February 16, 2009

Publication: Sunday Times Style

Date: Sunday, February 15, 2009 Page: 36


Headline: Why can't I get to sleep?

Sometimes I worry in the night about going blind, or infertility, or getting cancer or Aids. At other times, it's about things I shouldn't have said, phone calls I should have made, things that need sorting out and that I know I've been ignoring because I've got too much to do," says Kate, 29, a lawyer. During the day, she seems the picture of cheeriness and calm but, like many others, when she wakes at 4am, she becomes strangely low. Kate, it turns out, is speaking for about one in five of us, for that is the proportion of people who wake during the night or early in the morning — often at 4am on the dot — feeling jittery and with our minds whirring with thoughts, usually negative ones.

Traditionally, early-morning waking has been linked with depression, but sleep expert Dr Neil Stanley of Norfolk and Norwich University Hospital believes that more and more of us as many as 20% are suffering from waking and worrying in the night, not because we are depressed, but because modern life is increasingly tense. Clinical psychologist Linda Blair agrees. "More than 80% of people who have anxiety or depression have insomnia, but insomnia is not necessarily a sign of depression," she says. "We're working around the clock, waking up to never-ending to-do lists, childcare hassles and interest rate fluctuations. People arc on the alert for disruption and stress at all times." Even, it seems, when we should be getting some shut-eye.

Some research puts the number of people suffering from sleep problems even higher: a 2007 study by the National Sleep Foundation (NSF), in America, found that almost two-thirds of women report one to three disturbed nights' sleep each week. Interestingly, this also appears to be more of a female problem: women are almost 20% more likely to suffer from insomnia than men, according to the NSF perhaps because of all the stressful demands of work and family that make the modern woman's life so fraught. When this started happening to me about a year ago, I assumed I was in a minority, until I began to talk to my girlfriends. Nearly all of them were getting the 4am blues, too. But why? Research suggests our sleep patterns are determined by our genes; about 10% of us are morning larks and 10% night owls, with the rest of us somewhere in between. You have as much chance of changing this as you would changing your eye colour. Those of us who get the 4am blues probably went to sleep around midnight, and, struck by feelings of pre-dawn anxiety, we know that if we don't get back 5 to sleep, we'll start the day feeling shattered. In fact, we wake naturally many times during the night, as each sleep cycle of about two hours ends. Plus, our body clocks aren't programmed to make us feel sleepy and alert only twice in each sleep cycle.

Animals and human babies often naturally sleep and wake many times in a day; and in hot countries, it's normal to sleep for five hours at night and three in the afternoon as a siesta. At night, the body normally shifts from deep sleep to the rapid eye movement (REM) phase of light pre-waking sleep from 3am onwards. REM sleep prompts the body to wake up, so it is normal to have up to 60% of REM sleep in the second half of the night. If we are already wound up, we become more sensitive to this internal wake-up signal — as we arc to other signals such as rising body temperature and falling melatonin levels.  "However," he says, "you tend to have more responsibilities in your thirties and therefore naturally have more worries — you've probably got a mortgage and are wondering how you're going to be able to the pay bills." As to why we often think negative thoughts when we wake in the early hours, that is entirely psychological. It could be because we're cut off from familiar stimuli. It's dark and quiet; you're trying not to move so you don't wake your partner, and you have no way to communicate. "You haven't got what you know what's familiar makes you feel relaxed," says Blair. "That, coupled with just having been dreaming, makes things feel unreal, and that is a very disturbing feeling. You can't make normal decisions because you're not in your normal framework, so it does feel like you can't get tasks done."

The mentally nauseous feeling, similar to that of jet lag, is also caused by the same disorientating lack of familiar cues. Stanley explains that the 4am blues are simply an evolutionary hangover, an instinctive fear of aloneness and of being cut off from our usual surroundings. "You're not meant to be awake at night," he says, "and we all have a residual primeval fear of the dark — it's a time of being alone and vulnerable. "People say, 'I just want to be able to turn my brain off," he adds, "but apart from stopping the things that wake you up — like kicking your snoring husband out of bed — the cure is to be less stressed. We all need to wind down in general." If only it were that easy. Once we're in the pre-waking phase, signals in can also easily disturb sleep — a husband snoring. on the bed, needing the loo, early summer dawn breaking or being too hot (for instance, during menstruation, a woman's body temperature rises and she is more likely to wake). Whatever the reason for waking, once we are awake, says Stanley, we've probably met most of our sleep needs, so the body doesn't see any reason to let us go back to sleep. As we age, our need for sleep also decreases, but that shouldn't really affect women until their late forties. the environment the cat jumping

• Avoid stimulants like caffeine and nicotine. A drop in blood sugar during the night could also wake you up, so, in the evening, opt for low-GI foods (whole-grains, fruit and vegetables), which release sugars slowly.

• Avoid alcohol in any quantity near bedtime — it lightens sleep in the latter part of the night because its sedative effect wears off as the body metabolises it. Also, the body produces the stimulant adrenaline to compensate for the effects of the alcohol, and alcohol makes you thirsty, both of which can wake you up.

• Meditation and/or cognitive behavioural therapy (CBT) can help in the long term to change anxiety and negative thought patterns. The London Sleep Centre (londonsleepcentre.com) offers CBT as part of its treatment. Or read Linda Blair's book, Straight Talking (Piatkus £10.99), which contains negative-thought-blocking strategies for good sleep.

• De-stress your life to put your sleep and health first: cut down on checking e-mails at night; avoid working at weekends.

• During the night, remember there are others lying awake around the country — this isn't as weird as it may feel. Look for familiarity and ways to share the negative feelings. If you've been tossing and turning for more than 20 minutes, do something comforting and familiar such as reading a favourite book, watching a comedy DVD or making a cup of herbal tea.

• Take some deep breaths and focus on your breathing. When thoughts come, accept them and then return your attention to your breathing. Encourage dreamy thinking by naming favourite foods or flowers.

• Walk or do other exercise for 30 minutes every day — studies have shown it leads to a calmer mind. It also tires the body out, prompting it to sleep more soundly.