Health – Sweet dreams can be hard to get

When we go to sleep, it feels like everything in our body is switching off, but a better explanation is that the “night shift” comes on and does lots of important things that we are unaware of. If this unconscious functionality is disrupted for any reason, the body and the mind pay a price.  

Sleep is cyclic, with light and deep phases on a roughly 90-minute rotation. During the deep sleep phase growth hormone is released, patching up tissues and regenerating muscle and bone. There are also benefits to the immune system. We have more deep sleep in the earlier part of the night and this is essential to feeling genuinely refreshed in the mornings. No wonder Shakespeare called it “nature’s soft nurse”.

It is possible to spend eight hours in bed but still feel washed out and sluggish in the mornings, usually due to lack of deep sleep cycles. 

Alternating with deep sleep is the fascinating REM (rapid eye movement) phase. During this brain activity increases, breathing becomes faster and irregular and heart rate and blood pressure increase to awake levels. Voluntary muscles are paralyzed to prevent movement during dreams. For many years we didn’t really know what function REM sleep performed, but recent evidence shows it is important for memory organisation and retention. I tell people that, while they are asleep, somebody comes in to tidy up the filing cabinets. 

As an aside, the interpretation of dreams has an ancient history, encompassing spiritual, psychological and latterly neurophysiological concepts. If you are preparing to go on The Chase, the scientific study of dreams is known as oneirology, a field which is progressing rapidly but still has many mysteries.

Sleep problems commonly present in general practice. It takes a careful analysis to figure out what is going on. Obviously external factors can be relevant, such as a snoring partner, restless children and noisy neighbours. Then insomnia as a symptom of anxiety and depression should be considered. Shift work is really hard on sleep patterns. Pain, sleep apnoea, the need to go to the toilet and hypervigilance may all disrupt deep sleep.

There is a temptation to reach straight for the prescription pad, but a healthier approach is to work on good sleep habits, exercise, pain management and avoiding disruption from screen time and stimulants. 

It’s commonly said that people need less sleep as they get older, but this is not true. It’s just that their sleep pattern changes, with shorter cycles, more waking and more impact from medical factors. Also, unhelpful habits can develop, either going to bed too late or too early, and fretting about night-time waking. 

As a profession, we are concerned about the regular use of sleeping pills, especially in the elderly. Though many people seem to come to no harm, sleep pills are addictive and there is an association with memory loss and fall risk, so if you can find a natural way to improve your sleep quality this is by far the preferred option.