Chances are, your eyes are sliding across this as you lie in bed, another day coming to an end.

Yes, always a good idea to read something non-stimulating before you drift off to…Sleep.  Slee-ee-p.

         But what if you don’t drift off?

 Or what if you get off to sleep straight away, but then wake up at 2, 3, 4 o’clock in the morning, and can’t fall asleep again?

         Most of us have experienced disturbed sleep at some stage in our lives, but for the majority of us this has been transitory, along with the life stage it punctuates: exams, a new job, a baby, trouble at work, financial worries.

         But a large number of us h ave chronic sleep problems, and just about all of us are sleep deprived, according to research. And years and years of too little sleep eventaully takes its toll on our health and lifespan.

         We are sleeping on average 20% less per night than our ancestors were a century ago.  We are busier, have global communications, more things to amuse us and, of course, the electric light.  When Margaret Thatcher reigned it was something of a status to be able to claim that, like her, you could get by on only a few hours per night (she claimed four was enough).  Sleep was a luxury, perhaps even an indulgence, which busy and important people could not afford. The eighties were all about getting ahead, leading the pack, and this lasted for the next twenty years or so. But this  now appears to be giving way to the opposite: sleep, and whether you can afford to get plenty of it, is the new status symbol, according to an article in the recent weekend SMH. (And surely cheaper than a designer handbag)

         However, about 30% of Australians do experience sleep problems during their lives, from insomnia to sleep apnoea, which is linked to cardiovascular problems, overweight, hormonal changes as well as daytime tiredness.In clinical practice, asking a patient if they suffer from ‘tiredness” is like asking a starving man if he is hungry.

         I think I can remember two people who have ever replied said ‘no’: One was hypo-manic and the other was a marathon runner who probably had obsessive-compulsive disorder.

Sleep is a fascinating topic, and research into its mysteries has exploded in the last twenty years: what is it for, how much is essential, do dreams have a purpose?  There is information enough for several articles, but I want to condense a few practical tips for the weary reader who hasn’t managed to drop off by now.

       It is a cruel fact that as we age, we actually sleep less, and sleep more lightly. This is at a time in our lives when we are more inclined to want to go to bed early, or want to reward ourselves with sleep or feel more physically tired.  It’s rare to meet anyone over 70 who isn’t taking sleeping pills, prescribed or herbal. It’s also true that there are a lot of genes involved in sleep: if you are an insomniac, it’s likely you come from a long line of insomniacs.

About 7 hours sleep per night seems to be the minimum required for physical and mental health; the more the better.

Whether it occurs before or after midnight is irrelevant.

Your mind is like a toddler: it needs routine and discipline.  All the rather trite sounding rules about so called ‘sleep hygiene’ are true: no TV in the bedroom, the bed is just for sex, sleep and boring reading, the room should be quiet and dark and you should have a routine associated with going to bed, that prods your brain to move into sleep gear about half an hour before bedtime.  A warm drink (not alcohol), ablutions, flossing, quiet time and a regular bedtime, plus or minus 20 minutes.

         If you have trouble settling your brain down, avoid caffeine after 2pm, avoid drinking more than one glass of alcohol (alcohol gets you to sleep but doesn’t keep you asleep) and don't exercise last thing at night.  If you can afford the calories, have a carbohydrate rich snack before bed, such as a bowl of breakfast cereal.

         Don't take naps during the day if you are a poor sleeper.  Dozing in the evening in front of the TV is a big 'no-no', as it really takes the edge of your proper sleep routine.

         The arrival of sleep is like a train: it comes along about every thirty to sixty minutes when you are on the sleep platform.  You may have already noted this yourself.  If you are just about to board your sleep train, and your partner starts talking to you, unless you block them out you may well miss that train and have to wait about another half an hour until the next one steams in.  If you are patient, and drowsy enough to stay on the platform, fine: if you are too restless,  go for a wander on the station in your imagination. If you miss a couple of trains in a row, you may want to get up and watch a bit of boring TV, read something unchallenging, like the junk mail, or have a warm drink.  Make sure you keep warm when you are out of bed, or you will become too alert.

