The Struggle to Sleep

Dear Readers,

Like food and oxygen, sleep is necessary for survival. But unlike what we put into our mouths and lungs, we’re not sure exactly why people sleep. Like so many brain functions, sleep is an elusive character in the cast of biological players.

This month, we look at the nature of sleep — what it is, why you need it, what happens when you don’t get enough, and how you can improve your slumber.

The Mystery of Sleep

The best window on sleep is studying how it affects other body systems. We’re learning that it probably plays an important role in regulating emotions and metabolism (how efficiently you absorb energy — calories — and use it), in your ability to think and perform physically, to remember things, and to recuperate from mental and physical stress.

As explained by the Harvard Medical School Division of Sleep, all organisms undergo daily patterns of activity and rest. Obvious human traits during the rest phase are a prone posture and closed eyes. Less obvious is a decreased responsiveness to external stimuli — that is, you’re less likely to be aware of and respond to sounds, sights, smells or touch when you’re asleep.

The sleeping brain’s wave patterns are different from those of a wakeful brain. And sleeping bodies demonstrate physiological traits different from wakeful bodies — lower body temperature and blood pressure, slower respiration. These markers differ not only between slumber and alertness, but between the two different phases of sleep. Brain waves, breathing and heart rate vary when you’re in the REM phase of sleep (Rapid Eye Movement, or the dream phase), but they’re regular during non-REM sleep.

Despite the labels, you also dream during non-REM sleep. The difference, according to Harvard, is that the more visually intense dreams occur mainly during REM sleep, except for night terrors, which occur during non-REM sleep.

Dreaming is a complicated process, and the subject for another day. It’s not well understood; some scientists believe that dreams are critical to the formation of memories, while others say they’re simply the result of random activity in the brain.

You Need to Sleep

According to “Sleep Disorders and Sleep Deprivation,” a report by the Institute of Medicine (IOM), most adults need seven to eight hours of sleep per night; adolescents generally need nine hours. But more than 1 in 3 adults gets less than seven, and almost 7 in 10 high school students get fewer than eight. That’s a lot of unmet sleep needs.

Some people, of course, are blessed with less need to sleep. But they’re the exception, and how much sleep you need is not a question of mind over matter — it’s a biological imperative. As explained by the Centers for Disease Control and Prevention (CDC), “[S]leep should be viewed as being as critical to health as diet and physical activity.”

Insufficient sleep, says the CDC, has major health consequences. Adults who don’t sleep enough are at greater risk for developing chronic disease, such as cardiovascular problems (heart disease and high blood pressure) and diabetes. They’re more likely to have a heart attack or a stroke. Children who don’t get enough sleep are more likely to become obese.

A study published this year in Cancer Research found that poor quality of sleep characterized by frequent awakenings can speed the growth of cancer growth, increase tumor aggressiveness and dampen the immune system’s ability to control or eradicate early cancers.

The immune system just isn’t happy if you don’t get enough sleep, so your ability to fight infection is compromised when you’re tired. Mood disorders, such as depression, also are associated with lack of sleep.

You don’t think as clearly with a lack of sleep, and your ability to concentrate, to remember things and to learn new things is impaired.

Everyone knows tired kids are cranky kids, but they also suffer cognitively.

Insufficient sleep causes daytime sleepiness … and reduced alertness and slower reaction time. That leads to errors of all kinds- – workplace injuries, medical errors and motor vehicle accidents.

Evidence also is emerging that adults who don’t sleep enough are more prone to gain weight.

Why Don’t You Sleep Enough?

Let us count the ways! Too much to do in too little time — work, family and school obligations. Changing work shifts make it difficult for some people to adjust to varying sleep schedules. Too much technology can be a problem for adults and youngsters alike — a lot of people can’t tear themselves away from computers, smartphones and the drive to participate in social media. These situations invite sleep disorders.

Maybe you have sleep apnea, which means you stop breathing for short intervals while asleep. That usually requires medical intervention, because it’s associated with a higher risk of cardiovascular events, and diabetes.

Personal behavior can impair sleep. If you eat too late, or eat or drink the wrong things at night, you can sleep poorly. Regular exercise is a wonderful sleep-enhancer, but not if you do it too close to bedtime.

Many people who struggle for a good night’s sleep turn to sleeping pills, such as Ambien. That’s seldom the best solution, and when it is appropriate, it’s only for the short term. Prescription sleep medicine, as I wrote in my blog, “Why You Should Avoid Sleeping Pills and What to Do Instead,” is highly addictive, can result in a hangover effect the next day, and predisposes users to a rebound effect. That happens when you go off the drugs only to experience insomnia worse than what you had in the first place. In addition, as the blog notes, recent studies indicate that these drugs might pose a risk of premature death.

