cycle gets longer and longer, so we dream more in the second half of the night. Sometimes I sleep in over the weekend. I typically get very disturbed, fragmented dreams when I do this, and feel more exhausted than if I wake up at my normal time. Understanding about REM cycles has helped convince me to wake up at round about the same time as during the week.
A whole sleep cycle takes 90 – 120 minutes and we typically need six to nine cycles per night to feel rested. Brief wake ups between cycles is very normal. When I do wake up and need to go to the loo, I try to keep the lights off, to keep me just before stage one sleep. I don’t want to wake up completely and then need a long sleep latency before falling asleep again.