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I never have an issue actually going to sleep. It’s pretty well instant. But I do generally wake up too early, far too early . Often from 5am. My brain then instantly goes in to overdrive
I appear unable to turn it off and go back to sleep so end up getting up so not to disturb mrsMcMad.
Please see my previous answers about going to bed a bit later, keeping a worry journal and action plan, and getting up if you've been awake in bed for more than a perceived twenty minutes, doing something else, and then only going back to bed when you feel sleepy again.
Kramer, I have a question that may be related to Restless Leg Syndrome. At the instant I drift off to sleep, my legs kick and twitch for a period of time but I'm completely unaware of it. Up to roughly 5 minutes, it can be quite violent at times. Any ideas what causes this?
I've struggled to find anything similar when googling the symptoms, everything comes back to Restless Leg Syndrome which I'm not sure it is.
I struggle to get to sleep. I stay up until I’m tired but as soon as my head hits the pillow my brain starts whirring away. Not so much worries, just thought after trivial thought. I wake up during the night needing the toilet* and then can’t get back to sleep again! Very annoying. I do try and get up at the same time but will sometimes have a lie in if I’m really tired. I’m tired almost all of the time (see below) but feel that I would have a bit more energy if only I could get a good night’s sleep!
To explain a little further; I’m 54 years old, reasonably fit, eat a healthy diet and I’m about the right weight, BUT, I also have stage 4 prostate cancer (spread to lymph nodes). I was diagnosed 18 months ago (PSA 374). I have had chemotherapy and radiotherapy (12 months a go and 9 months ago), and have a 12-weekly Zoladex injection. I also have paroxetine and Tamsulosin. I do understand that my condition and the hormone therapy affect my energy levels, but I’m sure they could be a bit better! PSA now 1.46 btw.
Any tips to help me sleep a little better most nights?
Sorry to hear about your diagnosis, that would affect most people I think.
Again I'd refer you to my previous answers about maybe going to bed a bit later, keeping a thought/worry diary/to do list by your bed, and not staying in bed for longer than 20 perceived minutes if you can't sleep.
Any thoughts on bedroom ventilation in Autumn/Winter?
Similar to someone else, doesnt appear to matter how much sleep I have or the perceived quality of it... I always wake up feeling tired with no sense of vitality. Presume it just means it is linked to something other than sleep but is there really such thing as "not being a morning person"?
ive tried everything to sleep, for over 20 years.One thing Im really bad at, is getting out of bed after 20mins if im still awake. Z drugs work mostly, if I can get them, but I rarely can. alcohol keeps me up,even just 2 pints at6pm. Could i be particularly sensitive to coffee and/or alcohol, so it would affect me for 2 or 3 days? I
canhave exercised very hard all day, then I cant sleep. Is it some kind of chemical imbalance?I dont stress about it anymore, I have to live with it, but it makes many things so difficult,like long drives, and precision work, and of course my riding. I really want 7+ hours sleep everynight. Could it be a side effect from psychotropic drugs i was put on many many years ago?
My GP cant help more. I average 4hrs sleep, 3nights very little sleep then one good night
A few quick answers - hard exercise often makes insomnia worse rather than better, especially if it's done with the expectation of better sleep.
The amount that people respond to caffeine is a combination of genetics and age. Some are more responsive than others, and for those who are sensitive it tends to have a greater effect as we get older. However the half life of caffeine is 10-12 hours so it tends to be out of your system within that time frame.
If it's something that you want to work on I would suggest that you find a way to access formal CBTi therapy or similar? The British Association Of Counsellors and Psychotherapists would be a good place to start.
However if you're living with it, then you don't necessarily need to do anything about it. People with chronic sleep issues often perceive their performance (and indeed levels of sleep!) to be far worse than they actually are.
I snore at vol 11. Window rattling, tile shatteringly loud.
Mrs BOAS says I don't stop breathing but reckons I can disturb myself, waking frequently but not to full consciousness. I think I know these nights as I wake up exhausted without really knowing why, but I don't have this every night and can have a bad snoring night and the only thing to show for it is an angry wife.
Through the snorelab app I've been able to track it and I know it's very very closely aligned to my weight (I would say I'm not heavily overweight - BMI is around 29 usually but I'm a solidly muscular build), but as I'm getting older I find I need to be lighter to keep the snoring at bay and it's got to the point where I can't maintain a low enough weight to keep the snoring acceptable.
