When sleep won't come
"O sleep, O gentle sleep, Nature's soft nurse, how have I frightened thee, that thou no more will weigh my eyelids down, and steep my senses in forgetfulness?"
So wails Henry in Shakespeare’s Henry IVth part 2. And if, like him, you have ever suffered from insomnia, you will no doubt recognise the desperation that lies behind this plaintive cry. But insomnia isn’t just the thing of fiction - its a reality that is incredibly common. In fact occasional insomnia - having trouble falling or staying asleep - is considered a completely normal part of adult life.
Also, the frequency of clinical insomnia - that’s when this trouble falling or staying asleep happens at least 3 times a week over a period of 3 months or more - is also increasing. The Great Sleep Survey, published in 2011, found that over half of us report regularly having trouble sleeping. Its an issue that is even more key for women, 3/4 of whom admit to regularly having trouble sleeping. Amongst my friends insomnia is a common topic - we exchange sympathy, empathy and tips from how to get through a long sleepiness night to reliable ways to turn your brain off and find that elusive calm of a deep sleep.
Insomnia matters ...
The trouble is, theres good evidence that not sleeping well isn’t something to be laughed off if it persists. Insomnia seems to be more than a inconvenient nuisance. It has been linked with an increased risk of depression and other mental health problems, as well as also having a significant impact on physical health, raising the rates of problems such as diabetes and high blood pressure. Opinions around what the precise function of sleep is varies, but most experts agree it is essential. The seriousness of sleep is demonstrated by the fact that the Guiness book of world records no longer endorse a record for the number of hours without sleep (for the interested, the last record they hold records for stood at 264.4 hours - thats 11 days 24 minutes!) - because we know that sleep deprivation has a critical impact on human beings - in situations of total sleep deprivation, lack of sleep can kill.
Why, oh why can't I sleep?!
So, why are we all struggling to do something which is so vital and, you would think, should come so naturally. Difficulty sleeping is often linked to negative emotions, particularly anxiety. It seems that anxiety triggers a feverish overactivity in the brain, and switching off those thoughts in order to slip into sleep can be very difficult. However other emotional health conditions are also associated with changes to sleep patterns - and this has lead to speculations that changes in the balance of certain transmitter chemicals in the brain may influence sleep patterns for some people. Very often though, sleep difficulties develop after a disturbance to our natural sleep patterns. Many parents have experienced the frustration after months of disturbed sleep with a small child that long after their child’s sleep difficulties are resolved, they still find themselves stubbornly wakeful in the small hours of the night. Many things can get in the way of sleep - shift patterns at work, travel - particularly across time zones - and lets not forget the influence of hormones, particularly for the women. Research shows that certain female hormones have an influence on sleep and it is not uncommon for women to find they sleep less well, or find it harder to get to sleep, in the week before a period, or in times of hormonal change such as the early stages of pregnancy or during the menopause.
The trouble is that whatever triggers your insomnia in the first place, finding yourself unable to sleep is unlikely to make things any better. Sometimes the addition of sleepless nights can be the final straw for someone already struggling to get through the days. If you are stressed out and anxious, finding that you cannot sleep is only going to make things worse. We are all more prone to negative emotions and unhelpful patterns of thinking when tired - add to that the impact that your grumpy sleep deprived self can have on relations with its easy to see why insomnia is likely to leave us more prone to emotional problems, whether it was them that started it in the first place or not.
Perhaps the biggest problem with sleep problems is that sleep ideally is a very unconscious thing. A bit like thinking about your breathing too much makes your breathing feel all odd, thinking about sleep, especially lying in bed at night wondering if you are going to fall asleep soon, can immediately make it impossible to do so. So occasionally not sleeping might be totally normal and nothing to worry about - but the key thing is what happens next. It seems your reaction to not sleeping is crucial - the more you become panicked or frustrated by not sleeping, the greater a chance it will become a frequent problem. In fact studies which demonstrate how effective cognitive behaviour therapy can be in combatting insomnia clearly link thoughts like ‘I am never going to get to sleep tonight’ and worries about the impact lack of sleep might have - ‘I am going to feel dreadful tomorrow’ etc with a tendency towards insomnia. If you do struggle with sleep the message is clear: working to rationalise those kind of thoughts, or breaking the though cycle by getting up and doing something else for a bit rather than staying in bed and worrying, is very important. Remind yourself that actually a night with little sleep is not a disaster - most adults will function perfectly fine (albeit a bit sleepy!) after a poor night’s sleep.
There’s one question that I get asked a lot - is there something about our modern 21st century life that makes having trouble sleeping more likely?
