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In today’s fast-paced society our workplaces, schools, communities, and daily routines often become packed.

These busy schedules make it difficult to maintain healthy sleeping patterns.

Sleep plays a large role in both our physical and mental health. Despite spending a third of our lives asleep, sleep deprivation is incredibly common.

Around 1 in 3 of us will experience occasional sleep problems at some point in our lives and 1 in 10 people will be affected by ongoing sleep problems.

The importance of sleep

Sleep plays a significant role in healing and repairing blood vessels, maintaining a healthy weight and balanced hormones, and helps control sugar levels.

Sleep also affects our moods, behaviour, learning capacity, and how we interact with others.

Not getting enough sleep can limit our ability to deal with negative situations and alter our decision-making processes. 

Five factors that could be affecting your sleep

1. Mental and physical health

Lack of sleep is correlated with mental health issues – problems with sleep can be both a contributing factor and a side effect of poor mental health.

Sleep problems are common in individuals who experience mental health difficulties such as depression, ADHD and anxiety.

However, it is difficult to determine exact cause and effect relationships between sleep and mental health, and research into the topic is ongoing.

Studies have shown improved quality of sleep is associated with improvements in mental health and well-being.

Poor physical health can also cause your sleep to suffer. 18% of adults said that a physical health condition or disability had negatively affected their sleep.

2. Relationships and lifestyle

A fast-paced lifestyle with constant use of technology can make it difficult to switch off at night and busy social schedules can get in the way of getting enough hours of sleep.

Caffeine and alcohol usage before bed can result in poor sleep.

The relationship between sleep and social relationships has not been fully defined but sleep quality and relationships have been shown to have a correlation.

In one study, a stable relationship history was shown to be associated with improved sleep quality and continuity. Furthermore a separate study suggests quality and presence of social relationships, especially our closest relationships play a role in sleep quality.

3. School

School is a factor that can often limit a child’s sleep, the early start times require adolescents to wake up earlier than their body clock would prefer. 

Children and adolescents who achieve a recommended sleep duration may be better able to manage their emotions and report better quality of life and wellbeing.

4. Work

High work demands, job strain, level of control people have over their job, work pressure, workplace bullying, and an imbalance between effort and reward are all workplace factors that could negatively impact your sleep.

37% of working adults report their work reduces the amount of control they feel they have over their sleep.

5. Environment

Environments that are noisy and bright are linked to a lack of sleep.

Bedrooms should be kept cool, quiet, and dark to ensure good sleep.

Screen time usage before sleeping is linked to unhealthy sleeping habits and bad sleep and LED light, in particular, can lead to poor sleep.

Sleep and COVID-19

An additional factor that has been negatively impacting sleep is COVID-19. The pandemic has resulted in worsening sleep for UK adults.

Over 25% of UK adults reported COVID-19 has negatively affected how well they sleep.

Fixing your sleep

Although bad sleep is incredibly common, the principles and practices of developing a healthy relationship with sleep are simple.

  1. Reduce stress.
    • Stress can have major impacts on sleep, practicing relaxation techniques such as breathing exercises or progressive muscle relaxation can help reduce the impacts of stress.
  2. Protect your sleep from lifestyle and environmental factors which could upset your sleep pattern.
    • Consider reducing the intensity of aritifical light in your home and spending a couple of hours before bed without technology like your phone, laptop, or television.
    • Create a time to wind down before bed.
    • Avoid drinking alcohol or caffeine before bed.
  3. Make your bedroom more sleep-friendly
  4. Personalise your sleep by determining how much sleep you require and what times work best for you to go to bed and wake up.
    • Try keeping a sleep diary for 10 days to see what works best for you.
  5. Maintain a regular bedtime and sleep pattern.
    • It is particularly important to get up at a similar time each day, even on weekends. This will help train your body clock to regular sleep and wake times.
    • To increase your chances of getting a good sleep try to avoid napping throughout the day. If you must nap, try to keep it short (around 20 minutes).

Learn more

The National Centre for Mental Health (NCMH) offers further information about the relationship between sleep and mental health.

Episode 5 of NCMH podcast Piece of Mind: Mental Health & Psychiatry discusses sleep and if it is a cause of mental health problems or a symptom.

Listen here.

Resources

HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to free mental health support for all NHS Wales employees, students and volunteers. 

HHP Wales is a free, confidential service that is supported by Welsh Government funding and administered through Cardiff University.

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When you first get in touch with HHP Wales you will be put in touch with one of our doctor advisors to help us understand the support you need. Dr Rob Morgan is one of these advisors and has shared his story of how he came to work for HHP Wales.

