As a medically trained science writer and, until recently, long-term insomniac, I’ve long been fascinated by sleep — why it’s so important to our health and the best ways to get more of it.
The latest science clearly shows that good sleep is a powerful way to protect us against heart disease, diabetes, depression and even dementia, which is bad news for the estimated three quarters of all UK adults who sleep fitfully, and potentially disastrous for the one in three whose lives are blighted by insomnia.
Having had my own fair share of sleep problems in the past, I’ve pulled together all the latest research and expertise in a new book, 4 Weeks to Better Sleep, which is being serialised in the Mail today, tomorrow and on Monday.
All the evidence shows that good sleep is an achievable skill. It just takes a little time and training to perfect and the right advice — which is why, by incorporating a few clever strategies that really work, I’ve come up with a four-week plan that can dramatically improve the quality of your sleep and even shift insomnia for good.
If you are suffering from sleep deprivation there is no end of advice online on how to improve it. It’s confusing.
Well rested: Michael and his wife Dr Clare Bailey
MICHAEL MOSLEY: My multi-faceted approach brings together all the latest research and breaks it down into a simple week-by-week series of tasks (stock image)
But my multi-faceted approach brings together all the latest research and breaks it down into a simple week-by-week series of tasks. These slowly build, one on the other, to create sleep habits that will transform the way you sleep, offering health benefits which should last a lifetime.
I’ve seen this approach change many lives and it has certainly changed mine.
Today, I’ll explain how sleep problems can particularly affect women and introduce the first stages of my four-week plan.
Tomorrow, in the Mail on Sunday, I’ll look at the reasons why men struggle to sleep and share more of my tips for a better night’s rest.
In Monday’s Daily Mail I will focus on the impact sleep has on the brain and how getting enough quality slumber is not only vital for good mood but can also fight off the ravages of dementia.
Sleep is often a topic of discussion in our house.
It is not uncommon in the middle of the night, and while she is fast asleep, for my wife Clare to climb right over me in bed and start rummaging through her wardrobe. She will usually be mumbling incoherently about looking for a missing hamster or trying to find a patient.
We haven’t had hamsters for years and she’s recently retired as a GP.
After 37 years of married bliss, I have become accustomed to Clare’s sometimes bizarre night-time behaviours. She has a sleep disorder called ‘parasomnia’ which affects about 10 per cent of the population and manifests occasionally as sleepwalking and sleep talking.
It is one of many factors that contributes to Clare’s less-than-ideal sleep patterns, and as a woman, I’m afraid she’s got the odds stacked against her.
All the evidence shows that good sleep is an achievable skill. It just takes a little time and training to perfect and the right advice (stock image)
Erratic hormones and the responsibilities of motherhood mean that women’s sleep is so much more likely to be fragmented and lower in quality than men’s. Research shows that women are 40 per cent more likely than men to be diagnosed with insomnia.
The sleep-disrupting effects of female hormones start in puberty and extend through pregnancy (studies show more than half of pregnant women experience insomnia) and beyond.
As anyone who has had children will know, you spend the first few months of parenthood wandering around like a zombie for much of the night.
A recent study by Warwick University found it takes new parents at least six years to get back to sleeping as well as they did before having children.
I know the impact affects both parents, but mums tend to bear the brunt. The Warwick study showed women tend to lose an average of one hour’s sleep a night for the first three months after giving birth, while dads are snoozing again after just 15 minutes’ break in their sleep.
Things do slowly get better as the children grow up, but as Clare frequently pointed out to me, her brain was often far more highly tuned to listening out for our children’s cries than mine. And once a pattern of hypervigilance forms, it can be very difficult to shake off.
Unfortunately, studies show that both men and women tend to sleep less (and get lower-quality sleep) as they get older. But women have the extra burden of having to cope with the hormonal upheavals of midlife which often herald a period of infuriating insomnia.
