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In Your Dreams
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How to sleep better, longer, easier and reap more of the health benefits of getting enough rest
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By Beth Howard
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MediZine's Healthy Living Summer 2009
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It’s an epidemic: More than half of Americans are sometimes unable to fall or stay asleep, and about one-third of us experience sleeping problems every night or almost every night, according to a National Sleep Foundation survey.
Why are so many of us on night watch? Physical problems such as ulcers or back pain are among the culprits, as are asthma, allergies, certain medications and nighttime conditions such as sleep apnea.
Depression, anxiety and other emotional problems can also take a toll on your slumber. Then there’s plain old stress, a major problem in our hurry-up-and-get-it-done-yesterday culture. “So many people are sleep deprived,” says Carol Ash, D.O., medical director of Sleep for Life, a sleep disorder treatment program in Hillsborough, NJ. “We’re living in an unprecedented time of sleep debt.”
It doesn’t help that we’ve evolved into a 24/7 society. “Two hundred years ago, we went to bed when the sun went down,” Ash says. “Technology has allowed us to turn night into day. Human physiology just can’t keep up with that. People sacrifice sleep to get more and more done.”
But our round-the-clock lifestyles come at significant cost. “The ability to think, remember, concentrate and problem-solve deteriorates as we become sleep deprived,” says James Walsh, M.D., director of the St. John’s Mercy Sleep Medicine and Research Center in St. Louis.
Even worse, as research has shown, a chronic lack of sleep disrupts the body’s endocrine system, which is responsible for regulating appetite and blood sugar, among other functions. Sleeping less than seven hours a night increases one’s chance of becoming obese, according to Texas Tech University researchers.
And women who sleep five hours or less per night have a 39 percent greater chance of developing coronary heart disease, according to data from the Nurse’s Health Study. Other data suggest that skimping on sleep even increases diabetes risk.
When it comes to sleep, some people are their own worst enemy. “There are a lot of things that interfere with sleep,” says Paul Selecky, M.D., medical director of the Hoag Sleep Disorders Center at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. “But most are of our own doing.” Try these good-sleep measures:
1. Establish a bedtime routine that allows you to spend some time winding down. Perhaps a warm bath, a soothing cup of warm milk or relaxing music can help.
2. Make your bedroom as quiet, dark and comfortable as possible. Consider blackout curtains, eye shades, ear plugs, fans or a white-noise machine.
3. Limit your intake of caffeine, alcohol and nicotine late in the day.
4. Exercise regularly—but not close to bedtime. That can actually stimulate you and interfere with sleep.
5. Try to quell your worries prior to bedtime so you don’t spend precious hours fretting. To help, give yourself time during the day to record your worries, or devote a half hour to worrying well before lights-out.
6. Don’t go to bed unless you feel tired. If you are not sleepy at bedtime, do something relaxing until you feel drowsy.
7. If you haven’t fallen asleep after about 20 minutes lying quietly under the covers, get out of bed and engage in a relaxing activity until you are sufficiently sleepy.
8. Stay on schedule! Get up at the same time each morning—even on weekends and holidays.
9. Use your bedroom for sleep and intimacy only. Banish bill-paying, work and every other potentially stressful activity to other rooms.
10. Talk to your doctor about using a prescription sleeping medication for short-term or occasional sleeping woes. “These can be used as an adjunct to good sleep hygiene, but not to replace it,” says Dr. Selecky.
Good sleep habits aren’t always enough. A sleep specialist can help determine if you have a bona fide sleep disorder. Here, three of the more common complaints:
Sleep Apnea
• What it is: The tissue at the back of the throat collapses and blocks the airway during sleep, causing you to stop breathing a number of times a night. It’s most common in obese men, but can affect women.
• How you know you have it: You snore loudly, wake up gasping for breath or feel fatigued and sleepy during the day. An overnight sleep test, called a polysomnogram, confirms it.
• What you can do about it: “The best, most successful treatment is continuous positive airway pressure,” says Dr. Selecky. Also known as CPAP, this treatment involves wearing a mask over your nose or face to deliver air blown gently into the back of the throat, keeping the airway open. Weight loss may help by decreasing the amount of obstruction in the throat. Other options include staying off your back or raising your head during sleep, wearing an oral device that improves oxygen flow or having surgery to remove excess tissue.
Restless Legs Syndrome (RLS)
• What it is: uneasy feelings in the legs and the strong urge to move them, which worsens at night. This condition occurs more commonly in women and is associated with kidney disease, iron deficiency, pregnancy and certain medications, including antidepressants.
• How you know you have it: You have a tingling, burning or prickly sensation in the legs or get strong urges to move them, symptoms that are eased by repositioning.
• What you can do about it: Regular exercise may help with mild cases, but medicine may be needed to suppress uncomfortable sensations.
Narcolepsy
• What it is: a condition marked by excessive sleepiness that may involve daytime sleep “attacks.” Narcolepsy affects about 1 in every 2,000 people and tends to run in families.
• How you know you have it: You find it difficult to stay awake during the day, feel sleepy even after sleeping all night and feel drowsy even after a long nap. You may be briefly unable to move as you are going to sleep or waking up. Tests of nighttime sleep and daytime naps diagnose the condition.
• What you can do about it: A schedule of naps and the use of certain stimulant medications are usually helpful, according to Dr. Selecky.
Production of the hormone melatonin is stimulated by darkness and
inhibited by light. That’s led researchers to investigate the effect of
melatonin supplements on sleep. Unfortunately, the promise hasn’t
panned out.
A roundup of research from the federal Agency for Healthcare Research
and Quality (AHRQ) concluded that melatonin was not effective for
treating most sleep disorders. “There’s very little evidence that
melatonin works for a majority of patients with insomnia, the most
common sleep problem,” says St. Louis’ Dr. James Walsh.
The AHRQ report suggested melatonin might be useful for delayed
sleep-phase syndrome, characterized by the inability to fall asleep for
two or more hours. Other research suggests it might help with jet lag.
But, Dr. Walsh says, more studies are needed before it gets the medical
establishment’s seal of approval.
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Just as the sleep-stealing business of child-raising is coming to a
close, women may once again find themselves tossing and turning. The
culprit? Hormones. “Complaints about sleep go up at the same time many
women are experiencing perimenopause and menopause,” St. Louis’ Dr.
James Walsh says. In fact, about half of women report insomnia as their
estrogen supplies dwindle, triggering the hormonal changes that lead to
hot flashes and night sweats. These symptoms can rouse you from a sound
sleep and make it hard to return to your dreams.
Hormone replacement therapy (HRT)—even low-dose regimens—can help
sleep. But since HRT involves other health risks, it’s not for
everyone. Preparations containing the herb black cohosh have shown
mixed results in studies of their use for hot flashes; some SSRI
antidepressants have been shown to help relieve this troublesome
symptom. |
Napping isn’t just for babies. A midday snooze helps if you’re hurting
for shut-eye and is almost as restorative as nighttime sleep, says Sara
C. Mednick, Ph.D., assistant adjunct professor of psychiatry at the
University of California, San Diego School of Medicine and author of
Take a Nap! Change Your Life. To get a good nap, find a quiet place
where you feel comfortable and safe, and dim the lights. A 15- to
20-minute nap will make you feel more alert and refreshed. Or snooze
for 50 to 90 minutes to experience the most restorative stages of
sleep. Take note: Longer naps can make you feel groggy the rest of the
day. Avoid caffeine, fat and sweet foods and drinks, which interfere
with sleep, says Mednick, and don’t nap too late in the day.
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