Are you TATT?

1st January 2016

From the odd restless night, to persistent insomnia; lack of sleep can have a significant impact on quality of life – limiting what you’re able to do during the day, affecting your mood, and ultimately leading to relationship problems with friends, family and colleagues. Heather Harris finds out more...

Insomnia: ‘habitual sleeplessness; inability to sleep’. It sounds so innocuous, but it’s a huge problem for those afflicted. And when a child asks innocently ‘How many sleeps until…?’, for an alarming number of adults the question simply reminds them just how many restless nights they will have before the big day in question.

There’s even a new acronym in the medical profession, TATT: ‘tired all the time’. London GP Dr Rupsl Shah says that tiredness is one of the most common complaints in her surgery. “I see loads and loads of people who complain of feeling exhausted. Often it’s been going on for several months.”

According to the highly alert and caffeine-fuelled researchers at the Sleep Council, nearly half of us are getting just six hours or less at night. ‘Four out of five people’, they say, ‘complain of disturbed or inadequate – or toxic – sleep.’

45-year-old marathon runner Suzy, from Rickmansworth, who struggles to stay alert past 9.30pm but then regularly wakes up around midnight, recognises this. “I am then often awake until 3am,” she tells me. “I have a routine: I go downstairs make a herbal tea and sit with my book. I look at the kitchen clock and tell myself I have to be back in bed at 2.45am.”
Like many of the insomniacs I speak to she knows it is a problem but is reluctant to get professional help. “I don’t like to take tablets, so I have tried natural remedies but they just wipe me out the next day. If I am honest, I do think alcohol plays a big part.”

Irshaad Ebrahim, the medical director at The London Sleep Centre, recently undertook an exhaustive review of 27 sleep studies and found, unequivocally, that alcohol may seem to be helping induce sleep, ‘but overall it is more disruptive to sleep, particularly in the second half of the night. Alcohol also suppresses breathing and can precipitate sleep apnea or pauses in breathing that happen throughout the night.’

Bang goes the nightcap theory then.

For a supposedly natural state we spend an awful lot of waking hours theorising and researching the whole phenomenon of the sleep cycle and its effect on our physical and mental health. There are now a number of specialised NHS Sleep Clinics all over the country where researchers and patients are presumably all dropping off at their desks as they struggle to get to the bottom of just what does keep us awake at night and why.

One thing is clear. There are two distinct stages of sleep: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep – and we need both to strength and repair tissues, boost our immune system, allow our brain to recharge our learning capacity and basically give us the mental and physical energy to face the day ahead.

Hardly surprising then that people like Suzy and her fellow night owl, Harrow-based Tanya, 50, can struggle to function successful during waking hours. “I haven’t slept properly for over 22 years and have a general feeling of being exhausted,” Tanya explains. “I see bed as almost an enemy and have to resort to prescription drugs if I know I have an important day ahead. It all started when my Mum died, and every time I shut my eyes I had bad visual images.”

Where there is a psychological reason behind insomnia, Lizzie Hill, Sleep Physiologist and Executive Committee Member of the British Sleep Society, is keen to stress the success of Cognitive Behaviour Therapy or CBT. This tackles the reasons behind the wakefulness. “Most problems with sleep can be cured or treated. The key is for the patient to find out what the underlying reason is – this could be medical, related to lifestyle and behaviour, such as alcohol, stress and diet, or in many cases a psychological trigger which sets off the irregular sleep routine.”

And like so many routines – once we get into them it’s hard to stop (going to the gym being the exception).

A common problem reported to GPs is the inability for new mothers to switch off their brain from that initial ‘one eye open’ mode. So when their baby starts sleeping through the night – unfortunately, they don’t!

This is a problem admitted to me by a friend, Amanda, who, ironically, was herself a practising therapist specialising in sleep. “It’s a bit like a builder having a house that’s falling down… professionals are the worst at using their skills on themselves!”

Amanda says she hasn’t slept properly since her son was born – and that was 16 years ago. “It’s now just a routine which I am used to… ridiculous I know!” She adds that most of her insomniac patients were women. The Royal College of Psychiatrists backs up her evidence. “At any given time one in five people feel unusually tired, and one in ten have prolonged fatigue, and (despite what our male partners tell us) women do tend to feel tired more often than men.”

Surprise, surprise… this can once again be all the fault of our hormones, with the menopause and accompanying night flushes meaning hot hours staring at the ceiling as our partner snores next to us.

“I did have one male patient though who had suffered for years and had no idea why. Finally, what worked was the introduction of a consequence– if he woke in the night he had to complete a really mundane job – like mopping the floor. He did it a few times, but then the mere thought of it was enough to keep him in a deep sleep,” Amanda tells me, adding that it was far more productive than counting sheep.

So are we all turning into a society of hamsters eager to stay awake with our little minds whirring away into the early hours? Lizzie is not so sure. “Part of the reason that referrals to sleep specialists are rocketing is that sleeplessness is now better recognised as medical problem, and so more people are seeking help,” she says, adding that one worrying area is the number of young people being diagnosed.

The National Sleep Foundation’s 2014 study recommends that children aged six to ten get 10-11 hours of sleep per night and older children 8.5 to 9.5 hours a night – but few are. In a study of one thousand 12-16 year olds, almost 30% achieved just four to seven hours sleep and almost a quarter admitted they fall asleep watching TV/listening to music or with other gadgets still running more than once a week on a school night.

“There is a clear link between the use of electronic devices and bad sleep,” says a clearly frustrated Lizzie. “The blue light from screens fools the brain into thinking it’s daytime and delays the production of melatonin”.

Speaking recently to the BBC, Professor Paul Gringras from Evelina London Children’s Hospital called on manufacturers to build in an automatic ‘bedtime mode’ which filters out the blue light. “There is converging data to say that if you are in front of one of these devices at night-time it could prevent you falling asleep by an extra hour. It’s not good enough to say do less. The key is to automate it. We need protection over what children do at night-time.”

That’s a rallying cry that many teachers and parents of sleepy teenagers would applaud.

“I always take my 15-year-old son’s phone off him at night, but if I charge it in my room it amazes me to hear texts arriving at 2am – I wonder if his friends ever sleep,” says David, a father of three teenagers.

Perhaps they argue – as my own children do – that they don’t need eight hours sleep a night. “Just look at Margaret Thatcher,” one of them announced this week,” she ran the country on five hours a night…”

…and succumbed to Alzheimers at a premature age, I pointed out (under my breath, of course, for fear of breaking the cardinal rule of not telling a teenager that they’re wrong).

The fact is that as adults we all need to recognise that a regular six to eight hours’ sleep should be top of our priorities, and we should do everything we can to achieve it. This means throwing out all gadgets from the bedroom, avoiding caffeine, rich food and alcohol late in the evening. Try and relax the mind with some pre-bedtime meditation – or a good book. Oh, and physical activity in the day also helps so our body is ready to rest too. And if all else fails – get professional help.

Sounds boring, doesn’t it? But that’s exactly what sleep should be. It’s simply an altered state of consciousness, with little sensory activity; nearly all voluntary muscles are switched off and there is barely any interaction with surroundings.

Night, night…

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