Like 60 per cent of women going through the menopause Clare struggled with sleep. Hot flushes are very common and Clare used to spend the night first burrowing under the duvet, then throwing it off as she overheated.
At least the hot flushes were eventually sorted out by taking HRT and her sleep improved. Sadly, there’s no cure for parasomnia, just tolerance. I have learned the best thing is to humour Clare and after a while she gets back into bed and falls asleep.
Interestingly, women are twice as likely as men to develop a condition called ‘restless leg syndrome’, which can cause involuntary jerking of the legs and arms and is more common in midlife.
A recent study by Warwick University found it takes new parents at least six years to get back to sleeping as well as they did before having children (stock image)
They are also more likely to experience heartburn and acid reflux, both of which can worsen the quality of your sleep.
Although men are usually the loudest snorers, after the menopause, women often rapidly catch up.
One reason is that as oestrogen levels drop, women are more likely to gain weight, and a thickening neck can put pressure on the breathing tubes, causing snoring and often sleep apnoea (where you actually stop breathing at intervals through the night). An awful lot of people with sleep apnoea go untreated because they think it is just snoring and that snoring is harmless. It is not.
The actress Carrie Fisher, famous as Princess Leia in Star Wars, died from a heart attack at the age of 60 while on a plane. The coroner said that the main contributory factors were untreated sleep apnoea and a build-up of fatty tissue on the walls of her arteries.
Losing weight can certainly help because it helps shrink the fat deposits in the lining of the throat (just a 10 per cent loss in weight has been shown to have a beneficial impact), so relieving pressure on your breathing tube.
EAT MORE OF CERTAIN FOODS — NOT LESS
The science shows that for women in particular, making a few dietary tweaks really can have a big impact on weight gain as well as quality of sleep.
Emerging research in Australia shows that a woman’s need for protein rises after the menopause. As we age, we become less efficient at absorbing and using protein anyway, but the fall in oestrogen leads to increased breakdown of protein that is stored as tissue in the body.
We need protein not only to build muscle and healthy bones, but also for many of the basic functions of the body. That’s why, if you are not getting enough protein in your diet, you are likely to start feeling unaccountably hungry.
The Australian researchers believe we have a specific appetite for protein and when the protein content of the food we eat is too low, we are compelled to go on eating until that protein need is met.
This helps explain why it’s so easy for some of us to polish off a big bag of crisps or a packet of biscuits in one sitting, eating in a way that triggers weight gain and often also fractures sleep.
Although men are usually the loudest snorers, after the menopause, women often rapidly catch up (stock image)
Studies have shown that when we eat more protein-rich foods, such as eggs, meat, fish, beans or tofu, we experience less hunger and fewer cravings, which makes it easier to stabilise our weight and stop those late-night binges that can disrupt sleep.
By increasing your consumption of protein, only by a small amount, you could be improving your chances of getting a good night’s sleep. Clare and I try to make sure we have protein in every meal and we aim to reach a daily target of 1-1.5g of protein per kg of body weight per day.
As well as that we are big fans of a Mediterranean diet, which not only means consuming more olive oil, nuts, oily fish and veg, but shunning, where possible, factory made cakes and biscuits.
Clare shows you on her Instagram account (@drclarebailey) how simple it is to make tasty treats as well as savoury dishes designed to help you sleep better.
I am very convinced by studies which show eating a diet rich in saturated fats, carbohydrates and sugar leads to lighter, disrupted sleep but that by tucking into meals rich in protein and fibre, you get to sleep faster and spend more time in deep sleep.
GO TO BED LATER NOT EARLIER
Anyone who has suffered from insomnia, as I have, will be familiar with the pattern of long nights of fitful, broken sleep, forever feeling wiped out, longing to go to bed, but unable to sleep when you get there.
The trouble is that the more time you spend in bed, the more time you spend lying awake, ruminating and worrying about how tired you’re going to feel the next day.
