Sleep – we can’t function without it

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Dr Loretta Poerio
Senior Mental Health Adviser
Department of Veterans’ Affairs

Yet one in 10 Australians suffer from a sleep disorder.

Want to improve your mental (and physical) health? Get enough sleep. It is one of the most powerful ways of enhancing and sustaining a healthy life, and contrary to popular belief, sleep is not just the absence of wakefulness. The brain is active during sleep, with a number of functions to perform. When these tasks are disrupted, our ability to learn, remember, problem-solve and maintain emotional equilibrium, among other things, is reduced. Even though the importance of sleep has been acknowledged for decades, we have not given this area of health the attention it needs, and deserves.

Sleep is intimately linked to mental health / ill health and is a common presentation across clients I see. It is estimated that four in every ten Australians are not getting the sleep they need, and this has significant impacts on many aspects of our day-to-day life.

The sleep we need depends on many factors, including our age, our health and our sex. At any point in time, our experience of sleep can be impacted by a range of variables, including quality, timing, and duration. Our sleep experience has consequences for our ability to function effectively when awake. The Australasian Epidemiological Association states that ‘…poor habitual sleep increases the risk for the development of chronic health conditions by 20 to 40 per cent’.

Sleep is closely connected to the quality of our mental and emotional health and has been linked to depression, anxiety, and bipolar disorder. There is a two-way street in relation to sleep and mental health. Being mentally unwell makes it difficult to sleep and inadequate sleep can affect your mental health.

Even though we may feel that we sleep in one long stretch, our sleep is actually broken up into stages of about 90–120 minutes duration, with each stage made up of a deep, restorative period as well as a phase of Rapid Eye Movements (REM sleep). The fascinating thing is that researchers have found that different stages of sleep activate different parts of the brain, with REM sleep, for example, related to the processing of emotional memories. Restorative sleep codes memories for long-term storage, and disruption of this phase of sleep reduces our ability to take on new information.

Generally, there are four areas of sleep difficulty, and we can experience one or more of these:

  • trouble falling or remaining asleep
  • difficulty staying awake during the day
  • imbalances in the body’s circadian rhythm that interfere with a healthy sleep schedule
  • being prone to unusual behaviours that disrupt sleep.

Insomnia is one common manifestation of sleep difficulty. It is associated with trouble falling asleep, staying asleep and/or early morning wakening, where sleep is inadequate to feel well-rested. These symptoms are present despite the time spent in bed. Many people experience insomnia at some point in their lives, with one in three people experiencing some symptoms at any given time. Chronic insomnia is defined when sleep difficulties are present for at least one month and occurring three or more times a week.  Symptoms include irritability, daytime tiredness, difficulty paying attention, depression and anxiety. If these disruptions do not resolve after a few weeks, talking with your GP may be an option.

One of the less helpful ways of dealing with sleep difficulties is the use of alcohol. Alcohol is seductive as a central nervous system depressant, as it has sedative effects that can bring feelings of relaxation and sleepiness. Unfortunately, the use of alcohol, especially in high levels, has been linked to poor sleep quality and duration. Those with alcohol-use disorders often experience symptoms of insomnia. Alcohol use can also exacerbate the symptoms of sleep apnoea. High levels of alcohol use is defined as more than two drinks for men and more than one drink for women per night, with research indicating that sleep quality can be reduced by 39%. This can result in shorter sleep duration and more sleep disruptions.

Since alcohol can reduce REM sleep and cause sleep disruptions, people who drink before bed often experience insomnia symptoms and feel excessively tired the following day. This can lead to a cycle of drinking and waking – self-medicating with alcohol to fall asleep, using caffeine and other stimulants during the day to stay awake, and then using alcohol to help counteract the impact of the stimulants to bring on sleep.

A more helpful approach to managing sleep difficulties is cognitive behavioural therapy for insomnia (CBT-I). This is an evidence-based, structured approach to treating insomnia that has been shown to improve insomnia symptoms. It addresses underlying psychological, behavioural, and physiological dynamics that maintain insomnia. CBT-I has been recommended as a first-line treatment by the Royal Australian College of General Practitioners. Recommendations include:

  • going to bed and getting up at the same time most days no matter how disrupted the sleep
  • establishing rituals for bed time to provide a quiet buffer between daily activities and sleep
  • keeping the room cool, dark and free of distractions such as a TV
  • establishing a regular exercising/stretching routine.

There are a number of programs and resources on the Head to Health website and the Open Arms website that may be useful.

Establishing good sleep habits is essential and the foundation of achieving the quality sleep we all need. Sometimes that can mean unlearning poor sleep habits of a lifetime, and this can take a little time, so be patient. Finally, remember changing habits and learning new skills requires time and effort, but your mind, and body will thank you.

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