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