Can’t sleep? Studies suggest about a quarter of Kiwis will suffer sleep issues in their lifetime. Researchers say too little sleep can increase the risk of obesity and diseases like Alzheimer’s and diabetes. Dawn Picken spoke with Rotorua residents desperately seeking shut-eye, and got expert advice for keeping The Sandman on board.

LES ROLSTON says he's had trouble sleeping since he was a kid.

He has tried over-the counter remedies and even prescription medicine, which failed.

"I can get tired at seven o'clock and go to sleep for a few hours, but if I get woken up, if I've had two or three hours' sleep, that's me. I'm up until five in the morning and don't get tired until it's time to go to bed again."

Having three children, ages 3, 8 and 9, has, at times, disrupted sleep. So did shift work, where his hours varied from midnight to 8am, then 3am to 11am.

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"I've never recovered from that side of it, and it was maybe six years ago."

He says his partner often watches TV in bed.

"I can tune out for a couple hours, but after a while, it wakes me up with a fright."

Les can't get back to sleep, so he goes to the lounge and does paperwork for his plumbing business. Rotorua Maori cultural performance director Frank Grapl says he, too, has had sleep issues since childhood.

"It goes from bad to worse, worse to bad..." Frank has tried medication, which didn't help, and background noise, which did. He says he can't shut off his brain. Or his snoring.

"Once I do get off to sleep I actually stop breathing. I don't notice until I wake up coughing. My last girlfriend said I stopped breathing for probably 30 seconds."

Frank says he plans another visit to his doctor in three weeks.

BRAIN TRAINING
Sleep expert Dr Alex Bartle heads what's branded as New Zealand's largest private sleep service, Sleep Well Clinic. Dr Bartle says the practice sees 15 to 20 patients in Tauranga each month for issues like insomnia, snoring and apnoea (a condition inwhich a person stops breathing during sleep).

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Dr Bartle says sleep is largely about belief.

"People with insomnia have lost their confidence." Dr Bartle says behavioural therapy, rather than medication or alcohol (the latter has been proven to exacerbate sleep problems), can provide a long-term solution for healthy sleep.

Sleep specialist Dr Alex Bartle recently spoke at a Rotorua convention of GPs about the incidence of insomnia. Photo/Stephen Parker
Sleep specialist Dr Alex Bartle recently spoke at a Rotorua convention of GPs about the incidence of insomnia. Photo/Stephen Parker

"As we get older, it's not the waking, it's the going back to sleep that's
the problem. One of the most destructive things is looking at the clock. Everybody
wakes. We've got to be able to turn over and go back to sleep."

Clinical psychologist Dom Vettise, who works for private sleep clinic and testing company Eden Sleep, says insomnia rarely stands alone. He says research shows 40 per
cent of insomnia patients have depression; 15 per cent have anxiety.

"They start to get really anxious when they go to bed, wondering if they'll sleep...then start to catastrophise what happens if they don't get enough sleep. It's like a self fulfilling prophesy. If they think they're not going to get much sleep, they're not going to get much sleep."

Dom says studies show a "massive rise" in insomnia at retirement age. "About a quarter of people meet the diagnostic criteria for insomnia at age 65 to 79-plus."

Even mild sleep deprivation can affect mood and metabolism, causing weight gain or loss and memory and concentration problems, according to studies. Dom says if you're awake more than 30 minutes, get out of bed.

"We don't want them thinking bed is a place of worry. It's for sleep and sex only, that's it."

He recommends doing something non-stimulating, like reading a magazine, performing relaxation and mindfulness exercises and staying in the present.

"If we're thinking too much about the past, we get upset. If we think too much about the future we tend to get anxious."

He aims through four to eight counselling sessions to teach clients techniques to become more mindful and less judgmental. "After eight sessions, therapy starts becoming ineffective. I don't want the client dependent on me. I want skills they can take away and use."

WHY YOU CAN'T SLEEP
Experts say a range of variables, from gastroesophageal reflux disease (GERD), to ageing, to alcohol consumption can disrupt sleep. So can technology.

Dr Bartle says screens backlit with blue, such as those found on computers
and smartphones, are proven sleep disruptors, creating restlessness not just for adults, but also for teenagers who take phones to bed.

"Far more important than these things, people need to spend more time outside. Outside light is the best for us. We don't do it nearly enough."

He says at a recent sleep conference, an attendee halfjoked one of the best treatments for insomnia is camping for two weeks.

"You're up at dawn, go to bed when it's dark, there's no electronic media and it all regulates normal circadian cycles."

Studies show some people with tendencies towards perfectionism, intensity and a high need for control can be predisposed to insomnia. Precipitating events such as work stress, health issues or the birth of child can also cause chronic sleeplessness.

Sleep specialist Dr Cat Chang, who works with EdenSleep, says studies show sleep time for adults in Western countries hasn't changed much the past 20 to 30 years.

"What's not clear, and what we think probably is sleep quality, may be worse, like apnoea that's not treated. We're spending the same time in bed, but might not get as much restorative sleep as we'd like."

Dr Chang says rising obesity rates at home and abroad have fuelled growth in sleep apnoea. Southern Cross Medical Care Society reports 1 to 4 per cent of the general population suffers obstructive sleep apnoea, rising to about 10 per cent in middle-aged males.

Dr Bartle says in recent years, more children-up to 3 per cent-are being diagnosed with apnoea.

Removing tonsils and adenoids can be curative. So can weight loss. "Losing weight for anybody is difficult if they have sleep apnoea. When we're tired, we struggle to do any
exercise."

He says lack of sleep alters hormones that make us hungrier. The doctor says regular incidence of snoring in children can be associated with lack of impulse control and other behaviour problems mimicking ADHD.

In the States, they've done a study and found almost a third of children who'd been treated for ADHD actually had a sleep problem. When they treated the sleep problem, they came off the medication."

PILLS, SUPPLEMENTS AND DROPS
Experts I spoke with recommend medication such as zopiclone (a hypnotic agent) for short-term use. The NZ Health Navigator website says research has shown taking sleeping tablets more than 10 nights in a row can make sleeping difficulties worse.

Dr Bartle says he prescribes melatonin (a synthetic form of a naturallyoccurring hormone that helps regulate sleep) only for jet lag in adults and in small doses for teenagers. He says other popular remedies, such as sleep drops and magnesium, are placebos.

"Thirty to 50 per cent of anything you put in your mouth for sleep is the placebo effect. Anything you put in your mouth for sleep becomes the thing you need.

So I spend most of my time talking about behavioural changes to do it yourself." Les Rolston admits downing energy drinks to keep going throughout the day and says he's gotten used to being up in the middle of the night.

"I always say sleep's overrated. You get plenty of it at the end of your lifespan."

Sleep hygiene:
- Avoid caffeine, nicotine and alcohol before bedtime.
- Avoid heavy meals within two hours of bedtime.
- Avoid energetic exercise within three hours of bedtime.
- Reduce extreme light, temperature, and noise in your bedroom
- Include an hour of quiet time before bed.
- Keep sleep hours regular-same bedtime and rise time.
-strong>- Excerpted from healthnavigator.org.nz
-Online:
- sleepwellclinic.co.nz
- edensleep.co.nz
- sleepfoundation.org
- asmnet.org