You don’t need us to tell you that sleep is vital for good health. But statistics about the habitually sleep-deprived tell a troubling story. WH Health Editor Claudia Canavan (@claudiacanavan) reports on the reality – and explores the best tools to soothe sleeplessness.
As the trill of the Monday morning alarm penetrates Amarachi Clarke’s consciousness, she commands her eyelids to open, resisting her body’s plea to keep them shut. Despite the struggle to get out of bed, Amarachi hasn’t actually been asleep for hours.
Instead, since the depths of the pre-dawn morning, she’s occupied that strange, liminal space of insomnia, lying in the dark while her mind dances. She begins the day exhausted, as she always does. The 38-year-old has suffered with insomnia since she was 17, when her family moved to a new house.
Back then, she filled her interminable nights listening to Ian Collins And The Creatures Of The Night on Talk Radio as the inky-black hours slipped into daybreak. This morphed into a pattern that has dominated Amarachi’s adult life: a relatively seamless transition into sleep; a sharp, sudden awakening around 2am; and a total inability to drift off to sleep again, as to-dos for her life and business– she founded the craft-chocolate company Lucocoain 2015 – stream through her mind.
It doesn’t help that Amarachi knows the benefits of sleep go far beyond avoiding the feeling you’ve been hit by a bus. The knowledge that clocking up seven to nine hours of quality sleep a night is good for your health is as baked into our collective consciousness as sultanas into a spotted dick, with wins ranging from getting you through the day (by playing a role in regulating your emotions), to helping you live longer (warding off heart disease).
It’s knowledge that adds another layer of anxiety to the tangled web of worry that torments the estimated one third of Brits who report difficulties with falling or staying asleep*. And as society begins to emerge from a two-year period best described as ‘nocturnally challenging’, scientists are learning more about the identities of the habitually sleep deprived – and they’re more likely to be women.
Research from the University of Southampton found women were almost twice as likely as men to report they’d lost sleep during the early weeks of the first national lockdown – a discrepancy some have blamed on the fact that women disproportionately bore the brunt of the increased volume in unpaid labour.
But this gender sleep gap predates the pandemic. In 2017, a poll of Britons and Americans, conducted by YouGov on behalf of meditation app Calm, found women are 40% more likely than men to regularly sleep badly. This supported the results of a 2006 meta-analysis,* which found women are 40% more likely to develop insomnia than men.
With fresh research regularly delivering fascinating findings on sleep’s significance for health, is falling asleep now a feminist issue?
Sleep like a lady
For Jennifer Cooney, a 35-year-old health physiologist and coach from Snowdonia, Wales, her story of the perimenopause begins like so many others. A cocktailof debilitating symptoms that seemed a mystery to health professionals manifested: intense feelings of anxiety, pulsating headaches, dizziness and fatigue so potent she had to take sick leave from her role as a university lecturer.
After blood tests and MRI scans came back ‘normal’, she began her own research and realised her experience chimed with symptoms of perimenopause. During this time, her sleep was greatly disrupted.
First, there was the anxiety to contend with, which made it hard to drift off. With this came heart palpitations and, sometimes, the feeling that she couldn’t breathe properly. Compounding this were violent headaches that made getting to sleep a nightmare and woke her at around 4am. She is now focusing on health coaching to help peri and menopausal women with their wellbeing.
Interestingly, all of Dr Cooney’s symptoms have been linked with fluctuating levels of oestrogen and progesterone. ‘It looks like these two hormones have specific sleep-protective effects,’ explains sleep scientist Sophie Bostock (thesleepscientist.com). ‘The former is associated with relaxation and calm, while the latter is involved in the metabolism of serotonin, the so-called “happy hormone”, in your brain, meaning that lower levels can lead to issues with mood.’
Dr Bostock also notes that the anxiety around the loss of control – your body suddenly behaving in alien ways you cannot ‘fix’ – can also affect your emotions.Plus, oestrogen controls your body temperature, affecting your ability to stay cool, which further hampers your efforts to fall asleep.