After a while, spending more time in bed is no longer restful but very stressful and this can set up a really bad pattern of behaviours which puts your brain in wide-awake stress mode whenever your head hits the pillow.
Sleep specialists have long known that one of the most effective ways to break this vicious cycle is to spend less time in bed. It’s called Sleep Restriction Therapy (or sometimes Bedtime Restriction Therapy) and it can be a powerful tool to help people break their insomnia.
MICHAEL MOSLEY: The more time you spend in bed, the more time you spend lying awake, ruminating and worrying about how tired you’re going to feel the next day (stock image)
The principles are simple: by reducing the amount of time you spend in bed you intensify your urge to sleep so that when your head does hit the pillow, you drop off quickly into a deep and restorative sleep. After a while, your brain re-learns to associate being in bed with being asleep, rather than with ruminating and worrying.
This process re-programmes your body and brain so you naturally fall asleep when you get into bed.
It’s not easy, but it is powerfully effective. Even the most stubborn cases of insomnia can be shifted. As you go through my four-week plan, I’ll show you how.
FOUR WEEKS TO BETTER SLEEP: WEEK ONE
Although men and women might face different sleep problems at a various stages of their lives, the effective solutions are the same.
The key is to slowly introduce lifestyle adjustments that build over time to create a strong ‘sleep muscle’ which will see you sleeping through the night, each and every night.
Here’s how to retrain your sleep muscle in just four weeks.
START KEEPING A SLEEP JOURNAL
In preparation for good sleep, spend a few days filling out a detailed sleep journal before you start on this plan.
As well as recording how long you sleep, ask yourself key questions such as: Did you find it hard to fall asleep? Did you wake in the night and for how long? How tired did you feel in the day (rated 1-5)? (You can download a sleep diary template at fast-asleep.com).
Your bedroom should be a sanctuary of calm and comfort. Make sure your bed is comfortable with a fluffy duvet and soft pillows, clean sheets and all clutter cleared away (stock image)
Recording your answers will help identify the possible patterns and factors which might be affecting your sleep, and as the plan progresses, your diary will show clear evidence of improvement.
After a few days of logging the time you go to bed and wake up and how much time you actually spend asleep, you will be able to calculate your ‘sleep efficiency’ — this is a measure of the amount of time you spend in bed actually sleeping each night (in minutes), divided by the amount of time you spend in bed (again, in minutes).
For example, if you went to bed at 11pm and got up at 7am, but you lay awake for two hours during the night you might have been in bed for eight hours, but you only slept for six.
This gives you a sleep efficiency score of 360/480 = 75 per cent (0.75).
A 100 per cent sleep efficiency score would be unrealistic because most people take time to drift off and many of us wake up a little during the night. Once you reach the age of 60, a sleep efficiency of 80 per cent is a perfectly acceptable goal.
DE-CLUTTER FOR A CALM SANCTUARY
For great sleep your bedroom should be a sanctuary of calm and comfort. Remove the TV and any computers (electronic devices excite the brain just at the point where you need everything to be calm and relaxed).
Make sure your bed is comfortable with a fluffy duvet and soft pillows, clean sheets and all clutter cleared away. Check that the room is cool, dark and quiet throughout the night too. You might want to invest in decent curtains or blackout blinds, particularly if you are a shift worker, though a sleep mask will be cheaper.
If you are a sensitive sleeper (or your partner snores) earplugs are definitely worth a try.
SET YOURSELF A REGULAR BEDTIME
If you struggle at all with your sleep, even if it is only occasionally, the best way to ring-fence good sleep, night after night, is by setting a regular bedtime and creating a sleep-inducing wind-down routine. You also need to set a morning wake-up time that you can stick to seven days a week.
If you are prone to waking up multiple times during the night, try — for this first week of the plan — going to bed an hour later than normal, but make sure you stick to the same alarm call each morning, weekends included.
This mild time restriction may be enough to concentrate your sleep ‘muscle’, allowing you to slumber more deeply with fewer interruptions.
