Dealing with poor sleep Online information package for staff

Introduction This information package is designed to give you some helpful tips for improving your sleep. It covers some simple strategies that you can implement in your: environment, behaviour and thinking. The last section will give you more information on how to make progress and where you can get further support.

Understanding sleep Sleep gives us the rest we need. It is also vital for our health and wellbeing. We can all have a bad night’s sleep. This is quite common. However, if it goes for on for over two weeks, it can become a sleep problem.

How much sleep do we need? Most people think that they must have 8 hours of sleep. However, this is not true. The amount of sleep we need varies from person to person. Some people need less and some people need more sleep. Our sleep also changes as we get older. In older people sleep tends to get shorter and more broken up.

The “sleep cycle”. What happens when we sleep? We all go through a number of cycles during the night. There are four stages of sleep followed by Rapid Eye Movement (REM) phase. Stage one: this is light sleep when we are nodding off Stage two: slightly deeper sleep but it is still light Stage three and four: these are stages of deep sleep that is restorative. We need this type of sleep the most. REM sleep: we dream during this stage. Our brain activity has similar patters to when we are awake.

The “sleep cycle”. What happens when we sleep? It takes about 90-110 minutes to go through all of those stages. We can also ‘wake up’ for one or two minutes a number of times during the sleep. This is natural and is linked to the natural period of light sleep. You can wake up during light sleep and then go back in to the sleep cycle after waking and still have a good night’s sleep.

What sort of sleep problem do you have? Getting to sleep - for some people it might take hours to drop off Staying asleep - some people get off okay but wake frequently Waking too early- other people wake early then can’t get back to sleep Poor quality sleep- and others report light, disturbed, restless sleep, sometimes with nightmares Sleeping too much- feeling tired all the time While you rest, your brain stays busy, overseeing a wide variety of biological maintenance that keeps your body running in top condition, preparing you for the day ahead.

What are the reasons for poor sleep Poor sleep could be related to: Stress Feeling down, worried, anxious Pain Being ill or injured Snoring Sleep apnoea Poor routine Shift work and disrupted routine Surroundings Age Others…

Tips for Getting a Good Night’s Sleep How to sleep better? Tips for Getting a Good Night’s Sleep

Getting a good night’s sleep If you have trouble sleeping, there are some things you can do to help yourself get a good night’s rest.  These include making changes in: Your environment Your behaviour Your thinking

Bed and bedroom environment It is important to link your bedroom with sleep and try to minimise the impact of things that may keep you awake such as noise, light or temperature. Are there any helpful simple changes you can make? Light level – is your bedroom too light or dark? Also check whether there are any sources of light from phones or clocks etc. Dim lights an hour or so before bedtime. Bedroom too hot or too cold Bedroom too noisy Bed too uncomfortable

Sleep environment, bed and bedtime routine

Bed and bedroom environment To get a good night’s sleep it is important to try to allow your body to relax and slow down before you go to bed. Try to avoid watching TV in your bed, doing work, study or eating in your bedroom. Your bedroom should only be for sleep and sex. You need to link your bedroom with sleep.

Bedtime routine Give your body some time to wind down at the end of the day. Do something relaxing and calming 30 minutes before going to bed. Set up a routine of getting ready for bed e.g. have a bath, brush your teeth. Keep to a regular pattern of going to bed and getting up at the same time every day, whether you are tired or not. Don’t go to bed until you feel sleepy.

Sleep behaviour – 20 minute rule Spend less time in bed lying awake and worrying. If you are not asleep within 20 minutes, get up. Go to another room. Do something relaxing. Go back to bed when tired. Keep repeating this until you fall asleep.

Relaxation skills and sleep diary

Sleep behaviour Give up trying to sleep. The more you worry about not sleeping, the harder it will be to fall asleep. You may want to try: Imaginary relaxation – imagine a calm scene. Picture what it looks like. Think of what you can see, what you can hear and smell. Repeat a neutral or relaxing word. The word you choose should be simple and relaxing or neutral like “calm” “the”. This can also help with worries and unhelpful thoughts.