Night sweats are thought to impact up to 80% of peri and menopausal women – and they don’t just keep you from sleep, they yank you out of it, too. ‘Episodes of night sweats are associated with a release of adrenaline in your brain, so you might wake up just before one occurs,’ adds Dr Bostock.
Bed of fails
This can add up to a scenario in which it feels as if your body is conspiring against you. And compounding the physiological barriers to sleep are social ones; namely, structural inequalities. If it was generally felt that women bear the brunt of the domestic load pre-pandemic, it became a stark fact during the lockdown of spring 2020.
Research from the Institute Of Fiscal Studies showed that, in families with children in which there are two parents of opposite genders, mothers were doing two hours a day more childcare and housework than men from the end of April until the end of May 2020.
Mothers were also one-and-a-half times more likely than fathers to have lost or quit their job. In the aforementioned University of Southampton study, researchers drew a direct line between the additional layers of pressure and responsibility women faced and their ability to sleep.
Sleep loss was also associated with being a key worker, having young children at home, being concerned about financial circumstances and feeling lonely.
None of which comes as a surprise to Estelle Keeber. The 39-year-old self-employed business consultant and single mum to two boys, aged 10 and 12, has experienced sporadic sleep problems for years, unable to drift off with work projects on her mind.
But in March 2020, things took a turn for the worse. ‘There were some nights where I would only get two or three hours of sleep,’ she recalls, blaming the sudden change in routine wrought by the first lockdown, on top of the stress of home-schooling two children.
‘My youngest son initially needed a huge amount of support that left me temporarily unable to work.’ After full days grafting as an amateur teacher, she’d head to bed shattered, but the whirr of her mind –thinking about how she could best support her youngest – kept her from nodding off.
‘I got advice around sleep hygiene and was going to bed at a regular time, putting my devices away before bed and doing meditations, all to no avail. But in hindsight I can see how difficult that period was, so even with those tools it was hard for my mind to switch off.’
The consequences were as you might expect: Estelle spent days feeling lethargic, irritable and quick to become emotional.
The frequency with which sleep issues were reported during national lockdowns earned the phenomenon its own moniker. ‘“Coronasomnia” refers to stress-related insomnia due to the coronavirus pandemic,’ says Lindsay Browning, a chartered psychologist, neuroscientist and sleep expert (troublesleeping.co.uk).
She explains that while the initial shock around the virus has passed, its impact was so great that a heightened level of stress lingers, as does the disruption to sleep patterns. Guy Meadows, co-founder of Sleep School and creator of Sleep School App, agrees.
‘We know the pandemic has affected people’s sleep and their mental health, and those things are intimately connected,’ he says. ‘I don’t think going back to something like “normal” will suddenly correct people’s poor mental health. I think we’ll see a lag effect, where the cost of the pandemic continues to affect those areas for some time.’
That’s not to say that all is lost if you do struggle with sleep. While it’s true that knowledge is power, and it pays to pay attention to the latest REM research, it’s also true that sleep is closely intertwined with your emotional state.
And the last thing you need when you’re not sleeping is to feel even worse about it. Every expert WH spoke to for this piece emphasised one crucial point: whether it’s due to an intense period of work or relationship stress, the early days of parenthood, health issues, or the panic of trying to home-school while working, short periods of insomnia are almost inevitable – and, while they are difficult, try not to become fixated on them.
It’s worth noting, too, that it’s normal for your sleep to worsen in your forties. ‘As you age, you produce less melatonin [a hormone involved with your sleep-wake cycle] and have more disrupted sleep,’ says Dr Bostock. ‘If you [wake] during the night, that doesn’t necessarily mean that you’ve had a bad night’s sleep– it could simply be a natural break in your sleep cycles. If you can accept it and go back to sleep, it’s no big deal.’
