Improving Your Sleep

Here we have included user-friendly information for improving your quality of sleep - just click on any of the headings below to go to that section:

What is Normal Sleep?
Sleep Hygiene Tips
Tips for Overcoming Jet Lag
Tips for Shift Workers
More Information

WHAT IS NORMAL SLEEP?

What is Sleep?

Sleep is a behavioural state characterised by little physical activity and almost no awareness of the outside world.

Sleep is an active, highly organised sequence of events and physiological conditions and is made up of two distinct states: (1) Non Rapid Eye Movement Sleep (NREM); and (2)  Rapid Eye Movement Sleep (REM).

The Sleep pattern

• NREM sleep is divided into 4 stages.  Stages 1 and 2 are known as “light sleep” ,and stages 3 and 4 are known as “deep sleep”.
• Normal adults will enter sleep via NREM light sleep and deep sleep will predominate the first third of the night.
• REM sleep is also called “dream sleep” and this stage predominates the last third of the night. 
• Normal adults cycle through NREM and REM sleep approximately every 90 minutes.  It is this typical sleep stage distribution that defines healthy sleep in an adult.
• "Sleep quality" refers to the pattern of sleep stages, in particular, the amount time spent in each sleep stage, and the amount of time spent without waking or being aroused. 

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Our Circadian Rhythm

The timing and control over wakefulness and seep depends on our bodies’ biological clock or “Circadian rhythm”. 

• This clock is sensitive to light and has evolved to the 24 hour light/dark cycle of our world.
• In humans sleep is physiologically programmed to come each night.  The timing of sleep and wake is controlled by our exposure to natural light and dark cycles of the earth. It takes the body several days to change to a different light-dark schedule.
• Individuals who sleep in an environment free from time cues follow a shorter rhythm for the onset of sleep and length of sleep.

Sleep and Ageing

One of the factors affecting sleep is age -  the sleep of an infant is very different to that of a healthy middle aged adult.  For example, NREM sleep is not present at birth and evolves over the first 2-6 months of life.  Deep sleep is then maximal in young children, decreasing by 40% by adolescence. 

By the age of 60, deep sleep diminishes dramatically and may no longer be present, however REM sleep as a percentage of total sleep is maintained in healthy old age.   Arousals from sleep also increase with age.  However, it is unclear whether this is a direct effect of age or because older people having more causes of sleep disturbance e.g. sleep disorders, pain.

Sleep Deprivation

• Sleep loss or sleep deprivation can occur  in an individual as result  of a sleep disorder, irregular work hours or shift work; or by external factors.
• Apart from sleep loss causing daytime sleepiness, it also has an effect on the next “normal sleep cycle” ; when sleep is next available.
• Deep sleep will usually dominate after a period of sleep deprivation.
• If partial sleep deprivation has occurred then rebound of the deprived sleep stage will occur when normal sleep resumes.

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The Effect of Sleep Disorders

Sleep disorders can dramatically affect the normal sleep cycle.  Common ones are:

• Obstructive Sleep Apnoea (OSA) is a condition where the airway narrows during sleep causing the sufferer to stop breathing many times during the night.  People with this disorder have a more fragmented sleep pattern with reduced deep sleep and REM sleep.
• Narcolepsy is a disorder causing episodes of unpreventable sleep, which can occur frequently and at inappropriate times.  These episodes are usually REM-based sleep.  Sufferers of narcolepsy have a short delay to REM sleep.  This abnormal sleep pattern can see components of REM sleep entering the wake state causing hallucinations, sleep paralysis and cataplexy.

Sleep and alcohol

The occasional use of alcohol and chronic alcoholism has been linked to sleep disturbance. 

• Initially, alcohol use leads to an increase in NREM deep sleep and can lead to reduced REM sleep with continued use.
• Following this, increased sleepiness, restless sleep and often vivid dreams during the second half of the night are experienced.
• With continued habitual use, alcohol continues to show a short lived sedative effect, followed by sleep continuity disturbance for several hours.

Sleep and Drugs/Medication

• Drugs and prescription medication can also affect sleep.
• Caffeine is known to result in increased wakefulness and sleep fragmentation and reduce deep sleep.
• Illicit drugs such as cocaine and amphetamines increase the time it takes for you to fall asleep.  They also result in a reduced total sleep time and break up of sleep architecture.
• Amphetamine use also reduces REM sleep and deep sleep.
• Sedatives and sleeping pills produce an increase in sleepiness.  They also decrease REM sleep and increase “sleep spindle activity”, which is a feature of light sleep.  Long term use of sedatives may actually induce symptoms of insomnia as the person becomes dependant.

