Improve your sleep: Professor Robert Thomas offers tips for getting more shut eye

Ideally, as adults, we should be aiming for about seven hours of sleep a night yet a third of the UK get less than six hours and a colossal 10 million people are looking for help every year from their GP's or turn to over the counter remedies.

Although it's completely normal to have the odd sleepless night, persistent insomniacs suffer chronic fatigue and reduced brain function. In the short term this can lead to relationship and work issues, demotivation to exercise and undertake healthy living programmes. In the longer term, it increases the risk of dementia, obesity, high blood pressure, cancer and heart disease.

Multiple physical, environmental and psychological factors conspire to disrupt regular sleep patterns but before resorting to sleeping tablets here are some practical strategies which can help.

Address physical symptoms

Pain, hot flushes, restless legs, getting up at night to pass water, joint stiffness and arthritis, chronic cough and indigestion all can keep us awake. You may be able to get help from the GP for these disruptive symptoms. You may be able to talk to your GP and change your regular medications which could affect sleep such as steroids, statins, glucosamine, beta blockers for the treatment of blood pressure.

Identify and treat sleep apnoea

The National Sleep Foundation reported that sleep apnoea likely affects as much as 20% of the population and that around 85% of individuals with sleep apnoea don't know they have it. It occurs when the upper airway becomes blocked many times while you sleep, reducing or completely stopping airflow. If you have symptoms including loud snoring and waking up gasping for air it would be sensible to ask your GP for a referral to a sleep apnoea clinic.

Adopt sensible sleep hygiene habits

Adopt a good sleep routine such as getting to bed at a regular time and avoiding stimulating films or electronic gadgets late in the evening. Although it may be difficult to avoid noisy neighbours or traffic earplugs could help. Investing in a comfortable bed and black out curtains can reap enormous benefits.

Get light right

Increase bright (blue) light exposure during the day and avoid in the evening: One of the best ways to set your circadian clock is to be exposed to bright light, ideally sunlight, during the day by keeping curtains open and facing a window as much as possible. Conversely, it's just as important to avoiding blue light and increase red and yellow wavelengths in the evenings with dimmer switches or by turning on fewer lights. Once you go to bed, sleep in a completely dark room, cover up any LED lights on or other gadgets. If you need to use the loo at night, either learn to navigate in the dark or use as little light as possible. A good bio-hack is to wear amber-tinted glasses for the last 2-3 hours of your day.

Increase morning exercise

Insomniacs given moderate to strenuous exercise programs had better sleep duration and quality. Exercise helps regulate the circadian rhythm, but for the best effect, for most people, it is better to exercise in the morning, outside in the sunlight (even if cloudy), rather than very late in the evening.

Manage stress

Turning over stressful scenarios prevents us getting off the sleep and having a low mood or being depressed will wake us up in the early hours fixated on negative thoughts. It is clearly not always easy to reduce stress, but measures you can take include making changes to the structure of your work and social life, making time for regular exercise, taking up meditation or yoga, or simply making time for relaxing activities such as listening to music or taking a bath.

Avoid certain foods

Steer clear of heavy, fatty or fried dishes and carbonated drinks late in the evening, which can trigger indigestion and heartburn. Obviously, omit coffee or caffeinated drinks, preferably from mid-afternoon. Chocolate has a little caffeine but also contains other stimulants such as theobromine.

Processed sugar in the evening is particularly bad for sleep as studies have shown it causes peaks and troughs in blood sugar levels. Processed sugar is also bad for gut health. Prevent spikes in blood sugar levels by avoiding high glycaemic foods and instead concentrating on complex carbohydrates and healthy fats, both of which will help you avoid hunger pangs overnight.

Improve gut health

Bloating and wind can make you feel uncomfortable at night. On top of this, there is now convincing data to show that that poor gut health can lead to sleep disorders, via a gut brain pathway. It is really important, for general and sleep health, to adopt lifestyle and dietary strategies to improve gut health, throughout the day.

As well as quitting smoking, lowering alcohol and proceeded sugar intake this includes eating healthy pro-bacteria bacteria rich foods such as kimchi, kefir and sauerkraut and well as pre-biotics in beans, mushrooms, herbs and vegetables.

