Are women REALLY worse sleepers than men?

TODAY, in the final part of our illuminating series, Dr Guy Meadows, of The Sleep School, looks at the life triggers that can disrupt sleeping patterns.

THERE’S a new battle of the sexes and it’s taking place in our bedrooms: who suffers the most with poor sleep? It’s a competition women appear to be winning, although I’m sure it’s one they would love to lose.

That’s because, if you’re female, you’re at risk of experiencing sleep disturbance caused by the hormonal fluctuations of the menstrual cycle, menopause and pregnancy. The responsibilities of motherhood are another factor, while women also have a greater tendency to worry.

Indeed, a study by the University of Surrey found that nearly 20 per cent of women have a bad night’s sleep five times a week, compared with only 8 per cent of men.

But men are suffering with lack of sleep, too. Being male doubles your likelihood of suffering from obstructive sleep apnoea, where you stop breathing through the night and constantly wake up.

Meanwhile, whether male or female, being anxious or worrying about everyday life will lead to over-thinking, which causes heightened arousal and, subsequently, an increase in wakefulness. Generally speaking, people with higher arousal levels, who are ‘hyper’, ‘full of beans’ or ‘excitable’, tend to find it harder to switch off.

BUT, gender aside, the simple truth is that some of us are at more risk of developing insomnia than others, in the same way that you might be more at risk of heart disease or cancer.

A variety of factors can increase your likelihood of developing insomnia, but a big one is getting older. As we age, we more often experience disorders that disturb sleep, such as physical pain or an increased need to use the toilet during the night.

Suffering from depression is another risk factor because it changes the structure of sleep by reducing and increasing the

amount required and the incidence of early awakening. Meanwhile, if you suffer from insomnia, there is a good chance other family members will also suffer.

Scientists believe there is a hereditary link of around 59 per cent in women and 38 per cent in men, which explains why we sometimes see three generations of a family attending a single Sleep School workshop.

Those whose genetics mean they function best in the early morning (larks) or the late evening (owls) also have a higher risk, with a tendency either to wake up earlier than planned or to take longer to fall asleep.

Your socio-economic status can play a part, too — those with lower income, education, occupation and housing opportunities are exposed to a constant level of stress, which can affect sleep.

Remember, though, that these risk factors simply predispose you to insomnia; they are not a direct cause. Just as being overweight does not guarantee you will suffer from a heart attack, having one or more of the risk factors does not mean you will be an insomniac. They simply increase the risk and make you susceptible when a trigger comes along.

So we know that some people have a higher risk of insomnia. What happens next is that a stressful life event triggers it.

It can be unexpected, such as a stressful day at work, or it can gradually build up, for example, when planning your wedding. When your thinking mind is overstimulated, this can create feelings of worry, anger and sadness. These feelings might even cause the release of stress hormones, such as adrenaline, all of which, in turn, stimulate the waking centre of your brain, preventing you from sleeping.

Thankfully, most stressful situations don’t last and sleep patterns return to normal once the stress has passed.

But in the case of the insomniac, the period of sleeplessness outlasts the stress, so the initial reason why you couldn’t sleep is no longer the problem.

The real issue, therefore, is not the trigger, but the subsequent worrying about poor sleep and your reaction towards it.

FIND THE ROOT CAUSE

OF COURSE, there are situations where there is a medical, physical or environmental reason why you’re struggling to sleep.

You could have a condition that causes you pain, or perhaps be

living next to a noisy nightclub — what do you do then?

This is where we return to Acceptance and Commitment Therapy (ACT), which we looked at yesterday. First, you must control what you can. So, if the problem is medical, you should work with your doctor to make sure everything is being done to keep your condition under control.

If environmental noise is to blame, then look at whether rules are being flouted and whether the relevant authorities could intervene.

Then, knowing you’ve done all you can, you must let go . . .

ACT means viewing what you suffer — in this case, sleeplessness — as either ‘original’ or ‘amplified’.

Original pain refers to that which naturally shows up because of your insomnia risks, triggers and arrivals. In contrast, amplified pain refers to the additional pain and suffering that shows up every time you unhelpfully attempt to control and avoid your original pain.

