Experts agree that proper sleep, or the lack of it, affects all systems of the body. It’s fundamental to wellbeing because it actually affects how your DNA functions in your body. So when your sleep is interrupted several times in the night when you need to pee, it’s affecting you in more ways than just making you tired and irritable next day.

Physically, sleep impacts your immune system, your metabolism, hormone regulation and your body’s ability to repair damage. It’s also crucial for your memory, thinking, decision-making, creativity, problem solving abilities, emotions, mood, stress and anxiety.

Matt Walker, Professor of neuroscience and psychology at the University of California, Berkeley, says in his brilliant 15-minute Ted Talk, Sleep is your Superpower: “Sleep unfortunately is not an optional lifestyle luxury, sleep is a non-negotiable biological necessity. It is your life support system.”

Among other things, he points out that all it takes is 1 less hour of sleep for 1 night to cause catastrophic results. It’s proven in a global experiment with 1.6 billion people that happens twice a year, called daylight saving.

In spring on the day when clocks change and people lose an hour’s sleep, there’s a 34% increase in heart attacks. In autumn, when we get an extra hour, there’s a 21% decrease. Similar statistics are shown in other causes of death including even car crashes, and suicide.

Why does interrupted sleep matter?

There are 4 stages of sleep, and you cycle through these stages several times every night (see table below). It’s only during the 2 deeper stages that the good stuff happens.

So, if your sleep is repeatedly interrupted, you’ll spend more time in the stages where you’re trying to get to sleep or becoming wakeful than you do in the deep sleep stages. That means there’s a bigger chance that you’ll lose out on the benefits of sleep.

There’s a strong connection between the continuity of your sleep and the total amount of sleep you get. Seems obvious, but scientists have gone to the trouble of proving it. The eye-opener is that just 2 nights of interrupted sleep can give you a higher sensitivity to pain.

That’s really not helpful when you’ve got a chronic condition. And that’s just with 2 nights of disrupted sleep – many people with pelvic pain conditions consider themselves lucky to get 2 decent nights’ sleep in a row. So it would be fair to surmise that when your painful condition is disrupting your sleep, then you’re in a negative cycle where your lack of sleep is making your pain feel worse.

Sleep deprivation also promotes inflammation and increases activity of the sympathetic nervous system – meaning you feel more stressed or anxious. So again, when you have an inflammatory condition such as Bladder Pain Syndrome, you could feel worse physically and emotionally because you’re not getting enough sleep.

The study says: “Short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits.”

Longer term consequences include neurodegenerative disease, depression, cardiovascular disease, weight gain and type 2 diabetes.

Poor sleep can badly reduce the power of your immune system. Matt Walker talks about a study which showed that people who were allowed just 4 hours of sleep a night had a 70% drop in Natural Killer Cell activity. NKCs identify dangerous substances in your body and eliminate them. There’s such a strong connection between NKCs and cancers that the World Health Organisation has classified shift work as a probable carcinogen.

It’s clear that when you have a painful, inflammatory condition, it’s worth taking steps to make sure you get enough sleep.

How much sleep do I need?

Sleep experts generally agree that healthy adults need 7-9 hours per night.

When your sleep is interrupted, you may benefit from being in bed longer. Your overall time asleep will be longer which will increase the chances of you getting enough of the 2 deeper stages that repair your body.

Dr Michael Breus, The Sleep Doctor, has a sleep calculator. On average, a sleep cycle is 90 minutes, and a typical night of sleep includes 5 full cycles, which amounts to 7.5 hours. So if you have to be out of bed at 7am, you’d work back from there, meaning you’d have to be in bed with the lights out by 11.30pm.

However, sleep cycles vary from person to person, especially when sleep is frequently disturbed. By tracking your sleep patterns (see tools below) you can get a better idea of your sleep needs, and keep adjusting your bedtime until it works for you. Give it a week at a time before changing the schedule.

