Sleep is an important way our bodies and minds recover after each day. Poor sleep can sometimes cause emotional distress, but it may also be a symptom of mental illness. Sometimes medication is used for a period to help people sleep; however, usually non-medication methods are the mainstay. These non-medication methods are sometimes called sleep hygiene and include the tips below:

1. Slowly increase exercise, but not within 2 hours of your bedtime. You should get some form of exercise 3-4 days per week (e.g. walking, running, swimming, cycling). Seek advice from your GP if you have not exercised for some time, if you have any serious medical condition, or if you find it difficult to exercise.
2. Reduce your daytime napping. This can affect your ability to sleep at night; if you spend time during the day in bed, you may not feel tired at night. Occasional napping during the day when tired is not likely to affect your overall sleep pattern, however one should not routinely nap during the day, and naps should generally be limited to 30 minutes.
3. Reduce caffeine intake, especially before bedtime. Caffeine is a stimulant which prevents you from falling asleep. Coffee has significant amounts of caffeine in it. Tea also contains caffeine, about half the strength of coffee, and it too should be avoided before bedtime. Cola also usually contains caffeine and should be avoided. Some tablets such as Solpadeine or Neurofen plus contain caffeine and are best avoided before sleep also.
4. Reduce alcohol intake, especially before bedtime. Some people feel that alcohol helps sleep, however in the long term it is likely to make your sleep worse. Alcohol also reduces the quality of sleep that you do get, so you may feel tired the next day. If you have been a heavy drinker and decide to stop or cut back you are likely to experience sleep difficulties for a number of weeks while your body adjusts.
5. Avoid large meals within 2 hours of your bedtime.
6. Avoid playing computer games or watching TV in bed. Anything that is too mentally stimulating can affect sleep. If you have difficulty sleeping it is best to only sleep in bed and do other activities elsewhere. If you associate bed only with sleeping, you will usually feel more tired when you get into bed.
7. Relaxation techniques may be useful if you feel anxious when trying to get to sleep. Such techniques include breathing exercises and muscle relaxation.
8. Develop a routine for going to bed and waking up at the same time each day, even at weekends. We all have an internal body clock which tells us when we are tired and should go to bed, and when we should be getting up. This is why people yawn when it is bedtime, and why people often wake up at the same time each day, even without an alarm clock. By keeping to your usual routine, this will help your internal body clock to adjust so that you feel sleepy at the right time each night, and fall asleep quicker.
9. Avoid ‘clock-watching’ or repeatedly looking at the time on your alarm clock when lying awake in bed. This can keep you awake by making you anxious at not falling asleep.
10. Some people find it helpful to get out of bed to do something like reading a book if they are lying awake for too long, and then going back to bed when they feel tired again, usually after 15-20 minutes or so. Some people also find a bath early in the evening helpful.

More information may be found on the Royal College of Psychiatrists website and from the BBC Headroom episode on sleep.

Exercise can form a crucial part of maintaining good mental health. Physical activity has traditionally formed a greater part of people’s daily work life, however over the last hundred years, advances in technology have meant that many people work in offices and other jobs requiring no exercise at all. Exercise can work as a natural anti-depressant and anti-anxiety measure, and can have other benefits such as improving our concentration and sleep. Exercise can also have health benefits in many other aspects of our life such as reducing the risk of diabetes, obesity, heart attack and stroke.

Exercise can take many forms, and it is important to be realistic in your goals when starting.

Any exercise at all is better than none, but at least 30 minutes per day, 4-5 days per week is recognised as providing the most benefit. This kind of exercise may include activities such as brisk walking, gardening, yoga, dancing or team sports.

Some of these activities can provide further benefits from the social interactions which come from meeting others. It is important not to over-exercise as this may make you tired, and greater amounts of exercise beyond the 30 minutes per day may not necessarily provide more benefit for your emotional well being. You can discuss with your doctor or a fitness instructor about how much exercise is most beneficial for you.

Cycle of Depression/Anxiety and Exercise

Gaining the motivation to exercise is often the most difficult part to getting started. If you have not exercised for some time then it is worth attending your general practitioner for a check up, and to discuss your new plans. People with mental health difficulties such as anxiety and depression can find it particularly difficult to start back exercising as low energy and lack of enjoyment can be hugely debilitating symptoms in these conditions. These symptoms are often tied in with anxiety and poor sleep, both of which can be improved with exercise. This can often lead to a destructive cycle whereby when you get depressed and you exercise less, which can worsen your depression. Even gradual, small amounts of exercise can have benefits in this situation. If you find it too difficult to exercise then consult with your doctor.

More information may be found on the RCPsych website.

Alcoholic beverages are commonly consumed in Irish society, and it is recognised as being part of our culture. Some of the benefits of alcohol are that it is used for socialising or winding down, and mild to moderate drinking usually causes no ill health effects. Recent times have seen an increase in the number of young people drinking, particularly heavy binge drinking, and increased alcohol consumption among women has also been noticed.

Safe Drinking limits
The recognised safe drinking limits are reported in units. These limits differ between men and women because even at the same weight, a woman will store a higher amount of alcohol in her body for the same amount of alcohol drunk as a man. The weekly limit for men is 21 units, and for women is 14 units. These limits should be considered as maximum safe limits, and some people may be more sensitive to the effects alcohol than others.

This drinking should be spread throughout the week rather than all in one go, and there should be at least 2-3 days of no drinking each week. Binge drinking should also be avoided if possible as this is more likely to cause damage to organs such as your brain and liver. Greater than eight units in one day for men and six units in one day for women is considered binge drinking.

