Sleep tips never seem to help me drift off

Q

EARLIER this year, you wrote about the importance of a good night’s sleep. As an insomniac for many years, I found this quite depressing. So, any advice on how to get a good night’s sleep? If only it were as simple as the usual sleep hygiene. Kath Squire, by email.

A

If I depressed you earlier in the year I apologise for mentioning that lack of sleep is a risk factor of progressive brain damage. I, too, was depressed by what the evidence now shows, as I spent decades limiting the amount of sleep I got. This was partly because of my duties on the night rota in our practice, and partly because — being a lark — I could get up at 5am or earlier and accomplish more at work.

The fact is, in many cases of insomnia, we train ourselves out of being able to sleep — often due to circumstances such as shift patterns or having a family.

Getting back to a healthy sleep pattern will take equally lengthy training — at least a year.

It does take that long, just as getting fit to run a half-marathon would do, or dieting to lose 10kg, but it is possible. Indeed, while it is difficult to advise you on how to get a good night’s sleep without trotting out a list of dos and don’ts, what is never said is that it takes determination, persistence and self-discipline.

The sensible ‘rules of sleep hygiene’ are available to anyone who searches the internet, so I will limit my comments to underlining the science behind some of the rules that might seem obvious, but are crucial.

There are three areas to cover: light, caffeine and temperature.

Experts recommend that with daylight being a key regulator of brain function and sleep pattern, getting outside into the daylight for at least 30 minutes is essential, preferably in the morning.

In conjunction, it’s important to minimise lighting at home in the evening. Blue light in particular — the light we get from smartphone screens and laptops — has a harmful effect on reducing secretion of the hormone melatonin in the brain. This hormone gets the brain ready for sleep and levels of it start to rise just after dusk.

Therefore, the use of any screen after 6pm will have a detrimental effect on melatonin release — interfering with sleep. Indeed, in his book Why We Sleep, the neuroscientist Professor Matthew Walker reveals that using an iPad for two hours before bed reduces melatonin levels by more than 20 per cent.

But it’s not just screen use — there are other pitfalls.

In my bedroom there is a small green light on the smoke alarm on the ceiling, and another on a central heating control. In the otherwise total darkness of the bedroom, they radiate a fair amount of light. I have now covered these with a square of black tape (if you do this, remember to test the smoke alarm on the first day of each month, because the light you’ve covered shows the battery is working).

Next: caffeine. This stays in your system for 12 hours or more and it ‘hijacks’ receptor sites in the brain for a chemical called adenosine. It is adenosine that helps you feel sleepy — your levels rise throughout the day and fall during the night, so when we wake in the morning our brains are completely cleared of it.

Because caffeine blocks the sleep - inducing effects of adenosine, you will struggle to fall asleep.

Be very strict about not allowing any caffeine to enter your system after 2pm — this includes chocolate cake and chocolate ice cream, and many other temptations.

finally, temperature. Your body temperature needs to fall by 1c for sleep — that is why taking a hot bath or shower before bed will help, as your body temperature will fall as you dry off.

Additionally, keep the bedroom cool, no more than 18c if possible, and avoid hot-water bottles or electric blankets, which will prevent you from sleeping as well as you might.

Remember — be patient, and good luck.

Q

I HAVE often suffered a few minutes of extreme itching, mainly on my arms and legs. Then about four months ago I developed an itchy rash on my chest, stomach and back. Betnovate cream initially helped, but new spots keep appearing and now seem less responsive. The itching sensation is almost continuous but worse late in the evening. I am 70. Name and address supplied.

A

WITH any skin complaint, an examination is vital to make an exact diagnosis. But there are clues in your letter which enable me to give an opinion.

The first is that the rash affected your chest, abdomen and back, sparing your face.

Secondly, four months after appearing, the rash has faded — although I accept that some new spots continue to appear. My suspicion is that you have pityriasis rosea, a harmless condition that is usually caused by a virus. It is characterised by raised scaly patches up to 1cm in size.

The rash is often itchy, and an important feature is that in half of cases it begins with one larger spot, known as the herald patch, which is usually between 2cm and 5cm in diameter.

The herald patch turns scaly and begins to clear from the middle outwards; then the other, smaller spots appear, on the trunk, arms and legs closest to the trunk, as you have described.

Identifying a herald patch is a clue to the diagnosis (although it could still be pityriasis rosea even if you don’t find the herald patch — in this case, the sparing of the face and the fact that it is mainly on the trunk distinguishes it from any other cause).

Itchy conditions are often worse at night — possibly due to waning cortisol levels from the adrenal glands, which follow a rhythm of being at a high at 9am, then declining all day until 3am, when they soar again.

The corticosteroid cream Betnovate eases the itch but the rash usually clears up by itself — and this may well happen in your case by the time you see a dermatologist.