Just like healthy eating habits, healthy sleep habits are an
important part of good overall health. But, unlike food, we often
try to get by with as little sleep as possible to get through
our days. That can lead to poor performance, irritability, excessive
daytime sleepiness, and maybe even illness.
Most healthy
adults require about 8 hours of sleep a night, at about the
same
time each night. Like our food intake, we can
manipulate how much and when we sleep, but we cannot change
our actual sleep need. Sleep scientists continue to find more
and
more evidence that we do not perform well without it. While
we might be able to "get by" on a few hours of sleep
or even none at all for a night or two, continuous short nights
of sleep (even 6 hours) leads to reduced daytime function.
Sleep
in women differs from sleep in men in a few important
ways. Most women who have been pregnant know that sleepiness
is common
in the first trimester, while insomnia is common in the last.
The physical changes that occur in the last few months make
sleeping cumbersome. Of course, worry and excitement can
make sleep difficult,
too. Muscle cramps are also common in pregnancy and can cause
abrupt awakening.
Restless
legs syndrome is a sensation in the legs, and sometimes arms,
that makes one have to move to
get comfortable. It
occurs in the evening, at rest, and gets better with movement
or tensing
of the muscles. It may cause difficulty falling asleep.
Although it affects both men and women, it is more common in
pregnancy.
It is easily treated with medication, but this is usually
not advised in pregnancy. Other strategies to control the
symptoms
include avoiding all caffeine and alcohol, and taking warm
baths.
While pregnancy
can disturb sleep, there is nothing quite like the first few
weeks of motherhood when it comes
to
sleep disruption.
Awakening to a baby's hungry cry is natural, but getting
enough sleep at other times is sometimes hard to accomplish. "Sleep
when the baby sleeps" doesn't always happen for
mothers with other children and busy schedules. The best
strategy
may be to sleep when one can, and try to get as many
hours in a row
as possible. Continuous sleep is more refreshing than
the same amount of sleep broken up into shorter periods.
It
is reassuring
to remember that this phase is only temporary, and most
babies sleep through the night by about 3 months of age.
Menopause
is known to cause sleep disruption in many women. Hot
flashes are an obvious cause for some, but
other causes
of arousal
from sleep may occur. Sleep apnea is more common in
men than it is in women who have not gone through menopause.
After
menopause, however, the odds start to even out. While
some have speculated
that this is related to hormonal changes, there is
some
evidence to suggest it is more closely related to body
weight and
other factors.
Obstructive
sleep apnea, due to collapse of the upper airway, is the most
common type of apnea, and
the most
commonly
diagnosed sleep disorder. It is typically associated
with snoring,
and often causes excessive daytime sleepiness. An
episode of apnea
often causes a lower oxygen level, increased blood
pressure, and brief awakening.
Most apnea
is easily treated. CPAP (continuous positive airway pressure)
provides
pressurized air through
a mask worn over
the nose during sleep, and almost always controls
apnea. Weight loss
can also help, and sometimes cures apnea. Others
may benefit from surgery to remove the uvula and
some of
the soft palate
at the back of the throat, but this is only effective
in fewer than half of patients. An oral appliance
can be worn
during
sleep to reposition the jaw forward. This treats
some people with mild
to moderate sleep apnea, but is not generally effective
in severe cases.
Insomnia
refers to difficulty initiating sleep or difficulty maintaining
sleep. In general, it
is more
common in
women than in men, especially over the age of
40. In younger
adults, it
is equally common in both sexes. It is very important
to think of insomnia as a symptom rather than
a diagnosis. The underlying
causes must therefore be recognized and treated.
Our sleep
habits, or "sleep hygiene" can play
a major role in insomnia. Starting with good
sleep
hygiene is always a good idea when trying
to overcome insomnia. If that is not effective,
looking for other causes may be in order.
Good
sleep hygiene is simple. The idea is to give
yourself enough time to sleep, sleep in
bed, be
awake everywhere
else, and don't
do anything to interfere with any of those.
