In part two of our special feature on sleep problems in Huntington’s disease, we bring you Prof Morton’s ‘simple rules for a good night’s sleep’, distilled from her comprehensive review of sleep research in Huntington’s disease.

Simple rules for a good night’s sleep

In the first part of this special feature on sleep, Prof Morton reviewed what’s known about sleep problems in Huntington’s disease. Problems with sleeping and loss of normal daily rhythms in HD are common but potentially manageable. Here, based on what’s known about sleep disturbance in HD, as well as advice that comes from sleep research more broadly, we are pleased to present Prof Morton’s simple rules for a good night’s sleep.

The rules are reproduced here by kind permission of Elsevier Science, from A. J. Morton, Circadian and sleep disorder in Huntington’s disease, Experimental Neurology 2012.

As ever, this extract is provided for information only, and that HDBuzz is not a source of medical advice. If you are having problems with sleeping, you should see your doctor.

Bedtime and napping

1. Set a bedtime, and go to bed within 30 minutes either side of this time.

2. Fix a ‘wake-up’ time that is 8 h after your set bedtime. Note that you will probably need to set an alarm to wake you up. You must get out of bed when the alarm goes off, even if you still feel tired. It will probably take a couple of weeks to get used to your ‘going-to-bed’ and ‘wake-up’ times. Stick to your going-to-bed and wake-up times, even at the weekends, until your sleep patterns are consolidated.

3. Establish going-to-bed patterns of activities that will help you to sleep (see below, ‘Getting ready for bed’).

4. Avoid taking naps during the day. If you feel sleepy, do something else. Go for a walk, do the dishes, take a shower. If you must take a nap, limit it to 30-40 minutes and set your alarm clock to wake you up.

Exercise

Take a regular bout of exercise during the day, but don’t do strenuous exercise within 2 hours of bedtime.

Food and drink

1. No coffee more than 4 hours after your wake-up time. (For example, if you get up at 7 am, you should not drink coffee after 11 am.)

2. No alcohol within 2-3 hours of bedtime. (If you go to bed at 11 pm, ideally you should not drink alcohol after 8-9 pm.)

3. Try to eat your last full meal at least 4 hours before bedtime.

4. Have a light snack before you go to bed. Foods that are rich in tryptophan may be helpful. These include milk, yogurt, eggs, meat, nuts, beans, fish, and cheese (Cheddar, Gruyere, and Swiss cheese are particularly rich in tryptophan). Try warm milk and honey or bananas.

5. Avoid smoking or chewing tobacco for at least 1-2 h before bedtime. If you smoke, cut down on cigarettes/tobacco. Nicotine is a potent drug that speeds your heart rate, raises blood pressure, and stimulates brain activity. If you are addicted to nicotine, withdrawal symptoms may wake you at night. It also goes without saying that quitting smoking offers other health benefits.

Your bed

“Your bed should be used only for sleeping, reading and sex! ”

1. Should be used only for sleeping, reading and sex!

• No working in bed;

• No watching television;

• No playing computer games.

1. Should be comfortable. This may sounds obvious, but if your bed is too hard, or too soft, you will not sleep well. If you have not bought a new mattress in the past 10 years, consider whether or not it is time for a new one. If you have joint pain or get cold at night, use a mattress pad or underlay. If you get cold at night, use a duvet with a high tog rating rather than layers of blankets that can be heavy. If you get hot in the middle of the night, try using two thinner duvets so you can throw one off in the middle of the night. If you share a bed, and you both have disrupted sleep, trying using separate sets of sheets and duvets, so you are not competing with your partner for your bed coverings.

Your bedroom

Should be:

1. Cool (18-20 °C) but not cold;

2. Well-ventilated;

3. As dark as possible;

4. As quiet as possible.

Your bedroom should not have a television set or a computer in it. If it does, make sure they are switched off at the wall (so there is no light showing.) Your mobile telephone must be switched off and left in another room before you go to bed.

Getting ready for bed

1. Establish a pre-sleep ritual. For example: switch off your mobile phone, have a snack, put the cat out, clean your teeth, get into bed, read a book for a few minutes. Or: walk the dog, switch off your mobile phone, have a bath, clean your teeth, get into bed, read a book for a few minutes.

2. Worrying

• Don’t take your worries to bed. Try not to think about your job, school, daily life or illness when you are in bed. If you are naturally a worrier, try ‘active worrying’ whereby you use a worry period during the late afternoon or early evening. Write a list of the things that are worrying you, and decide which ones you can do something about the next day. Decide on a plan of action for those. Leave the others on the list for another day.

• Don’t worry about not sleeping. Humans have amazing capacity to do without sleep, and a good night’s sleep is often enough to restore the balance. Contrary to popular belief, insomnia is not lethal. It might make you grumpy, and in the long term it can be deleterious to your health, but it will not kill you. It is not clear how much sleep is essential to life, but it is much less than the average insomniac gets, so worrying about not getting to sleep is counter-productive.

• Remember if you can’t sleep, you can always rest. One of the major functions of sleep is to allow your body to rest. While you are asleep, your heart slows down significantly. The simple act of lying quietly in bed achieves a decrease in heart rate. So, even if you spend 8 hours in bed, resting without sleeping, this is better for you than being up, pacing about and being anxious about not being able to sleep.

Falling asleep & staying asleep

Get into your favorite sleeping position. If you don’t fall asleep within 15-30 minutes, try getting up, going into another room, and reading until you are sleepy. Some people find that listening to the radio or a talking book helps them go to sleep. Radio is a much less stimulating medium than TV, so listening to the radio is fine.

Getting up in the middle of the night

Most people wake up one or two times a night for various reasons. If you wake up and cannot get back to sleep within 15-20 minutes, you do not need to stay in bed trying to sleep. Get out of bed if you want to, but if you get up, you should leave the bedroom. You can sit quietly, read, listening to the radio, have a drink or a light snack, do a quiet activity such as a crossword puzzle, or take a bath.

• Do not do office work;

• Do not do housework;

• Do not watch television;

• Do not play computer games;

• Do not check your e-mail;

• Do not check your phone messages.

After 20 minutes or so, go back to bed.

Remember that your sleeping time starts at your chosen bedtime. If you don’t sleep, you shouldn’t roll your wake-up time forward to compensate. You should get up 8 hours after you went to bed.

Share