While we acknowledge the importance of sleep for children we often fail to recognise its importance in adults' lives. By Kirsten Braun.
We know that children need an established bed time routine and if it doesn't occur it can result in poor concentration, behavioural problems and even lack of appetite. Similarly, we know that if a day time nap is too long children will not be sleepy at bedtime. As adults, however, we don't seem to pay enough attention to our own sleep routines or acknowledge the negative effects of inadequate sleep.
We often think of sleep as consisting of a stage of feeling sleepy followed by a deep sleep which we then gradually wake from in the morning. In fact our sleep is regulated into two different types of sleep, rapid eye movement (REM) sleep and non-REM sleep.
We spend about three quarters of our night's sleep in non-REM sleep and about one quarter in REM sleep. The amount of time spent in each stage also changes through the night. In the first half of the night the deep sleep stages are longer and the REM stage is relatively short, sometimes only 5-10 minutes. In the second half of the night the deep sleep stages are shorter, whilst the REM stage may last for up to an hour.
Sleep and women's life stages
For women different life stages can have a large impact on their sleep quality. Pregnant women, for example, often experience interrupted sleep because they have to get up to go to the toilet frequently. They may also experience reflux and/or find it difficult to get comfortable in the latter stages of pregnancy. Mothers are another group that commonly do not get a good night's sleep. Mothers of newborns will wake to provide regular feeds through the night. Mothers of young children may need to assist them in getting back to sleep if they awaken during the night. In addition, mothers get up to see to children who are unwell, having nightmares or for night time toilet training.
Menopause is also a stage where women find their sleep can suffer. Night sweats can cause many interruptions, with women even needing to get up and change their nightwear and/or bed linen. Menopausal women also experience itchy skin which can make sleep more difficult and a small percentage will suffer from a condition called formication which feels like insects are crawling on or under the skin. Even for women not suffering from these physical symptoms of menopause, they may still experience insomnia at menopause.
Not getting sufficient sleep or having a poor quality of sleep can lead to sleep deprivation. Sleep deprivation has many effects on both our body and mind. When we are sleep deprived we have a shorter attention span, slower reaction time, diminished motor skills, poor concentration, poor memory and reduced decision-making skills. Due to these changes we are also more at risk of making a mistake or sustaining an injury.
Not having enough sleep also affects our mood, making us more likely to be bad tempered or impatient. Long term sleep deprivation has been linked to a higher risk of developing depression and anxiety. Not getting enough sleep is also thought to lead to weight gain by interfering with the hormones that both stimulate our appetite and tell us when we are full.
A loss of deep sleep is most damaging as this sleep stage is where the body restores its energy levels. Deep sleep also allows the body to repair and regenerate tissue and to strengthen the immune system. We do not need to lose a lot of sleep before we feel the effects of sleep deprivation. Even an hour or two a night will have an impact.
Why are we not getting enough sleep?
While the amount of sleep required does differ from person to person, in general adults require seven and half to eight hours of sleep a night. An evaluation of sleep habits of Australians found that difficulties initiating and maintaining sleep, inadequate sleep, daytime fatigue, sleepiness and irritability are experienced by between 20-35% of people.
Interestingly, these difficulties were more common among women, with the exception of snoring. In addition to the impact of life stages (see above) it seems our busy lives are impacting on our ability to get a good night's sleep. Some of the contributing factors are
• Later dinners. Digesting food actually requires a great deal of energy. If you eat too close to your bedtime, especially if the meal is a heavy one, it can interfere with your sleep.
• Screen time. Many people use the time before bed to answer emails, catch up on social media or watch TV. With the popularity of smart phones, laptops and tablets people are increasingly doing these activities in their bedroom. While some of these tasks might feel relaxing the light emitting screens use by these devices interferes with the production of melatonin, a sleep-producing hormone.
• Taking work home. Many people are extending their work day by completing work tasks at home. In addition to using a lit computer screen, working at home interferes with the winding down time that we need to go off to sleep successfully. If the work that people are carrying out is stressful or very though provoking it can be very difficult to switch off when retiring to bed.
• Alcohol. Women sometimes have a glass or two of wine with dinner to relax after a long day. While drinking alcohol before bedtime can result in drowsiness and going off to sleep easily, if people drink too much alcohol they will awaken a few hours later and experience difficulty getting back to sleep. Overall alcohol interferes with the quality of a person's sleep.
• Late exercise. Generally exercise is good for improving our sleep, particularly if conducted outdoors. However, exercising too close to bedtime can actually be detrimental. When we exercise we raise our body's core temperature which makes it difficult to go to sleep. So hitting the gym or going for a run too late in the day can actually make it harder to sleep.
• Caffeine. It seems obvious that having a coffee after dinner will keep you awake. What people often don't know is that the stimulating effects of caffeine are quite long-lasting. For many people even their late afternoon pick me up of coffee, tea, cola or chocolate could still be impacting on their sleep.
Tips for a good night's sleep
There are a number of steps that we can take to improve our sleep
• Set a regular sleep schedule, same bed and wake-up time (even on weekends)
• Avoid eating dinners too late and/or heavy dinners
• Avoid the use of light-emitting devices to close to bedtime
• Sleep in a darkened room (including covering lights from electronic devices)
• Sleep in a cool room (18 C)
• Avoid alcohol, caffeine or exercise too close to bedtime
• Avoid drinking too much liquid before bedtime (and, therefore, toilet trips)
• Quit smoking (nicotine is a stimulant)
• Limit daytime naps (10-30 minutes maximum)
• Regular exercise (but not too close to bedtime)
When to seek help?
For some people their sleep can be improved by better sleep habits but others may have an underlying sleep disorder. People should consult a doctor if the regularly experience sleeping difficulties, if they find they struggle to keep awake during the day or if they feel their concentration, memory or emotions are impacted. Common sleep disorders include insomnia, sleep apnea and restless legs syndrome.
For more information
Sleep Health Foundation
Last updated: June 2014
©women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey 2014 Issue 2.