Stress is certainly one easy to blame culprit. I have worked with many adults who describe themselves as struggling with stress, and for many of them the trigger that pushed them into seeking help was when they began to find themselves unable to sleep. Too often we push ourselves relentlessly, allowing little or no time to wind down and relax, juggle responsibilities and demands on our time from both home and work, and also carrying the weight of guilt that we don’t, somehow, do more. In pushing ourselves to become superpeople, the inability to sleep can be the symptom that finally makes us realise we are, sadly, just human. But the kinds of demand that take their impact on our sleep may be more mundane than we think. Some of us are kept awake by the simple mental demands of the life we are managing - worrying about work meetings, overdue assignments or how on earth to find childcare that will cover you right to the end of that all important conference. But how many more are actually having their sleep impacted by the influence of the quietly addictive power of our mobile devices and the temptation to see if anyone has responded yet to our last Facebook post? Whether or not it was an initial trigger, if you are experiencing problems sleeping, thinking about what is called your ‘sleep hygiene’ (see below) can only be a good thing.
A spiritual perspective ...
And finely … one rarely considered perspective we mustn’t overlook when thinking about insomnia is a spiritual one. The night is a powerful place where spiritual factors come into play. The bible frequently uses the metaphors of light and darkness and it is certainly true that we feel more spiritually (and emotionally) vulnerable during the night. You can find yourself a different person - at 11 am on an ‘everything going according to plan’ day you may feel like you could conquer the world but at 4 in the morning after 5 or 6 fruitless hours seeking sleep you may well turn into a blubbering wreck. But there is comfort in the Bible - in knowing that even in those darkest nights, God is with us. ‘You’ve kept track of my every toss and turn through the sleepless nights. Each tear entered in your ledger, each ache written in your book.’ writes psalm 56 (v8, the message). Psalm 74 reminds us that God owns not just the day - but the night as well night (v16). No matter how alone and desperate you feel at night, God is with you.
The bible has several examples of people struggling to sleep, so you’re in good company (see for example Genesis 31v40 or Daniel 6:18). There are all kinds of references I have seen quoted and suggested for those facing insomnia. My personal favourite reference when I encounter times of struggling to sleep is Psalm 77. The psalm talks of someone in distress, calling out to God. The new living translation tells us (in v3) that he thinks of God and moans, ‘overwhelmed with longing for his help.’ There’s a pause after this - and I guess its easy to think of the times when we too have felt that kind of desperate need for God’s help. The next verse is an interesting one - the new living carries on ‘you don’t let me sleep, I am too distressed even to pray.’ Looking at this verse in some alternative translations helps us to understand a bit more what the psalmist originally meant - the NIV puts it ‘You kept my eyes from closing,; I was too troubled to speak. The message says ‘I’m awake all night - not a wink of sleep. ; I can’t even say what’s bothering me.’ But perhaps the version I like the best comes from the french Bible de Semeur - when it says ‘Quand je veux endormir, tu me tiens en éveil.’ (when I want to fall asleep, you keep me alert.’) This makes me think - sometimes we find ourselves alert due to our worries, stresses or anxieties - but there are also times that God calls us to wakefulness in the small hours - times when He grabs our attention in perhaps the only times we stop racing round with other things for long enough to listen to him.
So perhaps the best biblical advice for times of sleeplessness comes from Proverbs 20v 13 - which states simply ‘don’t be too fond of sleep.’ (the message translation). It is all too easy to make tiredness the scapegoat for all the things that are going wrong in your life, but placing too much pressure on sleep can make it much harder to get enough! Avoid the temptation to become obsessed with ‘how many hours’ you have or haven’t slept, and instead trust God with your mind. Wakeful periods in the night can be a time where our faith and focus in God is tested (see Psalm 7:3), so if you find yourself lying awake at night, rather than getting more and more frustrated, why not take some advice from Psalm 119:148 and spend some time seeking God? You could give some time to intercessory prayer, read a great Christian book, catch up on some sermon podcasts - put those wakeful, peaceful hours to good use. If you can manage to stay calm, your sleepless spell will pass - and perhaps you can come through it with some spiritual ‘pluses’ too.
Having trouble sleeping?
Experts talk about something called ‘sleep hygiene’ - making sure that the circumstances surrounding you as you try to sleep do their best to promote drowsiness, relaxation and the all too illusive sleep. So if you are having trouble sleeping, here are some simple things to think about:
Avoid late nights, late mornings and naps! How awake or sleepy you feel throughout the day is strongly influenced by the levels of certain hormones in your bloodstream. These are designed to rise and fall in synch with your usual daytime - and nighttime - schedule, making sure that you feel sleepy at the right time in the evening, and (hopefully) reasonably alert in the morning when it is time to start the day. Take advantage of this hormonal influence to your sleep patterns and harness it effectively by sticking to as regular a routine as you can. Try to go to bed and get up at roughly the same times each day (and over the weekend) - within half an hour or so. If you really must nap in the day, limit it to a 30 min power nap - nothing more. And tempting though it is to lie in when you get the chance, especially if you have had a bad night, try not to.
