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Problems with sleep: Oct'13

Tags: Anxiety , caffeine

Dr Mark Winwood Director of Psychological Services answered your questions around problems with sleep:

AXA PPP healthcare: Hi and welcome to today's live chat discussing problems with sleep. Please get your questions across to Dr Mark Winwood now.

Lynda Knight asked: Hi, I'm having really violent dreams at the moment, which is causing me to wake up and feel pretty stressed.  How do I stop them? Thanks

Dr Mark Winwood answered: Hi Lynda, dreams are very interesting and have been studies for years - Sigmund Freud's theory was that your dreams are an expression of what you're repressing during the time you are awake. And Carl Jung believed that dreams provide messages about "lost" or "neglected" parts of our selves that need to be reintegrated. Many dreams simply come from a preoccupation with the day's activities. But some offer rich, symbolic expressions -- an interface between the conscious and the unconscious that can fill in the gaps of our self-knowledge and provide information and insight. Sometimes we have violent dreams if we have experienced some kind of trauma in our lives -in fact it can be a very common symptom.  If you are experiencing violent dreams because of this it might be helpful to see a counsellor or therapist to help you work through any traumatic event you have experienced. If you haven't experienced a trauma and you are still waking feeling stressed it might be worth thinking about other things that are in your life that might be worrying you.  Start a worry record and note them down, leave the record outside the bedroom and dont take them to bed with you. Good luck

Anonymous162 asked: What are the side effects of taking over the counter non herbal sleep aid tablets for a long period. What is the best way to stop taking them?

Dr Mark Winwood answered: Hi 162. A pharmacist will be able to tell you the clinical side-effects of taking 'over the counter' sleep medications.  However, from a psychological perspective i believe it is possible to become reliant on these medications over a period of time and it is also possible for them to become less effective (we develop tolerance) so the dose needs to be increased.  On the whole - sleep disturbance is usually due to behavioural or psychological factors so it might be more useful for you to examine your sleep hygiene and try to improve your sleep by tweaking your behaviour.

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Anonymous188 asked: When i sleep i have been told i stop breathing for about 10 seconds should i be worried about this?

Dr Mark Winwood answered: Hello 188. You may have obstructive sleep apnoea if you have many periods when your breathing stops for 10 seconds or more when you sleep. People with this wake up briefly after each episode of stopped breathing to start breathing again. They do not usually remember the times you briefly wake up, but you have a disturbed night's sleep. As a result, they can feel sleepy during the day. A typical person with this condition is overweight, male, and middle-aged, and snores loudly. However, it can affect anyone. There are a variety of treatments but first you need to be correctly diagnosed.  As well as being over weight, smoking, drinking alcohol, being on sedative medications and sleeping on your back can also contribute to the condition. There is a scale called the Epworth Scale which helps determine if you have this problem - treatments can include improving lifestyle factors such as weight loss, sleep position but there are  also CPAP (continuous positive airway pressure)devices which can be used or even surgical treatments.
I would recommend visiting your GP to discuss this.

Anonymous193 asked: Hi I have anxiety and depression as a result of 3 major traumatic events in my life the last 2 years. I am still having problems with my sleep. It has got better but I am still not getting enough restorative sleep. Currently I go to bed around 10ish. I sleep heavily for about 4-5hours and then awaken early hours but for the next 3 - 4 hours it is very restless sleep, in and out of dream like state but in this time I also get very itchy hands (I do have eczema) and scratch a lot. I then do come to about 6 - 6.30 but feel very groggy and depending on the types of restless dreams I have awaken feeling very panicky. Do you know why this happens, why can I not seem to get rid of this pattern and what can I do to try and get back to a normal sleep pattern where I can awaken feeling refreshed. Thank you

