How to have a good night sleep
Dr Thanh-Tam Pham - 29/8/2020
There are 4 stages of sleep:
Stage 1: non REM- wake. It is the changeover from wakefulness to sleep and it lasts a few minutes
Stage 2: non REM- light sleep. It lasts about 25min when heart beat and breathing slow down and muscles relax.
Stage 3: non REM-deep sleep. It occurs in longer period during the first half of the night. Heart beats and breathing slow to their lowest levels during sleep. The muscles are relaxed and it may be difficult to be awakened. Brain waves become even slower. You need deep sleep to feel refreshed in the morning. The body replenishes its energy and repairs cells, tissues and muscles.
Stage 4: REM (Rapid Eye Movement): brain activity is markedly increased, breathing and heart rate increase to near waking levels.. It is a dreaming stage, the muscles of arms and legs are temporarily paralysed to prevent you from acting out your dreams.. It lasts about 10min the first time and increased with each REM cycle. The final cycle usually lasts about 60min.
When you fall asleep at night, you cycle through all these stages of sleep multiple times (about 3 to 4 times) roughly every 90 min or so.
Good sleep hygiene
1- Keep a consistent sleep schedule: going to bed and wake up at the same time each day will help to set the body “internal clock”
2- Routine exercise and being active during the day.
3- Limit the nap time to no more than 30 min.
4- Have sunlight exposure during the day will help to maintain a healthy circadian rhythm
5- Try to keep away from bright light because they can hinder the production of melatonin, a hormone that the body creates to facilitate sleep. Limit “blue light” exposure 1-2 hours before sleep such as televisions, mobile phones, computers, ipads…
6- Cut down on caffeine in the afternoon and in the evening as caffeine is a stimulant. Alcohol can help with the initial sleep but it makes you wake up in the middle of the night sometimes with dreams and not be able to fall back asleep easily.
Do not have a big heavy and spicy meal before bedtime.
7- Turn the bedroom into a sleep inducing environment, a quiet dark and cool environment can help to promote sleep. Keep computers, TVs, work materials out of the room will strengthen the mental association between bedroom and sleep. Only use your bed to sleep or sex.
8- Pre-sleep routine; avoid physically and psychologically stressful activities as they can cause the body to secrete stress hormone cortisol which is associated with increasing alertness.
9- Do not toss and turn, if after 20 min and you cannot sleep, better to get up and stretch or do something else in low light before going back to bed again.
When people are stressed, they tend to have difficulty to fall asleep. With chronic insomnia, it is often the anxiety and frustration about poor sleep that causes the stress and leads to daytime fatigue and irritability.
1- Do not be anxious that you could not sleep and expect to be tired tomorrow. Do not try too hard as anxiety is the cause of not be able to sleep. Some people with chronic insomnia start to feel apprehensive when the night comes. Accept that sleep will come when you are feeling sleepy and relaxed. If you cannot sleep tonight, you will sleep tomorrow.
2- Focus on relaxation and not thinking about sleep. You can do progressive muscle relaxation by focussing on a body part from head to toes. Firstly you try to contract the muscles and then relax that body part and start to feel heavier.
3- Aware of the breath going in and out from the nostrils or aware of the abdomen rising and falling. Do not follow any thoughts that come to the mind. If you experience any discomfort or pain, try not to be upset about it and you will find that the sensation will wax and wane.
4- People can sleep on the sides or on the back. In my opinion, the healthiest option is to sleep on the back. It allows the head, neck and spine to rest in a neutral position. This means there is no extra pressure on those areas so you are less likely to experience pain. If you sleep on one side, there is pressure on that area and you have to turn to the other side. If you have a painful body part, when you turn you will experience pain and become awake again. In my own experience after surgery, it is best to make a habit to lie on the back and do not move during sleep as it will help not to feel the pain and you could have a good night sleep
without much pain killers.
5- Sleeping on the back is not good if you have acid reflux. Sleeping on the left will prevent acid to come up into the oesophagus to cause heartburn.
