‘Tap into your own clock – not the clock on the wall’: What to do when you can’t sleep

A complete guide to improving your sleep once and for all.See all 6 stories.

When Macbeth said sleep is the chief nourisher in life’s feast, he was onto something.

When we are starved of this vital function, we suffer on every level.

Berkeley neuroscientist and sleep researcher Matthew Walker describes wakefulness as a time of reception, experiencing and learning the world around us; the first stage of sleep, NREM sleep, as a time of reflection, storing and strengthening the raw ingredients of those new facts and skills; and REM sleep as a time of integration – interconnecting the raw ingredients with past experiences and, in doing so, “building an ever more accurate model of how the world works including innovative insights and problem-solving”.

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In short, we need each of the three elements to be a healthy, functioning human.

Ron Grunstein, the head of the Sleep and Circadian Research Group at the Woolcock Institute of Medical Research, says that although some people are more prone than others to the effects of sleep loss, it’s hard to find a part of the body that isn’t affected.

Effects of sleep loss

• When we don’t – or can’t – sleep enough, our sympathetic nervous system is activated, which impairs our body’s ability to regulate blood glucose, and drives insulin resistance. These factors increase our risk of diabetes and obesity. With the sympathetic nervous system – our fight and flight response – activated, our heart rate speeds up and cortisol is released, which constricts blood vessels leading to increased blood pressure. Growth hormone, which surges at night, is also suppressed, meaning the body doesn’t get the chance to repair the damage caused.
• Chronic activation of sympathetic nervous system leads to inflammation (which increases the risk of cancer and other diseases). Sleep loss also diminishes M1 cells (macrophages which help combat cancer) and boosts m2 cells (which stimulate cancer cells).
• Sleep also plays a role in calming the nervous system which improves the bacterial community in our gut. Cortisol, triggered when we don’t get enough sleep, cultivates bad bacteria and impedes our absorption of food which can affect the diversity and health of our gut bacteria.
• Sleep strengthens connections between different parts of the brain – like the prefrontal cortex (emotional brake or regulation) and amygdala (emotional accelerator) for instance, which is why a lack of sleep can make us less rational and more emotional.
• During sleep, we detoxify the brain, clearing away toxins that build up while we’re awake. When we don’t sleep well for a prolonged period, our brain can’t clear away these toxins effectively. For this reason, chronic sleep loss is associated with an increased risk of dementia.

Studies show global rates of insomnia are around 10-to-30 per cent of the population, though some suggest rates are as high as 50-to–60 per cent. So, what can we do when we can’t sleep or are regularly waking up feeling exhausted?

Sniff out the problem

Sleep apnoea, where breathing stops and starts while we’re asleep, is one of the most common medical problems among adults.

While some people don’t even realise they have sleep apnoea, others experience a range of complications from it, explains Grunstein.

Generally, he says, losing weight “makes a tremendous amount of difference” to sleep apnoea because it reduces fatty deposits in the neck and tongue which can contribute to restricted airflow.

Nasal obstruction is another factor, particularly because humans are designed to breathe through our noses. In his book, Breath: The New Science of a Lost Art, James Nestor writes:

“Mouth breathing, it turns out, changes the physical body and transforms airways, all for the worse. Inhaling air through the mouth decreases pressure, which causes the soft tissues in the back of the mouth to become loose and flex inward, creating less space and making breathing more difficult. Mouth breathing begets more mouth breathing.”

It also increases the risk of sleep apnoea and decreases the quality of our sleep.

“If you block the nose your sleep is worse,” says Grunstein. “You often do develop apnoea because humans are obligate nasal breathers – when you go to sleep your brain wants you to breathe through your nose, so if your nose is blocked you don’t sleep well… It puts more collapsing pressure on the throat.”

Spend less time in bed

The first thing sleep experts do when people are struggling with their sleep is match the time in bed with the amount of sleep the person is getting, explains Moira Junge, chief executive of the Sleep Health Foundation. “We encourage them to get no more than five or six hours, and they say ‘What? You’re kidding?’”

But, if someone has been going to bed at 10pm every night but not falling asleep until one, then she suggests waiting until 12.30 to get into bed.

“We take away the sleep effort,” she explains. “And then build up if they do need more.”

Instead of tossing and turning, if you have been trying to get to sleep for more than 20 minutes or so, Junge suggests sitting in another, dimly-lit, room and doing a quiet activity like listening to gentle music or reading a book, only returning to bed when you feel very sleepy.

‘You don’t have to chase sleep and rugby tackle it to the ground. If we put all the right principles in place, it comes to you.’

Moira Junge, Sleep Health Foundation

This way, she says, we associate bed with sleep and comfort, not anxiety: “You don’t have to chase sleep and rugby tackle it to the ground. If we put all the right principles in place, it comes to you.”

Find the right treatment

A lot of the basis of insomnia is anxiety and rumination, says Grunstein.

“You can’t separate the mental health aspect for a lot of patients. It’s often a mental health problem, and it’s often not recognised.”

Whether the insomnia causes depression or depression causes insomnia is hard to study, Grunstein explains, but the rate of depression increases dramatically, with insomnia.

Tackling any underlying depression or anxiety is therefore an important first step for managing insomnia.

A terribly unfair consequence of insomnia is that it activates the amygdala, where emotion is regulated, causing people to become overactive emotionally and ruminate more. This, in turn, perpetuates the insomnia.

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“There are biological characteristics to insomnia,” Grunstein says.

This Way Up provides a free online insomnia program and the Sleep Health Foundation also has information and tips.

If problems are ongoing, and you have trouble sleeping regularly for several months, seeing a sleep specialist can help.

“Sometimes you do have to resort to medication to get control of the symptoms and reduce people’s anxiety,” Grunstein says. “In the past, there were medications that reduced deep slow wave sleep. Now you have this new class which are called orexin antagonists… they’re not perfect, but they’re a whole lot better.”

Take the pressure down

When someone is battling with insomnia, they tend to put a lot of pressure on themselves, says University of Sydney sleep medicine researcher and clinician, Delwyn Bartlett.

But trying to pressure ourselves into sleep sends a stress message to the limbic system, which is our body’s alarm system, and results in a body that is primed for danger.

“And so what does it do? It wants to keep us awake,” Bartlett says.

Instead, ensuring a good unwind period, writing a to-do list and reminding ourselves to let go of our worries for the night and revisit it in the morning, can help relieve some pressure.

“It’s important not to be worrying about what the time might be and calculating the hours,” Junge says. “It’s about calming yourself and learning how to tap into your own clock – not the clock on your wall. It’s going to be a process… if you’ve had poor sleep for ages, it’s going to take time and consistency.”

Sleep take home: We can’t force sleep, but we can create an environment that facilitates it and we can get help with the issues that might be preventing it.

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