Sometimes patients come in and say 'Doctor, I have not been sleeping well lately,'. Bruno Ariens is a doctor in Herenthout who gives information and advice regarding this very common problem.

1. Nobody sleeps in one go

'Do not worry if you wake up for a little while, because this happens to everyone, several times per night. About every 1.5 hour we wake up from a deep sleep. Most people open one eye, realize subconsciously that everything is safe, and continue sleeping. There also are countless mini breaks when sleeping, about ten per hour on average. Those who sleep well do not remember these the next dat at all. You need to be awake for at least five minutes to remember it in the morning. But those who do not sleep well open both eyes and look at their alarm clock. That makes them restless. The trick is to learn how to feel comfortable in your bed, even if you are awake. Pretend like you have got five last minutes before you have to get up, and enjoy.'

2. Put your alarm clock out of sight

'Studies in nursing homes have shown that senior citizens mainly stay awake because they are worried about their sleeping problems. As soon as this begins, you become tense. Sleeping needs a relaxed situation. For most people it is best to put their alarm clock out of sight. Those who do not sleep well worry when it is just 1 AM - "I still need to lie awake for so many hours!", - but also at 6 in the morning ' "Oh, now it is probably too late to fall asleep.". When you lie awake, it does not really matter what time it is.'

3. Get up if you have been awake for twenty minutes

'Those who stay awake still, are better off getting up, so they do not start associating their bed with negative feelings regarding sleep. I generally do not recommend to watch television, as this can grab your attention for an extended period of time. Instead, do something boring or read a book which you are not all that interested in. Until you feel sleepy again: then go back to bed to fall asleep. This advice is important in order to break through negative conditioning - "I am going to bed (stimulus) and that means I am going to stay awake (response)". Conditioning occurs already after three weeks.'

4. Do not make your bedroom a second living room.

'This is one advice which sleeping shops will not like. Of course you will need a comfortable bed, in a properly aired room, but this room should be used for sleeping, not for watching television or reading - not even for discussing plans for the next day or next vacation with your partner. Those who find a little bit of reading to be part of their sleeping ritual, should of course continue doing so. The most important thing is that you do something relaxing before going to bed, so that your bed is linked to relaxation in your mind. Because sleeping is something you cannot learn. Sleeping comes naturally, when your brain flips the switch. But you can learn to relax: sleeping is an advanced stage of relaxing.'

5. Do not do any intensive sports activities before going to sleep

'Those who sport intensively, stay wide awake for a few hours after they are done. Sports cause an adrenalin-kick, which makes you work and perform better. It takes an hour or two for this energy level to fall back down. Light activities before going to sleep, on the other hand, are good: a short walk, some yoga. Having intercourse also helps many people relax.' 'Sports in themselves are good for a good night's rest, as long as they are done in the early evening at the latest. The more active your day is, the better your night is. As the expression goes: the night is a mirror of the day. That is why one should avoid napping during the day. A nap from half an hour at most can be energizing to those who sleep well at night anyway. But if you have a sleeping problem, this will cause you to sleep less well at night.'

6. Always get up around the same time

'There is a small center in our brain which helps us wake up in the morning, and it helps us suppress our tiredness during the day. Because during the day we get more and more tired. In the evening, this mechanism changes so that we suddenly feel the tiredness. That is when we should go to bed. You need to get on the sleep-train when it passes. If you wake up very early one day and very late the other, you will confuse the mechanism. By always waking up around the same time, your internal clock will keep your circadian rhythm in good shape.' 'Sleeping in is also a bad idea because the last hours of your sleep are very shallow. And it is the deep sleep which you need most. A common saying is that the hours before twelve count for two. It is better to say that the first four hours you sleep count double. Staying in bed longer in the morning will only make you more drowsy during the day. And a drowsy day, of course, will lead to a bad night.'

7. Avoid alcohol at night

'Those who drink alcohol before going to bed, might fall asleep quickly. The beginning of the night starts well, even though the amount of REM sleep decreases. The second part of the night you are more restless: you wake up more often, you have bad dreams. It means you lose the deep sleep during that second period. You need deep sleep for your body to repair itself. During this sleep, growth hormone is produced. Those who produce little of this hormone, age more quickly. REM sleep is needed for your mind to recover: compare it to cleaning up your computer, defragmenting the hard drive. Alcohol hurts both these recovery mechanisms. Especially people who experience problems sleeping should be wary of this.'

8. Also avoid coffee, black tea, caffeine and nicotine

'What most people do not know, is how long caffeine stays in the body. Its half-life is five hours: the person who drinks two cups of coffee at six, will feel like they have just had a cup at eleven. After ten hours, we still have one-quarter of the substance left in our blood. This means you do not sleep well, and some people want to get rid of their tiredness with even more coffee. It is a vicious cycle.' 'Nicotine does not stay in the body as long, but smokers still do not sleep well. First of all there is the nicotine which keeps them awake for an hour, and then there are the withdrawal symptoms created by a lack of nicotine. In the morning, they crave a cigarette.'

9. Three good reasons to stop taking sleep medication

'Sleep medication, too, has a negative effect on your sleep quality. The architecture of your sleep changes: you have no deep sleep and less REM sleep, and you experience many more micro sleep breaks. Those who stop taking such medication will sleep better and enjoy it more. Even those who have been taking pills for years can stop, but it is then best to slowly decrease the amount you take, under guidance of a doctor.' 'Sleeping pills actually stop working after two weeks. "Oh well," people then say, "even if it does not help, it will not hurt.". But it does. Sleeping medication has the negative side effect of muscles getting weaker. If you wake up to go to the bathroom, you can fall more easily and break something. Another side effect is that you wake up feeling drowsy. More important than medication is a healthy sleeping ritual: several standard things you do which make you relax. This could be a yoga exercise, preparing breakfast, or having a cup of tea or warm milk.'

10. Rule out medical causes/practise self-relaxation

'Sleeping issues can also have a medical cause: people with a depression, or with thyroid problems, or even people who take certain medication can find the cause of their sleeping problems in this. It is best to speak to your doctor about eventual outside causes. Anxiety and stress, caused by problems at work, in your relationship, or because of exams, can be taken care of with the help of relaxation-exercises. That is why I included three listening fragments on a CD with my book. One is meant for children: I make them think of a summer beach, floating on water, or petting a cute bunny. Children are very susceptible for that.

More information can be found on the Blog by Ariens, MD.

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