How to get to sleep:

An ex­pert be­lieves ‘per­for­mance anx­i­ety’ is caus­ing sleep prob­lems for many peo­ple – and that most such is­sues are ‘in­nocu­ous and treat­able’

The Irish Times - Tuesday - Health - - Front Page - Sylvia Thomp­son

‘There are few health is­sues that cause more stress and anx­i­ety than sleep prob­lems and few that are as in­nocu­ous and treat­able.” So writes sleep ex­pert Dr Chris Win­ter in the open­ing chap­ter of his new book, The Sleep So­lu­tion: Why Your Sleep is Bro­ken and How to Fix It.

Win­ter, dubbed “the sleep whis­perer” by Ari­anna Huff­in­g­ton, works with ath­letes and sports teams around the world to im­prove their per­for­mance. He says he set out to write a primer on sleep, in con­trast to all the tech­ni­cal, fact-driven books on sleep or the ones that of­fer you a hun­dred tips on how to sleep bet­ter.

But start­ing by call­ing sleep prob­lems “in­nocu­ous and treat­able” sounds rather un­sym­pa­thetic – al­beit hope­ful – to peo­ple who strug­gle with sleep prob­lems for years.

Speak­ing from his neu­rol­ogy and sleep medicine clinic in Charlottesville, Vir­ginia, Win­ter says: “I wanted to take peo­ple on a sleep jour­ney with this book but also to help read­ers un­der­stand that peo­ple’s per­cep­tions of their sleep and the re­al­ity of how much they sleep are of­ten two very dif­fer­ent things.”

The book is writ­ten just like Win­ter speaks: in a hu­mor­ous, con­ver­sa­tional style. He sprin­kles pa­tient anec­dotes and per­sonal re­marks through the facts he re­lays and says that he doesn’t wear a white physi­cian’s coat in his clinic as he be­lieves the doc­tor-pa­tient re­la­tion­ship is one of team­work rather than be­ing ex­pert-driven. One of his favourite analo­gies is to com­pare the im­por­tance of sleep to the im­por­tance of eat­ing, re­mind­ing us that if we re­ally need to sleep or eat, we will.

Sleep de­pri­va­tion

“It’s im­por­tant to dif­fer­en­ti­ate be­tween sleep de­pri­va­tion and in­som­nia. A 15year-old ER nurse who has worked full time all her life and works a sec­ond job as a sit­ter and has a child is sleep-de­prived. She will fall asleep in 20 sec­onds. But a lot of peo­ple who say they can’t sleep are sleep­ing much more than they think,” he says.

“For ex­am­ple, I deal with many peo­ple in my clinic who tell me they haven’t slept for years or that they wake up at 2am ev­ery night and they can’t get back to sleep, yet when we do sleep stud­ies on them, we find that they’ve slept maybe six hours.”

Ac­cord­ing to Win­ter, peo­ple who suf­fer from in­som­nia of­ten de­fine them­selves by their sleep prob­lems. “I’m in­ter­ested in read­ing the con­sumer on­line re­views of my book – par­tic­u­larly the neg­a­tive ones – be­cause it helps me un­der­stand my pa­tients bet­ter. Not sleep­ing well can be­come cen­tral to the way some peo­ple iden­tify them­selves – and that can’t help them sleep [bet­ter],” he says.

Al­though eat­ing and drink­ing al­co­hol or cof­fee late at night, cer­tain med­i­ca­tions and over­stim­u­la­tion from elec­tronic gad­gets in the bed­room af­fect sleep, Win­ter firmly be­lieves that fear and anx­i­ety are the root causes of in­som­nia for many peo­ple.

“In­som­nia is about peo­ple not sleep­ing when they want to. There is an emo­tional re­sponse in this. If some­one takes time to fall asleep but spends that time re­view­ing their day, happy to have the quiet per­sonal time and space to rest, it can be nice, but if they tell them­selves that they can’t go asleep, they are putting them­selves un­der pres­sure to go asleep.”

Win­ter be­lieves that this “per­for­mance anx­i­ety” about sleep is what’s caus­ing sleep prob­lems for many peo­ple.

“What I want to do is to ex­tract the fear or anx­i­ety out of the sit­u­a­tion. I work with a lot of ath­letes with sleep prob­lems, and many of them see rest­ing and med­i­tat­ing as a waste of time. But rest can be restora­tive, and if you’re not sleepy, you need to tell your­self you’re okay,” he says.