HHP Wales provides access to mental health support, which includes signposting for cognitive behavioural therapy (CBT), self-help, guided self-help, peer support and virtual face-to-face therapies with accredited specialists. Find more details of how we can help you here.

Part-time GP Dr Rob Morgan began working as a Dr Advisor for Health for Health Professionals Wales (HHP Wales) in March of this year.

As the pandemic has increased strain on the NHS at every level, Rob explains the stress this has in turn placed on staff.

Rob explained: “Like other branches of healthcare, at the moment, General Practice is tough, trying to deal with backlogs of routine service and the everyday demand coming through the front door, both acute and long term, and more often or not related to COVID-19 in some way.

“Appreciating this situation in January this year made me think, as I have more free time than I have ever had in my career, why don’t I try and work for HHP and go on applying the bank of non-judgmental listening skills I have been applying all of my career.”

The impacts of COVID-19 on Rob’s life extended beyond professional when he was diagnosed with COVID-19. For Rob, seeing first-hand the negative impacts COVID-19 can have on both physical and mental health led him to join HHP Wales.

“My own experience of COVID-19 both as a GP and as someone infected early in the first wave I am sure had some influence on my decision to want to help.

“Speaking to people with this terrible illness back in March 2020 was a new experience, even though I have seen a lot of ill people in my working life.

“Having covid itself was an experience I would not like to repeat, and although I was lucky enough to not need hospitalisation, it’s too soon we forget those feelings of uncertainty over having an illness that we didn’t know much about at that time.

“That uncertainty wasn’t something unique to me or other patients it was also deeply felt by family members who gave care and comfort.”

Rob found his personal experience of COVID-19 gave him a deeper insight into the experiences of his patients.

“What has become clear to me, the more patients I have spoken to over the last 12 months, is the psychological burden that a lot of people have suffered.”

Rob discusses these psychological burdens including:

  • Coping with isolation during COVID-19 lockdown
  • Working under stressful circumstances with no end in sight
  • Losing family members and colleagues to the illness
  • Feeling a loss of confidence

Have you found NHS workers to be affected by the psychological struggles associated with COVID-19?

Rob discussed how he has found the psychological struggles associated with COVID-19: “It is more apparent in health and social care workers who have manned the front lines, gone over and above normal duties and put themselves at risk by the very nature of what they were doing.

“This last point gives extra emphasis to the reason I felt I would like to help such individuals and working for HHP has allowed me to do this on a weekly basis.”

What is the role of a HHP Wales Dr Advisor?

“As a Dr advisor, my role is totally different to that of being a GP. I don’t offer therapy and I don’t diagnose. During an HHP Wales client call, I listen, encourage and help whoever phones to tell their story and say what’s needed to allow things to move forward.

“Conversations are confidential and provide a space for people to talk to someone unrelated to their situation who can hear things afresh and without any bias. Most of my conversations last half an hour but can take less or more.

“At the end of a Dr advisor conversation options are discussed to decide what people want to do next and what options might benefit them moving forward.

“This can take many forms and can range from referral to a therapist or not doing very much at all as self-realisation has found the appropriate answers anyway. There’s no right or wrongs.”

Dr Rob Morgan is one of the Dr Advisors you may speak to when you reach out to HHP Wales. The easiest way to access HHP Wales' resources is through the referral form.

Have you found any challenges moving from working as a GP to a DR Advisor?

“My greatest challenge I think has been moving away from my GP role into a DR advisor role and acting as a conduit to something that can bring about change rather than bringing about that change myself.

“This movement has been helped by the regular team meetings and supportive supervision that HHP offers me and other doctor advisors on a regular basis.”

Resources

Read more

Sarah is a consultant anaesthetist living in Cardiff. She shares her experience of how HHP Wales helped her through personal struggles.

  • Read Sarah's story here

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Many people think of PTSD as something that affects those who have had traumatic experiences while serving in the military, but it can affect anyone who has experienced a traumatic situation.

Post-Traumatic Stress Disorder (PTSD) is the name given to a set of symptoms that some people develop after experiencing major traumatic events. The traumatic event can be a single incident or take place over many months or years.

The condition can be brought on by events such as serious traffic accidents, rape or sexual abuse, domestic violence, physical assault, traumatic childbirth, witnessing a violent death or virtually any other situation that is exceptionally threatening or catastrophic and likely to cause distress in almost anyone.

Symptoms of PTSD

People living with PTSD  often experience repeated and intrusive distressing memories of the event.

There may also be a feeling of reliving (or ‘re-experiencing’) the event through ‘flashbacks’ or ‘nightmares’, which can be very distressing and disorientating. There can also be physical reactions such as shaking and sweating.