But, like dieting, this may be easier said than done
for some
of us. Here
are some ground rules to help you stay on track.
1.
Go
to bed when you are sleepy, not earlier. Going to bed
before you are sleepy will promote lying awake in bed,
which can condition (teach) the brain to be awake in
bed. Limiting your time in bed helps consolidate and
deepen your sleep. Excessively long times in bed lead
to fragmented and shallow sleep. When you wake up refreshed,
get up. Don't linger in bed for long.
2.
Get
up at the same time every day, 7 days a week. A regular
wake time will help you fall asleep more easily at night,
and helps set your "internal clock."
3.
Sleep
only in bed. Sleeping in other locations at home may
make it more difficult to sleep in bed.
4.
Use
the bedroom only for sleeping and sexual activity. Avoid
reading, watching TV, eating, or talking on the phone
in bed. Also avoid lying awake thinking in bed. If you
need to problem-solve, make plans, or sort things out
in your mind, do it elsewhere. Get up and sit in another
room to "process" your thoughts. Do not take
your problems to bed. It is often helpful to spend time
earlier in the evening to work on your problems or plan
the next day's activities. Some people find it helpful
to designate "worry time" before bed to work
through difficult issues that might otherwise keep them
awake. All this should be done in a room other than the
bedroom.
5.
Cover
the clock or put it where you cannot see it. Looking
at the clock when you either can't fall asleep or have
awakened and can't get back to sleep only perpetuates
the problem.
6.
Regular
daily exercise may help deepen sleep. Exercise too close
to bedtime may disturb sleep. Finish exercising at least
3 hours before bedtime.
7.
Insulate
your bedroom against sounds. Carpeting, wearing earplugs,
and closing the door may help. Noise may disturb your
sleep even if you are not fully aware of it. This is
especially problematic for third-shift workers who need
to sleep during the day when most people are awake.
8.
Keep
the room temperature moderate. Excessively warm rooms
may disturb sleep, even more than you might be aware
of.
9.
Don't
go to bed hungry, as it may keep you from falling asleep.
A light snack at bedtime may help sleep, but avoid having
a big meal. Stomach and intestinal activity slow down
and food is not well digested during sleep.
10.
Avoid
excessive fluid intake in the evening to minimize the
need for nighttime trips to the bathroom. While it is
generally healthy to drink plenty of water during the
day, limiting this for the last 2-3 hours before bedtime
can help you sleep through the night.
11.
Avoid
caffeine, especially in the afternoon or evening. A single
cup of coffee in the morning can affect sleep at night,
even if you are not aware of it. This doesn't mean caffeine
should be avoided by everyone, but it does mean that
anyone with trouble sleeping should stop it completely,
at least until the insomnia is in control. Many people
say "caffeine doesn't affect me," or "I
stopped caffeine once and it didn't do any good." If
a person has insomnia and uses any caffeine, there could
be a relationship. And, stopping caffeine without following
all the points of good sleep hygiene may not have been
enough on its own. Use of caffeine to treat headaches
may actually disrupt sleep. If sleep disruption is an
issue for an individual, other treatments should be considered.
12.
Avoid
alcohol, especially in the evening. Although alcohol
may help some people fall asleep at the start of the
night, the sleep through the night becomes fragmented.
Occasional social use of alcohol in modest amounts is
fine for most people, but regular use or drinking large
quantities may be a significant problem for sleep.
13.
Avoid
using tobacco in any form, especially at bedtime or if
you awaken at night. Tobacco use disturbs sleep.
14.
If
you cannot fall asleep, do not "try harder" to
fall asleep. This often makes the problem worse. Instead,
get out of bed, go to another room, and do something
quietly (such as reading a book) until you become sleepy
again. Avoid television, computer use, snacks, or tobacco
use, as these can make you more alert. Return to bed
only when you become sleepy again. Get up at your regular
time in the morning, no matter how much you slept.
15.
Avoid
naps. If you have an irresistible urge to sleep during
the day, a single nap of 30 minutes or less may be taken
in bed. Longer or more numerous naps can disturb sleep
the following night.