He also doesn’t agree with the oft-cited ad­vice that if you can’t fall asleep within 20 min­utes, you should get up and do some quiet ac­tiv­ity un­til you feel sleepier.

“If you’re not too both­ered by be­ing awake, I rec­om­mend sim­ply ly­ing there and rest­ing. It’s im­por­tant to re­mem­ber that rest­ing, even without sleep­ing, is good for you too,” he writes.

It’s im­por­tant to dif­fer­en­ti­ate be­tween sleep de­pri­va­tion and in­som­nia. A lot of peo­ple who say they can’t sleep are sleep­ing much more than they think

He also says that if you’re reg­u­larly awake for 20 min­utes or more, then you’re sim­ply go­ing to bed too early and it’s worth stay­ing up a lit­tle longer. This is ad­vice that some par­ents might also take on board when it comes to chil­dren who can’t fall asleep at night.

Ac­cord­ing to Win­ters, many peo­ple have be­come pre­oc­cu­pied with get­ting enough sleep – of­ten without know­ing what con­sti­tutes enough sleep for them. And this of­ten leads them to take sleep­ing pills to help them go to sleep.

“Peo­ple say to me ‘I re­ally need to func­tion the next day, so I take sleep­ing pills’, but there isn’t any re­search that shows that tak­ing sleep­ing pills leads to im­proved per­for­mance,” he says.

So, what is the so­lu­tion, then, for anx­i­ety-filled in­som­ni­acs? Well, get­ting your sleep hy­giene sorted out is a good start­ing point. Win­ter ded­i­cates a chap­ter to prepar­ing your­self and your bed­room for ideal sleep­ing con­di­tions but says that “sleep hy­giene only ac­counts for about 25 per cent of sort­ing out sleep prob­lems”.

So, for those who are still strug­gling with sleep prob­lems – and haven’t been di­ag­nosed with more com­plex med­i­cal sleep dis­or­ders such as sleep ap­noea or nar­colepsy, what does he sug­gest?

Well, it seems there are two parts to the so­lu­tion. The first one in­volves chang­ing your men­tal at­ti­tude to sleep. This is de­fined by Win­ter as “the con­trol­lingy­our-mind ex­er­cise”. And the sec­ond part is set­ting your­self a set wake-up time and work­ing back from that to find your cor­rect bed­time.

Mind ex­er­cise

The con­trol­ling-your-mind ex­er­cise set out in The Sleep So­lu­tion in­cludes not talk­ing about how you sleep for a month, and if any­one asks you, just say­ing you slept fine. Dur­ing this time, you prac­tise a goal-di­rected ac­tiv­ity when you are in bed awake. Win­ter sug­gests med­i­ta­tion, re­lax­ation, vi­su­al­i­sa­tion and so on.

“I’ve got a pa­tient who likes to vi­su­alise him­self play­ing golf dur­ing this time while his wife likes to imag­ine her­self bak­ing

ba­nana bread,” says Win­ter.

The sec­ond part of the so­lu­tion is to pick a wake-up time and stick to it. Win­ter says you then work back­wards from your wake-up time 5½ hours.

“If you’re not cheat­ing, your brain will be­gin to ex­hibit a stronger and stronger drive to sleep upon go­ing to bed be­cause . . . those pre­cious 5½ hours are the only time to get it,” he writes.

Over time fol­low­ing this sleep-re­stric­tion ap­proach, the in­di­vid­ual is al­lowed to go to bed a lit­tle ear­lier but not to ad­just the wake-up time.

And while this ap­proach might work for adults, what about chil­dren with sleep prob­lems?

“Ninety-eight per cent of chil­dren’s sleep prob­lems are ac­tu­ally par­ents’ sleep prob­lems. The way par­ents re­spond to their chil­dren’s sleep dic­tates chil­dren’s sleep,” he says.

And, if you want more ad­vice where this came from, you’re in luck, be­cause Win­ter is mid­way through writ­ing a book about sleep so­lu­tions for chil­dren.

PHO­TO­GRAPH: IS­TOCK

“A lot of peo­ple who say they can’t sleep are sleep­ing much more than they think.”

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