By Dr Praveen Rooproy, GP and Lifestyle Medicine Physician, in collaboration with Dr Lisa Rodolico. 

Praveen and I first met in our early days at university. One summer, she emailed asking if I had a spare room in the house I was moving into — her accommodation had been delayed, she said, and she only needed somewhere temporary. Four years later, she finally moved out, having become an irreplaceable part of my life. We spent countless late nights revising together, quizzing each other on anatomy, physiology, and everything medical school could throw at us.

Our careers eventually took us in different directions, but when I decided to write about sleep — something that affects so many of my patients — she was the first person I wanted to ask. I’m delighted to share her expertise in this piece....

Sleep difficulties are extremely common, affecting up to one in three adults. While many people experience short periods of disturbed sleep during stressful periods of life, others struggle with persistent problems that affect their concentration, mood, physical health and overall wellbeing. The two most commonly recognised sleep disorders are insomnia and obstructive sleep apnoea, but sleep disturbance can occur for many different reasons — medical, psychological, behavioural, and environmental.

Understanding why sleep is disrupted is often the key to improving it.

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Why Sleep Matters for Overall Health

Sleep is not simply “rest”. It is an active biological process essential for emotional regulation, cognitive performance, metabolic balance, immune function and cardiovascular health.

Chronic sleep disruption has been associated with an increased risk of:

• Cardiovascular disease

• Depression and anxiety

• Impaired glucose regulation and Type 2 diabetes

• Stroke

• Certain cancers

• Migraine and chronic headache conditions (If you experience headaches or migraine alongside sleep problems, this article may be helpful).

From a lifestyle medicine perspective, sleep is one of the foundational pillars of health. During sleep, the body carries out essential processes:

• Cellular repair

• Inflammation regulation

• Memory consolidation

• Hormonal balancing

• Emotional processing

When sleep is consistently disrupted, these systems become dysregulated, which is why poor sleep can feel so impactful — physically and emotionally.

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How Much Sleep Do We Need?

Sleep need varies, but the general guidelines are:

• Adults: 7–8 hours

• Teenagers: 8–10 hours

• Children: more, depending on age

Rather than focusing solely on the number, it is useful to consider:

• Do you wake feeling refreshed?

• Do you feel sleepy or irritable during the day?

• Are you relying on caffeine to function?

• Are concentration or memory affected?

If the answer to many of these is “yes”, your sleep is likely insufficient or not restorative.

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Understanding the Structure of Normal Sleep

Sleep is made up of cycles lasting around 90 minutes. Each cycle includes four main stages:

1. Stage 1 – Light sleep (NREM)

2. Stage 2 – Intermediate sleep (NREM)

3. Stage 3 – Deep sleep (NREM)

4. Stage 4 – REM sleep

Deep sleep is vital for physical restoration, while REM sleep plays a key role in memory, creativity and emotional regulation. A typical night involves moving through these cycles multiple times.

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What Affects Sleep?

Sleep is influenced by a range of internal and external factors:

Biological and medical factors

• Obesity

• Hormonal changes (e.g., menopause, thyroid dysfunction)

• Chronic pain

• Respiratory illness

• Neurological conditions

• Gastro-oesophageal reflux

Mental health and cognitive factors

• Stress and worry

• Anxiety

• Depression

• Trauma or hyperarousal

Lifestyle behaviours

• Caffeine or alcohol use

• Irregular sleep-wake patterns

• Excess screen time

• Lack of exercise

• Dehydration

• Unbalanced nutrition

Environmental factors

• Noise

• Light exposure

• Temperature

• Uncomfortable bedding

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Sleep and Neurodivergence

Sleep disturbance is particularly common in neurodivergent individuals, including those with ADHD, autism, and other forms of cognitive or sensory difference. Neurodivergence influences how the brain regulates alertness, sensory input, routine, and transitions — all of which play a role in sleep. Traditional sleep guidance, such as strict routines or limiting stimulation, may not always be effective and can sometimes increase pressure or anxiety around bedtime. A neuroaffirming approach recognises that sleep needs and rhythms vary widely, and that there is no single “correct” way to sleep well.

Working collaboratively to understand personal patterns — sensory preferences, movement needs, relaxation styles, and circadian tendencies — can be far more helpful. Speaking with a clinician experienced in neurodivergence can support you in identifying strategies that are realistic, compassionate, and tailored to the way your brain works. I’ve written more here about supporting neurodivergent wellbeing.

Autistica have an excellent article on the links between sleep and anxiety and CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) have a lot of resources covering sleep in ADHD.

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Signs You May Have a Sleep Problem

You may notice:

• Difficulty falling asleep

• Lying awake for long periods

• Waking frequently or too early

• Difficulty returning to sleep

• Feeling unrefreshed in the morning

• Excess daytime tiredness

• Irritability, low mood or reduced stress tolerance

• Difficulty concentrating or “brain fog”

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Evidence-Based Strategies to Improve Sleep

These measures form the foundation of effective sleep hygiene:

1. Build a wind-down routine (around 90 minutes)

Choose calming, predictable activities: reading, a warm bath, guided meditation, gentle stretches, or soothing audio.

2. Keep consistent sleep and wake times

Regularity strengthens your internal body clock.

3. Optimise your sleep environment

Aim for a quiet, cool, dark bedroom and minimise screens.

4. Limit screens before bed

Blue light and mental stimulation interfere with melatonin release.

5. Don’t force sleep

If you cannot sleep, get up and do something quiet before returning to bed when sleepy.

6. Try mindfulness, CBT-I techniques or journaling

These can help settle a busy mind and reduce nighttime worry.

7. Be mindful of food and drink

Avoid heavy meals, alcohol and caffeine later in the day.

8. Avoid daytime naps

Unless medically necessary or extreme fatigue makes it unsafe.

The UK National Health Service has some excellent sleep related resources:

• • NHS – Insomnia: https://www.nhs.uk/conditions/insomnia

  • NHS – Sleep and tiredness: https://www.nhs.uk/live-well/sleep-and-tiredness

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When to See a GP

Consider seeking medical review if:

• Sleep problems persist despite lifestyle changes

• You feel unrefreshed despite adequate hours

• You fall asleep unintentionally during the day

• Your mood, concentration or functioning are affected

• You snore loudly, stop breathing during sleep or gasp for air

• A partner observes unusual movements or behaviours at night

• You increasingly rely on alcohol or medication to sleep

• Sleep difficulties worsen a chronic health condition

A GP can help identify underlying causes, arrange investigations, and support you in developing a tailored approach that aligns with your lifestyle and health needs. 

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How Rodolico Health Can Help

If sleep problems are affecting your wellbeing, concentration, mood or day-to-day functioning, a personalised assessment can be extremely helpful. As a private GP service in Florence, we offer:

• Comprehensive evaluation of sleep difficulties

• Guidance for insomnia, sleep apnoea and lifestyle-related sleep issues

• Neuroaffirming support for sleep in neurodivergence

• Child and adolescent sleep advice

• Evidence-based strategies tailored to your routine and health needs

Book an appointment or virtual consultation here