Information from NHS Inform
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning.
It's a common problem thought to regularly affect around one in every three people in the UK, and is particularly common in elderly people.
If you have insomnia, you may:
- find it difficult to fall asleep
- lie awake for long periods at night
- wake up several times during the night
- wake up early in the morning and not be able to get back to sleep
- not feel refreshed when you get up
- find it hard to nap during the day, despite feeling tired
- feel tired and irritable during the day and have difficulty concentrating
Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time.
Persistent insomnia can have a significant impact on your quality of life. It can limit what you're able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues.
How much sleep do I need?
There are no official guidelines about how much sleep you should get each night because everyone is different.
On average, a "normal" amount of sleep for an adult is considered to be around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less.
What's important is whether you feel you get enough sleep, and whether your sleep is good quality.
You're probably not getting enough good-quality sleep if you constantly feel tired throughout the day and it's affecting your everyday life.
What causes insomnia?
It's not always clear what triggers insomnia, but it's often associated with:
- stress and anxiety
- a poor sleeping environment – such as an uncomfortable bed, or a bedroom that's too light, noisy, hot or cold
- lifestyle factors – such as jet lag, shift work, or drinking alcohol or caffeine before going to bed
- mental health conditions – such as depression and schizophrenia
- physical health conditions – such as heart problems, other sleep disorders and long-term pain
- certain medicines – such as some antidepressants, epilepsy medicines and steroid medication
Read more about the causes of insomnia
What you can do about it
There are a number of things you can try to help yourself get a good night's sleep if you have insomnia.
- setting regular times for going to bed and waking up
- relaxing before bed time – try taking a warm bath or listening to calming music
- using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
- avoiding caffeine, nicotine, alcohol, heavy meals and exercise for a few hours before going to bed
- not watching TV or using phones, tablets or computers shortly before going to bed
- not napping during the day
- writing a list of your worries, and any ideas about how to solve them, before going to bed to help you forget about them until the morning
Some people find over-the-counter sleeping tablets helpful, but they don't address the underlying problem and can have troublesome side effects.
When to see your GP
Make an appointment to see your GP if you're finding it difficult to get to sleep or stay asleep and it's affecting your daily life – particularly if it has been a problem for a month or more and the above measures have not helped.
Your GP may ask you about your sleeping routines, your daily alcohol and caffeine consumption, and your general lifestyle habits, such as diet and exercise.
They will also check your medical history for any illness or medication that may be contributing to your insomnia.
Your GP may suggest keeping a sleep diary for a couple of weeks to help them gain a better understanding of your sleep patterns.
Each day, make a note of things such as the time you went to bed and woke up, how long it took you to fall asleep, and the number of times you woke up during the night.
Treatments for insomnia
Your GP will first try to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems.
They'll probably also discuss things you can do at home that may help to improve your sleep.
In some cases, a special type of cognitive behavioural therapy (CBT) designed for people with insomnia (CBT-I) may be recommended.
This is a type of talking therapy that aims to help you avoid the thoughts and behaviours affecting your sleep. It's usually the first treatment recommended and can help lead to long-term improvement of your sleep.
Prescription sleeping tablets are usually only considered as a last resort and should be used for only a few days or weeks at a time.
This is because they don't treat the cause of your insomnia and are associated with a number of side effects. They can also become less effective over time.
Insomnia can often be improved by changing your daytime and bedtime habits or by improving your bedroom environment.
Making small changes may help you to get a good night's sleep. Try some of the methods below for a few weeks to see if they help.
See your GP if you're still having difficulty getting to sleep after trying these techniques.
- Set a specific time for getting up each day. Try to stick to this time, seven days a week, even if you feel you haven't had enough sleep. This should help you sleep better at night.
- Don't take a nap during the day.
- Take daily exercise, such as 30 minutes walking or cycling. But don't exercise for at least four hours before going to bed, because this may make it more difficult to fall asleep.
- Stop drinking tea and coffee for a few hours before bedtime.
- Avoid drinking alcohol and smoking, particularly shortly before going to bed.
- Don't eat a big meal just before bedtime.
- Only go to bed when you're feeling tired. If necessary, go to bed later than usual if it means you might be able to fall asleep more quickly.
- Don't use back-lit devices shortly before going to bed, including televisions, phones, tablets and computers.
- Try to create a relaxing bedtime routine, such as taking a bath, listening to soft music, and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness.
- Avoid regularly using over-the-counter sleeping tablets. It is not clear how effective these are, they don't tackle the underlying problem, and have potential side effects. Read more about treatments for insomnia.
- Don't lie in bed feeling anxious about lack of sleep. Instead, get up, go to another room for about 20 minutes and do something else, such as reading or listening to soft music, before trying again.
- Avoid watching the clock because it will only make you anxious about how long it's taking you to fall asleep.
- Write a list of your worries and any ideas to solve them before going to bed. This may help you forget about them until the morning.
- Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright street lamps affect your sleep.
- Make sure your bedroom is at a comfortable temperature for sleeping.
- Wear ear plugs if noise is a problem.
- Don't use your bedroom for anything other than sleeping or sex. Avoid watching television, making phone calls, eating or working while you're in bed.
