Eyes open till dawn

Eyes open till dawn
  • Specialists say they are seeing considerably more patients who are experiencing prolonged problems with insomnia this year - and coronavirus is to blame. But what's the key to getting a good night's sleep?

Staying awake is a voluntary act, but sleeping isn't. Our brain is in charge of our body and it decides when we can close our eyes and rest. In fact, most people realise that the more we try to force ourselves into 'sleep mode', the more our 'boss' rebels and uses a wide range of resources to keep us awake and not let us get our own way. There might be an itch somewhere... or we start thinking about what we have to do the next day... or a memory suddenly springs to mind for no apparent reason... and did we remember to lock the front door?

This struggle creates a kind of vicious circle that makes it impossible to sleep and sleep well. It is insomnia, something which the Spanish Neurology Society (Sociedad Española de Neurología) says affects between 20 and 48 per cent of the adult population at some time in their life.

This high percentage is an average over the year, but the problem is worse in summer. This is not just due to the heat. It is caused more by the lack of social routines (work, school etc.), afternoon siestas that last longer than recommended, alcohol consumption and raised noise levels at night in cities, towns and villages.

This year, however, the problem seems worse than ever. These difficulties may be normal every summer, but 2020 is breaking all records. Specialists say they are seeing considerably more patients who are experiencing prolonged problems with sleeping this year.

Once again, coronavirus is to blame. During the lockdown, it was one of the pillars of health which was worst affected, together with diet and exercise, and now "the uncertainty has not gone away", says Javier Puertas, vice-president of the Spanish Sleep Society and a specialist in the sleep unit at the Alzira hospital in Valencia.

"Many people are suffering a type of post-traumatic stress because of their own experiences, such as family or financial problems," he adds.

Children are also being more affected by sleep disorders. Gonzalo Pin, a specialist pediatrician at the Quirón Hospital in Valencia, quotes a survey carried out recently among around 13,000 families.

Worse this year

"Before coronavirus about three per cent of children were affected by nightmares or other disorders which affected the quality of their sleep, but now the figure has risen to 13 per cent," he says.

"There is a problem with stress which can't be overcome so quickly. Fear and insecurity are still having an effect."

With this scenario, there will be more people suffering from insomnia than ever this summer and it means those of us who are affected will have to make more effort than just putting a fan on to keep the bedroom cool (although that helps, too).

We need ways of helping our brains to disconnect from everything that could stop them resting. Some habits have a direct effect, but there are others which affect us indirectly without us realising. For example, it is surprising how the amount of time we are exposed to natural light during the day affects how we sleep later on, when there is none.

A lack of sleep over a long period increases the risk of becoming overweight or obese, suffering from hypertension and other illnesses such as cardiac problems, as well as affecting our wellbeing in general.

Now is the time to work on keeping insomnia at bay and here, six specialists from the Spanish Sleep Society (Sociedad Española del Sueño) tell us what they do in order to have sweet dreams instead of lying awake, tossing and turning.

“A warm shower, not a cold one, before going to bed”

Lung specialist at the Ramón y Cajal hospital in Madrid Dr Irene Cano admits that she feels satisfied that she always sleeps well, and says it is because “I don’t take my worries to bed with me”.

She does, however, say that her patients tend to have two habits which make them sleep badly, although they think they are doing the right thing. The first is taking a cold shower.

The aim before going to bed should be to lower your body temperature but also the room temperature (which should be 18ºC), and as well as ventilating the bedroom. A shower can help, “But not a cold one; the water must be warm. If it’s cold, the body overreacts by raising your temperature and the result is worse,” she says.

She also advises against physical exercise at night. “Don’t go for a run or to the gym or even take a walk after the sun goes down,” she warns.

“I cycle to work and in the evening we use warm lighting"

What you do during the morning has a major effect on what happens at night. Gonzalo Pin from the Sleep Unit of the Quirón hospital in Valencia takes physical exercise during the day and is careful about lighting. Light regulates the production of melatonin, and that directly affects sleep.

Dr Pin chooses to cycle to work every day, and that gives him the exercise he needs and enough natural light for his body to regulate itself. “At home, in the evening, we use warm lighting, the type that reminds you of bonfires at night and sunsets,” he says.

It may seem obvious, but it is also best to avoid looking at computer and other screens with their white light, because they reactivate the brain again.

He also has some advice about children. “They need a moment of affection, a cuddle, before going to bed, so they feel secure when they fall asleep,” he says.

“I meditate in silence at sunset”

Juan Antonio Madrid, Professor of Physiology at the University of Murcia, keeps to a strict timetable and uses physical exercise to maintain the quality of his sleep. He doesn’t have an alarm clock and sleeps with the blinds open, so the daylight wakes him up. He says these two factors, natural light and physical exercise, are essential and, due to his profession, he has developed ways of measuring them and using them to help him sleep well.

However, he has another helpful tip: he meditates in silence at sunset on the terrace of his home. “At first it was a bit of an effort, but now I look forward to it,” he says. He just needs a little silence in order to breathe and relax. “It helps to relativise everything that is happening and puts it in context. In that moment you disconnect and unload the emotions of the day," he explains.

“Reading in bed works for me"

Javier Puertas, vice-president of the SES Sleep Unit at the Alzira hospital, believes everyone needs to know themselves well to find out what helps them to disconnect from the rest of the day.

Temperature, ventilation, the importance of eating two or three hours before going to bed and avoiding fatty foods and alcohol late at night are important. However, entertainment is also a factor. He says it should be something light and enjoyable. If it is the TV, the emotional load from the film or series should not play on your mind during the night.

He says he likes to read in bed, but never anything to do with his work. Music helps him, too. “Everything that gives you a feeling of wellbeing and helps you to unwind is beneficial,” he says.

Finally, he advises spending as little time as possible in bed, to prevent nervousness about whether or not you are going to be able to sleep.

“I keep the bedroom tidy.”

Milagros Merino from the Neurological Sleep Disorders unit at La Paz children’s hospital in Madrid explains that the brain is a very sensitive organ and it is activated by numerous stimulants.

Have you heard of visual noise? It refers to an excess of objects in the bedroom, especially if they are untidy, because they alter the sensation of stability and wellbeing. “Order relaxes and brings wellbeing,” says Dr Merino.

She also recommends good, dark curtains to block out the light pollution which is so common in towns and cities, and says sheets and pyjamas should be pure cotton to help keep cool and avoid perspiration.

All this aims to provide a calm and comfortable environment.

She also says we should never start an important conversation which could end up with an argument, and warns against becoming obsessed with sleeping for eight hours. “Everyone needs different amounts of sleep,” she says.

“I don’t get angry when I can’t sleep"

For many people with insomnia, just going to bed makes them anxious. With this disorder, there is a vicious circle where people stress about not being able to sleep, which then makes sleep impossible. “It happens to me too sometimes, there are days when I can’t sleep but I don’t worry about it. If you get angry, it’s worse. You have to just accept it and, of course, keep to your normal routine,” says Dr Francesca Cañellas from the Son Espases university hospital in Palma de Mallorca.

By that, she means going to bed at the usual time even if you haven’t slept a wink the night before. “It’s tempting to get up late during holidays if you’re tired,” she admits, but says it is actually counterproductive in the days afterwards.

“I always give myself a time limit and stick to it,” she says.

Finally, she says people should be aware that drinking alcohol makes your sleep quality worse.