Watch your light levels! Cells in the back of your eyes react to levels of light you are exposed to and use this information to influence the part of your brain that deals with day-night cycle. So try to expose yourself to lots of light in the daytimes, sunlight if possible (a lot more tricky in Jan/feb!) and when it draws near to bedtime, reduce the light stimulation. Watch out especially for using backlit devices - you may love your iphone, iPad or kindle but research has demonstrated that the light shining out of your device hits bang on to those cells at the back of your eye and can affect hormone levels. So turn down the brightness of your screen and avoid using them in the hour or so before you want to fall asleep, or disable the backlight and use a good old fashioned lamp instead for your bedtime reading.
Put away your clock! When you’re sure you have been lying awake for ages it is tempting to keep checking the time. Try to avoid repeatedly looking at clock, or panicking, working out how many hours of sleep you are (or aren’t!) going to get. Sometimes it isn’t about how much you sleep, and a shorter time of good sleep can be just as refreshing as a long night. More importantly, as Dale Carnigie once said: ‘If you can't sleep, then get up and do something instead of lying there worrying. It's the worry that gets you, not the lack of sleep.’ Counting hours will only make you less likely to sleep! Remember too that the hours you feel you are lying awake it is quite likely you are having periods of light sleep - studies show that when we wake from these little dozes we do not remember having them, and sleep studies with people struggling with insomnia reveal they are often sleeping a lot more than they think. Try to relax - remember time spend relaxing in bed is not wasted just because you are not in a deep sleep.
Don’t just lie there, do something! One repeated, but very hard to take, advice from sleep experts is that if you really cannot fall asleep, do not just lie there hour after hour trying to sleep. You want your brain to associate bed with falling asleep, not with tossing and turning. If you really can’t sleep, get up and do something different for at least half an hour. Read a book, grab a cup of something warm and milky (avoid caffeinated drinks though!), anything that is relaxing (avoid strenuous exercise, this is not the time to catch up on household chores!). Then when you feel sleepy again return to bed.
Get into a good routine! Its true for babies and it is true for us: we sleep better if we have a clear routine that lets our bodies and brains know that sleep is next on the agenda. Whether its a hot bath, time reading, a cup of horlicks before bed - whatever works for you, get into a routine and stick to it. This can be particularly valuable when sleeping away from home (a common time for insomnia to strike). If you do travel a lot try to incorporate things into your sleep routine that you can take with you: a lavender spray for the pillow or even a favourite pillowcase you can take to sleep on - these familiar reminders of home can help ease us into sleep. Meanwhile, help yourself associate your bedroom with sleep and avoid the temptation to use it for work or anything stressful. Banish phones, laptops or anything you might associate with work so that when you go to bed your mind is clear of any preoccupations.
Get some exercise! - no not at night, but in the day! The link is clear - people who are more active in the day tend to sleep better. Its good biblical advice too - Ecclesiastes 5:12 (from the message translation) says that ‘hard and honest work earns a good nights sleep’! We’re not talking running daily marathons - just 30-40 minutes of gentle exercise can help, as well as helping to make you feel less sleepy in the day if you didn’t have a great night the night before. So nip out for a walk, grab the chance for a swim or dust off that old bicycle from the garage.
Avoid stimulants! The most common culprit here for lost sleep is caffeine. You probably know it is in coffee and tea but watch out for other sources Green tea contains caffeine, and so do many energy drinks. Even chocolate contains caffeine, and some people find even eating it late at night (especially rich strong chocolate desserts) can give them a wakeful night. To be totally clear, avoid caffeine after lunchtime. Alcohol, believe it or not, is another stimulant. You might feel drowsy if you drink enough, but alcohol actually stimulates your mind and means you will experience more vivid dreams and generally a poorer quality of sleep, with a greater chance of awakening during the night and struggling to get back to sleep. Finally don’t forget medications - some over the counter medicines (eg decongestant tablets) or prescribed medications can affect sleep in some people. Never just stop taking something you have been prescribed - but if you are taking any form of medication, talk to your doctor about whether it might be making things worse. More information on sleep and addicitons here.
For more great information, articles and tips on how to sleep well, check out the national sleep foundation website
Kate Middleton, 25/04/2023