Anyone who has lain awake half the night staring at the ceiling understands the value of a good night’s sleep. Without it, you’re cranky, tired and unmotivated. Sleeplessness is also bad for your health; it can lead to depression, anxiety and mood swings, according to the experts. But there are solutions to help us fall—and stay—asleep.
sleeplessness
the dangers
Two categories of insomnia are the biggest reasons people struggle to go to sleep at night, according to Subramanian Paranjothi, a pulmonologist and sleep medicine specialist at Mercy Clinic Pulmonology. Acute insomnia is a short-term issue caused by worrying or grieving for a loved one. It is something everyone deals with on occasion. Chronic insomnia is a more serious issue that can be caused by other medical conditions like anxiety or depression.
“Chronic insomnia even can lead to a higher mortality rate, not to mention it impacts performance at work, focus, irritability and mood swings,” says Dr. Gabriela de Bruin, assistant professor of neurology and sleep medicine at Washington University. “People should understand that chronic insomnia can be easy to manage. There are solutions, and no one should settle for a bad night of sleep.”
the triggers
Some triggers for sleeplessness can be eliminated by lifestyle changes. Caffeine and alcohol are major reasons people struggle to fall asleep. These two beverages also cause people to wake up in the middle of the night and struggle to fall back asleep. Paranjothi encourages his patients to give up caffeine altogether. If they must drink it for safety at work and alertness, he advises abstaining past noon.
“Alcohol is what people often use to get themselves to sleep,” Paranjothi says. “But it’s a poor, poor drug to help you sleep. People who use alcohol chronically actually can go through a withdrawal in the middle of the night. So they may fall asleep quickly, but they do not stay asleep.”
Sleep requirements definitely shift as one ages. While children require 10 to 11 hours of sleep, adults often can function with about seven and a half hours, says Paranjothi. “Each individual may need a little more or can get away with a little less,” he says. “We can all get away with a little less, but it’s not what is best for us.”
early vs. late risers
why people differ
People fall into patterns at an early age that make them early or late risers. Sometimes their pattern is determined by the environment in which they are raised. If the parents are early risers, the children follow suit. In other instances, there may be more of a natural proclivity one way or the other. “Fifty percent of it is genetic, and 50 percent is based on environment,” says Matt Uhles, the chief operating officer at Clayton Sleep Institute. “For example, you can have two kids in the same home with totally different sleep schedules,” he says. “I have a daughter who has been very much a night person from the time she was an infant. The other one was always up as the sun rose, awake, happy and ready. We had to put black-out shades in her room!”
Those early patterns can change during teenage years, however. “The brains of teens go through rapid redevelopment,” Uhles says. “Teens are still alert from 1 to 2 a.m., and it can cause sleep deprivation because of the early start times at school.”
While some districts across the country have accommodated teen needs by moving start times for high school later, most kids just have to adapt. There are ways to help move their bedtime earlier, and these methods work for adults as well. Cutting back on exposure to light an hour before going to sleep is critical for people of all ages. Clocks, TVs, laptops and mobile phones all can trigger alertness because of the blue light emitted. Blue light, part of the light spectrum, is emitted by electronics and energy-efficient light bulbs.
The driving force for initiating and maintaining sleep is the production of melatonin, says Dr. Mesfin Mitike, a neurologist, sleep specialist and director of SSM St. Mary’s sleep lab. “Melatonin secretion reaches its peak at the time of initial sleep and continues at levels enough to maintain sleep,” Mitike says. “Once awake and exposed to bright light, the drop in production of melatonin occurs.”
help yourself
While doctors will sometimes encourage taking supplemental melatonin to initiate sleep, there are a number of changes you can make yourself. Reduce the amount of light seen before bed. There are now apps or adjustments on phones that shut off the blue light at night so devices can still be used but do less damage to sleep schedules. Glasses that block blue light are sold online for less than $10 to allow us to work on our laptops at night or even watch TV without blue light. They should be worn only the hour before bedtime, however.
