Healthy Sleep : the Why, the When and the How

It is an activity which we actually spend about one-third of our whole lives engaged in, yet many of us struggle to get enough. Sleep has intrigued us since time immemorial – from the Classical poets, through to Shakespeare, then Sigmund Freud, and in current times many of the best doctors and researchers around the world. In this article, we will take a practical and evidence-based look at just why sleep is so important, especially in young people, and explore how we can all go about improving things. Quoting from the Great Bard: “To sleep, perchance to dream” ⁽¹⁾. This is great advice, even 400 years on.

We’ve known for a long time that inadequate sleep can cause tiredness, irritability and ‘mental slowness’ through the day (the medical term is ‘daytime somnolence’), and makes us prone to a range of physical illnesses. Yet, it is only in recent decades that we have discovered just why this is the case, as well as discovering a whole range of very important activities that the brain, and the body as a whole, does when we get a quality night’s sleep. Some of those key activities are ⁽²⁾:

• Cleaning-out toxins in the brain that have built-up through the day
• Recharging our immune system, which helps us fight infection
• Consolidating our memories and learning
• Allowing the body to efficiently store energy in a healthy way
• Fighting rogue body cells, which could eventually cause cancer
• Repairing damage to our body organs which may have been stressed during the day, such as our skin, muscles and guts.

As you can see, sleep is important in a wide range of important ways. I’d particularly like to draw attention to my third point above, that of consolidating memories. This is clearly very important for school students as we learn about new or complex things – both facts and concepts - daily. It is thus extremely important to get a regular good night’s sleep, to help students reach their potential. An even more amazing discovery is that during deep sleep our brain can actually work on problems or questions that have intrigued us during the day – maybe you have noticed this phenomenon yourself. I’m reminded of that well-known adage : “Maybe I’ll sleep on it” when confronted with a problem – which turns out to be quite effective ⁽³⁾.

Let’s take a quick look at what the sleep experts recommend, in terms of how much sleep we need at different ages. Many of you will have noticed that babies and infants need to sleep much more than youths and adults – in fact, they spend most of their day asleep! This is thought to be due to the point mentioned above, that in sleep, the brain consolidates and stores memories and learning. It is true that, as we get older, we need less and less sleep. In primary school, it is recommended children get at least 9-12hrs of undisturbed sleep; in early high school, we need about 9-10hrs, and in later high school 8-9hrs⁽⁴⁾. Research shows that many school students suffer from chronic sleep deprivation, sometimes at a severe level ⁽⁵⁾. We’ll now look at the most common reasons why.

Quantity of sleep, and also the effectiveness and quality of the sleep we get, can be affected by stress, such as the pressures of homework & revision; doing numerous extra-curricular activities; digital distractions such as TV viewing, smartphone use and computer gaming; anxiety or worries at night-time; and physical health problems ^(2),(6).

As a child psychiatrist, I am very aware of the impacts of mental illness on sleep quality. In addition, getting poor quality sleep alone can make mental health problems worse, and in some cases can precipitate an episode of illness ⁽⁷⁾. Some of the mental health disorders that impact on sleep include: depression, anxiety, attention-deficit disorder (ADD), bipolar disorder (manic depression), autistic disorders, obsessive compulsive disorders (OCD), eating disorders, and psychotic/ paranoid conditions ⁽⁸⁾. In fact, almost all mental health disorders have an important association with sleep. That is why I make sure it is an important part of my history-taking with clients, and in their management-plan.

Which thus brings us to the ‘digital age’ and how computers, smartphones and so on – and also televisions in bedrooms before the digital age – have affected sleep, especially in young people. Many of you will have read about the ‘blue light’ that is given off by screens, and how this can adversely impact on sleep quality, by suppressing the level of the brain hormone melatonin ⁽⁹⁾. That is why all sleep experts recommend that we do not use our screens for at least 1 hour before our sleep-time ⁽⁴⁾. Of course, it is not just the blue-light effect that could impact on our sleep – by engaging in gaming, or social-media interactions, we are exciting and stimulating our brain and mind, making it hard to ‘switch off’.

So, what are the practical steps we can all take to get a healthy night’s sleep? The great news is that around 80-90% of all sleep problems can actually be addressed by practical, ‘non-medical’ methods ⁽²⁾. Essentially no cost, no pills or tablets, or even doctor visits, how good is that?!

So, here are my ‘top tips’ for a great night’s sleep :

• Create a good routine; set a bedtime and waking-up time, both through the school week and into the weekend, as much as is practicable. The brain and the body can take up to a few weeks to fully get into the ‘habit’ of a quality, deep sleep.
• Wind-down. In the 60 minutes or so before the planned ‘lights out’ time, avoid strenuous exercise, heavy meals, caffeinated drinks, and stimulating online activities such as gaming and social-media use. Try reading a book, using a bedside-lamp, or doing a few minutes of relaxation.
• Minimise screen use before bed. Try sticking to the ‘sixty minute rule’ around screen usage before bedtime - even for senior students. If screens must be used within this time period, try dimming the screen’s brightness, or setting it to ‘night-mode’ which automatically reduces the blue light emitted. Another point to remember is that phone screens are almost always held much closer to the eye, than a laptop or tablet device; where possible try to utilise the latter types of device instead of the phone, to reduce the light getting into the eye.
• Tech-free zones. For younger students, eg. in Primary school or early High school, we recommend not having any devices at all in the bedroom. This will avoid children being distracted by automatic updates, notifications and so on, and reinforce the point that bedtime is for uninterrupted sleep and nothing else. Having a shared overnight ‘recharge area’ for all devices in the common or living area is one suggestion, and this also models good behaviour for the whole family.
• Consistent sleep routines.Try to avoid ‘catch up sleep’ at the weekends. It often does feel good to have a well-deserved sleep-in for a few hours after a busy or stressful week, but this risks stopping the mind and body achieving a stable and predictable sleep-wake cycle in the long run.

Maintenance Remember, it can take a few weeks for the mind and body to fully adjust to a new sleep timetable. So, don’t expect quick results! The key is planning ahead, preparing well, and maintaining your healthy habits.

Additional resources

There are many useful Apps, websites or video-clips available to assist with improving sleep patterns, to assist relaxation in the evenings, or to reduce stress and anxiety. Some are free and some may charge a small amount to download. Try to see which ones may work for you and for your family. Two Australian websites that I recommend, designed by specialists in the field and using evidence-based principles and research, are :

www.thesleepconnection.com.au

www.sleepshack.com.au

Finally, if your sleep issues and difficulties persist despite active efforts to improve the situation, it may be useful to discuss this with a health professional. GP’s will be very familiar with managing sleep problems in young people. They will also be able to refer you to a specialist if the problems are serious, such as a neurologist, a sleep-medicine specialist, or a psychologist. Your child’s school-counsellor or psychologist will also be very skilled in giving advice around healthy sleep.