The amount of alcohol in one drink varies depending on the strength of alcohol and the size of the measure. For example a pint of beer usually contains between 2-3 units of alcohol, while a standard 125ml glass of wine contains between 1.5-2 units. A bottle of table wine usually contains between 9-11 units of alcohol. A pub measure of spirits in Ireland contains approximately 1.25 units.

For more information on your drinking patterns, understand the risks and find out hwo much is too much visit the Ask About Alcohol website.

More information on the number of units in different drinks may be found on the RCPsych website.

Complications of Alcohol Use

When people start drinking alcohol it usually causes no problems; however, after a number of years of excessive use, alcohol can affect our health in many different ways. In the United Kingdom it is estimated that 1 in 3 men and 1 in 6 women have some sort of health problem caused by alcohol. We can divide alcohol health problems into physical, psychological and social.

Physical complications of alcohol include conditions such as stomach ulcers, liver failure, inflammation of the pancreas, and heart conditions. It is now recognised that just a few days of binge drinking can cause brain damage, and chronic heavy use of alcohol can lead to dementia. It is also recognised that chronic alcohol use can lead to worse hangovers, and it may take longer to recover from alcohol use over time.

Other people experience psychological effects from drinking, such as depression, anxiety, psychosis and memory difficulties. Alcohol is often used by people as a ‘crutch’ when they are suffering with low mood or experiencing severe life stresses. This can often seem as a good way of coping with life, however it is recognised that use of alcohol for this can lead to depression in the long term. It is also recognised that alcohol use can be the main cause of depression in some people, and when they stop drinking they notice an improvement in their mood.

Some people can suffer from social problems as a result of their drinking, such as relationship difficulties, financial difficulties and occupational problems. Alcohol dependence is a severe condition where drinking becomes part of someone’s daily routine. This condition can develop over time, and may be associated with many of the difficulties described above.

Reducing your drinking

If you wish to cut down your alcohol consumption but are finding it difficult, it may be worth discussing this with your General Practitioner, who could consider referring you to a counsellor or an addictions specialist. It could be worth keeping a drinking diary to monitor the amount of alcohol you are consuming each week so you are aware of situations where you may be drinking too much.

The following tips may help:

1. Eat before drinking, because alcohol will have a stronger effect on you if you go out on an empty stomach.
2. Avoid getting into large rounds when out drinking.
3. Drink at the same pace as the slowest drinker in the group rather than the fastest drinker.
4. Take sips of alcohol instead of gulps.
5. Drink a non-alcoholic beverage between drinks. This could be a non-alcoholic beer or a glass of water.
6. Offer to be the designated non-drinking driver when attending social events.
7. Consider discussing your worries about the effects alcohol is having on you with your friends or with someone in your group of friends who you trust. You may be surprised that you are not the only one in your group who has worries about the effects alcohol is having on you.
8. Be aware of the amount of wine poured in a glass, and ask for a small glass if possible. In order to keep aware of how much alcohol you are consuming, finish your drink completely before accepting a re-fill.

If used responsibly drinking alcohol can provide much enjoyment and complement our social lives. Awareness of the safe use of alcohol is important so that risk of the complications of alcohol described above will be low, and alcohol can be used with enjoyment for many years.

More information may be found here:

• Alcohol: Our favourite drug – Health advice from RCPsych website
• Alcohol and depression – Health advice from RCPsych website
• The cost of alcohol abuse – BBC Health Matters
• Alcohol – BBC Healthcheck

Drug use has become more prevalent in Ireland over the last few decades with increased availability. Many people feel drugs cause few problems to their health. However there is increasing evidence that drug use can have detrimental effects on our health.

Often when people use substances for the first time they do not notice psychological problems; however, over time people who use drugs may develop conditions such as anxiety, psychosis and depression. Some people can develop these complications after using drugs for the first time. Sometimes a severe reaction to use of certain drugs (such as cocaine and ecstasy) can occur when they are used for the first time, which may lead to severe complications including death.

People who use substances may become physically or psychologically dependent on a drug, which often leads to serious social consequences having detrimental effects for a long time. These consequences can include financial difficulties, family and relationship consequences, occupational problems and legal difficulties.
Headshop substances recently received much media attention due to their widespread prevalent use, and the severity of the psychological reactions to these drugs, such as severe anxiety and psychosis. Little is known about the exact content of these substances and there was no regulation investigating their safety. Head shops were recently banned in Ireland as a result of this media attention, and reports of serious health complications in hospitals.

Family members may often be concerned at use of drugs by someone in their family. They will often notice a change in the behaviour and moods of a person which can be worrying. If you have any concerns seek help or advice from your General Practitioner who will be able to direct you to the services available in your local area if appropriate.

More information may be found at:

• Alcohol and drugs – RCPsych health advice
• Drugs and alcohol: information for young people – RCPsych health advice
• Cannabis and mental health – RCPsych health advice

Work-Life Balance

Maintaining a good work life balance can play an important role in maintaining our mental health. Excessive work can lead to stress, tension and anxiety. If we work too hard we can sometimes become less productive at work, which can lead to further stress in a destructive cycle. Winding down is important in the evening time and can help us to sleep well. Finding the time to take part in activities which we enjoy can reduce stress levels, and sometimes lead to better productivity at work.

Smoking

People with mental health difficulties are more likely to smoke, however the reasons for this are not clear. Smoking is a major risk factor for common serious illnesses such as heart attack, stroke, and many types of cancer. People who smoke are more likely to have poor overall health as well as drink excessively and use drugs. Reducing smoking can be beneficial to your overall physical and emotional health. More information may be found at on the RCPsych website here.

Diet

Maintaining a healthy diet also forms part of a healthy living lifestyle, and can have huge benefits for physical health reducing risk of diabetes, high blood pressure and obesity as well as the many complications associated with these conditions. Healthy diet is also good for our overall emotional well being. More information may be found at on the RCPsych website here.