More recently, complex PTSD has also been identified, which may harbour similar symptoms to PTSD, but with additional symptoms such as difficulty controlling your emotions, constant feelings of hopelessness, dissociative symptoms such as depersonalisation, and many more.

10 things you may not know about PTSD

  1. Two million people in the UK are affected by PTSD.
  2. Only one in four of those living with PTSD get treatment.
  3. £400,000 is spent on research on PTSD each year in the UK.
  4. Exercise can help manage PTSD.
  5. People have different thresholds for trauma.
  6. Children can also develop PTSD.
  7. Some studies show that giving people an opportunity to talk about their experiences very soon after a catastrophic event may reduce some of the symptoms of PTSD.
  8. Women are at higher risk of developing PTSD.
  9. For some people therapy might be all that’s needed for treatment.
  10. Even when no longer in danger, some people with PTSD continuously release hormones called cortisol and adrenaline – the ‘fight, flight or freeze’ response.

Getting help

If you think you might have PTSD you should first see your GP who will perform an initial assessment.

Depending upon the outcome of this, your GP will decide whether you need a referral to a primary care mental health worker, your local Community Mental Health Team (CMHT) or another service, depending on your needs.

If you are referred to your local CMHT you will receive a further, more detailed assessment, and you may then be referred on to a specialist traumatic stress service or receive help from within the team.

Treatment for PTSD

Psychological therapies are considered to be the most effective treatments for PTSD.

In particular, there is good evidence that two types of psychological treatments which focus on the traumatic event called Trauma-Focused Cognitive Behavioural Therapy (TFCBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are effective.

Both techniques have been shown to reduce the symptoms and the distress experienced by PTSD sufferers.

Cardiff University research trials into new treatments using both of these techniques have seen success over the last few years:

  • The RAPID trial looked at creating a new guided self-help tool, using an online programme called Spring.
  • 3MDR or Modular Motion-assisted Memory Desensitisation and Reconsolidation, is a new treatment, originally developed in the Netherlands, that combines Virtual Reality Exposure and EMDR, and adds motion through walking on a treadmill.

Other treatments such as medication and stress management techniques are sometimes used to treat PTSD and can be helpful, although these have not been shown to be as effective.

There are a variety of treatment options for PTSD and while medication can be very helpful, it isn’t the only option. Often, just talking to a professional can be the most effective way to work through the trauma and learn how to manage the symptoms.

Be forgiving to yourself

Give yourself time and space to acknowledge what you have been through and that you are having strong emotional reactions to it.

Avoid using alcohol and drugs to make you feel better. Although these may make you feel better in the short term, they can cause serious problems for you and your loved ones. They can also worsen symptoms and interfere with treatment.

Stick to normal routines as much as possible. If you have problems with sleep try to keep to a regular time when you wake and get up and avoid caffeinated drinks after 4pm.

Tips for carers

  • Try to be patient and understanding with the person with PTSD.
  • Don’t put pressure on the person with PTSD to talk about their experience, but do allow them time and space to talk about it if they want to.
  • If they haven’t done so, try to encourage them to seek professional help. A good place to start is discussing things with your GP.

Resources

HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to mental health support for all NHS Wales employees, students and volunteers. 

HHP Wales is a free, confidential service that is supported by Welsh Government funding and administered through Cardiff University.

Read more


This blog was originally shared on the National Centre for Mental Health website. To read the original post please click here

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Sarah is a consultant anaesthetist of over twenty years from Cardiff.

Sarah shares how her mental health was affected by issues in her family and how HHP Wales and therapy services have helped her access the help she needed to cope.

Sarah has kindly shared her story in the hope that it will help others reach out for support when they need it.

woman and child walking in a forest

“Things started for me three years ago in January 2018. I had a normal, busy life: happily married with two teenage daughters and I had never suffered with mental health problems before. Life was good but then things started to unravel.

"My mother passed away in January 2018, which was unexpected, but I feel I coped fairly well. I was perhaps a little bit reserved at home and had maybe taken my eye off the ball with my teenage girls.”

Sarah’s family situation took another unprecedented turn when her youngest daughter was diagnosed with anorexia in June 2018.

Sarah explained, “This diagnosis came after a case of depression for my daughter that had been well hidden from the family, but we came together to tackle it.

"I thought I understood eating disorders and I was determined we were going to fight to get my daughter back into good health. But unfortunately, it really took its toll on all of us.

"Initially I struggled on at a very high-stress level at both work and home but by August my daughter was severely unwell, needing 24-hour care with suicidal ideation and anorexia.

