The myths and facts about sleep

Most people have trouble sleeping at one time or another. If we worry about not sleeping, the worry may actually affect us more than the lack of sleep itself. That is why there are a number of things you should know about sleep. What is normal sleep? What happens to sleep as we age? What are the best treatment options for sleep difficulties? This brochure aims to tell you what is myth or fact when it comes to sleep.

What are some of the myths about sleep?

Normal sleep is continuous

Normal sleep is not continuous; it passes through a number of 90 minute cycles throughout the night. Each cycle has different stages of sleep ranging from lighter sleep, from which you can easily wake up, to a deep sleep, from which it is much harder to wake. Each cycle also includes Rapid Eye Movement (REM) sleep, otherwise known as dreaming.

Sleep medicines have no side effects

Sleep medicines (often called sedatives, hypnotics or benzodiazepines) can cause serious side effects such as:

daytime drowsiness
dizziness, balance problems and falls
memory loss, poor concentration, confusion
abnormal behaviours during the night, for example ‘sleep walking’
incontinence.

Sleep medicines may make you feel sleepy past the time for sleep. These side effects can increase the risk of falls and, if you drive, increase the risk of motor vehicle accidents.

An alcoholic drink before bed can help me sleep

An alcoholic drink can initially help you get to sleep but may end up disturbing sleep later in the night. This is because the relaxing effect of alcohol wears off after only a few hours and then withdrawal causes you to wake. Once this happens, it may be even harder to get back to sleep. It can also make snoring worse and you may be more likely to have vivid dreams or nightmares.

Herbal medicines can help me sleep

There is not much proof that herbal sleep medicines such as valerian, chamomile or lavender can improve sleep. In addition, herbal and complementary medicines may interact with other medicines that you may take. It is always a good idea to talk to your doctor and pharmacist before starting any new medicines, even herbal ones.

As we age we need more sleep

Sleeping less is a normal part of ageing. Sleep cycles also change with age to include less deep sleep and more light sleep, and thus you may wake up more frequently during the night. The amount of sleep needed varies from person to person. Despite getting less sleep with age, generally people still have the energy to function well in their daily activities.

Average hours (hrs) of sleep as we age¹

¹Ohayon MM Carskadon MA, Guilleminault C, Vitiello MV. Sleep 2004; 27 (7): 1255–1273.

What are some of the facts about sleep?

There are many causes of sleep difficulties

Sleep difficulties or insomnia can be related to a specific event such as the death of a loved one, divorce, losing a job, moving home or ceasing driving. Worrying about not being able to sleep and its impact can also make sleeping more difficult. Other reasons for sleep difficulties include: side effects of some medicines, sleep apnoea, pain, restless legs syndrome, anxiety and depression. If you have sleep difficulties, talk to your doctor who can help you to work out what is causing the sleep difficulty and find the best treatment for you.

Sleep medicines are only for short term use

Sleep medicines can help reduce the time to fall asleep, but not by much. They increase total sleep time only by a small amount and they can make the quality of sleep worse. Thus it is best to limit the use of these medicines to occasional use only, or at most 3 to 4 days in a row at any one time.

If you are using sleep medicines frequently, talk to your doctor and ask about reducing the dose. There are many treatment options which are more successful than sleep medicines in the long term.

It is possible to stop taking sleep medicines

It is possible to stop taking sleep medicines, especially if they are stopped gradually. When sleep medicines are first stopped, some people may have worse sleep for the first few nights (this is called the ‘rebound effect’). It is important not to give up at this stage. This effect is short lived and the benefits of stopping sleep medicines are better quality sleep and avoidance of possible serious side effects.

Make an appointment to talk to your doctor if you wish to reduce the amount of sleep medicines that you use. If you have trouble stopping your sleep medicine the first time, it is important to try again, as every time you try, you are more likely to succeed.

Stopping sleep medicine needs to be done gradually. Always talk to your doctor before stopping, starting or changing any of your medicines.

Waking up in the middle of the night is normal

Because of sleep cycles, waking up in the middle of the night is quite normal and most people wake up a few times during the night. These awakenings are usually shorter than a minute. Sometimes it can feel as if you have been awake for much longer, but this is because you cannot remember the sleep you have had in between awakenings.

Medicine-free options are better in the long term

Yes this is true. A number of medicine-free treatment options have been shown to be more effective for improving sleep than sleep medicines and are more successful in the long term:

Relaxation exercises help you to physically and mentally relax, especially if you find it hard to switch off at night.
Bedtime restriction gradually reduces the time you spend in bed over time until you are only in bed while sleeping. It may help if you find you are spending more and more time in bed trying to catch up on lost sleep.
Cognitive therapy will give you information on normal sleep and helpful ways of managing sleep difficulties. It can help if you worry about not getting enough sleep and how it affects your daily activities.
Bright light therapy in the evening can help adjust your biological clock. It can help break the pattern of falling asleep early in the evening but waking up in the early hours of the morning.
Stimulus control can address negative associations between the bed, bedroom and not being able to sleep. It can be helpful if it takes you a long time to get to sleep and if you worry about waking up during the night.
Good Sleep habits such as establishing bedtime routines, avoiding caffeine, smoking and alcohol near bedtime, and avoiding napping during the day, can be helpful for anyone having difficulty sleeping.

Make an appointment to talk to your doctor if you wish to learn more about medicine-free treatment options. Your doctor may give you a sleep diary to fill out to help identify which treatment option/s is right for you. Your doctor may also refer you to a sleep clinic or a psychologist who specialises in sleep.