My snoring is definitely the vibration of soft palate in the nasopharynx area - more of a snorting/gathering up a greeny type of thing rather than oropharynx/soft palate snore.
My questions:
1) Even if I don't stop breathing should I still get checked out for sleep disorder?
2) Will I do myself long term harm if I just shrug and keep snoring (assuming I stay married)?
3) Is there a procedure that would shut me up?
What ratio of sleep is optimal - light/deep/rem
Can you sort out 14 years of shit sleep induced but having kids?
Why can't I get enough? Even though I get to bed at 9 religiously and get up at 6 and rarely drink
Hi @Kramer
I take Tegretol (200mg prolonged release, twice a day) for temporal lobe epilepsy:
Am I correct in my perception that the medication puts me into an immediate deep sleep for 2 – 4 hrs, (as in shut my eyes and I’m off) followed by waking and fitful dream sleep for a further 3 – 4hrs?
Probably not.
Tegretol is a sedative, but if you've been on it long term people tend to become accommodated to it. What you're describing sounds like a normal sleep cycle. As mentioned, it's normal to have multiple cycles of sleep going through deep sleep, then REM (dream sleep) , then brief waking and repeating. It's more likely that as you've slept more, later on in the night you're achieving full consciousness in the brief waking periods, and this is entirely normal.
Only occasionally do I sleep through, and would like to sleep better – should I change the timing of the medication so that i’m not taking my second dose at bedtime – would that help?
Not without consultation with your epilepsy specialist. Timing of your dosage can be important in fit prevention. As mentioned above, it is normal to have waking periods in our sleep.
I read somewhere it affects quite a lot of people as we age, and it is because the natural melatonin our bodies produce to get us to sleep is fading as the night progresses. For me I think that as the melatonin wears off, then the mask and pipe from my cpap machine is more likely to wake me.
For others also minimising wake triggers would probably be a good idea, usual sleep hygiene, blackout blinds, cool room, no led’s etc Maybe also separate beds or mattresses so your partners sleeping movements don’t disturb you.
The three things that we need to stimulate sleep are:
- A peak in our melatonin levels - this is stimulated by avoiding exposure to bright light leading up to bed
- A build up of adenosine (sleep fuel) in our brain - we maintain this by staying awake long enough to get properly tired.
- A lowering of our cortisol - we can help this by helping it to peak by being exposed to daylight or similar for 20-30 minutes quite soon after we wake up. To do this we need to be outside in daylight. Sitting in a car is not enough unfortunately.
However, we cannot make sleep come. We can only create conditions that make it more likely. Which is why if we're lying in bed not getting off to sleep, after 20 perceived minutes we should get up and do something until we feel tired again.
As mentioned before, once we're asleep, we all have brief waking periods where we're conscious, throughout the night, however whilst our adenosine levels remain high and our cortisol levels remain (hopefully) low, during these periods we do not generally achieve full awareness, it is only later on in the night that this starts to change.
Thanks for your reply Dr Kramer.....and thanks for putting the time aside for this!
Why do I wake up feeling tired, regardless of how much sleep I’ve had! I never, ever, wake up feeling refreshed and ready to go. Every day I have to drag myself out of bed 😞
Without knowing what your sleep routine is I can't answer specifically. However the three things that I find most commonly when taking a sleep history are:
- An irregular routine with different getting up times on different days, essentially giving yourself jetlag every day as you try and move your circadian rhythm
- Getting up at the same time every day, but going to bed too late so not getting enough sleep
- Disordered sleep from probably sleep apnoea
On a serious note though, I have pretty bad tinnitus and whilst I’ve learnt to ignore it mostly and I can get to sleep, I’m convinced it affects my sleep quality WHILST I’m sleeping. Any thoughts on that Dr K?
Tinnitus is most likely a phenomenon of consciousness and attention, so it's unlikely to occur whilst you're actually sleeping.
Why can I fall asleep really easily on a train, in a cinema seat, in front of the telly etc. but not in bed?
Very specific but I’m struggling with post concussion syndrome at the moment. It led to me having depression in October but I feel like I’ve moved past that.
However, I’m still sleeping ten hours a night and need a nap in the afternoon. If I sleep less then I feel absolutely knackered all day – like fall asleep where I stand knackered. Even if I’ve had a good solid eight hours.
Is this something I’m perpetuating by letting myself sleep so long and napping? If I force myself to sleep less will it get me out of the habit or will I just make it worse? The knock on the head was back in September and I’d like to move on with my life.