6- Sometimes you can have neck stiffness on awakening. Sleeping without a pillow can keep your head flat. It may reduce some stress on your neck and promote better alignment.
7- It is normal to wake up in the middle of the night, just try to relax by following your breath, do not think or be frustrated and you could sleep back again.
I have the experience to wake up many times at night as I have to look after my mother who has dementia for over 2 years. When I go back to bed, I make sure I do not follow any distracting thoughts and I am able to sleep again quickly. My routine is to go to the gym every morning and have a shower after and I am refreshed to start a new day.
Even if you could not sleep, do not feel frustrated or expect to feel tired the next day and you will be fine.
Everyone dreams and you spent about 2 hours a night dreaming but may not remember most of your dreams. It can be described as a state of consciousness characterised by sensory, cognitive and emotional occurrence during sleep.
Dreams can be experienced in all stages of sleep but usually are most vivid in REM sleep.
Studies of brain activity suggest that most people over 10 years old dream between 4 to 6 times each night. Most dreams are entirely forgotten by the time someone wakes up. It is often said that 5 minutes after a dream, people have forgotten 50 percent of its content and increasing to 90 percent after another 5 minutes.
Researchers suggest that memories of personal experiences are expressed fragmentarily and selectively during a dream. Dream can reflect waking -life experiences.
Psychoanalysis concentrates on the meaning of dreams and placing them in the context of the history of the person. Some dreams tend to be full of emotional and vivid experiences that contain themes, concerns, people and objects closely related to the waking life.
There are possible explanations why dreams happen:
1- Freud maintained that undesirable memories could be suppressed in the mind. Dreams can allow these memories to be reinstated, as themes of dreams can be linked to the suppression of unwanted thoughts, of stressful and painful events in the past. In post traumatic stress disorder, people are often re-experiencing the traumatic events as flashbacks. Even when the dreams are not exact replays of the trauma, they may have a strong symbolic or indirect connection to the event.
Sleep therefore does not help people to forget unwanted memories. Instead in REM sleep, the brain is active and allows the resurgence of repressed memories making them more accessible for retrieval. Psychoanalysts can help in interpreting dreams to tap into the unconscious mind to recover repressed emotions and deep seated sometimes forgotten experiences. By gaining a better understanding of the subconscious mind, patients can acquire insight into the motivation that drives their thoughts and behaviour. Thought suppression may lead to significantly increase mental disorder symptoms.
In Insight Meditation (Vipassana), you can train the mind to be aware and observe the emergence of disturbing thoughts or memories to acquire an insight into the problems. By practicing not to react negatively or emotionally to those thoughts, you can be free from their effects in your life later on. Memories cannot be erased but if they no longer evoke emotional pain, anger, guilt or shame, they will not have the power to make you suffer and you come to achieve acceptance and peace in the mind. Any unresolved conflicts in the subconscious will always find means to re-emerge as dreams, nightmares or disturbing thoughts.
2- Dreams can act as an offline memory reprocessing information gathered through the day and consolidate learning. I can remember in the past when I tried unsuccessfully to solve a mathematical problem and I fell asleep and in my sleep I could see clearly the solution to that problem. Dreams can help to develop cognitive capabilities.
3- Dreams can represent unconscious desires and wishes. Some paraplegic people reported having dreams about walking or running or doing things that they could not do in their real life. People can dream about flying in the air or travelling in a different countryside or be with the people they love…
4- Some dreams may have contents to prepare for possible future threats. This may be associated with a stressful situation of the dreamer leading to anxiety or fear of future adverse events.
5- Events from the day often invade your thoughts during sleep and people suffering from stress and anxiety are more likely to have frightening dreams.
Dreams therefore can be considered as a unique state of consciousness that incorporates the experience of the present, processing of the past and preparation for the future.
Dreams may help people learn more about their feelings, beliefs and values. Images and symbols that appear in dreams will have meanings and connections that are specific to each person.