Dr Mark Winwood answered: Hi 193. You mention that you have anxiety and depression - unfortunately a common symptom of depressed mood is waking early in the morning.  I am wondering what treatment you might be taking for your mood problems and  if it might be worth asking you GP to refer you to a therapist who specialises in Cognitive Behaviour Therapy.  A therapist could work with you not only to help you deal with your depressed mood but also introduce you to some techniques to help you improve your sleep hygiene. In the meantime there are a few things that you might like to try - reduce your tea, coffee and alcohol intake, as these substances can impact on the quality of your sleep.  If you do wake early, rather than lying in bed and watching the clock - get up and do something mundane like read a book or listen to relaxing music, then go back to bed again when you feel tired.  This might help to strengthen the link between bed and sleep.
A good resource to use which uses Cognitive Behavioural Techniques to improve sleep is an on-line programme called Sleepio - this can be purchased online at www.sleepio.com All the best

Anonymous203 asked: Over the past few weeks I haven't been able to get to sleep, meaning I'm only getting 5-6 hours a night. I go to bed at a reasonable hour, but then lie there tossing and turning for hours even though I feel tired. What would you recommend to help me to get to sleep easier?

Dr Mark Winwood answered: Dear 203. There is no rules when it comes to the amount of sleep we need.  On average people sleep between 7-8 hours per night but that is an average - babies sleep for 16 hours a day and older adults only sleep for 4-5.  The measure of how much sleep we need is how alert and refreshed we feel during the day.
A few suggestions:
1. Start a sleep diary - these can be downloaded from the internet  from sites such as www.getselfhelp.co.uk
2. Start a wind-down routine prior to bed - ie have a bath, listen to music etc...
3. Only go to bed when you are tired
4. If you are still awake after 20 minutes - get up - do something mundane like read a book - then go back to bed when you are tired.  Don't lie in bed awake - keep bed for sleep & sex
5. Cut down on your caffeine and alcohol intake
6. Do not exercise late in the evening

Rich asked: Unfortunately i can't make the web chat but i have questions around sleep. I have been feeling, tired for the last 12 months or more despite getting what i think is a good sleep. On some days by early afternoon i can be struggling to stay awake. There is a lack of motivation at work and sometimes i do struggle to engage with work. I have been to my GP and have undergone a sleep study and been referred to a respiratory consultant as a result of the sleep study. The respiratory consultant dismissed the sleep study results. I guess i will get referred to my GP again at some point in the future.
I'm none the wiser as to the cause of the fatigue but i am more concerned about the impact to my work.
Is there anything else i can do, or you can suggest to understand the root cause of the fatigue?

Dr Mark Winwood answered: Hello Rich. Thank you for your question.  It seems that you have already done quite alot to try to understand why you are feeling so fatigued in the afternoons.  Your GP is a good source of support. Has there been any assessment of your thyroid functioning?  Somethimes this can affect your energy levels? Alot of people, however,   do feel tired in the afternoon (after lunch fatigue is called post-prandial-somnolence) this mid-afternoon drop in energy levels is linked to the brain’s circadian rhythm. There are ways to reduce the severity of the slump, including including lifestyle factors. A fit, healthy and well-rested body is less prone to severe drowsiness in the afternoon. Suggestions: Eat a combination of protein and carbohydrates for lunch, for example a tuna sandwich. Carbohydrates provide glucose for energy.
More good reasons to eat protein for lunch – the amino acids produce dopamine and norepinephrine, which helps keep your mind attentive and alert. Get moving. A brisk walk or even 10 minutes of stretching at your desk improves blood flow and boosts energy. Also studies suggest,  that between 50 and 80 per cent of fatigue cases are mainly due to psychological factors - so:
1.Assess your lifestyle – for example, are you putting yourself under unnecessary stress? Are there ongoing problems in your life that may be causing prolonged anxiety or depression? You mention you feel unmotivated at work - are there career issues you need to address?
2. Relaxation training – constant anxiety drains the body of energy and can lead to burnout. Strategies include learning relaxation techniques, such as meditation or yoga, to help ‘switch off’ the adrenaline and allow the body and mind to recover.
3. Learn to do nothing – one of the drawbacks of modern life is the urge to drive ourselves to bigger and better heights. A hectic lifestyle is exhausting. Try to carve out a few more hours in your week to simply relax.  If you can’t find a few more hours, it may be time to rethink your priorities and commitments.
4.Have more fun – maybe you’re so preoccupied with commitments and pressures that you don’t give yourself enough time for fun. Laughter is one of the best energy boosters around. Good luck

tree123 asked: My dreams become fixated - half way through I will get stuck on an image and I cant move on from it. When I wake up, I have to move around to reset myself. Its awful. I also have restless leg syndrome. Consequently.I am just tired all the time. Help!

