From paralysing night terrors to jogs at 3am, what’s it like to help people drop off at night? Consultant sleep therapist Dr Katharina Lederle opens the curtains on her job.
In my therapy room you’ll find little more than two armchairs and a small coffee table. But the most important thing in there is a box of tissues. Lack of sleep can be a hugely debilitating thing. It can affect how we live our lives, how we perform as a partner, friend or colleague and I often find myself becoming a talking therapist for my clients.
I treated one woman who was terrified of being around her grandchildren because she thought she would inadvertently do them harm because she was so sleep-deprived. Sleep can be a distressing thing when we’re not getting enough of it. People get very upset. That’s when I hand them the tissues.
I started my career studying sleep patterns in animals. The way they sleep is fascinating. Research shows that brown bats sleep the most on average (19.9 hours a day), whereas some animals such as giraffes or elephants may sleep for just four hours a day. But on the whole, most of them sleep much better than we humans, because only humans can worry. Animals don’t ruminate like we do. Once a gazelle has escaped from a lion, it takes a few breaths and then it’s fine. It won’t stay up late thinking about that lion, replaying the incident over and over in its head.
Now I work with people and see clients from all walks of life. But there are overwhelmingly more women than men. There are biological risk factors for insomnia and being female is one of them. That’s likely due to hormonal changes associated with menstrual cycles, pregnancy and menopause. But also because women are more prone to depression and anxiety, which often go hand in hand with sleep disorders. Research shows that after a poor night’s sleep, the effect of being more anxious the next day is much more pronounced in women than men. Things are sort of stacked against us.
You will often see a sleep disorder before a psychotic disorder presents itself. Schizophrenia is just one illness that can be linked to problems with sleep. Trauma can have a huge impact, too. I see clients who have experienced terrible events in their childhood and have either forgotten about them, or purposefully buried them, so they have manifested as troubled sleep or insomnia. For many of them it’s linked to darkness. The feeling of not being safe at night in a dark room.
Genetics can also play a part in how ‘good’ we are at sleeping, as can age (most people find that ageing causes them to have a harder time falling asleep). The other factor is how receptive we are to stress, and what situations we unconsciously interpret as being stressful enough to keep us awake at night. So personality plays its part, too.
I see a lot in my job and I am quite sure I could walk into a crowded room and tell you who is not getting enough sleep. Yes, there’s the pale skin and the droopy eyelids, but I’m looking for extremes: people who seem really withdrawn or, at the opposite end of the scale, someone who is acting very impulsively or flying off the handle.
The weirdest sleep disorder I have come across is probably sexsomnia – the act of having sex with oneself or a partner while you’re asleep. The sufferer wakes up and has no idea what happened the night before. Until their partner tells them. The causes are unknown but stress, alcohol and substance abuse, fatigue and even bruxism (the unconscious act of teeth grinding and jaw clenching while sleeping) are thought to contribute. It’s an incredibly rare disorder and often the person has no idea that they have it.
Another is called REM sleep behaviour disorder. Whereas most people’s bodies are paralysed during REM sleep, with this disorder the person will physically act out whatever is happening in their sleep. They might shout, or dance, or even attack their partner. It can be very, very scary.
Chronic sleep disorders can even find their way into the courts. There was one quite famous case where a man actually strangled his wife to death while asleep because he had thought they were being attacked by an intruder. He was cleared of murder when the court heard that he had been suffering from untreated pavor nocturnus (or ‘night terrors’, a partial waking from sleep which often comes with hallucinations) for 50 years.
You look tired
Lack of sleep doesn’t only affect us, though; it can affect those around us too. There is research which suggests that, as well as lack of sleep making a person withdrawn, it can make good sleepers withdraw from them in turn. This is because the visual symptoms of tiredness – being pale, red-eyed or droopy-mouthed – are very similar to looking ill. Naturally people step away from people who look ill. This is hard-wired into us as an unconscious behaviour. It’s the same with the sleep-deprived and it can have a huge effect on relationships.
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But no one sleeps perfectly for their entire life. ‘Normal sleep’ means there are periods where sleep takes a turn for the worse. It is up and down. And everyone’s sleep patterns are different, like fingerprints. Me, I’m a lark. 6am is when I’m at my bounciest. But my partner is the complete opposite and that’s fine. Speaking very generally, the majority of us need between seven and nine hours sleep; less than that and our body’s inflammation markers will be raised. But everyone differs in their response to lack of sleep. You might be absolutely fine with, say, five hours, whereas I might struggle. So it’s important not to focus on the numbers and instead check in with our bodies and brains on how different amounts of sleep make us feel.
In my opinion, insomnia is one of the most debilitating conditions around. The subjective fear that it produces – that we will not perform well the next day and as we run through all the ways in which we are going to fail – is horrendous. I have plenty of clients who fix themselves a stiff drink in the middle of the night in order to try and sleep (not helpful). I saw one man who would go for a run at 3am every night to tire himself out. Of course it didn’t work. He was just taking more of the precious energy that he would need for the next day.
If you find yourself awake in the middle of the night with a racing brain, try and stay in bed. This is important. Getting up and doing something else usually involves turning on the light and this will mess with your circadian rhythm. The best thing you can do is try and calm your brain and ‘accept’ the thoughts running through it – they are there because these things are important to you, but you can choose not to give them your attention. Mindfulness is hugely beneficial and it doesn’t need fancy apps or podcasts. Instead, focus on your breathing, concentrate on the feeling of the sheets on your skin and shift your focus to the smells and sounds in the room.
The biggest mistake most insomniacs make is to presume that preparing for sleep happens in the hour before you go to bed. Preparing for sleep actually happens the moment you wake up in the morning. It’s about setting up your day properly, building in micro breaks of 3-5 minutes throughout the day where you just stop and step away from whatever you’re doing in order to calm your brain and lower your cortisol (stress hormone) levels. There’s no point waiting for the evening in order to do this. Spend time outdoors in the morning and get direct sunlight (it even works on a cloudy day). Thirty minutes should do it and you can build it into your day by walking to the train station or getting off the bus a stop early. This resets the body clock and lets it know ‘now it’s daytime’. It’s like pressing the ‘on’ switch.
Sleep tech is not always the best way to track how we’re sleeping either. Instead we should be checking in with ourselves and asking how we’re feeling. How are our brain and our body doing? There’s a sleep disorder called orthosomnia, which is brought about by this obsessive measuring of sleep. People become unhealthily fixated on these devices and then develop a sleep disorder. The newest gadget isn’t always the most beneficial for us.
I’ve seen my clients change in many ways, but the biggest life transformation I’ve seen was a woman who booked a holiday with her husband after years of being too anxious to do so. It’s a great example of how someone literally became ‘unstuck’. She embraced her anxiety about not being able to go downstairs when she couldn’t sleep, the anxiety about being in a new sleep environment, and the anxiety of having to be ‘fun’ on holiday, and just went for it.
My parting advice is not to get too wrapped up in the ritual of sleep; not to worry about becoming the woman who can’t look after her children or the one who needs to pound the pavements at 3am in desperate pursuit of getting some shut-eye. Life is life. We can’t always prepare. Sometimes we have coffee at 5pm. Sometimes we have unavoidably stressful days. But developing a relaxed attitude to sleep, not being fixated on being perfect or being the best, is the wisest thing we can do in order to get 40 winks.
Sleep Sense: Improve Your Sleep, Improve Your Health by Dr Katharina Lederle (£12.99, Exisle Publishing) is out now; somnia.org.uk
Photography: Dennis Pedersen, Getty Images