Relaxed breathing Relaxed breathing is a simple way of relaxing your body and mind. Try each step in turn to help you relax: Breath slowly – take time to notice your breathing and try to slow it down. Extend the exhale – as you breath in count as long it takes. Then take longer to breath out. If you take 3 seconds to breath in, take 4-5 seconds to breath out. Belly breathing – put your hands on your belly; then breath in and push your belly OUT; breath out and pull your belly in. Or use your choice of relaxation technique before going to bed (whatever works for you). Please visit this website to access audio files of relaxation techniques: https://www.ntw.nhs.uk/pic/relax.php

Sleep behaviour You may want to try: Keeping a sleep diary for a few weeks- when complete, you can look back and notice what helps you sleep better and what doesn't. You can make positive changes and do more of what helps, and less of what doesn't. Please click below to access an example sleep diary: https://sleepfoundation.org/sites/default/files/SleepDiaryv6.pdf

Sleep behaviour Try to avoid napping during the day. If you’ve had a bad night, resist the temptation to sleep the next day – it will make it harder to get off to sleep the following night. Avoid clock watching – move your clock so that you cannot see it.

Lifestyle factors

Sleep behaviour – lifestyle factors Cut down on caffeine (tea, coffee, some soft drinks)  in the evening. Try a milky drink instead. Don’t drink a lot of alcohol. It may help you fall asleep, but you will almost certainly wake up during the night. Don’t eat or drink a lot late at night. Try to have your evening meal early rather than late. Get some regular exercise during the day. Try some regular swimming or walking but  avoid exercise late in the evening.

Sleep thinking and sleep retraining

Sleep thinking If something is troubling you and there is nothing you can do about it right away, try writing your worries down before going to bed and then tell yourself to deal with it tomorrow. Avoid clock watching when in bed - put your attention somewhere restful, use imagery, mindful breathing, or your relaxation technique. If you can’t sleep, don’t lie there worrying about it. After about 25 minutes get up and do something you find relaxing like reading or listening to quiet music. After a while you should feel tired enough to go to bed again.

But if these sleeping tips are not enough… Retraining your sleep You must follow this to the letter Don’t go to bed until you feel sleepy Keep your bedroom largely for sleeping If you don’t fall asleep in 20 minutes, get up Repeat (and repeat, and repeat) Get up early each morning Don’t try to catch up on sleep Keep at it. It takes time to change habits

Useful resources

Useful resources Step 1. Self-help booklets Sleep difficulties as well as stress, anxiety or low mood are common. There are some useful steps you can take to help manage your symptoms. We have a range of self-help information available on Newcastle OHS website: http://www.newcastle-hospitals.org.uk/about-us/staff-information_newcastleohs.aspx Self-help booklets on sleep and mental wellbeing https://www.ntw.nhs.uk/pic/selfhelp/ http://www.mhim.org.uk/stayingwell/sleep.html

Useful resources Step 2. CBT based self-help guide Overcoming Insomnia and Sleep Problems A self help guide using cognitive behavioural techniques. Colin A. Espie http://www.overcoming.co.uk/single.htm?ipg=7671

Useful resources Step 3: Online therapy courses Sleepstation is an online therapy course for insomnia which can be accessed via GP referral or self-referral. Please visit the following website for more information about NHS and private treatment options: www.sleepstation.org.uk Sleepio is another useful online treatment option for improving your sleep. Please visit www.sleepio.com for more information.

Useful resources Step 4: One to one support from OHS service If you feel you need more assistance related to sleep or stress you can self-refer for counselling by completing the referral form found on the above website: http://www.newcastle-hospitals.org.uk/about-us/staff-information_newcastleohs.aspx You can also be referred to OHS Psychology service for assessment and one to one Cognitive-behavioural therapy (CBT) for sleep difficulties. Please visit OHS Intranet site for referral information:

Acknowledgments This presentation is based on advice from the sleep booklets from the following sources: Self Help guide on sleep available from Northumberland Tyne & Wear NHS Foundation Trust. See more at: https://www.ntw.nhs.uk/pic/selfhelp/ Mental Health in Manchester (MHIM) guide on sleep: http://www.mhim.org.uk/stayingwell/sleep.html