Sleep and Insomnia

Nothing is as restrictive as sleeping problems. Everyone survives a bad sleep, but there are usually some very unpleasant consequences within a few days. For example, loss of concentration, lethargy, fatigue, falling asleep while working, or worse, in the car in traffic jams, finding it difficult to learn...
Of course, all these problems are not always caused by sleep problems, but sleep disorders are the main cause. Fortunately there is a lot of information and help available. There are even specialised sleep centres!

A healthy adult needs between seven and nine hours of sleep per night. It is not a problem if you sleep less one night, but if it keeps happening, and it hinders you in your daily life, then we speak of sleep problems.

• During our hours of sleep, we go through a four-stage cycle. This cycle is repeated several times during the night. The first stage is a short period in which you are not really asleep yet, but your body is preparing for it. At this stage, your muscles relax, your temperature goes down, your heart rate slows down and your eyes turn away.
• After a few minutes you will fall into a light sleep; the second stage. At this stage, you may wake up to the smallest sounds because you are not yet asleep. This phase does not take very long either.
• Now it is getting interesting; in the third stage your heart rate is even slower, your muscles are even more relaxed. You are now deeply asleep and will not be woken by small noises. This is when the real repair work of your body and mind starts. In this deep sleep, your organs and muscles will be restored, and your brain will be able to process all the information you have gained. Your body and your brain need this deep sleep!
• Finally, there will be a fourth stage. The REM sleep. REM stands for Rapid Eye Movement and refers to the rapid blinking of your eyelids. This sleep takes a lot of energy, and this is the stage where you start dreaming. At this stage, your brain shows as much activity as when you are awake. There are several researchers who state that the dreams are used to process daytime events.

These four stages are completed several times a night. It does not matter how often, but it does matter that they are evenly distributed.

As can be seen from above, sleep is of vital importance to us. During our sleep, our body and mind are being maintained so that the next day we can start afresh again.

On the other hand, if we do not get a good night's sleep, there will be problems of concentration, alertness and learning ability. 15% of road accidents are caused by fatigue. Too little sleep makes us irritable, gloomy and listless, all factors that make our lives unpleasant. And sleep deprivation confuses our hormone system, which, among other things, increases our risk of obesity.

There are various types of causes of sleep problems and poor sleep. We will discuss some of them below.

One of the most common causes of poor sleep is the so-called sleep hygiene. Fortunately, we can do a lot ourselves.

What also often makes it difficult to sleep in is when you are worried about something. As soon as you are relaxed, those thoughts come to the surface and the sleep is gone again. It is very difficult to memorise the subjects you are worried about and therefore you are short of valuable hours of sleep.

After all, you may have physical discomfort, possibly as a result of illness. Itching, breathing problems and restless legs can make your sleep impossible. And if you fall asleep, you will soon wake up to these symptoms.

Some of the most common diseases that cause this kind of sleeping problems are:

• Restless Leg Syndrome
• Allergies
• Asthma
• COPD
• Bowel diseases

Sleep problems can be divided into four groups:

• Snoring, and waking up all the time
• Not being able to fall asleep
• No being able to sleep through
• Sleep related disorders such as narcolepsy and sleep apnea

Clear indications that you are not getting enough sleep are, for example:

• Waking up tired and stiff; this indicates that you are not rested, and possibly that your mattress needs to be replaced.
• Dropping off suddenly, for example when doing paperwork, watching a program or working on your computer.
• Being languid, not getting started.
• Headaches, especially around the eyes.
• Being stimulated or irritated, crying quickly and getting angry quickly (the 'short fuse').
• Poor ability to concentrate. This, together with the falling asleep, is a great and real danger in traffic.

A large proportion of problems with falling asleep or sleeping in are the result of poor sleep hygiene. The following recommendations will help you improve your sleep hygiene and get a good night's sleep:

1. For a good night's sleep, it is important that your bedroom is dark, cool and well-ventilated. The ideal night temperature varies from person to person and can vary between 17 and 21 degrees Celsius. Do you suffer from environmental noise? Think of the possibility of setting up white noise. This is a monotonous sound, which brings ambient sounds to the background and cannot keep you awake.
2. No televisions, laptops, tablets or mobile phones in the bedroom. No matter how soothing it may seem to play a game, the blue light stops you from getting sleepy.
3. Maintain a routine; try to go to bed at about the same time every day and to get up again at about the same time. Your body will then be better prepared for sleep.
4. Make sure you have a good mattress, a pillow suitable for you and comfortable nightwear.
5. Make a worry diary. Shortly before you go to sleep, write down everything that worries you. You can let go of these thoughts, empty your head as it were, and relax enough to fall asleep.
6. A good next step is to lie down quietly and concentrate on your breathing. Breathe in through your nose, out through your mouth, and do so as quietly as possible.
7. You could also try to visualise your sleep. This works best after the previous exercise, if you are already largely relaxed.

