Most experts agree that the perfect night’s sleep is 7-8 hours long. However, the duration of sleep isn’t the only thing we need to think about. When I ask my clients if they feel rested on waking, the answer is often no, even if they have slept through the night and been in bed for a solid 8 hours. This could be because they had the right duration of sleep but the quality was sub optimal. Sleep is a complicated process that we don’t fully understand. The more we learn the more we realise how much our sleep impacts on wide ranging areas of our physical and mental wellbeing, in fact sleep scientist Matthew Walker says not having enough can have a detrimental impact on concentration, memory and the immune system, and may even shorten life span. So what constitutes a quality night’s sleep?
Sleep stages
A full sleep cycle takes about 90 to 120 minutes and there are four stages to cycle through. The stages are made up of two categories: rapid eye movement (REM) and non-rapid eye movement (NREM). Stages 1-3 are NREM and stage 4 is REM which is when most of our dreaming happens. In order to feel rested in the morning we need adequate amounts of REM and slow wave sleep (stages 3-4).
Slow wave sleep
Slow wave sleep (SWS) is the deep sleep that occurs in stage 3. During this third stage of sleep, brain waves slow down and begin a pattern that indicates a person is in deep sleep. It is thought that slow-wave sleep has a wide range of functions in the mind and body. It is a restorative phase and seems to help people to feel more rested on waking. It has also been linked to learning and memory, tissue growth and repair, immunity and expelling waste products from the brain and spinal cord. Stress, depression, pain, cardiovascular disease, dementia and breathing problems can all have an impact on SWS. The amount of SWS a person gets tends to decrease with age, adolescents and adults usually spend from 10% to 20% of their sleep time in SWS.
REM sleep
After falling asleep most people reach REM sleep (stage 4) by approximately 60 to 90 minutes. This is followed by cyclical alterations between REM and NREM every 90 to 120 minutes until waking. Most REM sleep occurs during the second half of the night, with NREM sleep dominating the first half. About 25% of total sleep time (TST) is made up of REM sleep. During this stage there are several changes in the body; eyes move rapidly, breathing quickens, heart rate increases as does blood pressure and brain activity.
It is thought that REM sleep is responsible for emotional processing, brain development and dreaming, meaning that it is pretty fundamental for our overall wellbeing. This stage assists memory differently to deep sleep, focusing on social-emotional memories and is thought to have an impact on mood.
Sleep latency
The time it takes to fall asleep is called sleep latency. A healthy sleep latency is, on average 10 to 20 minutes. However, this can be affected by a number of different factors, alcohol decreases latency as might sleep deprivation or going to bed later than usual, so a shorter latency isn’t always a good thing. There are also many factors that could increase latency such as chronic pain, stress and anxiety.
Sleep efficiency
This measures the amount of time someone spends in bed in comparison with how much of that time they were asleep. So if you were in bed for 8 hours but only asleep for 2 your sleep efficiency would be very low. It is measured as a % with 85% being a good score.
Common sleep disruptors
Sleep apnea
Apneas are periods when a person stops breathing (for at least 10 seconds) and hypopneas are instances where airflow is blocked, causing shallow breathing. The Apnea-Hypopnea Index (AHI) quantifies the severity of sleep apnea by measuring the number of apneas and hypopneas during sleep. Most people have some disruption that will go unnoticed. Normal AHI is less than 5 events per hour, while severe AHI is more than 30 events per hour.
Sleep arousals
Sleep arousals are awakenings of at least 3 seconds that the person may not be aware of. They could be related to respiratory events, limb movements, snoring, or respiratory factors. Arousals increase with age and people over 60 may have as many as 27 arousals per hour. Young and middle-aged adults average around 15 arousals per hour.
Medications can also deter sleep (pseudoephedrine, caffeine, some antidepressants, too much thyroid medication), etc could cause sleep arousals.
How to improve your sleep naturally
To improve sleep quality we need to optimise our sleep cycles to ensure adequate amount of each stage, especially 3 and 4, and minimise disruptions even if they are going unnoticed by the sleeper. Improving sleep can often take time and there isn’t usually a single easy fix. I have found that there is often an emotional imbalance at the core which needs to be addressed. However there are several simple things that can help give your body the best chance of a rejuvenating nights sleep.
1) Routine
Stick to the same bed/wake up time each day to help regulate your time asleep, this may sound basic but a study by wearable brand Whoop found a significant correlation between sleep consistency and emotional wellbeing. They stated ‘Extensive research indicates that sleep duration is important, but the current findings highlight the fact that the general recommendation to increase time in bed might be incomplete advice on its own. Rather, this suggests that a focus on sleep consistency, in addition to sleep duration, might yield more benefits.’
2) Light
Light is an important factor at the start and the end of the day. Get natural day light as soon after waking as possible to help with the body’s circadian rhythm (the internal clock that regulates sleep and wake times), and minimise screen time in the evening. Engage in a mindful, non-screen based activity for the last hour before sleep time like reading or doing a craft. Electronic back-lit devices like mobile phones, tablets, readers, and computers emit short-wavelength enriched light, also known as blue light which has been shown to reduce or delay the natural production of melatonin in the evening and decrease feelings of sleepiness.
3) Minimise alcohol
Alcohol can decrease sleep latency so some people assume it is actually helping them sleep. In fact drinking alcohol can disrupt a sleep cycle as well as sleep quality. Research is conflicting on how exactly alcohol affects REM sleep. But studies suggest duration and quality of REM sleep were lower following alcohol intoxication. It also contributes to sleep apnea and snoring, causes people to need the toilet more, and interrupts the body’s circadian rhythm. For anyone struggling with duration or quality I would recommend avoiding it completely to see if there is a positive impact on sleep.
4) Magnesium
Many people are low on magnesium and it isn't straight forward to test for. Even if you do get enough from your diet, you might start shedding it for various reasons including being stressed. Inadequate magnesium levels can impact mental health, sleep, pain, blood pressure, muscle cramps, hormones and may be impacting up to 80% of the population. For more detailed info about magnesium listen to this 30 minute podcast with Mark Hyman. If you're having sleep problems trying a high quality magnesium supplement is a no brainer (there are many forms but magnesium glycinate is a good all rounder that is easily absorbed by the body).
5) Avoid sleeping pills
Sleeping pills help people suffering with insomnia by increasing drowsiness and helping them to fall asleep. While they may be useful in the short term they can be addictive, and people may suffer side effects. On top of this they often reduce stage 3-4 sleep, so you are much less likely to wake up feeling rested, even if you’ve slept the perfect 8 hours.
6) Wind down
Allow enough ‘wind-down’ time in the evening. As we get older it becomes harder to switch off and fall asleep straight away so activities that stimulate the nervous system like working too close to bed can be detrimental to sleep latency. Eating too close to sleep time can also disrupt sleep, try to leave three hours between your last meal and bed.
7) Acupuncture
Acupuncture is an effective treatment for insomnia and studies have shown it has a positive impact on both sleep duration and quality. I have worked with many clients to help them improve their sleep, see acupuncture for insomnia for more details.
If you’re interested to see how acupuncture could help you, get in touch here or head to the bookings page to book a consultation and treatment.
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