What can cause sleep difficulties?
Most people have difficulty getting to sleep from time to time. This is quite normal and usually nothing to worry about. However, some people struggle to get to sleep (or stay asleep) on a regular basis. This is often called insomnia or sleep disorder. It is something that affects different people in different ways.
How much sleep do people need?
It is commonly said that we all need ‘our 8 hours’ of sleep. This is the average for most people, but we are all different. How much sleep we need is influenced by our age, physical health, and how busy we are during the day. Age is a particular influence. Children and teenagers need more sleep, but this need decreases during adulthood and into older age.
What can interfere with good sleep?
Before reading the list below, remember that we are all different. Some people can happily drink an espresso just before falling asleep!
- How we feel: worry, anxiety, recent major stresses such as bereavement.
- Where we sleep: too hot, too cold, too light, too noisy.
- Our health: Stimulants such as caffeine or nicotine taken close to bedtime can make it difficult for some. Certain medications and drugs can have the same effect. Alcohol can make us feel sleepy early on but can lead to a restless night.
When should I be concerned about my sleep?
The first thing to remember is that sleep disorders are more than just an occasional bad night. If any of the following apply, you might wish to discuss your sleep with a healthcare professional.
- You have had problems for several (3 or more) nights every week for 3 months or more.
- You feel tired all day (it is normal to feel tired for a while in the middle of the day).
- You fall asleep during the day, especially if you fall asleep without planning to i.e., while watching TV. This may be a sign of Obstructive Sleep Apnoea.
- You cannot settle at night because of a restless feeling in your limbs that was not there during the day.
If you do not have any of these features, it is much less likely that you have a sleep disorder. The advice on these pages may help you get back to your usual sleep but be kind to yourself; things are likely to recover by themselves without needing to make big changes.
I’m finding it hard to sleep
What can I do to help myself?
The most important thing is to think about why you have a sleep problem. Is it because of worry, or is it a more persistent problem?
Bedtime routine is important. We need to remind our brains that it’s time to switch off and take a break. Most people are helped by the following:
- Going to bed and getting up at roughly the same time, even on non-workdays. But don’t get too hung up on this, you will survive the occasional late night or lie in!
- Relaxing activity in the hour or so before sleep: a warm bath, reading, watching relaxing things on television. However, don’t watch or read for hours in bed.
- A cool sleeping environment; not cold but not too hot either.
- Dim lighting. Blackout blinds can help. Not everyone is comfortable sleeping in the dark, but if you do need a light, try using a dim bulb and put the light as low as possible (so it doesn’t shine on your face).
- Where possible, spend the waking day out of the bedroom. When we were babies, our parents spent a great deal of effort teaching us that the bed is for sleeping; we can undo that in later life. See point 3 below.
Most people find these things do not help:
- Watching action\horror films or playing similar themes of video games.
- Using nicotine or other stimulants before bedtime.
- Spending a lot of time in bed not sleeping. Teenagers and students are particularly vulnerable to this one and it was an issue for many during the COVID lockdowns. Working or gaming while on/in bed breaks the link in our minds between bed and sleeping and can lead to problems falling asleep later that night. If possible, try to do these things in a different room or at the least, in a different part of your bedroom. A chair on the opposite side of the room may be enough.
- “Chasing sleep”. While understandable, going to bed early ‘so I get more chance to fall asleep’ won’t work. You’ll just lie there staring at the ceiling. Unless you are so tired that you are falling asleep on the spot, stick to your usual bedtime.
What types of sleep problems are there?
Insomnia: a persistent difficulty in falling asleep or staying asleep for as long as you need to.
Obstructive Sleep Apnoea: a medical condition in which breathing is briefly and repeatedly interrupted during the night, so that sleep quality is poor. People with this condition often sleep for a normal amount or longer but feel exhausted during the day. Risk factors include loud snoring, high blood pressure, being very overweight (BMI > 35), male birth gender, age>50 and a neck circumference greater than 16” (collar size for men’s shirts). If reading this you are concerned that you might have this condition, you should seek further advice from your GP.
Restless Limbs Syndrome: a medical condition characterized by a feeling that usually starts a few hours before bedtime. People feel a strong and unsettling urge to move their limbs (usually legs), that can only be relieved by getting up and moving around. That makes it hard to get to sleep! If you think you might have this, discuss with your GP.
Sleep Wake Cycle Disorders: sleep disorders where the individual sleeps normally if left to their own devices but has difficulty in matching their sleep pattern to the expectations of those around them. Teenagers often have a transient form of this, that they usually grow out of; a tendency to want to go to bed later (12am-2am) and wake later (typically between 10am and 12pm). Fine for the weekends, not so helpful for school or workdays.
Some people can have this pattern (called Delayed Phase Sleep Wake Cycle Disorder) continue in early adulthood.
Parasomnias: Relatively rare sleep conditions such as sleepwalking or nightmare disorder.
Nightmares are quite common and not usually a health problem. Most people don’t have them often and fall straight back to sleep afterwards. Nightmare disorder occurs when someone has frequent, vivid nightmares that make them nervous about going to bed, stop them going back to sleep after the dream and are something they worry about during the day. The disorder is rare in the population as whole but more common in people who have experienced trauma, especially if they have Post Traumatic Stress Disorder.
Sleep difficulties in young people
As we know, sleep plays an important part in a child’s physical and emotional development, however when a child experiences difficulty sleeping, it can have an impact on their learning and ability to concentrate in the classroom.
Sleeping difficulties in children are common, and there can be many reasons why a child or young person has difficulty sleeping. It’s common for young children to experience fear of the dark or being left alone at night. Teenagers might find it hard to sleep if they are drinking too much caffeine or energy drinks, using drugs or feeling anxious. Sometimes not sleeping well can be an indication of depression.
It’s helpful to have a discussion with the child’s parent/carer to rule out any underlying causes for the sleep difficulties which may require referral to other services.