Secrets of a sound sleep

By JAN CORBETT

Sleep well last night? Or did you have one of those nights when you tossed and turned, your feet
sweated, your heart raced, the pillow felt like a bag of cement. You were unable to clear your mind of a myriad of small anxieties. The more you tried to doze off, the less sleepy you felt. The hours ticked painfully by until dawn. Then, you fell asleep.

If that's a familiar scenario once or twice a year, you're simply having a normal life experience. If it happens most nights, you have problems.

The most important thing with sleeping problems is to obtain a proper diagnosis. Wellington sleep specialist Dr Alister Neill says some people who think they have insomnia actually have a dramatic shift in their circadian rhythms — or body clock. These are the people who are awake until 3 am, then fall asleep for eight hours ... or they would if they didn't have to get up for work.

Because it runs on a 25-hour cycle, our body clock can shift forward if not corrected by daily routines. It can be shifted back by increased exposure to light in the morning.

Others who think they may have sleep apnoea turn out to have breathing-pattern disorders. Because they take in too much air, their carbon dioxide levels plummet, leaving them feeling unwell, anxious and then unable to sleep.

Physiotherapist Dinah Bradley, who specialises in treating breathing disorders, says it is not clear which comes first — the breathing disorder or the anxiety. Yet people may end up on Prozac for years when what they needed was to have their breathing retrained.

Insomniacs hardly sleep at all, although probably more than they think. Yet insomnia is not a disease but a symptom, often exacerbated by depression, anxiety, stress or too much caffeine.

According to Green Lane Hospital sleep specialist Dr Ken Whyte, chronic insomniacs are likely to remain like that all their lives, and dealing with it "is like getting someone to deal with having their legs cut off."

Insomniacs are often hyperactive people with higher metabolic rates than people who slip easily into sleep each night.

Insomnia takes on different forms, from difficulty getting to sleep, usually because of anxiety or an over-active mind, to waking in the middle of the night, or waking up too early and not being able to get back to sleep. The last can be a sign of depression.

Sleeping pills are considered okay for dealing with short-term sleeplessness or a sudden catastrophic event like grief, but are scorned as a routine means of treating insomnia.

"They don't work," says Whyte, "because they don't give you good quality sleep. They give you a hangover effect next day and they have the potential to be addictive. I say avoid them."

Relying on alcohol is also counter-productive. A little will help you get to sleep. Too much wakes you up again, usually when the dehydration kicks in about 3 am.

Sometimes depriving yourself of sleep is the only way to achieve a good night's sleep back. We need a small amount of sleep deprivation to fall asleep each night. Restricting sleep to the point you cannot stay awake sometimes restores an insomniac's belief that they can sleep. Believing they cannot is often what keeps them awake.

Generally the most effective way to get better sleep is to exercise during the day, but not close to bedtime or the stimulation will keep you awake.

After that there are several steps to achieve what the Americans call sleep hygiene.

* Reduce your caffeine and alcohol intake.

* Keep to regular rising, eating and going-to-bed routines. Put at least three hours between eating dinner and going to bed.

* Use the bedroom only for sex and sleeping. Keep awake-type activities like watching television or working or playing games at the computer away from the bedroom.

* Establish relaxing night-time rituals like having a hot bath, or reading.

* Don't worry about not sleeping — think about something else.

* Deal with the emotional, psychological or logistical problems that are keeping you awake.

* Make sure the bedroom and the bed are comfortable for you.

* Try listening to relaxation tapes or practising yoga.

But what if you have a job that requires you to work when you would rather sleep? Not only is that an issue for your health, but industry has realised that sleepy people are a safety risk.

Safety-dependent industries like flying, forestry and manufacturing are now racing ahead of science in the quest to understand the risks of sleep deprivation and to do something about it.

Air New Zealand was one of the first airlines in the world to introduce cockpit napping for pilots. The policy followed Nasa research showing there was less incidence of pilots falling asleep momentarily if they can take regular naps.

Air New Zealand says inflight napping is used relatively infrequently "but is available as a tool to prevent deep fatigue."

At the same time the airline established a group to study fatigue among flight crew. After regularly measuring high levels of fatigue among pilots on the Taipei-Brisbane-Auckland run, the airline changed its roster and now brings on a fresh crew in Brisbane.

Occupational therapist Fiona Johnston specialises in teaching shift workers how best to manage their sleep and roster patterns. She not only holds staff seminars, but checks to ensure the company is running sleep-friendly rosters.

She says a good roster rotates forwards, so you work days, evenings, nights and then have some days off. No one should be rostered on for more than four nights in a row.

This pattern allows the body clock to remain on a daytime (diurnal) orientation which is important for maintaining a stable body clock.

Johnston advises shift workers to sleep as soon as possible after finishing their night shift because that is when the body most wants to sleep.

And they shouldn't get into sleep debt. Losing three hours sleep four nights in a row means a 12-hour sleep debt.

Part of Johnston's strategy is to change management's attitudes towards shift workers.

"A tired shift worker is not a bad person," she says. Instead they should be encouraged to recognise when their blackspots are and to work in pairs at those times, or, like Air New Zealand crew, take a "power nap."

Johnston usually recommends 20 minutes for these naps. Any longer and you fall into deep sleep, meaning you awake groggy and take longer to reach full alertness.

Day napping is so common among tired and jetlagged diplomats at the United Nations that the former French delegate, Alain Dejammet, has compiled a dossier on the best places for a secret snooze — the UN library and newspaper lounge emerge as the favourites.

Yet some of his former colleagues considered it tasteless and unfair that he should expose and ridicule the UN's dedicated nappers.

Shame on them, the sleep therapists may say. It is time we stopped thinking of sleep as the refuge of the dull and unmotivated and restore it to its rightful place as a necessary and enjoyable part of being alive.

But if you still cannot achieve a good night's sleep, stop worrying about it, do something about it.