As for closing the gender sleep gap – which is, in part, a matter of female biology – the experts are also clear: it starts with education, both for women and healthcare practitioners. Dr Meadows cites recent research from The Sleep School, which found that 53% of those surveyed didn’t know how to improve their sleep.
What’s more, a lack of knowledge around the hormonal roots of sleeplessness – and with it, reduced access to the medications that can help – remains pervasive, as Jennifer’s experience demonstrates.
After taking her healthcare private, she is now on a trial dose of hormone replacement therapy (HRT), which seems to be working. Her night sweats are now occasional and she believes she’s ‘on the right track’. If you’re among the 40% to 60% of menopausal women who experience sleep problems*, speak to your GP about whether HRT could help your symptoms.
A 2016 review of trials showed that it was associated with better sleep quality in women experiencing flushes and night sweats. Cognitive behavioural therapy (CBT) – which focuses on challenging and changing cognitive patterns and behaviours – could help you here, too.
‘One of the most effective treatments for poor sleep, whether you’re affected by menopausal symptoms or not, is CBT,’ says Dr Bostock. ‘It won’t change your hormones, but it helps you to develop a better sense of control; teaching you how sleep works and how to relax.’
While CBT is available on the NHS, the waiting list can be long; Amarachi, whose GP recommended it, has been told to expect to wait nearly 12 months. If you need help now, there are some evidence-based – and affordable – tools you can try.
Sleepio – a digital, six-week CBT sleep-improvement programme – was shown in a placebo-controlled clinical trial to reduce by 54% the time it took participants to fall asleep, with 62% fewer awakenings during the night. It’s free on the NHS in London and the Thames Valley, and in Scotland – but use a London postcode when signing up, and you can use it wherever you live.
Another approach is that pioneered by Sleep School: acceptance and commitment therapy teaches you to notice and accept your thoughts, feelings and memories. If you have a trigger stopping you from drifting off – from financial worries to a fear of falling asleep, or because you’re a shift worker – their app has a section to help you work through it. (You can download and try sections for seven days for free, or pay £29.99 for a year’s full access.)
Such solutions aren’t perfect, but the range of resources that may help is growing. Getting them to those who are suffering in sleeplessness is vital if we’re to stop a poor-sleep epidemic from becoming a national health crisis.
As Dr Meadows says: ‘Poor sleep is normal, but getting treatment for it is fundamental.’ For the sake of any woman who crawls out of bed in the morning bereft of a solid sleep, unable to recall what ‘rested’ feels like, these truths are paramount.
How to look after your health, if you are dealing with trouble sleeping
Sleep is a pillar of good health, but what you eat and how you move have a major impact onyour overall wellbeing, too. Try these techniques.
Make time to move
The benefits of daily exercise are far greater than just helping you to nod off at night. It can actually offset some of the risks of not getting enough sleep.
Research published in 2021, which took data from over 300,000 men (and yes, only men were involved) showed that 25 to 65 minutes of ‘moderate intensity’ physical activity each day ‘eliminated’ the link between sleeping for six hours or fewer a night and cardiovascular disease.
Follow the MIND diet
A 2021 study found that the MIND diet can lower the risk of developing clinical dementia, even when the toxic brain proteins associated with Alzheimer’s disease are present. People who consumed three servings of whole grains, a green, leafy vegetable and one other vegetable every day, snacked on nuts, had beans every other day or so, ate poultry and berries twice a week and fish once a week were found to have better thinking and memory skills than those who didn’t follow the diet.
Exercise your brain
A 2020 study found that an eight-week mindfulness-based stress-reduction programme improved the sleep quality of participants. The practice, though, could also be handy for a sleep-deprived mind.
A 2019 study indicated that a single 20-minute period of meditation that focused on awareness of feelings, thoughts or sensations as they arose helped people to make fewer mistakes on a computerised distraction test. Time to re-download the Headspace app?
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