ABCs of ZZZZs -- When you Can't Sleep
Does it often take you more than 30 minutes to fall asleep at night? Or do you wake up frequently during the night — or too early in the morning — and have a hard time going back to sleep? When you awaken, do you feel groggy and lethargic? Do you feel drowsy during the day particularly during monotonous situations?
If you answered "yes" to any one of these questions, you may have a "sleep debt" that is affecting you in ways you don’t even realize. And, you aren’t alone. A recent NSF Sleep in America poll found that a majority of American adults experience sleep problems. However, few recognize the importance of adequate rest, or are aware that effective methods of preventing and managing sleep problems now exist.
Why Do You Need Sleep?
Sleep is not merely a “time out” from our busy routines; it is essential for good health, mental and emotional functioning and safety. For instance, researchers have found that people with chronic insomnia are more likely than others to develop several kinds of psychiatric problems, and are also likely to make greater use of healthcare services.
People suffering from a sleep disorder called sleep apnea are at risk for high blood pressure, heart attacks, stroke and motor vehicle crashes if left untreated.
Even occasional sleeping problems can make daily life feel more stressful or cause you to be less productive. In the NSF survey, those who said they had trouble getting enough sleep reported a greater difficulty concentrating, accomplishing required tasks and handling minor irritations. Overall, sleep loss has been found to impair the ability to perform tasks involving memory, learning, and logical reasoning. This may contribute to mistakes or unfulfilled potential at school or on the job and strained relationships at home. In fact, sleeplessness has been found to be a significant predictor of absenteeism. The direct and indirect impact of daytime sleepiness and sleep disorders on the national economy is estimated to be $100 billion annually.
Insufficient sleep can also be extremely dangerous, leading to serious or even fatal accidents. The National Highway Traffic Safety Administration has estimated more than 100,000 auto crashes annually are fatigue related. These drowsy driving crashes cause more than 1,500 deaths and tens of thousands of injuries and lasting disabilities. This problem has been found to affect drivers aged 25 or under more than any other age group.
How Much Sleep Is Enough?
Sleep needs vary. In general, most healthy adults need seven to nine hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can’t perform at their peak unless they’ve slept ten hours. And, contrary to common myth, the need for sleep doesn’t decline with age(although the ability to get it all at one time may be reduced).
So, how do you measure how much sleep you truly need? If you have trouble staying alert during boring or monotonous situations when fatigue is often "unmasked" you probably aren’t getting enough good-quality sleep. Other signs are a tendency to be unreasonably irritable with co-workers, family or friends, and difficulty concentrating or remembering facts.
Is All Sleep the Same?
It may surprise you to learn that during the hours you seem to be "out cold," a lot is actually happening. Normal sleepers have a relatively predictable "sleep architecture," the term used to describe an alternating pattern of REM (rapid-eye-movement) and non-REM sleep. REM sleep is when you dream, and is characterized by a high level of mental and physical activity. In fact, your heart rate, blood pressure and breathing are similar to what you experience when you are awake.
Scientists define the best sleep as having the right mix of REM and non-REM sleep. Getting enough sleep without interruptions from your environment or from internal factors such as your breathing is more likely to maintain your natural sleep architecture and result in restful and restorative sleep.
Who's At Risk For Poor Sleep?
Virtually everyone suffers at least an occasional night of poor sleep. However, as the list of "sleep stealers" implies, certain individuals may be particularly vulnerable. These include students, shift workers, travelers, and persons suffering from acute stress, depression, or chronic pain. And employees working long hours or multiple jobs may find their sleep less refreshing.
Older adults also have frequent difficulty with sleep problems, but inadequate sleep is not an inevitable part of the aging process. The total amount of sleep needed isn’t reduced. However, many of the sleep stealers can combine in the elderly including impaired health, pain and increased use of medications.
Teenagers can have difficulty falling asleep until late at night and awakening early in the morning.
Many young adults keep relatively irregular hours and as a group they report higher rates of dissatisfaction with the sleep they are getting.
Being overweight increases the risk for sleep apnea.
What are the biggest "Sleep Stealers"?
Stress is considered by most sleep experts to be the No. 1 cause of short-term sleeping difficulties. Common triggers include school- or job-related pressures, a family or marriage problem, and a serious illness or death in the family. Usually the sleep problem disappears when the stressful situation passes. However, if shortterm sleep problems such as insomnia aren’t managed properly from the beginning, they can persist long after the original stress has passed.
That’s why it’s a good idea to talk to a physician about any sleeping problem that recurs or persists for longer than one week.
Your doctor can help you take steps early to control or prevent poor sleep. Since insomnia can also be brought on by depression, evaluation by a healthcare professional is essential.
