Insomnia: Six things to do to help yourself get the best night's sleep you can

Insomnia is a condition which sees people find it difficult to get to sleep or stay asleep for long enough to feel refreshed when they wake. The NHS says it's a common problem that affects about one in three people in the UK, especially the elderly.

As well as lying awake at night, insomniacs also struggle to nap during the day and due to their tiredness can find it hard to concentrate, as well as feel irritable. Insomnia can be a near-permanent condition, or may come and go.

The first step in managing insomnia

If you feel you're not getting enough sleep, it would be sensible to identify and correct any physical, environmental and psychological factors which could be stopping you. Try to adopt sensible sleep hygiene habits like getting to bed at a regular time and avoiding stimulating films or electronic gadgets late in the evening.

You may be able to get help from the GP for any symptoms which keep you awake or even get a referral for your partner to an anti-snoring (sleep apnoea) clinic. Prescription medications such as hypnotics and Z-drugs which enhance the neuro-inhibitor Gamma-aminobutyric acid (GABA) are useful in the short term such as after an emotional trauma. Understandably, many doctors are cautions about prescribing them for long term use as they don't treat the underlying cause of insomnia and studies have linked chronic use with dementia and heart disease. Sleeping tablets also become less effective over time, meaning users often wake up in the early hours, unable to get back to sleep.

Self-help strategies for insomnia

It's unlikely that a single quick fix will help sleep, and what may work for one person may not work for another. Combining several strategies is likely to achieve the best results:

Exercise

The benefits of regular exercise were summarised in six well conducted randomised controlled trials. Insomniacs given moderate to strenuous exercise programmes had better sleep duration and quality. Exercise helps to 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.

Stress

Having some anxiety and stress is part of being human but if excess and long term, it will result in chronically raised levels of the master stress hormone, cortisol. This is also important for the regulation of the circadian rhythm and hence your sleep cycle. It is clearly not always difficult 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.

Vitamin D

There is growing evidence that vitamin D has a role in sleep regulation. Specifically, vitamin D deficiency, which can increase risk of sleep disorders in children and adults. Many people in the UK are low in vitamin D especially in the winter as regular, sun exposure (without burning) is the best way to maintain vitamin D levels - another advantage of exercising in the daylight.

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 increases absorption and utilisation.

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. Conversely, lack of sleep can increase gastric acid secretion and gut motility at night which can damage the ratio of healthy to unhealthy bacteria. 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.

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 whether these benefits were seen only in people with poor gut health or whether they helped everyone. If you are considering a probiotic, studies have shown that blends combining a prebiotic and vitamin D enhance the growth of the healthy lactobacillus strains.

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, and processed sugar is also bad for gut health. Many hormones are sensitive to swings in blood sugar, including both melatonin and cortisol. 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.