Sleep! An element taken so for granted in our younger years! As we age, we find more and more difficulty sleeping. These difficulties can be due to a number of biological processes as well as can be attributed to aging. With the fear of becoming addicted to sleep aids many individuals find themselves looking for alternative methods to getting a good night’s rest. Fortunately, there are a lot of recommendations to consider prior to making use of pharmacological sleep aids.
Sleeplessness in the US
“I can’t sleep”. You are certainly not alone! The National Institute of Neurological Disorders and Stroke estimates that approximately 40 million Americans each year suffer from chronic sleep disorders and an additional 20 million experience occasional sleeping issues. Sleep related issues correspond with age; as we get older we tend to have greater difficulty falling asleep and staying asleep. There are a number of reasons to explain this; underlying disease or psychiatric problems or changes in sleep patterns are a couple of elements to consider. The most common health problems that inhibit an individual’s ability to sleep include: sleep apnea, restless leg syndrome, psychiatric disorders, arthritis, acid reflux and certain medications. Or – my personal favorite sleep issue lately – too much “screen time” prior to bed, where screen light from our phones and tablets makes the brain think it is time to wake up. Regardless of underlying medical problems, practicing healthy habits that support a good night’s sleep are a good idea for everyone.
Sleep Hygiene
As doctors, we commonly refer to “healthy sleep habits” as Sleep Hygiene. Sleep hygiene habits are practices that promote regular sleep and are very important for setting yourself up for a restful night. Many of these recommendations may seem like common sense, but it’s amazing how easy it is to ignore them. In my practice, countless patients have been able to stop taking their sleep medication once they improved their Sleep Hygiene.
- Schedule
Get yourself on a good and regular sleep schedule. Go to bed at the same time every night and wake up at the same time every morning. Your body wants to maintain a circadian rhythm like this. If you go to bed and wake up at varying times every day, your body gets confused. Be consistent.
- Naps
Don’t nap during the day. If you fall asleep during the day, you’re going to have greater difficulty sleeping at night. If napping is essential in your life, limit naps to 30 minutes and take them at the same time each day. If they inhibit your ability to sleep, however, then you need to cut the naps.
- Exercise
It’s amazing how exercise seems to help almost every condition. The human body was not created to be sedentary. If you sit around and don’t get an adequate amount of exercise, your body is not going to be tired at the end of the day and you’re going to find greater difficulty in falling asleep. Get up and get moving on a regular basis. But, don’t plan on exercising right before bed.
Caffeine is a stimulant and can keep you awake. Smokers have difficulty sleeping because of night-time nicotine withdrawal. Alcohol can make you sleepy initially, but prevents individuals from being able to reach the deep stages of sleep. All of these substances can inhibit your ability to sleep.
While we’re at it, best to also avoid benzodiazepine medications like Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam). While these can be very helpful for sleep initiation, they interfere with deep sleep and shouldn’t be used long term. If you’re taking one of these medicines now, talk to your prescriber about tapering slowly; it can be dangerous to stop abruptly.
- Eating
Avoid heavy meals before bedtime. Light snacks are ok, but heavy meals may make it more difficult to sleep.
- The Bedroom
If your bedroom is not a place that you want to be, you’re going to have a difficult time sleeping there. Your bed needs to be comfortable and your bedding needs to be weather appropriate. Ensure your room is a comfortable temperature and is well ventilated. Make your bedroom a sleep room, not an entertainment room. Turn off the TV and the lights before you go to bed. Distractions (including reading) will make it difficult to sleep.
- A Bedtime Ritual
Make a habit of preparing yourself for sleep. This may be different for everyone. Some people enjoy reading before sleep and others may try gentle yoga or deep breathing. Preparing yourself for sleep means doing something that will relax you, reduce anxiety, and give you an opportunity to unwind. This ritual allows you to release the stresses and worries from the day so that you can go to sleep with a clear head. TV or Internet use are not great methods of unwinding. They tend to keep people awake between the engaging nature of the media and the lights from the monitors. It is not recommended to have a TV or computer in your room. It’s best to turn off your smart phone or tablet before entering the bedroom.
What if Nothing Works?
If you get into your favorite sleep position and still can’t fall asleep after 15 minutes, get up and go in the other room to read until you’re sleepy. Lying in your bed awake is not only frustrating, but it trains your body and brain to be awake in the bedroom. Get up, do something else, and come back to the bedroom once you are ready to sleep again.
If you continue to have persistent issues sleeping, talk to your doctor.