Dr Mark Winwood answered: Hello tree 123. I will take your question in 2 parts:
1. I have already answered a question on dreams - if you have perhaps experienced a traumatic event in the past it is not uncommon to have dreams that remind you of the event.  This requires specialist treatment and i would recommend a therapist who is experienced dealing with post trauma symptoms.  If however, your dreams are associated with everyday worries  it is important to put your worries to bed before you go to bed yourself.  You can do this by starting to write down your concerns and also steps you are going to take to address them.  Then leave the list outside of the bedroom so they are symbolically - not with you in bed.  Also try and develop a wind-down routine before you go to bed that includes relaxation - for example have a bath, listen to music.  Keep your bedroom dark and noise free.  Try and reduce caffeine (this will also help the restless leg syndrome) and alcohol can also disturb your sleep.
2. Restless Leg Syndrome (RLS) - can occur in people who have breathing problems when they sleep (or not) and to my knowledge there are no psychological treatments for this - although it requires careful assessment.  Periodic Leg Movement (PLMD) is more associated with the day time fatigue you describe as it disturbs the deep sleep pattern - everyone can get jerks in the leg at night  but if it becomes regular it can become more problematic.  There are some medications that might be helpful - some sedative drugs of the benzodiazepine family or some drugs that affect neurotransmitter production.  RLS is a bit of a mystery still i'm afraid.  I would have a chat with your GP. All the best!

tree123 commented: Thank you so much, really helpful!

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Dr Mark Winwood answered: Hello Tree. I have just chatted with a medical colleague and apparently there is some new research that has just come out from the US which indicates that RLS may be due to certain neurotransmitter production - we have know about the connection with dopamine for a while but more recently the substance 'glutamate'.  It will be a while before this may be of help - but research is happening!

Anonymous207 asked: Do you feel there is any value in these sleep tracking apps such as "Sleep Cycle"

Dr Mark Winwood answered: Hi 207. If you are experiencing disturbed sleep or even insomnia one of the best ways to try and start to understand what is going on is to have a 'sleep record' which tracks your sleep pattern.  This will include items such as when you go to bed, number of times you wake, what time you get up, subjective feelings of restfulness etc...  Apps can be a quick and easy way to record these factors, however, paper sleep diaries can also be just as effective if you want to monitor your sleep. Once you have a record of a weeks sleep you can start to notice patterns of sleep behaviour and start to figure out what might be helpful for you and also what might be having a negative impact on your sleep.

AXA PPP healthcare asked: We've just had a question come through on Facebook from Adam:
"I recently went on holiday, and was drinking quite heavily for the duration. Since I've come back and not been drinking, I've struggled with sleep despite being very tired. As soon as I feel as though I'm falling into a deep sleep I will feel as though I'm falling and feel a rapid jitter/burst in my chest and kick out of the sleep completely. I will then settle and the same occurrence will happen. What is causing this, and how can I stop it?"

Dr Mark Winwood answered: Hello Adam. It is not uncommon to have sleep disturbance following rapid withdrawl of alcohol.  Abrupt reduction of heavy drinking can trigger alcohol withdrawal syndrome, accompanied by pronounced insomnia with marked sleep fragmentation. It is not uncommon in rapid withdrawl for most of your sleep to be consisted of REM sleep which is light sleep and have constant awakenings - which maybe what you are experiencing at the moment.
These jerks you describe can occur as a result of you stopping drinking, but also as you have been on holiday your sleep pattern has probably been disturbed which can be another factor.  It is important to reduce your caffeine intake as this can also contribute to these symptoms.  If you are feeling anxious - this could be another contributory factor.
If your symptoms persist I would recommend visiting your GP. All the best!

AXA PPP healthcare asked: Thanks for joining us this afternoon, the live chat is now over. Thanks for your questions and thank you to Dr Mark Winwood for his answers. We hope they have helped.

 

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