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Tips for getting a GOOD night's sleep

Going to Bed

• Aim for at least 6 to 8 hours of uninterrupted sleep every night.
• Try to go to bed at the same time and get up at the same time every day - routine will encourage good quality sleep.
• Avoid naps during the day to ensure that you are tired at bedtime.
• Make sure you are exposed to bright light and sun during the day while you are awake – this will encourage you to feel sleepy at the same time every night.

Relaxation

• Try to go to bed only when you are sleepy - this will reduce the amount of time you are awake in bed.
• Try not to become stressed if you feel you are not getting enough sleep.  Remember that sleep will come eventually, and try to relax.
• Avoid looking at the clock while in bed.  If you can’t get to sleep or get back to sleep for an extended period, get out of bed and do something boring in very dim light, or sit and relax in the dark until you are sleepy.

Television

• Do not watch television in bed - your body needs to be accustomed to using bed for sleeping.
• If you like to read in bed to encourage sleep, use a 15 watt bulb or less.

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Activity/Exercise

• Reduce your activity before going to bed by exercising at least 3 hours before going to bed.
• You may like to read or listening to soft music for 15 minutes before bedtime.
• Exercise in the morning or early afternoon can encourage a healthy sleep routine.  3 to 5 periods of exercise per week (such as a 30-minute daytime walk) is recommended.

Sleeping Environment

• Keep your bedroom at a cool, comfortable temperature.
• Maintain a dark and quiet sleeping environment.
• If you have problems with noise in your environment, try listening to soft relaxing music, a CD of nature sounds, or good sleep/relaxation recordings, such ”Falling Asleep with Tottie Goldsmith” (available from Sleep Services Australia - phone 1300 867 533 to order).

Lights

• Avoid bright light around the house before bed, as lots of light gives cues to your brain that it is time to wake up.
• Use dimmer switches in living rooms and bathrooms before bed, but maximise the light around your house for your morning routine.

Food

• Do not go to bed hungry - an empty stomach can interfere with sleep.
• A light healthy snack before bed is OK, but don’t eat a heavy meal before bed.
• A cup of warm milk or herbal tea (caffeine-free) can help to induce sleep.

Alcohol

• Avoid consuming alcohol for at least 4 hours before going to bed.
• It can seem to help you fall asleep, but it also causes you to wake up during the night, leading to a disrupted sleep.

Caffeine / Smoking

• Caffeine and tobacco are both stimulants, so avoid caffeine and smoking at least 4 hours before going to bed.
• Do not smoke or consume caffeine during your sleeping hours.
• If you want to quit smoking, please visit Quit for more information - www.quit.org.au

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TIPS FOR OVERCOMING JET LAG

What is the Circadian Rhythm?

• The Circadian rhythm is a roughly-24-hour cycle in the physiological processes of living being, and is linked to the light-dark cycle.
• In the short term, disruption to rhythms usually has a negative effect—many travellers experience jet lag, with its associated symptoms of fatigue, disorientation and insomnia.
• In the longer term, this can have significant adverse health effects on peripheral organs outside the brain, particularly in development or exacerbation of cardiovascular disease.

What is Jet Lag?

• Jet lag is a temporary condition following air travel across several time zones in a short period of time.
• Persons travelling between different time zones need time for their internal body clock to reset itself and adjust to the new time zone. This causes their internal clock to be out of sync with the external environment.
• People have a difficult time maintaining their internal routine sleep-wake pattern in their new location, because external stimuli like sunshine dictate a different pattern.

Who gets Jet Lag?

• All age groups are susceptible, but individuals over the age of 50 are more likely to develop jet lag
• Made worse by pre-existing sleep deprivation
• Generally worse with Eastern travel

Jet Lag Symptoms

• •  Insomnia
• •  Loss of appetite
• •  Mood disturbances
• •  Difficulty concentrating or focusing
• •  Daytime sleepiness

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Tips for Minimising Jet Lag

• Before you leave for your destination, make sure you have had enough sleep and are well-rested.
• Some people to initiate sleep when travelling use melatonin, a naturally secreted hormone that regulates the body’s internal clock.  Melatonin (4-5mg) should be taken at 8pm destination time
• Jetlag can be mainly avoided by sleeping in the plane and by adjusting to your new time zone.

