The most common question I used to get from my
patients – bar none - was, "why can’t I sleep?"
Everyone knows that they need a good night’s
sleep, but how do you get a good night’s sleep?
Today I will teach you about the stages of
sleep, what “good sleep” is and how to get it!
Hey guys, my name is Sam
and I am a medical doctor based in New Zealand.
So let’s talk about sleep stages.
There are two types of sleep:
rapid eye movement sleep and quiet sleep.
Which is called non rapid eye movement sleep.
Each night you cycle through 4-5 periods of quiet sleep,
alternating with 4-5 periods of REM sleep.
This all happens over about 7-8 hours.
When you jump into bed, Non-REM sleep happens
first and there are 4 distinct stages that have
been shown with electroencephalograms or EEGs,
which measure brain activity.
In stage 1, the sleep is light and you can be
very easily woken up just by flicking on a light switch.
There is a slow-down in brain activity
and as your muscles relax, you may feel a falling sensation,
or have sudden muscle jerks.
This stage lasts for around 10 minutes,
but it can last much longer if you have difficulty falling asleep.
By stage 2 – you drop into a more stable sleep and
this is often considered the beginning of proper sleep.
Your heart rate and breathing slow down,
your temperature drops and you start to become
unaware of your surroundings.
Sleep spindles show up on an EEG which is thought to be when
the brain is blocking out harmless distractions.
This stage will last for around 10 to 20 minutes,
but over an entire night half of your sleep time will be in stage 2.
Let the good times roll with stage 3 and 4.
These are the deepest stages of sleep, known as slow wave sleep
or deep sleep.
Your breathing and heart rate slow down,
your eyes are still, your blood pressure drops
and muscles relax.
If someone tried to wake you up now,
you would not be happy with them
and you would feel groggy and disoriented.
It’s stage 3 & 4 where some children sleepwalk,
have night terrors or wet the bed.
Deep sleep lasts for about an hour.
This stage has been associated with tissue regeneration
and the brain releases
human growth hormone which helps tissue growth.
After this you cycle back up through the stages
to REM sleep, or rapid-eye movement sleep.
This begins about 90 minutes after you first fall
asleep and repeats every 90 minutes.
Your limbs are paralyzed but your eyes dart back
and forth behind closed eyelids.
Your blood pressure increases, and your heart rate
and breathing speed up to daytime levels.
There is also intense brain activity,
where you are dreaming and consolidating
new information from the day.
REM sleep is also very important for your memory.
Now there is a term called "Sleep Architecture",
which is how much time we spend in each sleep stage.
This changes over our life time.
Most healthy adults need about 7 to 9 hours of sleep
each night (although some people need much less than this).
About 2 to 5% should be spent in stage 1,
45 to 55% in stage 2,
5 to 25% in stages 3&4
and 20 to 25% in REM sleep.
Newborns spend about half their time in REM,
while in young children deep sleep is longer.
In the elderly, deep sleep reduces and sleep is more easily disturbed.
But the elderly still need their 7- 9 hours each night.
They just tend to go to sleep earlier and get
up earlier than they did when they were younger.
Today, it’s harder than ever to get
good sleep with electronic devices and the constant
noise in our lives.
But what is a good sleep?
How is this defined?
Sleeping more time while in bed.
At least 85 percent of the total time you are in bed, you are asleep.
Falling asleep in 30 minutes or less.
Waking up no more than once per night; and
Being awake for 20 minutes or less
after initially falling asleep.
So Dr Sam, how can you get a good sleep?
Isn’t this the million dollar question!
The first thing I say to my patients
when they are having problems sleeping is:
"Why do you think you can’t sleep?"
I know it seems like a silly question,
but I want to know do they have pain,
nausea, medicine side effects, restless legs, brain can’t switch off,
they’re worried, feeling depressed, sleep apnea
...the list is endless!
Then if they tell me what they think is causing it,
I work on trying to help them fix that cause.
If they don’t know why they can’t sleep,
I give my school ma'm advice.
Thankfully, 30% of people who have insomnia,
for reasons unknown, will improve with these simple tips.
1. Limit caffeine, which is in tea, coffee,
some soft drinks and energy drinks to one cup in the morning.
Caffeine is a stimulant and may cause poor sleep.
2. Avoid alcohol before bed.
Alcohol prevents us from entering the deeper stages of sleep
at night and actually causes broken sleep
with early morning waking.
3. Avoid cigarettes and vaping at night.
Nicotine is a stimulant so it will keep you up.
4. Avoid napping during the day.
The longer you have stayed awake for during the day,
the deeper your sleep will be at night.
5. Regular daily daytime exercise can help improve sleep,
but avoid strenuous exercise 4 hours before going to bed.
6. Try to relax and wind down
with a routine before going to bed –
meaning have a bath, read a magazine
or light book, listen to some calming music.
7. Avoid heavy meals just before bed,
but sometimes a light snack
may be helpful or a warm drink.
8. Sort out your bedroom environment
with a Goldilocks approach.
It should be a tranquil, dark place that is not too hot, cold, noisy,
or smelly and your bed should be comfortable for you.
9. Devices. 90% of us use an electronic device
of some sort an hour before going to bed.
Devices are physiologically and psychologically
stimulating, so will adversely affect our sleep.
They suppress the release of melatonin and make it
more difficult for you to fall asleep.
So, when it comes to devices and sleep I am ruthless.
Stop using them an hour before bed,
and keep them out of your bedroom,
or at the very least switch them off.
I personally don’t have a screen in my bedroom for that reason.
10. Hide your alarm clock.
Lots of people feel that waking up at night is not normal
and then worry about getting back to sleep.
Actually, it’s completely normal to wake up every 2 hours or so
for short periods, which if it’s less than 2 minutes –
you won’t remember.
When you wake up, you may clock-watch
which will then make you feel either irritated or anxious.
So either, hide your alarm clock or switch off your phone.
11. If you can’t fall asleep after 20-30 minutes,
then get up.
If you can, go into another room
and do something else such as reading and then go back to bed
when you feel sleepy again.
You can repeat this as much as you like.
12. Make sure you switch the light out
as soon as your get into bed.
Your bedroom should only be used for 2 things:
sleep and sex.
13. Finally, always get up from bed around the
same time each day, even on weekends.
Avoid the 'sleep-in' as this will upset your circadian rhythm.
It’s all about establishing good routines.
These tips are my go-to’s when it comes to insomnia.
If you have tried all of these things and
still suffer from either acute or chronic insomnia,
my next recommendation would be to consider
cognitive behavioural therapy treatments,
which are talking therapies.
CBT has been found to be as effective as prescription medications
for short-term treatment of chronic insomnia.
I’ve spoken on my other videos before
about medications like benzodiazepines.
They can be prescribed for insomnia,
but I would encourage you to stay away from them
outside of very short term use.
In my personal opinion, I think they are
very addictive, harmful medicines that should not be used regularly.
Please talk to your own doctor though,
if you are feeling overwhelmed with sleeping problems.
Your doctor should be able to tailor a specific plan to help you.
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found it helpful.
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I’d love to hear your tips on how
you get a good night’s sleep,
so hit me up in the comments.
Thanks so much for watching
and I look forward to seeing you again soon :)