Sometimes we can get out of the habit of  catching the train; we see it arrive on the platform, wait for passengers to disembark, then we just can’t quite step up into the carriage.  It’s a bit like hesitating before parachuting out of a plane.  In these cases, a couple of sessions with a hypnotherapist works a treat, and the by-product of this is that you learn a simple technique that enables you to tap into tranquillity p.r.n.  Some people swear by meditation before bed, but I think this can be too stimulating for most.

         Stretching the muscles can certainly help prepare for sleep, though: this is the  notion of ‘pose to dose’ There is a feedback loop between the muscles and the brain, so doing some slow stretches, such as gentle yoga postures, will help to relax and prepare the mind to sleep.  (This is how valium and the benzodiazepines in general, work; they are powerful skeletal muscle relaxants.)

         There is also a “breath-brain connection”.  A well-designed study  at Harvard a year or two ago found that the following technique significantly aided sleep onset:

         It’s called “4-7-8” .

Lie with your mouth and jaw relaxed and the tip of your tongue on your hard palate, just in front of your upper teeth, mouth slightly ajar. Exhale fully. Close your mouth and inhale through your nose for 4 counts. Hold this breath for 7 counts. Exhale while counting to 8.

Do this sequence 3 more times.

(It seems to me that you could use a bit of licence with the exact numbers, but the Harvard scientists used this in their study)

If your sleep routine has become completely disrupted by life events, stress or travel, you may get yourself into a situation where the idea of trying to go to sleep almost becomes an aversive stimulus, and you are convinced in your subconscious or conscious mind that sleep will not come easily.  In these cases, I believe it is often useful to use prescription sleeping pills to ‘re-sequence’ the sleep clock, and to get that “unruly toddler” that your mind has turned into, back in to routine.  A pill taken 20 minutes before the light goes out, and then followed by the ‘sleep hygiene’ preparatory steps for 5-7 nights in a row can get you back on track, and allow you to catch up on sleep in the process. Sometimes valerian forte from the health food shop can work as well.

Lack of sleep makes one irritable, cranky and inefficient. One study showed that people who drove after being awake for 17-19 hours performed worse than those with a blood alcohol level of 0.05. However, if you have one  or two bad nights, try no to become sleep obsessed, counting up the number of hours you get each night.  This focuses your mind on the problem and amounts to telling yourself that you 'should' feel exhausted, so you probably will

If you do wake up in the early hours of the morning, don't stress out about it.  First assess your  physical state:do you have a cramp, a full bladder or a thirst?  Sort this out first.  If you don't have a physical problem, chances are that this is just a normal part of the sleep cycle.  Normal sleep is not 'solid' but involves surfacing periodically.  Try the breathing technique, or a 'mantra', repeating a calming word over and over to yourself, as in self-hypnosis. Thinking of the same word over and over is relaxing and required less attention than counting sheep, which can easily become too engaging (There's a merino! There's one giving birth to twins!)

However, if you are regularly waking up in the early hours of the morning, this can be a sign of stress or even clinical depression.  The middle of the night is always the time when obstacles appear insummountable, so try to short -circuit your rumintaion cycle as quickly as possible.  If nothing is working, think about seeking help.  Your GP is a good place to start.

Sleep apnoea is almost a medical specialty on its own now, as it is estimated that 8% of middle aged men and 4% of middle aged women suffer from it.  We now know that sleep apnoea has significant morbidity, and even mortality associated with it.  If any of you express interest in this, I'II do a whole piece on it.  If your nearest and dearest is worried that you stop breathing for in your sleep for up to 10 seconds at a time, and if you are tired during the day, feel like nodding off while driving and can't lose weight or get your blood pressure down, you need a 'sleep study'.  This is where you spend the night in a sleep laboratory with electrodes recording your sleep waves and breathing. This can be organised through your GP, or email me for more info.  (I can also recommend good hypnotherapists).