Can't get a decent night's rest Call the sleep squad who can tell you what's going wrong
22:23 GMT, 30 April 2012
Just after 9pm at Charing Cross Hospital, West London, and the corridors are deserted.
Patients are asleep, most staff have long left for home and the reception desks are shuttered up.
But in a small room on the eighth floor, the day is only just beginning.
For this is the Imperial College Healthcare Sleep Centre, an overnight clinic designed to investigate — and improve — people’s sleep problems.
Ed Tighe, 29, has had sleep problems for as long as he can remember – and they are extreme
Initially, this was just a research centre, but four years ago, after increasing requests for help, they started seeing patients.
Sleep clinics are in great demand as this problem becomes endemic — just last month, a study found one in three British workers is affected by chronic lack of sleep, with many so tired they feel ‘sleep-drunk’ at work.
The fortunate ones are seen at specialist centres such as the one at Imperial College.
There are just two consultants, seeing 140 new patients a month (there is an eight-week wait for an overnight assessment).
I have been allowed access to see what goes on and find out what is behind so many people’s lack of sleep.
As an extremely light sleeper — I’ve also been known to become aggressive when woken in the night — I’m hoping to find some answers to help me, too.
Ed Tighe, 29, is one of five patients who has come to the sleep centre for overnight monitoring.
He’s had sleep problems for as long as he can remember — and they are extreme.
‘I have episodes two or three nights a week and they can be pretty alarming,’ says Ed.
‘While I’m asleep I yell foul language at the top of my voice, walk about, struggle to breathe and do things such as opening the window and leaning out.
‘I wake up thinking the ceiling’s coming down and often find myself clutching on to the bed.
'It can be scary and takes a few minutes for me to realise where I am and calm down.’
A study found one in three British workers is affected by chronic lack of sleep, with many so tired they feel 'sleep-drunk' at work
A healthy, slim young man, Ed otherwise has a normal life, working as a chartered surveyor in London and cycling to work every day.
But his erratic nightlife finally became too much to bear for him and his girlfriend, Catherine, 28.
‘We’ve been together seven years and she is fed up,’ he says.
‘In some respects, it’s worse for her as I’m not always woken by it, but she is. And six months ago she dragged me to the doctor.’
Like Ed, many patients wait years before seeking help for their sleep problem — usually because they don’t recognise they have a medical issue or that anything can be done.
‘We are getting more people treated nowadays, but there are still many more out there in need,’ says centre manager Gill Twigg.
In the clinic, Ed is shown to one of two bedrooms and gets ready to turn in under the watchful eye of several cameras.
‘We try to make things as natural as possible,’ says Gill. ‘The beds and sheets are nicer than standard hospital issue.’
Ed has wires, bands and electrodes attached to him to monitor every detail of his slumber, including breathing, brain waves, eye movements, heart rate, pulse, leg movement, sleeping position, oxygen levels and even the movement of his facial muscles.
This should provide the clues to what’s going wrong.
Meanwhile, four patients have come in for a simpler assessment: to see how they breathe.
Most have suspected sleep apnoea, where soft tissue in the throat collapses during sleep, causing the patient to stop breathing temporarily.
This can occur many times a night without the patient realising, but results in daytime exhaustion — an estimated 900,000 are affected.
Long-term sleep apnoea has serious health implications, including high blood pressure, stroke and diabetes.
Other common complaints the clinic sees include sleepwalking, night terrors, narcolepsy and restless leg syndrome, where a person wriggles their limbs in the night.
Sometimes patients are affected by several overlapping disorders, stemming from general sleep control issues in the brain.
‘People do quite complicated things while apparently asleep,’ says Dr Andrew Cummin, director of the clinic.
‘One lady did the ironing, while a male patient texted rude messages to his workmates in the night, but had no recollection of it’
One of the patients on the breathing observations ward tonight is Jerry Mays, 74, a retired electrician from Ealing, West London.
He suffers from emphysema and asbestosis, but was referred to the clinic when his wife noticed he sometimes stopped breathing in bed.
‘I think she cares more about it than me as she’s frightened,’ says Jerry, sitting in his private room with electrodes strapped to his chest and stomach.
‘She says she sometimes has to nudge me to start breathing again.’
The equipment strapped to Jerry will produce an extensive amount of data showing his breathing, movement, oxygen levels and sleeping position.
The sensor that measures a patient’s physical position is important as some conditions are made worse by sleeping on your back.
‘Generally, people turn five or six times in a night,’ says Gill.
‘It is rare to stay in the same position, but people are convinced they do.’
Back upstairs, Ed falls asleep at 11.30pm.
My eyes are glued to the screen — watching someone sleep is fascinating.
Immediately, the team notice that he goes straight into dreaming sleep, known as Rapid Eye Movement (REM); most people don’t start this stage until more than an hour after they’ve fallen asleep.
What’s even more unusual is that the data from the electrode on his chin shows Ed is moving his mouth.
Our bodies are meant to be paralysed in REM sleep to stop us acting out our dreams.
The movement suggests Ed may have REM sleep behaviour disorder, which affects an estimated 300,000 Britons.
This is when the mechanism fails that stops muscles moving during dreams.
‘If you lose normal paralysis then if you dream you’re fighting you may do fighting movements,’ says Dr Andrew Cummin.
‘It disrupts the sleep of the patient and their partner, causing them to feel tired the following day.’
This occurs more commonly in people over the age of 50, but occasionally runs in families. It can be associated with degenerative brain diseases such as Parkinson’s.
