Quiet sleep. This is divided into stages 1-4 which are progressively more 'deep'.
	REM (Rapid Eye Movement) sleep. REM sleep is when the brain is very active but the body is totally limp apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.
	Short periods of waking for up to 1-2 minutes.

	Concern about wakefulness - some people remember the normal times of being awake in the night. They may feel that to wake in the night is not normal and worry about getting back off to sleep. They may 'clock watch' and check the time each time they wake up. This may cause irritation or anxiety and the times of waking are more likely to be remembered. This may give the impression of having a bad nights sleep even if the total amount of time asleep is normal. Understanding that several short periods of waking are normal may help some people to accept these without concern. Sometimes it takes longer than usual to get back off to sleep after a period of being awake - but this may be due to anxiety or irritation about being awake.
	Temporary problems - poor sleep is often temporary. This may be because of stress, a difficult work or family problem, jet-lag, a change of routine, a strange bed, etc. Poor sleep in these situations is common and usually improves in time.
	Anxiety - some people find it difficult to switch-off their anxieties about work or home problems.
	Depression - poor sleep is sometimes due to depression. Other symptoms of depression may include a low mood, a poor appetite, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common and treatment of the depression often cures the sleeping difficulty too.
	Other illnesses - may keep some people awake. For example, pain, breathlessness, leg cramps, indigestion, cough, itch, hot flushes, dementia, mental health problems, etc. Treatment of the problem may be possible.
	Stimulants - can interfere with sleep. There are three things in particular to avoid. Alcohol - many people take an alcoholic drink to help sleep. Alcohol actually causes broken sleep and early morning wakefulness. Caffeine which is in tea, coffee, some soft drinks such as cola and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep. Nicotine (from smoking) is a stimulant and it would help not to smoke.
	Some medication - may interfere with sleep. For example, diuretics ('water tablets'), some antidepressants, steroids, beta-blockers, some slimming tablets, painkillers containing caffeine and some cold remedies containing pseudoephedrine. Stopping regular sleeping tablets and other sedative medicines abruptly can cause 'rebound' poor sleep.
	Street drugs - such as ecstasy, cocaine and amphetamines can affect sleep.
	No cause - poor sleep may develop for no known reason.
	Unrealistic expectations - some people just need less sleep than others. If your sleep pattern has not changed and you do not feel sleepy during the day then you are probably getting enough sleep. Older people and people who do no exercise tend to need less sleep. Some people think they should be able to nap during the day and sleep at night!
	A vicious cycle - whatever the initial cause, worry about poor sleep and worry about feeling tired the next day is a common reason for it to get worse.

What can I do to help improve poor sleep?
 

	Understanding - that short periods of waking each night are normal. Also that worry about poor sleep can itself make things worse.
	Body rhythms - try to get into a routine of wakefulness during the day and sleepiness at night. No matter how tired you are, do not sleep or nap during the day if there is difficulty with sleeping at night. It is best to go to bed only when sleepy-tired in the late evening. Always get up at the same time each day, 7 days a week. Get up at this time however short the time asleep. Use an alarm to help with this. Resist the temptation to 'lie-in'. The body becomes used to rhythms or routines. Sleep is more likely to occur if a pattern is kept to.
	The bedroom - should not be too hot, cold or noisy. Earplugs and eyeshades may be useful if you are sleeping with a snoring or wakeful partner. Make sure the bedroom is dark with good curtains to stop early morning sunlight. Switch the light out as soon as you get into bed. Don't use the bedroom for activities such as work, eating or television. The idea is to associate the bedroom as a quiet, relaxing place to sleep. Also, consider changing your bed if it is old or not fully comfortable.
	Mood - try to relax and 'wind down' with a routine before going to bed. For example, a stroll followed by a bath, some reading and a warm drink (without caffeine) may be relaxing in the late evening. Do not do anything that is mentally demanding within 90 minutes of going to bed. Go to bed when sleepy-tired. Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.
	Relaxation tapes - are commonly available and may help with sleep. This is mainly if you find anxiety at bedtime is affecting sleep. However, they may be of benefit even if you are not anxious but find it hard to get off to sleep. Relaxation tapes often take you through deep breathing exercises and teach you how to relax the muscles.
	Strenuous exercise - near bedtime is not advisable. Mild stretching exercises may help to relax just before bedtime. However, some people find the reason they can't sleep is that, although the brain is tired, the body has not been tired enough during the day. If possible, do some exercise each day. Even a walk in the afternoon or early evening is better than nothing. Daytime exercise can help you feel more relaxed and tired at bedtime.
	Stimulants - don't drink alcohol for a few hours before bedtime. Don't have food, medicines or drink containing caffeine or other stimulants before bedtime (see above). Some people have found benefit from cutting out caffeine completely through the entire day. Don't smoke.
	Food and drink - don't eat large meals before bedtime.
	Get up - if you find you are unable to sleep after 20-30 minutes. Go into another room and do something else such as reading or watching TV rather than brooding in bed. Go back to bed when sleepy. This can be repeated as often as necessary until you are asleep.
	See a doctor - if you feel illness, depression or medication is causing poor sleep.

What about sleeping tablets?

Sleeping tablets were often prescribed in the past. However, they have been shown to have their own problems and are now not commonly prescribed. They can cause a hang-over effect the next day. Also, tolerance to sleeping tablets may develop if they are taken regularly. This means the dose needed to produce the same effect needs to be higher. Some people become dependant on sleeping tablets and withdrawal symptoms can occur if the tablets are stopped suddenly.

Sleeping tablets are almost never helpful in the long term. However, occasionally they may be advised. Sometimes a short course of sleeping tablets, or one just every now and then may be helpful. A doctor will advise on the use of sleeping tablets.

Further help and advice

Sleep Council, High Corn Mill, Chapel Hill, Skipton, North Yorkshire, BD23 1NL
Tel (Leaflet Requests): 0800 0187 923 (24 hour answerphone)
Tel (Office): 01756 791089
Web: www.sleepcouncil.org.uk
A non-profit making generic organisation which aims to promote the importance of a good night's sleep to health and wellbeing - and the importance of a good bed, regularly replaced to achieving that good night's sleep. It is funded by bed manufacturers, retailers and suppliers but works completely independently. Produces a number of free helpful information leaflets including: The Bed Buyer's Guide; The Sleep Good, Feel Good Guide; The Good Night Guide for Children; Bed MOT; and Health Living MOT. All can be obtained free of charge via telephone or via the website.