Weighted blankets

One are one of the most popular sleep hacks on social media, they are supposed to work using a technique called 'pressure therapy' that relaxes the nervous system by mimicking being held or hugged. There are no reputable scientific studies to back up these claims for most healthy adults, but is evidence for a benefit in children with anxiety, depressive and bipolar disorders, or attention deficit hyperactivity disorders (ADHD).

Melatonin-Enhancing Foods

Melatonin is made from serotonin, tryptophan and natural precursor chemicals in plants known as phytomelatonins. Morello cherries, pomegranates, and other citrus fruits and seafoods are rich in both phytomelatonins and tryptophan.

Over the counter sleep remedies

There are an increasing choice of pills and tinctures which claim to work but most have limited evidence of benefit or, like sleeping tablets, they are contraindicated for long term use. Here is a summary of the pros and cons of the types which could help:

VitaminD: There is growing evidence that vitamin D deficiency is linked to sleep disorders in children and adults. Well conducted, albeit early, studies are beginning to show that vitamin D supplementation can improve sleep patterns. The best supplements for sleep would combine the vitamin D with a prebiotic and probiotic which enchases absorption and utilisation.

Probiotic supplements: Boosting the diet with capsules containing healthy lactobacillus bacteria has been shown to improve self-reported sleep patterns in a number of studies. It is not clear that these benefits were seen, only in people with poor gut health or they helped everyone. If considering a probiotic, studies have shown that blends combining a prebiotic and vitamin D enhance the growth of the healthy lactobacillus strains.

Magnesium supplements: One of the most popular OTC sleeping aids, studies show however, that magnesium only helps sleep if a person has deficient levels but not if their magnesium levels are normal, in the first place. It would be a good idea to incorporate more magnesium, and other essential minerals in the diet with foods such as pumpkin and chia seeds, nuts, beans and shell fish. If you are someone who does not eat these foods regularly, a multiple mineral supplement would be sensible rather than just a magnesium supplement alone.

Melatonin tablets: Available over-the-counter in some countries, and can be prescribed in the UK, multiple trails have reported significant benefits for the short term only and many conclude that dietary strategies to naturally improve intrinsic melatonin levels would be better, certainly in the longer term.

Chamomile and ginger: These have been traditionally used to enhance sleep for years. The active, phytochemical is apigenin but the amount in a cup of tea is thought to be too small to sufficiently cross into the brain and induce sedation. Studies using concentrated chamomile have shown more convincing benefits. Ginger is also rich in phytomelatonins, so a good nightcap would be some grated ginger added to your chamomile tea with a little lemon.

Valerian and ashwagandha plant extracts: Marketed for sleep problems in products such as Kalms, valerian is believed to aid sleep through its interaction with the GABA neurotransmitter system in the brain leading to a calming and sedative impact. Individual responses to valerian can vary, and some people complain of a hangover effect. About half of the available studies have reported a statistically significant benefit, and the other half did not.

Ashwagandha: The Indian medicinal plant has been used for centuries to treat insomnia. Like valerian, it can cause hangover effects in some people and in others had no benefits.

Phytonightplus+ - This supplement improved sleep and reducing day time fatigue, in a recent scientific study involving participants suffering from long covid. The intervention gave a combination of lactobacillus probiotics and a blend of concentrated whole foods which are rich in a range of melatonin enhancing phytochemicals such as pomegranate, chamomile and resveratrol. Although some of these foods can influence GABA levels, they don't directly cause sedation so have no hangover or additive effects but work in synergy to prepare the body for sleep. They improve mood and relax the mind and body, stimulate melatonin production and promote a regular circadian rhythm.

Antihistamines: Drugs such as diphenhydramine in Benadryl and Doxylamine in Unisom can be bought over the counter for hay fever or other allergies and can induce drowsiness which can aide sleep. Side effects include daytime drowsiness, dry mouth, constipation and urinary retention. There is evidence that they can help for two to three nights at a time but tolerance to the sedative effects of antihistamines can develop quickly. As a result, the longer you take them, the less likely they are to help.

In conclusion, sleep deprivation in the longer term causes multiple short and long term health issues. Surprisingly, medical interventions have considerable shortcomings but fortunately we can do a lot to help ourselves with the correct resources, advice, determination and persistence.