What many insomniacs need is psychological treatment to eliminate negative thoughts about not sleeping
Typical symptoms include moving, speaking or yelling during a dream and sometimes waking spontaneously during the attack.
‘Ed is able to move around and that’s not a normal situation,’ says Fatimah Mohamied, a trainee clinical scientist who is assessing his sleep.
Much of the rest of Ed’s night passes without incident, but at one point he talks to Fatimah as she re-attaches an electrode, claiming he hasn’t been to sleep yet. She doesn’t argue about it.
Then, in the early hours, he suddenly sits up. He looks confused and the graphs show he’s woken up, but he quickly falls back asleep.
In fact, most people sleep better in the laboratory. This is because they don’t associate it with their bed, which could have become a place of trouble and angst.
They also follow healthier sleep habits, such as going to bed at a reasonable time without the distractions of mobile phones and work.
Indeed, the team at the clinic say bad sleep habits are responsible for our greatest bedtime affliction, insomnia, which affect a third of us.
Insomnia is so widespread that most sleep centres don’t take these patients because they would be overwhelmed.
But often the triggers are so simple such treatment in a clinic should not be necessary.
‘For good sleep, people need to go to bed at regular times, avoid stress in the day and cut out any disturbances,’ says Dr Cummin.
Stress is a problem, says Adrian Williams, professor of sleep medicine at King’s College, London, and consultant physician at Guy’s and St Thomas’ NHS Trust. He runs one of the largest sleep clinics in the country, with 10,000 patients treated a year.
‘We’re living in stressful times, and that means we don’t pay enough attention to getting quality sleep. We also drink too much caffeine.’
The poor sleeper then worries about their lack of sleep, and the worry itself becomes part of the problem.
What many insomniacs need — and this is the reason sleep clinics can’t help — is psychological treatment to eliminate negative thoughts about not sleeping, says Dr Cummin.
However, these cost the NHS a good deal of money. Talking therapies, such as cognitive behavioural therapy (CBT) ‘are most effective for insomnia, yet there isn’t enough general investment into it’.
But maybe some of us aren’t really sleeping as poorly as we claim.
I ask Dr Cummin about my light sleep — even someone switching on a light wakes me — and the way I then become uncharacteristically angry and aggressive.
‘What you may be suffering from is “sleep drunkenness”,’ he says.
‘If you are woken from deep sleep, it can take a while to get your brain working properly and sometimes in this state you can have difficulty thinking straight and can even be aggressive.’
Back in the lab, at 7am Fatimah enters the room to wake Ed.
‘I slept better than usual,’ he says as the wires and bands are stripped.
‘I’m a bit disappointed that nothing much happened.’
But his night will still have produced valuable data, which will be analysed meticulously.
Meanwhile, downstairs in his room, Jerry is already up and waiting for his diagnosis.
At 8.30am, Dr Cummin strides in with the news: he does not have sleep apnoea. Though Jerry does occasionally stop breathing, a small number of episodes is normal, says Dr Cummin.
‘Our research shows everyone stops breathing a bit when they’re asleep, just for a few seconds,’ he says.
‘We allow for five episodes per hour.’
If Jerry had been diagnosed with sleep apnoea he would have been issued with a Continuous Positive Airway Pressure (CPAP) mask, which keeps the airways open by gently pumping air into the body.
Ed’s case is not so clear-cut. It could be REM sleep behaviour disorder — otherwise known as night terrors.
‘These are common in children, and cause a person to wake up terrified and agitated and spout nonsensical things or run wildly around the room,’ says Dr Cummin.
‘It can be confusing as sometimes different disorders overlap.’
Indeed, Ed’s behaviour also includes another sleep disorder — sleepwalking, which affects 2 per cent of adults.
Unfortunately, the only treatment is simply to make the bedroom safe, in particular locking windows and doors.
But all disorders can benefit from improving a patient’s sleep habits, such as consistent sleeping and waking times, avoiding sleep deprivation and minimising caffeine.
‘Patients benefit from reassurance, too,’ says Dr Cummin.
‘Everyone gets wound up by these things, and talking about it and receiving good advice really helps them improve.
I take comfort in the fact that I am not alone as a bad sleeper.
‘After all, everyone is at risk of sleep problems at some point,’ says Professor Williams.
‘I’ve yet to meet anyone who has slept perfectly every night.’
FIVE GOLDEN RULES TO HELP YOU CATCH 40 WINKS
So you’ve cut out caffeine, tried blackout curtains and earplugs, yet still find you’re tossing and turning Try these tricks from the experts.
Get outdoors for at least an hour every day and look at the sky. Sunlight regulates your body clock, so when it gets dark your body will know to get ready for sleep, says body clock expert Leon Kreitzman.
Drink wine with dinner, not after. Alcohol not only disrupts the sleep cycle, meaning you’re more likely to wake up, it also triggers snoring and the need to go to the loo in the night. Avoid taking medications just before bed, too.
Hot baths may seem relaxing, but it could make it harder to drift off because your body has to cool down to a certain temperature to get to sleep, according to researchers at the University of Michigan. So enjoy a soak when you get home, not just before bed.
See a counsellor. Anxiety and stress are one of the key triggers for parasomnias such as teeth grinding, night terrors and sleepwalking. You may need to address issues from childhood or in your work or personal life.
If you can’t get to sleep, don’t just lie there because you will associate your bed with anxiety. Get up and do something to relax you. ‘I always do the ironing,’ says sleep expert Dr Neil Stanley.