Sleep is really important for humans to stay physically and mentally healthy. This NHS article describes many of the physical problems that have been linked to sleep deprivation.  Too much sleep deprivation has been found to cause symptoms such as visual hallucinations, paranoia and disorientation in up to 80% of the population (see here.) These were the symptoms I which initially brought me to services while I was at university.  I now see them as an indicator that I haven’t had enough sleep which is less scary and much easier to fix.

When I began working with my previous care coordinator we created a long and detailed contact plan listing different self help tools I could be guided through if I rang up in crisis. These were the most helpful self sooth strategies I’d been taught in hospital but I still never wanted to use them in these crisis moments.

Over the years we worked together and noted what was happening it became clear that every time I rang up in crisis feeling unsafe I needed a nap. We found that she only ever needed to remind me that this was OK to do and sometimes help me find ways to do so safely while managing my blood sugar if the combination of type 1 diabetes and another illness was making it unstable. After I slept enough I always felt better so it became really important to me to have healthy sleep.  In fact I sometimes lay awake at night worrying that I wasn’t sleeping properly!

So what does healthy sleep look like? The NHS site above mentions how most adults need about 8 hours but as the other article I referred to points out, this amount varies so you could get eight hours every night and still become sleep deprived if your body needs more than that at this point in your life.

In hospital I had got the message that good sleep involved sleeping through 8 hours straight or at least being in bed for the whole time in one go.  Ideally it was better if I could do this with the lights on and lots of noise from staff and other patients but this was recognised as difficult.  I’ve been on wards that have rules about not leaving your room between certain hours to try and encourage sleep and also on wards that lock patients out of their rooms from 9am till 5pm and have rules about not sleeping in the communal areas to encourage sleep at night and a ‘normal pattern of living.’

During the early part of the three years I spent in hospital I was given sleeping tablets every night for months and then had to relearn how to sleep without them.  As someone with diabetes if my blood sugar is not perfectly controlled I know I will need to get up to visit the toilet during the night.  I also have lots of nightmares that sometimes wake me and am frequently woken by alarms from my continuous glucose monitor when my blood sugar drops dangerously low.  I was never able to manage sleeping through the night without sedation and that is simply not safe when I’m managing my diabetes twenty four hours a day.

I began to question. Was going to sleep and not waking up till the morning what I should be aiming at? Was that how humans had always slept? Reading ‘The Continuum Concept’ by Jean Leidloff I suspected not.  She describes the practices of indigenous tribes in South American jungles which she learned about while living with them for two and a half years.  In terms of sleep she described people waking to tend a fire or feed a baby or have a quiet chat or a joke before going back to sleep on a regular basis. Being able to sleep through any kind of disturbance in an environment where predetors are not far away is simply not a good survival strategy.

Then I began to hear about a two stretch model of sleep being the norm before electric light and the need to fit around factory shifts encouraged us to try and squish our sleep into a shorter period. This article describes this and explains how just knowing that waking at night is a normal sleep pattern and not being worried by it can really help.

Then I looked at the assumption that daytime sleep was to be avoided and found many articles pointing out benefits to health and performance of a short lunchtime siesta such as this.

Before I had even been given a mental health label I was being told that it was important not to sleep too much and that I should push myself to get out of bed and be productive so as to feel better.  The truth is that there are three things that have made me sleep constantly in my life and none of them were depression.

Being seriously ill makes you exhausted.  In the weeks before I was diagnosed with type one diabetes I was constantly being told that I was just tired because I was spending too long in bed.  In truth I was seriously ill.  The same was true just before I started treatment for my under active thyroid. If you are concerned that you are sleeping too much or are always exhausted then you need to see a GP and look for a physical cause.  Knowing you have mental health probelems can make this search harder.  My diabetes took longer to diagnose than it should have because I already had an eating disorder label on my file and my sudden weight loss was put down to that.  Keep asking and keep as detailed a record of what is happening as you can.

The second thing that led to sleeping excessively were the side effects of psychiatric medications.  I had one that literally caused me to fall asleep on my feet clutching the supermarket trolley as my mum told me to pull myself together.  Again try and record how often you are sleepy when you don’t want to be over at least a week and make an appointment with the person who prescribes your medications to talk about this.  When I saw my psychiatrist he switched me straight onto something else that worked better for me even though the first tablet is not one that makes many people sleepy.  I personally came off all my medications by working together with my team.  I’d stress that it is really worth working very closely with them if you want to do this.  In the past when I just stopped medication the professionals were left thinking it probably had been helping till I stopped it so when I had a bad time they encouraged me to take it again.  This time we took it slowly and agreed at each stage that things were not worse without it.  When I struggle we all look for different solutions now.

Finally and most importantly I sleep too much when I am sleep deprived.  If I let myself sleep when I can I stop wanting to sleep all the time within a few days. These things have helped me incorporate a more relaxed approach to sleep into my life.

Making sure I feel safe where I sleep including having thought about what I will do if I’m worried someone has come in who shouldn’t be there.

Going to bed early especially if I’m tired.

Using relaxation or hypnosis tracks if I need a nap but don’t think I can sleep.

Having things to make me comfortable like a drink, moisturiser for itchy skin and a cardigan readily to hand before bedtime.

Using daylight to wake me rather than an alarm (right now I have a door open to the landing where the curtains are open but I’ve also used sky lights and a window at the other end of my room.)

Creating a flexible working environment so that if I am struggling I can fit in a nap without worrying.  If I lie down in a safe darkened place and am asleep in 15 minutes then I was definitely sleep deprived.

Now that I’m a Mum I’ve found that this approach works really well with caring for my baby at night.  I sleep in his room so that I am not rushing around at night and we go to bed together really early so I am not exhausted by waking to feed him.  If I do have a bad night with nightmares and blood sugars then I try to have a nap with him in the afternoon too.

These are things that I found helpful in finding an approach to sleep that keeps me feeling good and not having visual hallucinations.  What works for you?

This is the second post in my Learning to Thrive series.