A yawning gap; health

Sound patterns of sleep are essential to wellbeing, but for many people a night in bed can be restless and exhausting. When you're full of hot cocoa and you've counted your last sheep, what's the next step?

As the acclaimed film The House of Mirth draws to its tragic and traumatic climax, its heroine Lily Bart is beset by chronic insomnia. For weeks she lies awake, tortured by financial worries and the uncontrollable series of events that have led to her demise.

The scene struck a chord with Chris Cavendish, a 26-year-old furniture restorer, who has suffered periodic sleeplessness for three years. "I could understand exactly how she felt," he says. For the past few weeks he has gone to bed feeling tired but when he closes his eyes his churning mind frequently keeps him awake. "I start thinking about all sorts of things," he says. "Things that happened in childhood; things that happened in the last few years. Fun things, bad things, anything really."

Work is a recurring theme. "I spent last night thinking of saws," he grimaces. "My mind goes on and on and on jumping from one thing to another. Then suddenly I realise what I am doing and try to control it and go to sleep but I can't - I'm just too awake." Often the insomnia persists for a week at a time until finally the demon that has kept him from sleep allows him a few nights' grace.

While Chris lies tossing and turning, an estimated 20 per cent of British people are also struggling to do what most of us take for granted. Experts say it is a serious and growing problem for society. Sleepiness caused by insomnia and other sleep disorders like sleep apnoea, a blockage in the upper airway of the nose, are contributing factors in road accidents and economic issues like decreased productivity. Furthermore, the huge quantity of sleeping pills, sedatives and anti-depressants doled out each year to poor sleepers are a strain on the health budget.

Stress over work, relationships or change in general tend to be important triggers for insomnia, although as the sleepless nights build up the original cause of anxiety tends to be replaced by a fear of not being able to sleep. Rapidly the mind takes on obsessive tendencies, worrying illogically about the damaging effects that lack of sleep will have on the day ahead.

Colin Espie, professor of clinical psychology at the University of Glasgow says if sleep doesn't come within 20 minutes the best medicine is to get out of bed and go into another room until the sleepy feeling returns. If problem recurs after returning to bed, get up again after 20 minutes. "Usually that will mean that you are only in bed for the amount of time that you can sleep, but you've got a much greater chance of then being successful and sleeping in bed and building up positive associations with successful sleep while in bed," he explains.

Ironically, a good method of falling asleep is to try to resist the process by keeping the eyes open for as long as possible. That way, the mind attempts to reverse the negative pattern that the patient tends to adopt.

"We believe that the insomniac has been caught in the cycle of direct effort and trying directly to control sleep in that way is probably an inhibiting mechanism - just in the same way as people who stutter will stutter even more if they become self-conscious," says Professor Espie.

Tackling the causes of stress is crucial in breaking patterns of insomnia. Worriers should aim to set aside time in the afternoon or early evening to think over difficult issues and "put the day to rest". Regular gentle exercise in the afternoon may also help.

Through group discussion or one-to-one counselling during daylight hours, insomniacs can reverse their negative nocturnal behaviour. As part of a research programme Professor Espie put 139 chronic insomniacs through a six-week course to counteract their problem. Each week, groups of five patients were instructed by a health visitor for 50 minutes on the methods of tackling insomnia. Participants kept sleep diaries to indicate how many hours they managed to achieve and were encouraged to aim for their average amount of sleep, rather than getting frustrated when they couldn't reach their optimum level.

After three sessions most patients noticed an improvement and by the end of the course the majority were weaned off medication such as sleeping pills or anti-depressants and returned to normal sleep patterns. "We managed to get about 84 per cent of people off their pills and still sleeping well a year after treatment," says Professor Espie.

Such treatments for insomnia are limited on the NHS, but sleep experts are lobbying for the condition to become as serious a public health issue as diet or exercise. Good sleep, like food, is a staple ingredient for the body's wellbeing More information from the British Sleep Foundation at www.britishsleepfoundation.org.uk/ or telephone 0207 345 3317

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