For example, you can’t change the fact that you are an anxious person and that this puts you at a slightly greater risk of insomnia than others. And you also can’t stop the arrival of thoughts such as: ‘If I don’t sleep, I won’t be able to cope tomorrow.’

The good news is that you can control the level of amplified pain that you experience, because it is nothing more than the product of your unwillingness to experience your original pain.

So, for example, if you feel excessively hot and sweaty in the night, remember it’s how you react that determines how much it affects your ability to sleep.

Choosing to struggle with it by constantly tossing and turning, huffing and puffing, flinging the covers off and on, or getting in and out of bed will only exacerbate the situation.

Watching objectively and welcoming the sensations of heat in your body and the unhelpful thoughts in your mind won’t make them go away, but won’t amplify them either.

WHEN BAD SLEEP RETURNS

WHETHER you’ve been sleeping well for one night, one week or one month, at some point you will begin to think that you have cracked it and your sleepless nights are over.

Then, one night, you will find yourself awake.

Your mind will start to ask what you can do to fix it, in the hope of nipping it in the bud as soon as possible.

You have tasted normal sleep again and are prepared to do anything to keep it. Out of desperation, you will begin to struggle and escape the arrivals that start to show up.

Your heart will begin to pound, your stomach knot, anxiety will creep in and your thinking mind will start to calculate what you stand to lose if poor sleep does return.

It will seem as if your normal sleep is shattered and your insomnia is back — but hang on. The truth is, just because you have learnt to sleep normally again does not mean you are immune from insomnia. Mind you, nor is a normal sleeper. Remember, your brain is a thinking machine that is constantly linking together bits of information and using them as a reference for anticipating what it might need to fix in the present or the future.

But there is a cost to having such a brilliant, problem-solving machine at your disposal. All you need to do is believe and act upon your mind’s projected tales of sleeplessness and you can keep yourself awake for days.

Understanding this process is not only paramount for learning how to sleep naturally again, we also need to remind ourselves of it to prevent a relapse.

For the majority of people, once the stress is resolved, their sleep returns to its original pattern because the brain has no reason for it not to.

In the case of a recovering insomniac, this is not always true, because your thinking mind struggles to distinguish between what would be considered a normal night of poor sleep and the possible threat of insomnia returning.

This means that, while your returning bout of poor sleep will probably pass within a few days, your mind can’t help but ask the inevitable question: What if this is the start of my insomnia returning? YOUR brain will always remember your poor sleep history, and so you will always have a greater risk of experiencing poor sleep than someone who has never struggled.

Sometimes, it takes only the suggestion of poor sleep for it to be triggered. For example, if your insomnia was originally caused by events in your life, such as work stress or pregnancy, experiencing them again is a possible trigger. Sometimes, it can even be sleeping well that reminds you of sleeping badly, and that triggers the return of

A BRAIN NEVER FORGETS

poor sleep with thoughts such as: ‘I’ve been sleeping so well recently, I must be due a poor night soon.’ I’ve even had people cancel an appointment with me in case simply thinking about poor sleep upsets their ‘good run’.

This is not some sort of malicious act, but rather your mind accessing your chequered sleep history and flagging up any potential risk factors for the future. Questioning thoughts such as: ‘What if this is the start of my sleeplessness returning?’ are commonplace for the recovering insomniac. The key is how you respond to them.

What you resist persists, and so if you go with your fear of poor sleep returning, you increase the likelihood that it will. If a bad night comes along, you need to welcome it using all the tools we’ve discussed, rather than struggle against it.

It’s the only way in the short term to defuse the fear and panic so that your brain thinks it is safe to sleep in the long term. Almost everyone will experience a poor night or two at some point. Triggers such as work issues, family arguments or financial worries are common.

Being open to experiencing them, and all the fears that arise, is the key to sleeping well.

BEHAVE LIKE A NORMAL SLEEPER

REMEMBER, to become a normal sleeper, you have to act like one.

Create a relaxed and flexible approach to sleep that treats it as an ordinary part of everyday life, rather than the pivot around which your world revolves.

Let go of any unnecessary sleep props that you have used and learn to stay in bed and rest, rather than get up through the night. This