Another suggestion for promoting better sleep is to exercise in the evenings—as long as it is done about three hours prior to bedtime. Also, people should create a regular sleep schedule. “We as humans like consistent patterns,” Uhles says. “The more consistent you keep patterns, the more efficient sleep will be. Start waking up earlier, exposing yourself to light as soon as you wake up. Eventually, your bedtime will naturally start to shift as well.”
all the night’s a stage
As people age, staying asleep becomes more of an issue, Mitike says. There are five stages of sleep: I, II, III, IV and REM sleep. The deepest stages are in III, IV and REM, which are much easier to come by when a person is younger. “The older we get, the less time we spend in deep or slow wave sleep,” Mitike says. “We become light sleepers. We also tend to go to sleep early and become early risers. Children and young adults spend higher percentages of their sleep in slow wave sleep and are deep sleepers.”
Knowing how well we have slept can be challenging, even if we try to keep a detailed sleep diary. But testing by a sleep specialist can help pinpoint the problems that need fixing. “Some people may not perceive they slept even if we confirm that they actually slept using brain wave activity,” Mitike says. Teens are still alert from 1 to 2 a.m., and it can cause sleep deprivation because of the early start times at school. It is about having a regular bedtime schedule, a regular wake-up schedule, and making sure that you exercise regularly and eat three set meals.”
age & sleep
sleep hygiene
As people age, consistent sleep becomes harder to achieve, but is no less important; in fact, it can be more crucial. “Lack of sleep impacts memory, moods and even balance,” says Dr. Shalini Paruthi of St. Luke’s Sleep Medicine & Research Center. “If you do not sleep enough, you are more likely to fall.”
While some sleeping disorders are caused by chronic medical conditions like sleep apnea, many troubles can be corrected with good sleep hygiene. “It is about having a regular bedtime schedule, a regular wake-up schedule and making sure that you exercise regularly and eat three set meals,” Paruthi says.
For good sleep hygiene, the bedroom setting should be properly prepared. “It should be quiet, dark and at the right temperature,” says Dr. Julie Gammack, professor of medicine for SLUCare Physician Group. “Reduce disruptions like noise, technology, text messages and TV. Also, limit daytime naps to create a more tired body in the evening.”
day vs. night sleep
If a person is tired during the day and considering a nap, Paruthi suggests going on a brisk walk. For retirees who may have time on their hands to nap, a 20-minute nap is acceptable, but an hour and a half nap will make them much more restless at night. “We do recommend no less than seven hours at night, but if they have a chance to make up that time during the day, it’s OK,” Paruthi says. “We are looking for seven hours, at least, in 24 hours.”
Another factor that can contribute to sleep issues in adults is prescription medication. Sometimes dosages need to be adjusted or doctors have to change when the medications are scheduled to be taken. Because adults often just accept sleep problems and even fear having to add more medication to their daily regimen, they do not always tell physicians about their problems. But bringing up the topic can be critical to turning around certain health issues. And doctors today have many more tools than just medication to help cure sleep disorders.
sleep as a medical problem
“Most important, we screen for medical sleep problems,” Paruthi says. “Additionally, for people not getting quality of sleep, we steer them toward Cognitive Behavioral Therapy for Insomnia (CBTI). We have a behavioral sleep specialist who meets with patients for four to six sessions. They go over sleep hygiene and cater the therapy to each individual. After four or five sessions, up to 80 percent will see improvement or complete resolution of their insomnia. It’s evidence-based solutions.”
Keeping a sleep diary is a good starting point for those concerned with their own sleeping patterns, Gammack says. This gives a person something to discuss with their physician to find out if a referral to a sleep specialist is necessary.
Lack of sleep should not be the only concern either. Too much sleep can be a sign of trouble as well. Depression or dementia causes people to sleep more than usual. Alzheimer’s patients also sleep more because as their brain degenerates, there is less to stimulate them and get them active. “Always look at what is normal for that person,” Gammack says. “Maybe they had been sleeping 10 hours for years and now they sleep only six or vice versa. Maybe there is something going on. Changes in sleep can be a symptom of something else happening—more so in older adults than young people.”