Everything You Need to Know to Get a Good Night’s Sleep

If you regularly find yourself lying awake at night, eyes glued to the ceiling or your phone, you’re not alone. A 2017 survey carried out by Aviva found that up to 16 million adults in the UK suffered from sleepless nights.

That’s one-third of all UK adults - and the study’s findings didn’t stop there. The findings also showed that 23% of UK adults managed less than five hours a night, while almost half admitted they didn’t get the right amount of sleep. In addition, a supermajority - two-thirds of the British population - said they experienced disrupted sleep. If you’re in the UK and sleep soundly, the reality is that you’re one of a lucky few.

The state of the UK’s sleep is so poor that recent commentators have warned of a ‘sleep crisis’ in Britain - one that is making us less productive and less happy. And while another study by Aviva found that UK adults are some of the worst sleepers in the world, the reality is that sleeplessness is a major issue outside Britain’s borders as well as within them.

So prevalent is the problem of sleep deprivation that an entire industry has spawned out of it, promising to help people get their suggested eight hours. Companies hire ‘sleep hygienists’ who consult on policies to help their employees sleep better; smartphone apps containing ‘sleep stories’, birdsong and soothing music can be downloaded with the touch of a button; sleep trackers that provide detailed insights into the quality of your sleep are now even available for smart watches.

The screen-lit ubiquity of the sleep industry is oxymoronic: every shut-eye service fights to grab your attention while at the same time promising to help you switch off. So if you’re struggling with sleepless nights, you’re probably wondering: does any of this stuff actually work?

Well, before we answer that question, we need to ask some others. What actually is insomnia? What can cause it? Is there a one-size-fits-all solution to insomnia? And if not, how do I know which solution will help me? Some of these questions aren’t easy to answer. But we’ll reveal everything our health experts know about insomnia, and how to get a good night’s sleep, in our ultimate guide to sleep.

What is insomnia?

Insomnia is the term used to describe regular difficulties either getting to sleep, staying asleep, or waking up too early and being unable to get back to sleep. As mentioned above, insomnia is by no means uncommon. But the repercussions of insomnia - and prolonged insomnia in particular - can be deeply disruptive.

There are two main types of insomnia. Acute insomnia, which many adults will suffer at some point, is a short-term bout of sleeplessness that may last for days or weeks. Chronic insomnia, on the other hand, is sleeplessness that lasts for a month or longer. It’s important to remember that while sleeplessness may emerge by itself, in many cases it is the result of underlying health conditions, diet or certain medications.

How much sleep do I need?

This is an important question, and the answer isn’t as simple as you might think. Most adults need 7-8 hours of sleep a night, but this is not the same in every instance. According to independent sleep expert Dr. Neil Stanley, sleep is like height. Anything from three to 11 hours can be considered normal - but it’s genetically predetermined. If you need 10 hours’ sleep to feel bright-eyed and bushy-tailed the next day, then that’s what you need. You can’t train yourself to survive on less.

The trick to figuring out how much sleep you need is trial and error. If you’re heading to work at 9am and feel wide awake two hours later, Dr. Stanley says, you’re getting enough sleep. If you don’t, then you’re not. It’s also important to remember that sleep deprivation is cumulative. So if you need nine hours a night and you’re only getting eight, that lost rest is going to build up over time.

What are the symptoms of insomnia?

As stated earlier, the classic symptoms of insomnia involve difficulties getting to or staying asleep. However, people who suffer from insomnia will in most cases present with symptoms caused by a lack of sleep. These include:

• Not feeling well-rested after a night’s sleep
• Daytime sleepiness
• Mood changes including irritability, depression or anxiety
• Difficulty concentrating
• Poor memory
• Clumsiness
• Increased worrying about sleep

If you experience one or more of these symptoms on a regular basis, you should see your GP to make sure they’re not being caused by an underlying health condition.

What are the causes of insomnia?

There are a huge variety of conditions and circumstances that can lead to sleeplessness, which is why it’s so important to see a GP if you think you have insomnia. Insomnia causes are separated into two categories: primary and secondary. Primary insomnia means sleep problems aren’t caused by an underlying health condition. Secondary insomnia means you have trouble sleeping because of a health condition.

Primary insomnia can be caused by:

• Temporary stress usually caused by big life events, such as the loss of a job, a change in career, bereavement, divorce or moving house
• A poor sleep environment, possibly caused by light, noise or temperature
• Disruptions to your sleep schedule, including a shift change at work or jet lag

Secondary insomnia can be caused by:

• Pain or discomfort at night
• Mental illnesses including depression, anxiety and psychotic disorders
• Certain medications that treat high blood pressure, asthma, colds or allergies
• Smoking
• Caffeine overuse
• Alcohol abuse
• Hormonal problems, such as hyperthyroidism
• Other sleep disorders, including sleep apnea and restless legs syndrome

Risk factors of insomnia include:

• Age - older people tend to have more difficulty sleeping than younger people
• Long-term illness
• Mental illness
• Shift work

What problems can insomnia cause?

Sleep is important. It gives our bodies and brains the chance to rest and repair, helps us retain memories and learn more effectively. In addition to immediate symptoms, such as difficulty concentrating, prolonged sleeplessness can put you at higher risk of:

• High blood pressure
• Obesity
• Depression
• Falling, if you’re an older person

How can I get to sleep?

If you struggle with sleepless nights for long enough, any product or service promising to help you sleep might look attractive. But while medication can be effective for temporary bouts of insomnia, addressing other factors that might be causing you to lose sleep first is a good idea.

