What stops us sleeping? Professor Robert Thomas answers all

The end of August is another peak period for insomnia. On top of the still relatively hot and bright nights, work, financial, school and family worries start creeping into minds as September approaches.   

How much sleep do we need? Ideally, as adults, we should be aiming for about 7 hours a night. Children need more sleep to ensure normal physical and mental development depending on their age. The ideal amount for my 10-year-old son, for example,  would be 9-10 hours and my 15 year old daughter 8-9 hours.

According to the latest figures from the National Centre for Health Statistics a third of the UK adults get less than 6 hours a night and a colossal 10 million people are looking for help every year. 

Why do we need sleep? Sleep recharges the energy stores in every cell, clears up oxidative toxic metabolites which have built up over the day. It slows the cell cycle allowing more time for DNA repair. It even encourages the growth of healthy bacteria in the gut so reduces excess inflammation and improves immunity.

What happens when we don't get enough sleep? It's completely normal to have the odd sleepless night but persistent insomniacs live in a world of chronic fatigue, cognitive impairment which can lead to relationship and work issues, demotivation to exercise and undertake healthy living programmes. In the longer term, insomnia increases the risk of  dementia, obesity, high blood pressure and heart disease. The International Agency for Research on Cancer now even class sleep-disrupting night-shift work as carcinogenic. 

What can interfere with a good night's sleep? Multiple physical, dietary, environmental and psychological factors conspire to disrupt regular sleep patterns. Here are the ones which more commonly effect many of us.

Environmental factors: Noisy neighbours or outside traffic, an uncomfortable bed, a snoring partner, too much light in the bedroom or is either too hot or too cold.

Physical disruptive symptoms: Menopausal hot flushes, pain, restless legs, getting up at night to pass water, joint stiffness and arthritis, chronic cough and indigestion. 

Anxiety and depression: 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. 

Snoring and sleep apnoea: If your partner snores this can keep you awake and may be a sign of sleep apnoea which can be harmful. 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. There are successful treatments for sleep apnoea. If you have symptoms including loud snoring, waking up gasping for air it would be sensible to ask your GP for a  referral to a sleep apnoea clinic.

Poor 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 processed sugar intake this includes eating healthy bacteria rich foods such as kimchi, kefir and sauerkraut and well as pre-biotics in beans, mushrooms, herbs and vegetables. 

Stimulating foods: Heavy, fatty or fried dishes and carbonated drinks late in the evening, can trigger indigestion and heartburn. Coffee, strong tea or caffeinated drinks, from mid-afternoon excite the nervous system causing wakefulness. 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.

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.

Medication: Steroids are well known to cause wakefulness but other drugs such as statins, glucosamine, beta blockers for the treatment of blood pressure can contribute.

Not getting enough sleep?

It would be sensible to talk to your GP to identify and correct any physical, environmental and psychological factors which could be stopping you. Try to adopt sensible lifestyle strategies such as exercise, improving gut health and destressing techniques such as mindfulness or yoga. Consider sleep hygiene habits like getting to bed at a regular time and avoiding stimulating foods, films or electronic gadgets late in the evening. 

A lot of people get additional help from some over the counter supplements. Only if these fail, would it be worth discussing prescription medications such as hypnotics and Z-drugs which can be prescribed for 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.