Sleeping problems are only exceptionally treated with medication. These medicines are often addictive, have many side effects and are actually only a stopgap if the underlying cause is not addressed.

Should it nevertheless be necessary to support the treatment of insomnia with medication, this should preferably be done for a short period of time. Preference is given to a short-acting benzodiazepine agonist: lormetazepam, temazepam, zolpidem or zopiclon. There is ample experience with these products and when used in low doses there is little chance of after-effects the next day.

Without having to resort directly to medication, there are also other, alternative treatments available to help you regain or strengthen your sleep rhythm.

1. Meditation and yoga can bring your body and mind to rest, creating the optimal conditions for a peaceful sleep.
2. Aromatherapy with soothing essential oils such as lavender (Lavandula angustifolia), lemon balm (Melissa officinalis), geranium (Pelargonium Asperum) and chamomile (Matricaria recutita). Aromatherapy is not scientifically proven.
3. Have a glass of herbal tea before bedtime. Herbs such as chamomile, valerian, orange blossom and lemon balm are soothing.
4. Melatonin is a hormone that your body produces itself. It helps with falling asleep, the depth of the sleep and the duration of the sleep. It also protects against free radicals. A doctor may recommend this medicine in some cases.
5. The production of this hormone is influenced by a number of factors; the amount of light is one of the most important, but also the availability of a number of vitamins and minerals. These are: zinc, magnesium, calcium, vitamins B3, B5, B6 and C. A shortage of these vitamins and minerals can be solved with a vitamin supplement. Please note that it is better not to take them in the evening, as they often have a slightly stimulating effect. Melatonin is prescribed against it for sleeping.
6. If the sleep problem cannot be solved with these options, you can ask for a referral to a sleep centre. These are special centres, usually connected to a hospital, where everything revolves around sleep. Diseases such as sleep apnea and narcolepsy, but also insomnia and snoring are treated here. The centres are generally multidisciplinary, in some cases specialising in some specific disorders, and in other cases broadly oriented. A total of about 60 well-defined sleep disturbances are known.

Changes in lifestyle are recommended in various areas. We describe them briefly below.

1. Bedtime activities; it is wise not to watch TV the last hour before you go to bed and to turn off your mobile phone, laptop or tablet. Instead, you can quietly read a book or magazine and turn on quiet music, for example, to prepare your brain for a restful, deep sleep.
2. Make sure you do enough exercise. Play sports, take a brisk evening walk. Start with relaxing activities such as dancing lessons, yoga, meditation.
3. Do not overload your agenda. Keep space free to relax and unwind in between. Do this for your professional life, but also for your social life. Build in sufficient moments of rest.
4. Avoid alcohol and caffeinated drinks in the evening. This also includes energy drinks, cola and black tea. Also reduce the number of cups of coffee during the day. Caffeine delays the production of melatonin (a hormone produced by your body that controls your wake/sleep rhythm) and stimulates brain activity. This is not convenient if you want to sleep.
5. Make sure you take on enough fluid. You may experience both physical and mental fatigue if your body is not properly hydrated. A well hydrated body can dispose of waste products quickly and well, which promotes a good night's sleep.
6. Stop smoking. Smoking reduces the blood flow to tissues and organs, and this causes toxins to enter the blood.
7. Make sure you are a good weight. Obesity causes extra fatigue in several ways.
8. Adapt your eating habits. Certain foods such as fatty meats, chips, mayonnaise, crisps, sweets and cakes require a lot of energy to process and therefore cause fatigue. Eat enough fruit and vegetables, so that you also get enough vitamins and minerals. Eating late at night and going to bed on a full stomach can greatly disturb your sleep.

Wayenberg, S (z.d.), why is sleeping important, consulted on 15 April 2019, at https://npofocus.nl/artikel/7741/waarom-is-slapen-belangrijk

Sonnevelt, A., (9 February 2018), The importance of sleep and 8 sleep tips, Consulted on 15 April 2019, at https://gezondnu.nl/blogs/belang-slaap-en-8-slaaptips/