Less is more: dealing with sleep problems

Sleep problems

Well, are you rested and refreshed after a good night’s sleep?

Are you one of those lucky people who can go to bed in the evening, snuggle down and drop off as your head hits the pillow? Or are you rather the sort of person who lies awake for a long time, has difficulty falling asleep and then, when you finally drop off, wake up again a bit later and can’t get back to sleep? In this situation, your early-morning alarm clock seems like a liberator, even if you feel absolutely whacked as you stagger out of bed.
People like this often have an entire arsenal of methods and rituals they use in an attempt to eliminate their sleep problems. They start with excessive exercise (“I need to tire myself out”) or taking things easy (“I mustn't get worked up and will go to bed early because I’m so tired”) up to all sorts of meditation and relaxation techniques, sleep- or calm-inducing teas, allegedly sleep-promoting diets, mental time travel and countless experiments with medication. It is then extremely frustrating when, despite everything, you still can’t sleep. On the contrary, that’s when the feelings of guilt arise, and you feel inadequate, sad, angry and anxious that it just isn’t working. These feelings trigger a whole series of physical reactions such as tension, nervousness, trembling and palpitations, all of which act to prevent you from relaxing and falling asleep. As a result, insomniacs frequently lie awake in bed for a long time. They believe that this gives the body, if not sleep, then at least a little rest, and lie there for hours – with consequences. Does this sound familiar?

Brooding as a consequence of disordered sleep

Day and night, your brain never stops working. When you lie awake for hours, your brain uses the time for all sorts of thoughts about long-forgotten incidents or for solving future problems. Everything looks worse at night, and it’s easy to start brooding, or for your thoughts to start running in circles. Actually, that is entirely normal, as the brain is inundated with melatonin, which the body produces but which has a depressive effect on your mood, so you more brood more. But melatonin also makes us tired, meaning it is easier to fall asleep. This is important, as we wake up several times every night. We do not spend the night in a coma. The ability to wake up is necessary for human life. It prevents pressure points from developing on the limbs we are lying on, because we change our positions. It makes sure we take care of the hungry baby when it screams. We can also wake up very fast indeed when we are in danger. This is a skilled gambit on the part of evolution: we have developed the ability to wake up at night without immediately being in high spirits. We merely check to see that everything is OK, then we sleep some more. However, if a sleep disorder has set in and the wakeful phases are longer, you will notice that you get gloomy in the evenings, with a tendency to brood. In general, brooding is a consequence of disordered sleep, not the cause.

General advice falls short

Sleep disorders arise for many reasons and every person with sleep problems is unique. That’s why it’s worth taking a close look at the causes, exploring them and devising personalised solutions. Sleeping badly every now and then is normal. In such cases, relaxation exercises, family conversations or simple sleep-hygiene measures often help. However, if you don’t fall asleep, or don’t sleep through the night, several times per week, over several weeks, your performance or daytime wellbeing suffers, and you start to worry, we then talk about sleep disorders (sometimes called insomnia). Alarm bells should also ring when sleep, despite being sufficient in terms of quantity, is not experienced as refreshing, and daytime tiredness/sleepiness occurs, with unwanted nodding off in front of the television or in conversations, in monotonous situations or even when driving. An organic sleep disorder could be the cause here. Organic causes include snoring with apnoea (when the breathing stops and starts again) or unusual movements before or during sleep.
Following the advice that you can find everywhere often isn’t enough, and it is important to have the symptoms treated by a specialist. For example, sleep medicine distinguishes between calm and restless sleepers, and sleepiness or tiredness during the day, or whether you suffer from insomnia or from poor sleep. The patient’s lifestyle (too demanding or not demanding enough) and what stresses are present are also examined. A number of mental illnesses, such as depression and anxiety, are also associated with sleep disorders. It is important that they are diagnosed and treated separately. Vicious circles are common: you’re afraid to go to bed, you agonise at night when you can’t sleep, you get tense, which really hinders sleep, as well as building up unrealistic expectations about yourself and your own sleep behaviours. If all possible causes have been explored, measures to remedy them can be developed. Frequently, a number of measures need to be combined in order to achieve a noticeable improvement.

Internal and external drivers

Expectations accompany us throughout our entire lives, but external expectations are frequently easier to identify. Your company expects good figures and projects must be completed with good outcomes. You do your best to meet these expectations. These things are called external drivers. If management has been happy with your results for a long time, but you still can’t relax, this is often because your internal expectations are active. These are called internal drivers and they are always whispering to us, for example: “be perfect”, “you can’t make mistakes”, “always be popular” or “don’t disappoint anyone”. These internal drivers can be so active that the person concerned never stops, personally or professionally, even when retired. This often facilitates brooding in the small hours too. Treatments mostly deal with the expectations that we have of ourselves but also of sleep, because excessive expectations of sleep and our own sleep behaviours are what prevent a relaxing sleep. Excessive expectations of sleep include: “I must always get to sleep before midnight”, “I need to sleep through every night like a log” or “I have to sleep for 8 hours every night”. It’s worth identifying these and other expectations and scrutinising them to establish whether they help you to fall asleep and sleep restfully through the night.

These statements should make it very clear that sleep disorders frequently cannot simply be remedied by following a few pieces of advice, but that a differentiated approach and treatment is necessary. If you also suffer from sleep problems, you are not alone, because approximately a quarter of the Swiss population have personal experience of sleep problems, and every tenth person in Switzerland suffers from a sleep disorder that requires treatment. Get help early and take care of your sleep – the most important source of rest and refreshment!

This post was co-written with Dr Eva Birrer, state-registered psychotherapist and sleep doctor and member of the Swiss Society for Sleep Research, Sleep Medicine and Chronobiology and the German Sleep Society. A big thank you to the author!

Are you interested in the subject of sleep? Under our heading Sleep you can find lots more information about sleep and sleeping. The articles “Sleep well, corona!” or, in the summer, “Sleeping not sweating” might also interest you. Happy reading and see you soon!

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