How do I improve my sleep?

First and foremost, go through the bladder training videos we’re providing each week with Bill Taylor and Elaine Walpole, two of the UK’s foremost pelvic health physiotherapists. Countless people have told them that their lives have been changed by the approach they take in in Bill’s Edinburgh clinic, Taylor Physiotherapy.

You may have been told at some point about bladder training, but the key to success is understanding why and how Bill and Elaine’s techniques work.

Habits

• Prioritise sleep. Having read everything above, you probably realise that it’s worth choosing sleep over extra leisure time. You have that choice to make every day, which can become irritating. Still, it’s the best medicine, and will make you feel better than anything on Netflix.

• Develop a regular routine, and do it gradually (see tips below). Remember, it only takes 2 days for lack of sleep to have a negative impact, so you want to be going to bed and getting up at the same time every day, including weekends. Regulating your schedule will anchor it and improve sleep quality and quantity.

• Get some sunlight. It’s probably the most important external factor affecting sleep because it regulates circadian rhythms, the body’s internal clock which signals when to be alert and when to rest. Natural light also affects production of melatonin, the hormone w hich will be used later to prepare you for sleep.

• Dim lights in the run-up to bedtime. Sunlight is good, but artificial bright lights inhibit your body from producing melatonin.

• Limit electronic devices. Blue light from devices such as phones, tablets and laptops cause mental stimulation and decrease production of melatonin. Experts advise against using any electronics for 30-60 minutes before bed, and limiting phone or tablet use to 3 hours a day. Blue-blocking glasses may help.

• Link bed to sleep not TV or other activities. Train your brain to understand that sex is the only other thing you do there, and it will associate bed with sleep which will make it easier to fall asleep.

• Aim for relaxation, not sleep. Use the Body Scan in the resources section or the techniques below. You’ll be putting less pressure on yourself and as a consequence more likely to sleep. But even if you don’t sleep, relaxation in the dark is doing your body good.

Stimulants

• Smoking is associated with numerous problems including higher odds of short sleep duration, trouble falling or staying asleep and sleep dissatisfaction.

• Alcohol and some other drugs decrease deep sleep cycles. Dr Breus advises that you should have your last alcoholic drink 3 hours before sleep.

• Caffeine has important disruptive effects on sleep even when the last dose is taken 6 hours before bedtime, a study in the Journal of Clinical Sleep Medicine found. It discovered that consuming caffeine 6 hours before bed reduced total sleep time by 1 hour. See our extra information on caffeine and alcohol in the resources section.

• Eating late at night especially if it’s big, heavy or spicy, can mean you’re still digesting it when you get to bed.

• Exercise in the day makes it easier to sleep at night, plus it produces helpful hormones which repair your body. But strenuous physical activity can stimulate your nervous system and raise your heart rate, so if you do it in the evening, it can make it harder to fall asleep.

Environment

• Stay cool – your body temperature needs to drop for you to fall asleep so if your bedroom is too warm, you’ll find it harder to drop off. This is one of the most important tips – aim for a bedroom temperature of 65F/18C.

• Tight fitting blackout blinds or curtains really make a difference. Light is like water, it will leak out of any cracks. If you can’t get good blackout conditions, use an eye mask.

• Experts talk about the importance of sleep hygiene, which usually means make sure your mattress and pillows are comfortable.

• Make your bed beautiful. A study by the National Sleep Foundation found that people who make their beds in the morning are 19% more likely to report having a good night’s sleep regularly. And 75% said they get a better night when their sheets are fresh because they’re feeling more comfortable.

• Soothing scents such as lavender can help. Choose an electric diffuser that has a silent running feature.

• Elevating the legs an hour or more before bed in order to reduce the resorption and conversion of peripheral oedema to urine during sleep.

Naps

Opinions are divided on whether daytime dozing is helpful or counter-productive. Some studies show that it can reduce stress, increase alertness, boost your immune system, moderate blood sugar, increase stamina and creativity that facilitates big-picture visualisation.