Here are three immediate changes you can make to your sleep environment to help you nod off easier:

• Turn off screens - any health professional who asks you about your sleep habits will ask if you watch TV or use your phone when you get into bed at night. That’s because their lights can make it harder to fall asleep
• Keep the bed for bedtime - Try to avoid working from bed or watching TV in it
• Make it comfy - ensure your bedroom is an inviting place to sleep: dark, quiet, and at Goldilocks temperature. If you can hear the traffic outside, wear earplugs. If there’s too much ambient light, get an eye mask

In addition to making the bedroom more comfortable for sleep, there are a variety of lifestyle changes you can make that can help reduce sleeplessness. These include:

• Eat earlier - lying down makes it harder for the body to digest food and can lead to heartburn, indigestion and other sensations that can make it harder to fall asleep. Eating dinner earlier can prevent this happening
• Keep consistent - go to bed at the same time each night, and get out of bed at the same time each morning. Daytime naps can make you less tired at night, so try to avoid those as well
• No staring at the ceiling - if you can’t sleep and don’t feel tired, get out of bed and do something calming in a different room. Reading is perfect for this (but not from a screen)
• Make a list - if worrying about things is what keeps you up at night, it can help to put your thoughts aside by writing a to-do list before going to bed
• Follow a routine - do something relaxing before bed every evening, such as taking a bath, reading or listening to calming music
• Exercise - a 2018 meta review on the interrelationship between sleep and exercise showed that exercise improved sleep quality and duration(). However, other evidence suggests exercising too soon before bed can make it harder to sleep. Therefore, experts recommend exercising at least three to four hours before bed
• No alcohol, no cigarettes, no caffeine - as stimulants, nicotine and caffeine will make it harder to fall asleep if you take them too soon before bed. Alcohol on the other hand, can damage sleep quality and cause you to wake up in the night

All these little changes and tips to help make it easier to dose off are collectively known as ‘sleep hygiene’. While studies have yet to show ‘sleep hygiene’ as a collective can help improve sleep, individual elements of sleep hygiene have been shown to help reduce sleeplessness(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400203/).

Sleep hygiene hasn’t worked for me - what about sleeping tablets?

If you’ve made the alterations recommended above and still find yourself unable to sleep properly (and ruled out underlying causes with your GP), you may benefit from the temporary use of over-the-counter sleeping aids, or over-the-counter and prescription sleep medications. To be clear: sleeping tablets are not supposed to be used long-term - doing so can cause other health problems or make it even more difficult to sleep once you stop taking them.

However, if you think you’d benefit from sleeping tablets for a short period of time, there are a number of options. Over-the-counter sleeping aids include:

• Melatonin - a hormone released by the pineal gland that makes you feel sleepy. Melatonin is available to purchase in tablet form from most health shops and pharmacies
• Valerian - a herbal remedy commonly used to treat insomnia, anxiety and stress
• Diphenhydramine (brand name Nytol) - an antihistamine with sedative effects
• Doxylamine succinate - another sedating antihistamine

Side effects from melatonin are usually mild, but can include headaches and daytime sleepiness. While valerian doesn’t appear to cause side effects, it may react adversely with antidepressants, which means you must inform your doctor before taking valerian with any antidepressant.

As actual medications, diphenhydramine and doxylamine tend to be more powerful sleep agents. However, they also have more side effects. These include:

• Daytime drowsiness (you should not drive or operate heavy machinery after taking these medications)
• Dry mouth
• Blurred vision
• Constipation
• Urinary retention

Diphenhydramine is typically available in strengths of 25mg and 50mg, while doxylamine is available in strengths of 12.5mg and 25mg. It’s important to remember not to exceed the recommended dose - taking too much of either medication can be very dangerous. If you do take too much of either antihistamine, go straight to your local A&E. If you take either medication and are still suffering sleepless nights after two weeks, stop taking the medication and see your GP.

What prescription sleeping tablets are there?

In the past, doctors often prescribed a type of medication known as benzodiazepines to treat sleep deprivation. These medications, however, were extremely habit-forming and easily led to dependence. In addition, benzodiazepine withdrawals are very dangerous: in severe cases sudden cessation of the drug can lead to fatal seizures. And even if gradually withdrawn, some withdrawal symptoms can become permanent.

In an attempt to overcome the problems associated with benzodiazepines, scientists developed a new family of medicines known as ‘Z’ drugs. These include:

• Zopiclone - available in tablet form with a half-life of five hours
• Zolpidem - available in tablet form with a half-life of 2.4 hours
• Zaleplon - available in capsule form with a half-life of one hour

‘Z’ drugs are quite effective as temporary sleep aids. But even though they were developed to circumvent the shortcomings of benzodiazepines, in reality they exhibit many of them as well. This is why ‘Z’ drugs should only be prescribed:

• For severe problems only
• At the lowest effective dose
• For the shortest possible time

People who temporarily take ‘Z’ drugs to treat insomnia may experience the following side effects:

• A metallic taste in your mouth
• Dry mouth
• Daytime sleepiness (you should not drive or operate heavy machinery after taking this medication)
• Dizziness
• Sleepwalking or performing tasks while asleep

The bottom line

Getting a good night’s sleep is a challenge for millions of people across the UK. If you’re having difficulty sleeping, it might be some consolation to know you’re not alone. But like a lot of other health problems, getting to the bottom of it starts with a trip to the doctor and addressing the things in your life that could be making it worse.

If you’ve done that and things don’t improve, that doesn’t necessarily mean sleep hygiene is a total waste of time. Reducing alcohol consumption, following routines and keeping organised are all things that have benefits on their own terms.

If you end up with a prescription for sleeping aids or buy some over the counter, make sure only use them temporarily. And if they don’t work, stop taking them and see the doctor again.