No you're not making it worse, the increased sleep is needed for your brain to complete the healing process. Forcing yourself to sleep less will be sleep depriving yourself and as mentioned in another answer, that has bad health outcomes.
I'm afraid healing takes as long as healing takes, and there's not really any way to speed up the process. I'm also sorry to tell you, you shouldn't be mountain biking or doing anything that risks further head trauma, even minor until you've fully recovered. Sorry.
Ok, that's all folks. I'm off to do the weekly shop, I'll try and pop back to the thread a bit later and tidy up and loose ends later.
I am of the opinion that people who have a TV in their bedroom are idiots, as I understand that studies show they have less sex and lower sleep quality. Please validate my horrifically judgmental opinion 😉
They are, especially those ones that rise out of a plinth at the bottom of the bed.
Double bonus idiocy if they use the phrase "and this is where the magic happens." 😉
Thanks 😊👍
Thanks, I got a lot from reading through your answers 👍
I go through periods where I have really vivid and realistic dreams about Kylie. What causes this, and how can I make it happen more often?
I wake up, a lot. I’ve been bad at sleeping since my early 20s, and am from a long line of bad sleepers. I have conquered the problem of not being able to get back to sleep by putting on podcasts – if it’s interesting I’ll almost almost always be back asleep within 10min. If I’m not, I don’t mind because I’m listening to something interesting, and usually will be back asleep within the hour. But, I’ll wake up probably 12.30, 1.30, 4.30, and 6.00 before eventually getting up at 7am (usually reluctantly, I could sleep until 8.30 comfortably). I am very rarely aware of having had any dreams at all. On the rare occasions I do sleep through the night, I feel much more refreshed in the morning.
Should I just accept that this is what my body does, or should I be trying to fight it/retrain myself?
What you're describing there is normal sleep cycles with brief waking periods. Acceptance is a reasonable strategy.
However you also seem to have trained yourself to wake up and listen to a podcast when you have those brief waking periods. I hope that it's not the Megasack vlogs because they are far too stimulating to be listening to during the night and need your full attention.
In your case it could be worth keeping a sleep diary and trying some sleep restriction
Basically you work out how much time in total you're spending in bed, and how much of that time you're actually asleep for (sleep efficiency). If it's less than 85% of the time then you move your threshold time a bit later. If it's more than 90% then you move your threshold time a bit earlier.
DOI I am in the process of developing an app to help people work out their sleep efficiencies and threshold time.
The other thing that you could consider is making sure that you get up at the same time every day with no lie ins, to help your circadian rhythm as much as possible.
My old A-level English teacher once claimed that despite the fact dreams can seem like they last ages, they actually in reality never last longer than about 7 seconds…do you reckon that’s true or was he talking utter bull**it?
Each sleep cycle is about 90 - 100 minutes long and is composed of a period of deep sleep, followed by a period of REM sleep (dreaming) and then a brief period of waking.
In the earlier cycles of the night the ratio is very much in favour of the deep sleep, with only brief REM sleep, however as the night progresses, the deep sleep becomes shorter, and the REM sleep becomes longer, as do the brief waking periods.
If you wake during the REM sleep and achieve full awareness, then you remember your dreams. If this happens very suddenly then they are particularly vivid.
I wonder if you’re going to regret offering this AMA but here’s another one…if I smash out a load of V02 max intervals on the turbo trainer and then can’t sleep all night afterwards, how annoyed should I be?
Like have I just cancelled out all my hard-worked for fitness gains from that session or is it merely the case that I will have benefitted slightly less than if I’d slept really well?
Not annoyed at all. VO2 max intervals are about conditioning yourself rather than fitness gains. Basically the more you're in the pain cave, the more you can stand being in the pain cave. <shudder>
However, doing intense exercise in the evening is very stimulating, and is unlikely to lead to a good nights sleep, because you will have raised your adrenaline levels and probably your cortisol.
If you wake during the REM sleep and achieve full awareness
I often awaken with a full something.....
I often awaken with a full something…..<br />
If it’s an erection count yourself lucky. If it’s your bladder then try drinking a little less in the evening.
Kramer, I have a question that may be related to Restless Leg Syndrome. At the instant I drift off to sleep, my legs kick and twitch for a period of time but I’m completely unaware of it. Up to roughly 5 minutes, it can be quite violent at times. Any ideas what causes this?
I’ve struggled to find anything similar when googling the symptoms, everything comes back to Restless Leg Syndrome which I’m not sure it is.