In these circumstances, the best thing is to try it and see how it works for you. It may depend on many other factors in your life at any given time. If you’re going to nap, there are some useful considerations.

• If your sleep problems include difficulty dropping off at night, Dr Breus advises against naps. Your natural rhythms with sleep are more likely to be disrupted. For everyone else, he says naps aren’t likely to affect your sleep cycles.

• Don’t overdo it. Some studies say 10 minutes is the best duration. It allows you to catch a quick rest without entering Slow-Wave Sleep which can mean you feel groggy when you wake.

• NASA pilots who took power naps of 20-30 minutes in a study found 54% improvement in alertness and 34% increase in job performance.

• Half-hour naps have been shown to boost production of leukocytes, or white blood cells, that help the immune system tackle infections diseases. This is especially useful in winter, when we’re more vulnerable to catching the common cold and other illnesses.

• Dr Breus says 1-3pm is the ideal nap gap – the traditional siesta. That’s when melatonin levels naturally rise and body temperature drops, and both prepare your body for dropping off. He recommends no more than 90 minutes, one sleep cycle.

• Exposure to bright daylight when you feel tired can do you just as much good as a nap.
For more information, see The Sleep Doctor’s article – 9 ways napping can improve your life.

Tools to help

• Try the Body Scan in our resources section. You can watch the waves lapping on the shore if you find it calming, or just listen with your eyes closed.

• Healthline has some techniques for falling asleep within 10, 60 or 120 seconds here.

• Sleep Education has a printable sleep diary to log daily habits that affect sleep and a digital version that can connect to your Fitbit.

Changing your sleep pattern


• As with everything in Feel Free, be consistent, not perfect.

• Start by considering how your morning looks. If you’re rushing about, you might benefit from getting up 15-30 minutes earlier and allowing yourself a slower, calmer start to the day. You want to be in bed until the last moment, but actually you might feel better if you don’t.

• When you’ve decided what time you want to get up, work back to decide what time is bedtime and remember that’s when your head hits the pillow, not when you start moving towards bed from whatever you’re doing.

• Build in a 30-60 minute wind-down time – and remember winding down isn’t watching Netflix in bed! It might be a bath, meditation, tidying up, or reading a book (not on your blue-light device!)

• Be careful about what you drink in the evening, and experiment with what, how much, and when you drink. Notice what keeps you hydrated but doesn’t get you up to pee a lot.

• Monitor the effects of your bedtime, and adjust a week at a time.

What about sleeping tablets?

Obviously, you’ll consider this in consultation with your doctor. Sleeping tablets don’t produce natural sleep, can actually contribute to insomnia and can be habit-forming. But there may be times when they are appropriate for you, depending on circumstances.

Sleeping StageNamesFunctionAverage Duration
1NREM/N1Dropping off. Body not fully relaxed, may twitch. Brain activity starts to slow down. Easy to wake from.1-5min
2NREM/N2Body in a more subdued state, temperature drops, muscles relax and heart/breathing slow. Brain waves in new pattern, eye movement stops. Short bursts of brain activity help to resist being woken by external stimuli.10-60min
3NREM/N3,
slow-wave
sleep (SWS),
Deltasleep, deep sleep
Muscle tone and breathing decrease as body relaxes deeply. Brain waves identifiable as Delta. Critical for restorative rest when body can recover/grow, and bolster immune system. Brain activity reduces but there is evidence that deep sleep contributes to insightful thinking, creativity and memory.2-40min
4REM,REM sleepBrain activity picks up, nearing levels when you’re awake. But body is in atonia, temporary paralysis of the muscles except eyes and muscles that control breathing. Eyes can be seen moving quickly even when closed. Essential for cognitive functions like memory and learning. Dreams can occur in any sleep stage but this is when they are most vivid.10-60min