Without realizing it, you may be doing things during the day or night that can work against getting a good night’s sleep. These include drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and nighttime schedule, and working or doing other mentally intense activities right before or after getting into bed.
If you are among the 17 percent of employees in the United States who are shift workers, sleep may be particularly elusive. Shift work forces you to try to sleep when activities around you — and your own "biological rhythms" — signal you to be awake. One study shows that shift workers are two to five times more likely than employees with regular, daytime hours to fall asleep on the job.
Still another sleep stealer is jet lag, an inability to sleep caused when you travel across several time zones and your biological rhythms get "out of sync."
A distracting sleep environment such as a room that's too hot or cold, too noisy or too brightly lit can be a barrier to sound sleep. And interruptions from children or other family members can also disrupt sleep. Other influences to pay attention to are the comfort and size of your bed and the habits of your sleep partner. If you have to lie beside someone who has different sleep preferences, snores, can't fall or stay asleep, or has other sleep difficulties, it often becomes your problem too!
A number of physical problems can interfere with your ability to fall or stay asleep. For example, arthritis and other conditions that cause pain, backache, or discomfort can make it difficult to sleep well. Sleep apnea, which is recognized by snoring and interrupted breathing, causes brief awakenings (often unnoticed) and excessive daytime sleepiness. If suspected, a person having signs of sleep apnea should see a doctor.
Disorders that cause involuntary limb movements during sleep, such as Restless Legs Syndrome, break up the normal sleep pattern and are also likely to make sleep less refreshing and result in daytime sleepiness.
For women, pregnancy and hormonal shifts including those that cause premenstrual syndrome (PMS) or menopause and its accompanying hot flashes can also intrude on sleep.
In addition, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.
So, What's The Secret To Good Sleep?
If you are having a sleep problem or feel sleepy during the day, a visit with your doctor is the best first step. Your doctor will first want to ascertain whether there are any underlying problems that are contributing to or causing your sleep problem.
In many cases, your doctor will be able to recommend lifestyle changes that can help promote sleep. Keep in mind that what works for some individuals may not work for others. So, your best bet is to find out what’s effective for you and stick with it. In general, try to build into your schedule time for eight hours of sleep, and follow this routine as regularly as possible. Even on the weekends. Here are a few tips many people have found to be useful.
* Avoid caffeine, nicotine and alcohol in the late afternoon and evening. Caffeine and nicotine can delay your sleep, and alcohol may interrupt your sleep later in the night.
* Exercise regularly, but do so at least three hours before bedtime. A workout after that time may actually keep you awake because your body has not had a chance to cool down.
* Don't use your bed for anything other than sleep or sex. Your bed should be associated with sleep.
* If you have trouble sleeping when you go to bed, don’t nap during the day, since it affects your ability to sleep at night.
* Don't use your bed for anything other than sleep or sex. Your bed should be associated with sleep.
* Consider your sleep environment. Make it as pleasant, comfortable, dark and quiet as you can.
* Establish a regular, relaxing bedtime routine that will allow you to unwind and send a "signal" to your brain that it’s time to sleep. Avoiding exposure to bright light before bedtime and taking a hot bath may help.
* If you can’t go to sleep after 30 minutes, don’t stay in bed tossing and turning. Get up and involve yourself in a relaxing activity, such as listening to soothing music or reading, until you feel sleepy. Remember: Try to clear your mind; don’t use this time to solve your daily problems.
When Do You Need to Seek Help?
If your sleep problems persist for longer than a week and are bothersome, or if sleepiness interferes with the way you feel or function during the day, a doctor’s help may be needed. To get the most out of your doctor’s visit, you’ll find that it is often helpful to keep a diary of your sleep habits for about ten days to identify just how much sleep you’re getting over a period of time and what you may be doing to interfere with it. It can help you document your problem in a way that your physician can best understand.
If the problem is the time it takes to fall asleep, staying asleep or waking up unrefreshed, your doctor may recommend lifestyle changes or behavioral approaches to treating the problem. However, lifestyle changes alone may not be enough. Treating insomnia with medication is the most common treatment for these sleep problems. In most cases, medication is only used until the immediate stressor is under control or lifestyle changes have had a chance to work.
While many individuals will try an over-the-counter medicine to help them sleep, these should be taken with caution. Your physician or pharmacist can help inform you about the different types of medications available and which would be most effective for you. Alcohol should not be used as a sleep aid.
For sleep apnea or other sleep disorders, your doctor may want to do a sleep study that will provide more information about your sleep pattern and whether you are breathing regularly while you sleep.
The bottom line is this: Adequate sleep is as essential to health and peak performance as exercise and good nutrition. If you aren’t getting enough, talk to your physician. You deserve it.