Health + Medicine
How to Get the Sleep You Need
Leah Ingram started having sleep problems in her 40s. “I was having trouble falling asleep as well as staying asleep, so if I woke up in the middle of the night to use the bathroom, I could not fall back asleep for hours,” said the 53-year-old.
Ingram, who lives in Pittsburgh, chalks up her insomnia to stress, combined with the hormonal shifts of perimenopause. “One of our pets had just died, our youngest was starting college, my husband had a new job and we moved to a new state where I didn’t know anybody,” she said. “In addition, my perimenopausal symptoms—primarily hot flashes at night—were getting more pronounced.”
Ingram’s insomnia is not unusual. According to the American Academy of Sleep Medicine, around 30 percent of adults experience some form of insomnia during their lifetime. And according to the National Sleep Foundation, women are more likely to develop insomnia than men, due to the fluctuating levels of estrogen and progesterone that accompany menstruation, pregnancy, perimenopause and menopause, which usually occurs between ages 45 and 64.
Pregnancy and motherhood take a physical toll as well. A growing belly can be cushioned by a pregnancy pillow, but fetal pressure on the bladder can mean nighttime trips to the bathroom. And once the baby is born, there is the attendant child care.
Besides social and emotional stress, there are also medical problems that commonly cause secondary insomnia, including chronic obstructive pulmonary disease (COPD), sleep apnea and restless legs syndrome. Because health problems tend to occur more frequently in older people, 44 percent of Americans aged 55 to 85 have symptoms of sleeplessness a few nights a week or more, according to a National Sleep Foundation survey.
Some people are simply genetically wired to have sleep problems, noted Dr. Steven Scharf, head of the Sleep Disorders Center at the University of Maryland Medical Center. “There’s no underlying cause, they just always have difficulty sleeping,” he said. “It’s thought that they have increased levels of neurotransmitters that control sleep-wake cycles.”
Insomnia is not just exhausting, it is also bad for your health. Sleep is crucial for healthy brain function, improving memory and cell repair. Recent research from the National Center for Biotechnology Information indicates that sleep also acts as a “brain cleaner,” clearing away neurotoxic waste that accumulates in the nervous system during the waking hours. This waste includes beta-amyloid, a substance found in people with Alzheimer’s disease. Chronic insomnia can result in weight gain, diabetes, depression and heart disease.
Fortunately, insomnia—whether short or long term, due to stress or trauma, a medical condition or medication—can be effectively treated.
Many sufferers seek a magic pill. While sleep aids—whether over-the-counter antihistamines such as Benadryl or prescription remedies such as Ambien—are often effective temporary tools, according to Dr. Scharf, they usually aren’t intended for long-term use, as they don’t treat the root causes of insomnia. “Once you stop taking the pills, you may find yourself sleepless again,” he noted. Melatonin, an over-the-counter hormone, helps control the natural sleep-wake cycle and can be taken in low doses, long-term, to get high-quality sleep.
A holistic way to tackle your sleep issues is by improving your “sleep hygiene,” otherwise known as good sleep habits. You may find classes on the subject at your local community center. The Marlene Meyerson JCC in Manhattan, for example, offers a class that promises to teach you “to ease into sleep and wake up refreshed.” The class teaches the elements of a bedtime routine (going to sleep and waking up at roughly the same time every day), gentle stretches (yoga) and breathing techniques to quiet your mind.
Other tools include relaxation techniques such as meditation, warm baths and progressive muscle relaxation. Weighted blankets, which have been found to calm the nervous system, have become a popular way to
Sleep hygiene also includes shutting down the screens. “I can’t overemphasize how much technology contributes to sleep problems,” said Lauren Broch, a psychologist and sleep specialist at Northwell Health Sleep Disorders Center in Great Neck, N.Y. “Being so aware of what’s going on in the world can add to emotional distress.” Broch advises people to keep all screens out of the bedroom. “Even the blue-green light designed to make screens less disruptive at night are not always effective,” she said. Her advice is to “read a good old-fashioned book,” an activity that involves different eye movements than reading on a screen, allowing for a more relaxing, sleep-inducing experience.
A first-line treatment for sleeplessness is cognitive behavioral therapy for insomnia, known as CBT-I. “For a while I took sleeping pills, but they weren’t helping much,” said Rachel Davidson. The 32-year-old Phoenix resident decided to try CBT-I with a therapist to learn constructive ways to deal with worry and other emotions that can interfere with sleep. For example, patients might be instructed to transcribe their disturbing thoughts on paper and then put the writing into a drawer, essentially putting away their problems for the night.
“Once you master controlling your thoughts and start viewing sleep as something pleasant and beneficial, you begin to be calmer and more comfortable about it,” said Davidson. Research in the journal BMC Family Practice has shown that CBT-I is more effective long term than pharmaceutical sleep aids.
If standard therapies haven’t worked, a patient might try a sleep study, which involves sleeping overnight in a lab with multiple sensors for breathing and electrodes placed on the face, head, legs and chest. A sleep study is required to discover underlying disorders that may be the cause of sleeplessness, such as apnea, narcolepsy, leg movements or unusual behavior during sleep.
Dr. Uri Laxer, director of the two-year-old Sleep Clinic at Hadassah Medical Center in Ein Kerem, is researching new remedies for insomnia. He and a colleague in the musicology department at the Hebrew University of Jerusalem are planning to launch an experiment on the impact of music on sleep.
“We speak of relaxing music, but of course that differs per ethnic group and generation,” said Dr. Laxer. “We might suppose that a Brahms lullaby will be universally soothing, but it’s not necessarily the right music for all. We’ll be testing if music is effective by watching sleep patterns with and without music and then determining which music really helps sleep.” (See sidebar for apps that use music, storytelling and cognitive therapy to help you fall asleep.)
Finally, sometimes it takes trial and error to come up with your own formula for sleep, as it did for Leah Ingram.
“I get regular, intense exercise during the day so that I’m more tired at night, and I avoid getting too hot in bed by not pulling the covers up like I used to,” she said. “I’ve also taught myself that a certain sleeping position means ‘review the day and let your mind calm down.’ That’s lying in bed on my back. By the same token, I’ve taught myself that when I turn over onto my left side, it means sleep. And that’s the position I fall asleep in.”
There are many apps to help you sleep. Most of them offer both free and premium services. Here are a few of the most popular ones:
Pzizz.com combines music, sound effects and beats, and uses an algorithm to generate a slightly different soundtrack each time you use it; the sounds are similar enough that your mind begins to associate them with sleep.
Calm.com helps you relax through meditation, spa-like sounds or by listening to bedtime stories read by people with soothing voices.
Sleepio.com features a cartoon therapist that provides behavior modification lessons (essentially CBT-I) over the course of six sessions.
Christina Frank is a journalist living in Brooklyn, N.Y. Her work has been published in The New York Times, Everyday Health and on WebMD.
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