I agree, it sounds more like a Sleep Paralysis type disorder to me. Usual caveats about diagnoses over the internet apply, but that's where I'd look. As far as I know, in the absence of other symptoms it's harmless. It may be worth looking at your sleep routine, if it's a bit variable (especially your getting up time) then making that the same time every day might help.
Any thoughts on bedroom ventilation in Autumn/Winter?
Yes. Ideally, to increase the chances of falling asleep your body temperature should be falling. This is why having a warm bath or shower prior to going to bed, and then having a cooler bed and bedroom can help.
Thank you @kramer hadn’t heard of the sleep restriction technique. May try it when I’m living in the same timezone as my husband and my nocturnal wriggling gets annoying!
Similar to someone else, doesnt appear to matter how much sleep I have or the perceived quality of it… I always wake up feeling tired with no sense of vitality. Presume it just means it is linked to something other than sleep but is there really such thing as “not being a morning person”?
There does seem to be a genetic and biological link between being a morning and an evening person. Interestingly in adolescence we almost all seem to become night owls, probably related to hormonal changes and the reproductive advantage in having a propensity to stay awake later than your parents.
How much is genetics, and how much is behavioural and within our control is debatable.
If you continue to feel tired all day, and this is persistent for longer than 6 weeks then it may be worth consulting your GP who would probably arrange some blood tests and may assess you for Obstructive Sleep Apnoea.
If you're not a natural morning person, and this applies to young people as well, then it's doubly important to have the same getting up time every day with no lie ins, and you'll be particularly susceptible to moving your circadian rhythm back in the day, and then giving yourself jet lag when your try and move it forwards again on work days.
this associating the bedroom with not sleeping thing is very interesting. Are there other examples of this kind of association that I can see and try to understand better?
If blue light/screen time is a bit of a myth, especially earlier in the night, regarding melatonin levels, then is scrolling and internet things some kind of behaviour likely to increase dopamine levels in place of serotonin?
Does slowing your breathing down decrease excitatory hormone levels?
I snore at vol 11. Window rattling, tile shatteringly loud.
Ha ha, me too!
1) Even if I don’t stop breathing should I still get checked out for sleep disorder?
Yes, it sounds like it's causing you daytime sleepiness, so you may well have disordered sleep.
2) Will I do myself long term harm if I just shrug and keep snoring (assuming I stay married)?
Not if you don't have disordered sleep (provided your wife doesn't smother you), but if you do, then yes sleep apnoea has been associated with increased mortality, not least from falling asleep whilst driving.
3) Is there a procedure that would shut me up?
It depends, if you have an obvious cause, then fixing it may be helpful, otherwise anti-snoring surgery doesn't have a stellar reputation. CPAP machines however can be very effective, and I was recently assured by someone on here that they're far less cumbersome than they used to be.
Tinnitus is most likely a phenomenon of consciousness and attention, so it’s unlikely to occur whilst you’re actually sleeping.
A bit off topic, but as a fairly severe tinnitus sufferer I'm interested in this. I take your point about attention - learning to zone it out is at present the only real tactic I'm aware of. I note that things like performing the valsalva maneuver (clearing the ears by blowing) changes the pitch and intensity of my tinnitus- as does yawning. Do you think tinnitus is a purely physical condition or are there psychological elements?
Back on topic, even if stressed I rarely struggle to fall asleep, but do wake up early hours and then can't get back to sleep. Any explanation as it seems counter intuitive? As I've got older (now 58) that's become more pronounced.
Really interesting thread by the way! Thanks for running it.
What ratio of sleep is optimal – light/deep/rem
No ratio, as explained in a previous answer it changes with each sleep cycle throughout the night, moving more towards REM and brief wakenings with each cycle.
Can you sort out 14 years of shit sleep induced but having kids?
Yes, look to establish a routine, which I'll below with your answer to your next question.
Why can’t I get enough? Even though I get to bed at 9 religiously and get up at 6 and rarely drink
Sleep? 😉
It depends how you measure "enough" but it sounds like you're spending too much time in bed and that your bedtime is too rigid. It's very important to get up at the same time every day, but we shouldn't be going to bed until we feel tired, rather than trying to force ourselves to go to sleep at the same time ever day. Please see previous answers with regard to threshold times and sleep restriction.
Do you have any experience with sleep tracking in smart watches? If so, how accurate are they generally? I’m surprised my Garmin tells me the difference between light, deep and REM sleep so confidently.
I think that they're reasonably accurate.