SPEND FEWER HOURS IN BED
A proper plan of sleep restriction could be powerfully effective if you have insomnia, or if your sleep diary reveals you have a sleep efficiency of 75 per cent or less. This means temporarily restricting the time you spend in bed to the exact amount of time you typically sleep each night.
If you have set your alarm for 7am and your sleep diary shows you typically sleep for six hours in various chunks during the night, count back six hours from 7am. This might mean not going to bed until 1am.
If you struggle at all with your sleep, the best way to ring-fence good sleep, night after night, is by setting a regular bedtime and creating a sleep-inducing wind-down routine (stock image)
This might sound brutal and even counter-intuitive, and yes, for the first week or so you are likely to feel sleepy during the day and a bit more irritable, but stick with it!
You need to feel really tired for the plan to work. This exercise is the best way to teach your body and brain to concentrate sleep as efficiently as possible in the shortened sleep window that you are providing.
No matter how hard it seems for the first few days, you shouldn’t lie down, nap or snooze during the day, and you must get up with your morning alarm at the same time every morning — no matter how tired you feel.
Remember, you are only doing this for a short time and it is certainly not suitable for everyone. To find out how to do this safely, do check out my book.
SWITCH TO A HEALTHY MEDITERRANEAN DIET
Start shifting your diet towards a more Mediterranean way of eating. It’s all about reducing your intake of sugar and chemical additives (which can impair sleep quality) and boosting your intake of fibre-rich foods that feed the trillions of ‘good’ bacteria living in your gut. These in turn produce chemical compounds to help you sleep.
By avoiding sugar and junk food you can starve out ‘bad’ bacteria, and by filling your plate with delicious vegetables, pulses and wholegrains you can create the best possible environment for ‘good’ bacteria to thrive.
Scientists studying the beneficial impact of the Mediterranean diet have discovered your health gains increase the more Mediterranean factors you add to your list (so increasing your ‘M score’).
So this week, aim to reduce the amount of processed food you buy and increase the range and variety of fruit and vegetables in your shopping trolley.
Switch to using olive oil, upgrade to wholegrains (brown rice, wholegrain pasta, seeded wholegrain bread) and snack on nuts not crisps. Ensure you incorporate protein into every meal, aiming for at least 1g of protein per kg of body weight every day.
Making these changes gradually will allow your taste buds and the populations of bacteria in your gut to adjust (if you overpower your gut microbiome too soon you might notice trapped wind and uncomfortable bloating).
CREATE A RELAXING BATHTIME ROUTINE
A nightLY bathtime ritual can help prime your body and brain for sleep.
For the best results, run a pampering warm bath an hour before bedtime with a few drops of lavender essential oil (vanilla, rose and bergamot oils can be effective, too). Soak yourself for at least ten minutes. The warm water raises your body temperature, increasing the circulation of blood to your skin, hands and feet.
When you get out of the bath your body will continue to radiate heat, but your core temperature will slowly drop over the course of an hour. This slow drop in temperature helps trigger changes in the brain which induce sleep. Play relaxing music as you soak. Studies show slow classical, jazz or calm folk music (ideally with a rhythm of 60-80 beats per minute) could help you fall asleep faster, sleep longer and wake up less during the night.
KEEPING A JOURNAL WILL HELP SEND YOU TO SLEEP
Keep a notebook by your bed and, before switching off the light each night, jot down a list of everything you need to do the next day.
One U.S. study found spending five minutes writing about the day ahead gets you asleep nine minutes quicker — which is a similar impact to taking a sleeping pill.
Keeping a journal also appears to reduce the tendency to wake up in the night.
You can also try writing down three good things that happened to you that day. Expressing gratitude is a proven way to reduce stress, which is one of the main causes of insomnia.
DID YOU KNOW
A two-week study of American women found that an hour of extra sleep increased the chance that they would want to have sex the following night by 14 per cent.