"I found I just couldn’t work any longer and I went to see my GP at this point and asked for some anti-depressants. I knew I needed resilience to carry on and I was struggling to sleep, eat and focus. I gave everything to my daughter and our lives were just turned upside down.”

What made you first realise that things weren’t right for you?

“I thought I was just about coping at home but until you have lived with or known someone with anorexia you just do not know what it does to a family. It is incredibly difficult.

"At work, my mind was totally on whether my daughter was safe at all times. I was doing treatments and procedures and I felt things were just getting to be unsafe. I was in a position where I could be dangerous.

"I thought I had to stop and take some time out, initially thinking it would just be a few weeks.”

However, Sarah’s struggles sadly evolved further.

“My daughter took an overdose a month later and luckily she survived but the level of care that she then required prevented my concentration on anything else.

"I continued seeing my GP monthly and while she was supportive, it turned into a horror story of life at home and not about much about myself and how I was dealing with things. I wasn’t concentrating on my mental health and everything was given to my daughter.

"That was the first six months; I saw no way of dealing with it other than increasing my dose of anti-depressants and being at home full-time.”

Did you try to seek help beyond your GP?

“I felt there was no time. There was no space in my life to look after me other than that monthly GP visit; that was all I could do and it didn’t seem right at the time to do anything else.

"I did ask to see Occupational Health because I was hoping to get back to work. We got to a slightly more stable position with my daughter in January 2019.

"I thought I had taken plenty of time away and now I needed to get back at it again.

"I did a fast return to work but there was no way of planning an easy workday as an anaesthetist; it is completely unpredictable.
I was back in and working the best I could. I wasn’t great but I struggled through it thinking this is where I should be.

"I just about coped at home and we grumbled on until my daughter’s second overdose where the world just stopped and the wheels came off again.

"I couldn’t cope with anything. That was a turning point for me and rock bottom for my daughter. She was kept as an inpatient for a few months and I decided to use that time to try and help myself.”

A self-referral to HHP Wales

“A colleague told me about HHP Wales and I phoned them. I had an instant response and was assigned a councillor who I managed to see in a couple of weeks. It was all very efficient and that’s how I started on my route with HHP.”

Sarah contacted HHP Wales over the phone. With the launch of our new website, the quickest way to refer yourself for support is through our referral form.

“HHP Wales were a very useful service and the explanation of the 8 sessions I received was well explained. We discussed a brief mental health history and began the CBT (Cognitive Behavioural Therapy) sessions. The overall experience had both good and bad elements.

"I saw a very nice counsellor and we talked through what was going on but I found that the sessions did turn into discussing my daughter’s problems, rather than directly aiding me in controlling my anxiety or improving my sleep problems.

"It could well have been the place I was in mentally and different things do help at different points in an individual’s mental health journey but I thought I’d done my best and found the sessions more as just a place to talk.”

What happened next?

“After those initial CBT sessions, I was referred for an assessment through my income protection insurance which highlighted how bad things were for me. This was my lowest point.

"Nearly a year on from my first visit to the GP, the psychiatrist undertook a medical assessment and understood my situation very quickly.

"I was offered further sessions with a local psychotherapist which became a real turning point for me. I was at the stage where my depressive symptoms were at their worst and I had been fully supporting my daughter through a year and a half of constant care while experiencing my own problems.

young woman with long dark hair speaking to another woman across a table

"The psychotherapist took a different approach and I was able to explain more about myself and my life. The sessions helped me understand why I thought in certain ways, due to my own upbringing and experiences throughout my career. Everything started to make a lot more sense and we used techniques that really resonated with me.

"I found myself stopping, thinking and working a different way. This connection with the therapist saw me through twelve sessions with my last one taking place in September 2020.”

HHP Wales provide access to mental health support which includes booking appointments with therapists. We offer self-help, guided self-help, peer support and virtual face-to-face therapies with accredited specialists. Find more details of how we can help you here.

How are things for you now?


The tools and support offered through therapy sessions have given Sarah new strategies to help her cope when life gets difficult.

“I returned to work at the start of the COVID-19 crisis in April and even there I noticed how I was so much better at coping than I thought possible.

"Within a few months, I felt more myself than I had done in the past three years. I’ve reduced my medication and everything is looking more positive because I have learnt to deal with things in a different way.

an older blonde woman smiling at a younger blonde woman

"My happiness is dictated to by daughter and the rollercoaster of mental health effects people differently and we are having a dip now. The last few days have been tough, but I am able to look at things more clearly.

"I am keener to look after myself and determined to not go back to where I was before.