How to Have Sweet Dreams

Like any other healthful lifestyle habit — eating regularly and well, exercising regularly — certain routines have been shown to improve one’s ability to fall asleep and stay there. Collectively, these practices are known as good “sleep hygiene.” Harvard’s Healthy Sleep site explains:

1. Avoid caffeine, alcohol, nicotine and other chemicals that interfere with sleep.

Caffeinated products decrease a person’s quality of sleep because caffeine is a stimulant. So avoid coffee, tea, chocolate, cola and some pain relievers (read the labels for caffeine content) for four to six hours before bedtime.

Don’t smoke, or if you must, refrain from using tobacco products close to bedtime.

Alcohol might induce sleep, but after a few hours it acts as a stimulant. So after drinking, you spend most of the night in fitful, poor quality slumber. Limit alcohol consumption to one or two drinks per day, or fewer, and avoid drinking within three hours of bedtime.

2. Make your bedroom a sleep-inducing environment.

A quiet, dark and cool environment promotes sound slumber. Use earplugs if you must, and heavy curtains, blackout shades or an eye mask — light cues the brain to wake up, which is why travelers at risk of jet lag should spend time in the sunlight when they arrive where it’s daytime.

Keep the bedroom temperature between 60 and 75 degrees, and well ventilated.

Limit bedroom activities to sleep and sex — keep computers, TVs and work materials out of the room.

3. Establish a soothing pre-sleep routine.

Ease the transition from wake time to sleep time with relaxing activities an hour or so before bed. Take a bath (the rise, then fall in body temperature promotes drowsiness), read a book, watch television, do relaxation exercises. Avoid stressful, stimulating activities, such as work or discussing emotional issues, because stressful activities can produce cortisol, a hormone associated with increasing alertness. If you tend to take your problems to bed, write them down, then put the list aside.

4. Go to sleep only when you’re tired.

Struggling to fall sleep is frustrating, and frustration does not promote relaxation. If you’re not asleep after 20 minutes, get out of bed, go to another room and read, listen to music or stretch gently until you are tired enough to sleep.

5. Don’t watch the clock.

If you’re trying to fall asleep, staring at a clock in your bedroom increases stress, making it harder to fall asleep. Turn the clock face toward the wall.

If you wake up in the middle of the night and can’t get back to sleep within about 20 minutes, get up and repeat No. 4, but keep the lights dim.

6. Use light to your advantage.

Natural light keeps your internal clock on a healthful sleep-wake cycle. Let in the light first thing in the morning and get out of the office for a sun break during the day.

7. Keep a consistent sleep schedule.

Going to bed and waking up at the same time every day sets the body’s “internal clock” to expect sleep at a certain time every night. Try to stick as closely as possible to your routine on weekends to avoid a Monday morning sleep hangover.

8. Take a short nap early.

Some people can nap without it interfering with their nighttime sleep, and some people can’t. If you can, mid-afternoon is the best time. If you can’t nap but feel droopy in the afternoon, take a short walk outside. Sometimes, daytime fatigue is the result of dehydration — try drinking more water.

If you often are tired on waking in the morning but can’t sleep any longer, for whatever reason, a nap might be good for you; you don’t necessarily need to get your seven or eight hours in one stretch if you can get it by combining a nap with an overnight sleep shift.

If you do nap, keep it short (10 to 30 minutes), and do it before late afternoon.

9. Lighten up on evening meals.

Most people who eat pepperoni pizza at 10 p.m. don’t sleep well. In fact, eating any meal late is setting yourself up for insomnia. Finish dinner several hours before bedtime and avoid foods that cause indigestion. If you need a nighttime snack, eat things you know don’t bother your stomach. Often, it’s carbohydrates. Try graham crackers, or a banana.

10. Watch your fluid intake.

Drink enough fluid at night to keep from waking up thirsty, but not so much and so close to bedtime that you will be awakened by the need to relieve yourself.

11. Exercise early.

Exercise can help you fall asleep faster and sleep more soundly … as long as you do it at the right time. Exercise stimulates the body to produce cortisol, which revs you up. That’s fine, unless you’re trying to fall asleep. Finish your workout at least three hours before bedtime.

12. Follow through.

Some of these habits are easier to adopt than others. But they’re all more convenient and less expensive and invasive than medical remedies. Before you seek a doctor’s assistance for a sleep problem, give them a chance to work.

Sometimes, sleep problems do require medical intervention, especially for apnea, restless legs syndrome (unpleasant tickling or twitching leg muscles relieved only by movement), narcolepsy (a neurological disorder characterized by sudden attacks of sleep) and clinical depression. If you have made a committed effort at good sleep hygiene and your sleep difficulties don’t improve, consult your doctor. You might be referred to a sleep center.

To learn more about sleep, visit the website of the National Sleep Foundation. And my blog, “Getting Your Baby to Sleep,” offers advice for helping your children (and by extension, yourself) get a good night’s sleep.


Here’s to a healthy 2014!

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Patrick Malone
Patrick Malone & Associates