Sleeping Better: for Young People Living with Fatigue Conditions

Problems with sleep are very common

It is common to experience sleep difficulties with chronic fatigue syndrome (ME/CFS), other fatigue conditions and many illnesses.

As you enter puberty and go through adolescence, you may develop erratic sleeping patterns linked with hormonal changes in your body. You may find it difficult to get the right amount of sleep as well as experience difficulty waking up in the mornings.

Being unwell can alter normal body signals that tell your brain it is sleep time, making it harder to get to sleep and stay asleep. No matter the number of hours you are in bed you may still wake feeling tired.

Worrying about sleep is much more tiring than just being awake.

Here are some tips to help improve your sleep:

Body Clock

• Stick to normal wake and sleep times as much as possible. When it gets dark your body releases melatonin, a hormone produced in your brain which sends a signal to your body that it is time to sleep. In the morning, production of cortisol, another hormone, wakes you up, letting your body know it is time to get up.
• It is important to get creative about how to get as much daylight as possible in the daytime and to have your bedroom dark at night, so your hormones be effective.

Environment

• Where possible, your bedroom should be for sleeping and the rest of your day spent elsewhere, e.g., when working, watching TV, gaming, resting. If this is not possible, try not to sit or lie on your bed in the day. Start to develop the connection that your bedroom is for sleeping.
• Keep your bedroom as calm as possible: tidy away schoolwork and take screens out of your bedroom at night. You are more likely to fall asleep if you’re feeling calm with few distractions in your bedroom.
• Make sure your bedroom is quiet, well-ventilated, dark and a comfortable (cool) temperature.

Routine

• Stick to a daily routine. This can help you to form good habits, feel more productive and feel more focused.
• Try to develop healthy habits, e.g., dress daily soon after you wake, eat meals at regular times starting with breakfast, go out daily, and keep a healthy consistent sleep routine in place.
• Make a daily/ weekly timetable of what you will be doing. This keeps structure in place. Include meals, physical activity, cognitive (thinking) activity, relaxation time, social activities and family time.

During the day

• Set your alarm for the same time each morning, about the same on week and weekend days (an hour variation is okay).
• Get up soon after waking, dress into day clothes as soon as possible, within an hour of waking is advised.
• Try and get a dose of sunlight, as early in the day as possible, by going outside.
• Doing 5 to 10 minutes of physical activity / gentle exercise a day, gradually building this up, can help your sleep.
• Avoid daytime sleep, this can disturb your sleep-wake cycle, quality of sleep and make getting to sleep and staying asleep at night more difficult. Resting and relaxing, for short intervals in the day, rather than daytime napping, can give you more energy and a better night’s sleep. Stop, do nothing, calm your mind, you may like to use breathing or seated guided relaxation. Let your muscles relax.
• Limit screen time (TV, tablets, phones, games consoles, computers). Take breaks after using screens for 60 to 90 minutes, this reduces eyestrain and headaches and improves sleep.
• Vary your activities during the day, e.g., seeing friends, going to school, using screens, spending time with family, including at mealtimes.
• Have regular mealtimes and snacks in between. Try to avoid a heavy meal close to bed. Your body will produce energy to keep you going through the day.
• Keeping to mealtimes can be helpful in providing the cues that support the body clock, e.g., eating late at night can provide the wrong messages and make falling asleep more difficult.
• Avoid caffeine in the afternoon or evening. Limit caffeine (coffee, hot chocolate, tea, fizzy drinks like colas or energy drinks) during the day too.

A wind-down routine is important

• Eat your evening meal about three hours before bed. You can have a light snack or warm drink (such as milk) before bed.
• Avoid heavy meals / stimulating activity close to bedtime.
• Switch screens off 1 to 2 hours before bed, taking screens out of the bedroom at night. Melatonin production is affected by light levels, stimulating activity and stress and worry. Light from screens tricks your brain into thinking it is daytime and gets in the way of melatonin production, preventing deep restorative sleep.
• Switch to activities such as drawing, listening to music/audio book, reading for pleasure.
• If ideas and thoughts are buzzing around your mind, writing them down can help.
• Watching a comedy a few hours before bed can produce endorphins that help you relax.
• Avoid physical activity just before bedtime, this stimulates your body rather than helping you to wind down.
• A relaxing activity such as a warm bath/ gentle stretching before bed can be helpful.
• Practising relaxation/mindfulness/meditation can be helpful (see relaxation leaflet). It is advisable to practise these strategies during the day before you rest to build your skill and confidence before trying this before bed. Practice at a time you feel calmer as it will help you to engage.

Decide upon a consistent bedtime and stick to it

• Try to go to bed at the same time every night.
• Make sure your bedroom is as dark as possible. Teach your brain the difference between day and night.
• Avoid tossing and turning in bed. If you can’t get to sleep after 20 minutes, listen to relaxing music or read a magazine for a short time in bed. This can take your mind off the fact that you are not sleeping and allow you to stay calm and try again.
• If you are having trouble getting to sleep, remember that even lying in a restful state is doing your mind and body some good.

Getting into bed

• Turn your clock around so it is facing away from the bedside.
• Gentle music before bed can be helpful. Some people listen to white noise or soothing sounds.
• Some people find lavender or bergamot helps them sleep. Try putting 1 or 2 drops on a cotton wool ball next to your bed.
• When you are in bed, think about pleasant places or events, using your imagination to bring to mind relaxing images. Avoid thinking about the day’s activities, or what you will do the next day

In the morning

• Set your alarm each night and get up at the same time every morning.
• Putting a second alarm out of arm’s reach can be helpful.
• If you get to sleep very late, move your bedtime gradually earlier, it is really important to have a regular wake-up time to ensure you will be sleepy later.
• If taking Melatonin, take it an hour before the time you will be going to sleep. Bright light in the morning helps switch off melatonin. Some lights mimic daylight and can be useful to turn on in the morning.
• Try to get up straight away.
• Open the curtains fully when you wake up.
• Once you’ve got up, get dressed in your day clothes.
• Trying to manage fatigue by sleeping more can make things worse. Keep to 8-10 hours of sleep per night. It is common to feel worse before you feel better.

Sleeping better gives you more time to...

• see friends and engage in social activities
• go to school
• be part of your family
• eat when everyone else does and helps your body produce energy to keep you going through the day.

Sleeping better reduces fatigue and pain

• Your sleep can be affected by lots of factors.
• There are no quick fixes, but understanding how sleep works for you can really help.
• Be patient and persevere.
• You may need to practise strategies consistently for weeks to months, it can take a while for changes to occur.
• Making small, consistent changes to your sleep routine and habits can make a big difference.