However I'm not sure that the information is useful. Diagnosis of disorders is based on Bayes Theorem, so if you do tests on well people, you're much more likely to pick up false positives than true positives. This applies to just about any health tracking in well people that you can think of, apart from, maybe, blood pressure, off the top of my head. And even then if it's not high, you only need it checking once a year or less depending on your age.
The best measurement of your quality of sleep is how you perceive yourself to have slept. If you feel you slept ok, and had normal levels of fatigue during the day, then tracking doesn't add useful information IMV.
Why can I fall asleep really easily on a train, in a cinema seat, in front of the telly etc. but not in bed?
Because of paradoxical intent. Sleep is by definition not a conscious process, therefore we cannot control it. The more we try and do it, the more we focus on it, the less likely it is to come.
However, when we're sat comfortably in a seat, not focussing on something, but being passively aware of what's going on around us, those are the perfect conditions that sleep may arrive.
An experiment to try, when you're in bed, and don't have anything important to do the next day, is to lie in bed with your eyes closed and see how long you can stay awake for. You're not allowed to open your eyes as that's cheating. You may be surprised.
Also, it sounds like you may also have got into the habit of going to bed and not sleeping. Please see my other answers about sleep restriction, and getting up after 20 perceived minutes awake.
I go through periods where I have really vivid and realistic dreams about Kylie. What causes this, and how can I make it happen more often?
Me too, and then I wake with a similar problem to you too. Still working on the answer to your question.
Quetiapine for a sleep aid (prescribed by Dr) – yay or nay?
I couldn't say without knowing the full medical history and this isn't really the appropriate modality.
It is used in some circumstances.
Do you think tinnitus is a purely physical condition or are there psychological elements?
Definitely. I think that tinnitus is an amplified sensation syndrome and I have it myself from stupidly spent too much time dancing in front of the speaker stacks in nightclubs.
The more we focus on any sensation, the more pathways we are building in our nervous system to transmit that sensation. The more we distract ourselves from it, the more gateways there are to block the sensation. If we are stressed, then one of the actions of adrenaline is to reduce blood supply to the frontal lobes, therefore it becomes harder to distract ourselves. Then it can quite easily become a vicious cycle.
Back on topic, even if stressed I rarely struggle to fall asleep, but do wake up early hours and then can’t get back to sleep. Any explanation as it seems counter intuitive? As I’ve got older (now 58) that’s become more pronounced.
Yes, as you get older, generally you need less sleep. If it's happening regularly you may be spending too much time in bed, and should look at optimising your sleep schedule to fit with your circadian rhythm etc.
- Get up at the same time every day, no lie ins
- No napping during the day or evening. If you know you're likely to fall asleep doing something then don't do that thing
- Look at previous answers I've given about sleep restriction
- Follow the 20 minutes perceived time awake rule
As detailed in other previous answers.
After night shift I literally fall asleep in seconds. I usually wake after 4-5 hrs, any suggestions to help me sleep a bit longer? Or is that just the way it is?
Usually once I’ve had my initial sleep I’ll get up, have a bite to eat and try and get another 2 or 3 hours.
Yeah, night shifts are exceptionally bad for our health, possibly as bad as smoking is. The bad news is that for most of us, it's worse as we get older.
The worst ones are the sporadic ones. The larger blocks that you have, the more chance that you have to adapt your sleep schedule to fit in with it.
The trick with changing sleep patterns with shift work is to see if you can find one that can fit in with the things that you want to do whilst minimising the amount that you're changing the time that you get up, which should be as close as possible to the same time every day.
ie if you're on permanent nights, then don't try and force yourself to live a normal daytime routine when you're not at work.
Other things that you could do is expose yourself to bright light as soon as possible after you get up from your sleep, and wear sunglasses and try avoid too much light exposure when you come home from work. When you get in, make sure you close the curtains and have the lights dimmed prior to going to bed.
However you're fighting an uphill battle I'm afraid.
Ok, I think that's everyone's questions answered. I'll keep looking in to see if there are any more follow up questions or similar, thanks for all the questions I've enjoyed trying to answer them.
Late to the party, apologies!
I work a four on, four off shift pattern. Two day shifts, followed by two night shifts. Twelve and half hour shifts starting at 5.30.
It’s impossible for me to build a routine in as you suggest, I feel permanently jet lagged and sluggish and contributes to my lack of motivation etc (blaming that anyways) Add in a two year old who understandably hasn’t a clue her Dads trying to sleep during the day and it causes me havoc in all aspects of life!
Any tips other than going to normal working hours??