Overcoming Jet Lag

• On average, it takes about a day to recover from jet lag.
• Expose your body to daylight to help 'reset' your body clock.
• Drink caffeinated drinks in moderation during the day.
• Avoid alcohol or caffeinated drinks for a few hours before going to sleep at night.
• Try to mimic your usual bedtime routine.
• Use relaxation techniques, such as meditation.
• Avoid heavy exercise close to bedtime.
• Try to have a power nap (limited to <20 minutes)  if you are feeling sleepy during the day.
• If you are flying westward, try to go to sleep as late as possible for two to three days before you leave.
• If you are flying eastward, try and get sunlight exposure as soon as possible to help reset your body clock
• Limit powernaps to less than 20 minutes

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Sleep TIPS for Shift Workers

• After working night shift, prepare your body and mind for sleep by wearing wraparound dark glasses on your way home from work to keep morning sunlight from activating your internal “daytime clock”.  Prepare for sleep even though it may be daylight outside, and go to sleep as soon as possible after work.
• Avoid the sun and bright light around the house before bed - light gives cues to your brain that you should be awake.
• Keep your bedroom at a comfortable and cool temperature., and try to maintain a dark and quiet sleeping environment.  If you have problems with noise in your environment that is beyond your control, try listening to soft relaxing music, a CD of nature sounds, or other sleep/relaxation recordings, such ”Falling Asleep with Tottie Goldsmith” (available to purchase from Sleep Services Australia - Call 1300 867 533 to order).
• Do not use alcohol or medication to help you sleep - they will not help your body clock to adjust to the new time pattern, and can often make the problem worse.  Avoid having alcohol for at least 4 hours before bedtime - while it may help you fall asleep, it can also cause you to wake up during your sleep time, resulting in disrupted sleep.
• Caffeine and smoking are both stimulants, so avoid caffeine and smoking 4 hours before going to bed. Do not smoke or consume caffeine during your sleeping hours.
• Reduce your activity before going to bed by not exercising at least 3 hours before going to bed; and/or reading or listening to soft music for 15 minutes before bedtime. 
• Do not go to bed hungry - an empty stomach can interfere with sleep.  A light healthy snack before bed is fine, but do not eat a heavy meal before bed.  A cup of warm milk or herbal tea (caffeine-free) can also help to induce sleep.
• Do not watch television in bed - your body needs to be accustomed to using bed for sleeping.  If you like to read in bed to bring on sleep, use15 watt bulb or less.
• Adapt to your new time frame as quickly as possible by timing meals and other activities to match the new “day”.  For example, have “breakfast” when you wake up at 6pm, before you start night shift.
• Exercise can help realign body rhythms.  Start the new “day” with gentle exercise, such as a taking a walk after you wake at 6pm before you start your night shift.
• Maximise the light around your house when you wake up from sleep. Exposure to a bright light in your wake hours in the form of a light box see Bright Light Therapy Boxes for more information) or dawn simulator can help you align your body clock when working night shift or adjusting to a new time zone. This will encourage you to feel awake during your “wake time” and sleepy during your “sleep time” regardless if this is during the day or night.

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• Sleep disorders are treatable, and more information is available on this website.  If you suspect that you or your partner have a sleep disorder, your doctor can evaluate your sleep problems with a sleep study, and may refer you to a sleep specialist if necessary.
• You may also want to complete our Interactive Epworth Sleepiness Scale, a handy self-evaluation tool to determine if you have Excessive Daytime Sleepiness, which is often a symptom of a serious sleep disorder.  Click here to go to the Epworth Sleepiness Scale section, or Click Here to download a PDF form.

• See your Dentist or General Practitioner for a Referral to Sleep Services Australia;
• Complete our Online Query Form (Click Here) or e-mail your contact details to query@sleepservicesaustralia.com.au; or
• Telephone us on 1300 867 533 (for the cost of a local call).

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Please Note<: This information is intended to be used as a guide only and is not an authoritative statement. Please consult your family doctor or sleep  physician if you have further questions relating to the information provided here.

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