- Make sure your mattress is comfortable and that you have a pillow you like, as well as adequate bedding for the time of year.
Information from Narcolepsy UK
Narcolepsy is a chronic neurological disorder characterised by excessive daytime sleepiness and often an array of additional symptoms, including (but not limited to) cataplexy, sleep paralysis, hallucinations, sleep fragmentation, vivid dreams, poor memory, automatic behaviour and obesity. Narcolepsy is a disability that affects around 1 in 2500 people or approximately 30,000 people in the UK. There is currently no cure, although medication and lifestyle changes can make life more manageable.
What is the cause of narcolepsy?
In most cases of narcolepsy, there is a loss of neurons that produce hypocretin (also known as orexin), a neurotransmitter that plays a central role in the regulation of alertness, motivation and mood. The damage to this important signalling system is thought to be the result of an autoimmune attack arising from a combination of genetic predisposition and an insult to the immune system (by a pathogen like the influenza virus or, in rare cases, vaccination).
Idiopathic hypersomnia (IH) shares some of the same symptoms as narcolepsy, although its cause is not yet known.
What are the symptoms?
All people with narcolepsy experience excessive daytime sleepiness (EDS), characterised by persistent and overwhelming sleepiness during the daytime. The pressing need to sleep usually builds over minutes, but some people with narcolepsy can also experience “sleep attacks”, where the transition from wake to sleep occurs without warning.
The majority of people with narcolepsy will also experience cataplexy, a sudden loss of muscle tone triggered by intense, often positive emotions such as laughter or surprise. The severity and duration of a cataplectic attack varies widely between people but also from one situation to the next. It may cause the lips to quiver and eyelids to close, the jaw to drop and the head to slump, slurred speech and the complete inability to vocalise, paralysis of skeletal muscles and eventual collapse. Importantly, a person experiencing cataplexy will remain completely conscious throughout an attack (in contrast to sleep or epilepsy). The experience is not painful and recovery usually occurs in less than a minute with no obvious ill effects. For many people whose cataplexy cannot be controlled by medication, however, the repeated loss of control - sometimes dozens of times a day - is likely to affect confidence and self-esteem.
Many people with narcolepsy will also experience sleep paralysis on a regular basis, waking up to find themselves unable to move. This state is not dangerous and will usually resolve in a matter of minutes, but it can be extremely alarming and is often accompanied by terrifying hallucinations.
Sleep fragmentation is common, with vivid dreams and multiple awakenings drastically reducing the quality of night-time sleep. Such disruption to the sleep cycle may account for the poor memory reported by many people with narcolepsy.
When people with narcolepsy are tired, they can exhibit automatic behaviour, losing consciousness but still able to perform a routine tasks as if awake. This can be unsettling and affect confidence and self-esteem.
In narcolepsy, the prevalence of obesity is twice that of the general population, most likely owing to a drop in the metabolic rate that occurs following the loss of hypocretin.
How will this affect me?
Narcolepsy is a spectrum disorder, so the combination and extent of symptoms will vary from one person to the next and this can make it hard to diagnose. With a diagnosis, however, with routine visits to a sleep specialist, effective medication, support from family and friends, and reasonable adjustments at school, college, university or work, it is possible to reduce the disability caused by narcolepsy.
If you think you may have narcolepsy, you will need to describe all your symptoms to your GP and present your score on the Epworth Sleepiness Scale. If you have cataplexy, you should emphasise this – with a video, if possible – as it is the most unusual of narcolepsy’s many symptoms. Your GP will need to refer you to a specialist sleep centre for further tests.
At the sleep centre, you will stay overnight for a sleep study so that the specialist can monitor the activity of your brain while you sleep. The following day, it’s likely that you will perform a multiple sleep latency test (MSLT), which measures how easily you fall asleep during the daytime and looks for the unusual sleep architecture characteristic of narcolepsy, notably rapid eye movement or dreaming sleep within minutes of falling asleep. Some sleep specialists will also ask to take a lumbar puncture to measure the concentration of hypocretin in your cerebrospinal fluid.
Treatment involves two complementary approaches. Pharmacological treatments include stimulants that can help with the excessive daytime sleepiness and other drugs that prevent cataplexy. It can take many years for you and your sleep specialist to identify the most effective drug regime and dose. Non-pharmacological treatments involve lifestyle changes, such as maintaining good sleep hygiene, having a healthy diet and taking short, planned naps during the day.
Narcolepsy UK promotes accessibility to early diagnosis, quality treatments and emotional and practical support for people with narcolepsy and IH and their carers. According to the charity’s Narcolepsy Charter, “people with narcolepsy have the same rights to a full and rounded life as any other person without having to fight to make this happen.”
Information from British Snoring & Sleep Apnoea Association
What is Sleep Apnoea? (Sleep Apnea)
Obstructive Sleep Apnoea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of 'stopping breathing' only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnoea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again. People with OSA will experience these wakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal.
How Do I Know I Have Sleep Apnoea?