"I now work part-time, my workload is more manageable and I have good support in the workplace. I know assistance is there through Occupational Health and HHP Wales should I need it again and that helps me feel supported.”

Do you have any advice to share with staff who feel they are struggling?

“Seek extra help earlier and don’t delay like I did. Occupational Health offered a helpful, positive experience. Speak to your GP, self-refer to HHP Wales and make your own health and well-being a priority.

"Finally, I’d recommend everyone get outside when they can. Getting into the open air and feeling part of nature really helps me feel well. Sleep is important too as everything feels worse when you’re overtired.

a woman walking down a path in a park

"It has been difficult in the last three years to always keep in touch with friends, particularly as people often didn’t know the best thing to say, but I have found my experience has made me see things differently with my relationships. I forgive people, my attitude to people and life has totally changed.

"I have always been a very driven person, but I now think of everyone’s struggles in a kinder way. Some good things have come out of this horrible journey of ours and the way I live my life now is better than before.”

Sarah and her family’s story remind us of the obstacles and difficulties that can cause a change in our mental health when we are forced to face new and unexpected life challenges.

Timing, relationships and accessing effective support through talking therapies, particularly when living with an ongoing difficulty, can impact our mental health on a day-to-day basis.

HHP Wales is here to help if you need us.

Resources

Read more

Natalie is a GP trainee living in West Wales. She shares her experience of accessing HHP Wales during the COVID-19 pandemic.

South Wales pharmacist, Geraint Jones, contracted COVID-19 in April 2020. He has kindly shared insight into his experiences of accessing support through HHP Wales after he was later diagnosed with Long COVID.

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Nature is the theme of this year's Mental Health Awareness Week and Professor Debbie Cohen, one of the founders of HHP Wales, has kindly shared some thoughts on how important it is for NHS staff to connect with nature.

Hello, my name is Professor Debbie Cohen and I'm an emeritus professor of occupational medicine at Cardiff University, which means I’m retired from the NHS and from Cardiff University, but I'm not fully retired!

Towards the end of my career and since I retired I have built up a 10acre small-holding or a small farm where I breed and manage rare breed animals such as sheep, pigs and goats.

There is a growing amount of evidence to show that there are many benefits to being outdoors, including positive effects on both physical and mental health.

Engagement with the outdoors and the natural environment can take many forms including gardening/growing, visiting or exercising in green spaces, interacting with wildlife and taking part in conservation work.

A recently completed study by Sustainable Health Care found that across three NHS sites included in the study there was a strong appetite among health staff to take time outdoors, with up to 89% of staff reporting that they would like to spend more time in green space at their site than they currently did (1). 

Staff who said they regularly spent time in their sites' green spaces during the working day reported significantly higher levels of wellbeing.

The most common way in which staff spent time in green space at work was taking a walk at the site during a break.

A young dark haired woman walking along a path through a park

Something else I've also learnt on my journey in my new occupation is how to manage the land, how to think about how to build up my land which had been left fallow for over 10 years.

In the face of climate crisis and loss of biodiversity farming and those concerned with the natural environment have had to think big about how they could regenerate and recreate a system that is more sustainable.

The challenge here for the NHS is to think about what we can learn from these ideas about sustainability and restoration from the natural environment that we can use to develop and create a more sustainable workforce as well as a more sustainable healthcare system?

Space to breathe: valuing green space at NHS sites for staff wellbeing

https://youtu.be/6W8vMW2srEs

We need to think bigger, we need to be bold and learn from others; thinking holistically about organisations in the same way we would think about restoring a natural environment and how we can continually regenerate something that becomes sustainable.

For example, adding nitrogen as a quick fix to soil without caring for what depletes it is not sustainable. We’ve got to get the foundations of the soil right to support healthy growth.

So what can we learn from what has been going on around us?

Why not click on some of the following videos to see what some of my friends and colleagues have been thinking about.

What ideas could you take and use?

Sue Pritchard - Chief Executive of the Food Farming and Countryside Commission

https://youtu.be/c2AnjRQZ24A

Kim Stoddart - Gardening journalist, writer and editor

https://youtu.be/uTqqA0bXtAI

Apologies if there are issues viewing this video in the blog, it is available here on Youtube.

Dom Higgins - Head of Education and Health at the Wildlife Trust

https://youtu.be/MdZ0UiLirC0

Thanks and video credits to Ben Harris

1.  Centre for Sustainable Healthcare (2020).  Workplace, Wellbeing and Green Space

Resources

HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to mental health support for all NHS Wales employees, students and volunteers. 

HHP Wales is a free, confidential service that is supported by Welsh Government funding and administered through Cardiff University.

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