People with sleep apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following:
- Extremely loud heavy snoring, often interrupted by pauses and gasps
- Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time)
- Irritability, short temper
- Morning headaches
- Changes in mood or behaviour
- Anxiety or depression
- Decreased interest in sex
Remember, not everyone who has these symptoms will necessarily have sleep apnoea. We possibly all suffer from these symptoms from time to time but people with sleep apnoea demonstrate some or all of these symptoms all the time.
Diagnosing Sleep Apnoea
OSA can range from very mild to very severe. The severity is often established using the apnoea/hypopnoea index (AHI), which is the number of apnoeas plus the number of hypopnoeas per hour of sleep - (hypopnoea being reduction in airflow). An AHI of less than 10 is not likely to be associated with clinical problems. To determine whether you are suffering from sleep apnoea you must first undergo a specialist 'sleep study'. This will usually involve a night in hospital where equipment will be used to monitor the quality of your sleep. The results will enable a specialist to decide on your best course of treatment. The ultimate investigation is polysomnography, which will include:
- Electro-encephalography (EEG) - brain wave monitoring
- Electromyography (EMG) - muscle tone monitoring
- Recording thoracic-abdominal movements - chest and abdomen movements
- Recording oro-nasal airflow - mouth and nose airflow
- Pulse oximetry - heart rate and blood oxygen level monitoring
- Electrocardiography (ECG) - heart monitoring
- Sound and video recording
This is a very expensive investigation, with few centres able to offer it routinely for all suspected sleep apnoea patients. A 'mini' sleep study is more usual, consisting of pulse oximetry and nursing observation. Home sleep study is becoming more popular.
Treating Sleep Apnoea
There are several forms of treatment for sleep apnoea. In mild and moderate cases weight loss and the use of mandibular advancement devices can be wholly successful. In moderate and severe cases mandibular advancement device or nasal continuous positive airway pressure (CPAP) are normally prescribed. CPAP is the gold standard treatment for OSA.
Central & Mixed Sleep Apnoea
OSA is the commonest form of sleep apnoea, (about 4% of men and 2% of women) but there is also a condition called Central Sleep Apnoea (CSA). This is a condition when the brain does not send the right signals to tell you to breathe when you are asleep. In other words the brain 'forgets' to make you breathe. It can also be associated with weakness of the breathing muscles. The assessment for CSA is often more complicated than for OSA and the treatment has to be carefully matched to the patient's requirements. There is also a condition called Mixed Sleep Apnoea that is a combination of both obstructive and central sleep apnoea.
Information from British Snoring & Sleep Apnoea Association
What is Snoring?
Snoring is the coarse sound made by vibrations of the soft palate and other tissue in the mouth, nose & throat (upper airway). It is caused by turbulence inside the airway during inspiration. The turbulence is caused by a partial blockage that may be located anywhere from the tip of the nose to the vocal chords. Snoring can originate from the nose, oropharynx or the base of the tongue.
Why do we snore only when sleeping?
It's most common when we sleep as our throat muscles relax and this can cause airways to narrow. This is because our muscle tone is reduced during sleep and there may be insufficient muscle tone to prevent the airway tissue vibrating. During waking hours muscle tone keeps the airway in good shape.
How to "stop" snoring?
Snoring is something that cannot be stopped at will, neither is it something that can be 'cured'. It can however, be successfully controlled. Snoring is caused by a physical abnormality that needs to be identified before a control can be found, we can break the cause down to different "types" of snoring.
Types of Snoring
The type is based on where your snoring originates, this can be multiple areas:
If you're not sure take our online test to find out what type of snorer you are and what treatments could help control your snoring.
Common Causes of Snoring
Some people only snore at specific times of year or after a particular food. Snoring can be affected by the following factors which you might be able to control:
- Sleeping medication
- Allergies and Hayfever
- Being overweight or out of shape
- Sleeping position
- Nasal problems e.g. deviated septum
Some Organisations which may be useful to you
British Snoring & Sleep Apnoea Association
Information and support for people affected by snoring and sleep apnoea.
0345 450 0394
Supporting people with narcolepsy, their families, carers and others interested in improving their quality of life
National Sleep Helpline
03303 530 541
Sleep deprivation can have a serious impact on emotional, physical and mental health and many people who are seeking their support are approaching crisis point, whether that’s adults or families. They aim to provide access to high quality information and advice to deal with most sleep issues, and ensure everyone understands the value of a good night’s sleep
SPEAK TO TRAINED SLEEP ADVISORS
Available Sunday – Tuesday & Thursday 7pm-9pm, Wednesday 9am-11am, *excluding Bank Holidays
Sleepstation is a clinically validated sleep improvement programme that can help you sleep better after just four sessions. Designed by experts and backed by science, their online sleep service is proven to combat even the most severe insomnia. Their team of coaches, doctors and sleep experts will help you identify the underlying causes of your sleep problem and provide the personal support needed to improve your sleep. They deliver remote care with a personal touch and that’s what makes their service so effective.
Good Thinking: Digital Wellbeing for London
Range of resources and sleep workbook
Mental Health UK
Forward Together for Mental Health: Sleep Station
Moodzone: Sleep problems (AUDIO PODCAST) | NHS
Paul's sleep apnoea story on Goodnight Britain by Michael Oko
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