
The brown bat sleeps for nearly 20 hours each
day. Humans function best on a comparatively thrifty seven to nine, but
more and more people are having trouble getting even that. The National
Sleep Foundation recently found that just 25 percent of Americans get
at least eight hours of rest on weekdays and that 60 percent of women
say they often sleep poorly."Insomnia
is a bona fide health problem," says Rubin Naiman, clinical assistant
professor of medicine at the University of Arizona's Program in
Integrative Medicine and sleep director at the Miraval Resort in
Tucson. "Skimping on sleep has a price, including weight gain,
diminished immune responses, lack of concentration, irritability, and
depression."
Why
should something that seems to come naturally to other creatures prove
so elusive for us? "Our society doesn't value sleep," says Phyllis Zee,
a professor of neurology at and director of Northwestern University's
Sleep Disorders Center. "We see it as a sign of laziness or a waste of
time" — so much so that sleeplessness has become something to brag
about. Plus, "the culture we've created is geared to keeping us awake,"
Zee says. Our minds are constantly aroused by stress, caffeine, and
even e-mail. "Scans of metabolic activity in the brain show that people
who suffer from insomnia have more activity than people without sleep
problems when they're trying to get to sleep," Zee says. "When people
say, 'I can't turn my brain off at night,' they're actually right."
It probably doesn't help that we're all
preoccupied with our sleep problems and inundated with pills, gadgets,
and treatments that claim to cure them. We asked experts to tell us
which solutions they recommend, and then we put them to the test with
bleary-eyed women. After all, sleep is the birthright of most animals;
but to toss and turn is uniquely human.
Free your mind
The problem: Anxiety.
You're alone with your thoughts for the first time all day, and you
become so fretful that you feel like a character in a Woody Allen
movie. "Worrying prompts your body to produce the adrenaline-like
chemical epinephrine, which keeps you awake," says Joyce Walsleben,
associate professor of medicine at the New York University School of
Medicine, who has studied sleep extensively. It also constricts your
blood vessels, making your extremities cold — and it's easier to fall
asleep when they're warm.
The solution: Imagine placing all your negative thoughts in a bubble
and then watching them drift away, Walsleben says. Replace each worry
with a restful thought of a beach or spa. Other calming ideas: Take a
warm bath an hour before you turn in, and put on a pair of socks before
slipping into bed.
Why it works: "Learning to control your
worries will reduce epinephrine production," Walsleben says. Most
people find a bath psychologically relaxing. Plus, the body warms up in
the tub, and then "the fall in body temperature afterward can entice
sleep," Zee says. The socks keep your feet warm, which will make you
even sleepier.
The
challenge: We tried to inject our worries into a bubble, but found that
they just kept leaking back out again. Plus, we started to fret about
why we weren't able to do it. But the bath really worked — we began to
feel drowsy minutes after climbing out of the tub.
Get physically tired
The problem: You simply haven't been active enough to feel sleepy.
The solution: Shoot for at least a half-hour
of moderate aerobic activity every day, even if it's only brisk
walking, says James Maas, a professor of psychology at Cornell
University and author of "Power Sleep" (HarperCollins).
Why it works: "The body must exert energy to
get physically tired," Maas says. Studies show that a half-hour of
exercise can improve sleep about as well as benzodiazepines (sleeping
pills sold under the brand names Restoril, Halcion, and Valium), which
are pre-Ambien and are still prescribed. In addition, "exercise over
the long-term can help you lose weight and reduce stress, both of which
can inhibit sleep," says Shelley Tworoger, assistant professor of
medicine and epidemiology at the Brigham and Women's Hospital in Boston
and the Harvard School of Public Health, who has studied the effects of
exercise on sleep.
The
challenge: The results were immediate and dramatic: After never working
out, we found that we fell asleep far more quickly and slept far longer
on days when we jogged for 30 minutes on the treadmill. We also woke up
during the night just once — rather than two or three times — on those
days.
Increase darkness
The
problem: Even the light level in most living rooms (100 lux) can
suppress melatonin, making it hard to sleep, reported researchers from
Brigham and Women's Hospital in Boston in 2005.
The
solution: An hour before bed, dim the lights and turn off the TV and
computer, then make your bedroom as dark as possible, Zee says. If
outside light keeps you up, buy blackout shades.
Why
it works: "We all suffer from light pollution — we have lights on 24/7,
which keeps our brains chronically aroused," Naiman says. "Most people
don't recognize how essential darkness is for a sound night's sleep."
Indeed, in the days before Edison invented the light bulb, people slept
ten hours a night.
The challenge: An hour before bedtime, we
dimmed the lights, switched off our TV and laptop, and transformed our
bedroom — normally ablaze from city lights outside — into a cave by
putting up blackout shades. We tossed a scarf over our alarm clock …
and the next thing we knew, it was 11 hours later.
Cut back on caffeine
The
problem: Caffeine stays in the body at least four to eight hours, and
researchers in Mexico recently reported that in people prone to
insomnia, the stimulating effect may be more intense.
The
solution: Drink half a cup less coffee each day — until you quit
entirely. That should minimize the killer headaches that often
accompany caffeine withdrawal. If that's too daunting, at least abstain
after noon.
Why it works: "Caffeine is more stimulating
than most of us think," says Meir Kryger, director of research at the
Gaylord Sleep Center at Gaylord Hospital in Wallingford, Connecticut,
and author of "A Woman's Guide to Sleep Disorders" (McGraw-Hill). By
keeping your brain in a semi-awake state, it can increase the number of
times you awaken and decrease your total sleep time. "I've had so many
people say, 'Caffeine doesn't affect me,' and yet they're sitting in my
office complaining that they can't sleep," Kryger says. "Eliminating it
can really help your brain and body relax."
The
challenge: We scaled back our normal five cups of coffee a day by a
half-cup per day as prescribed, but we still had pretty vicious
headaches. And although it did help our ability to fall — and stay —
asleep at night, we felt tired all day. On the fifth day, the headaches
subsided, but the general fatigue did not. After day ten, we chose to
go back to two cups per day and not after noon — and our sleep is still
better.
Limit alcohol
The
problem: More people use alcohol to sleep than any other substance, but
a nightcap can cause insomnia in the middle of the night, according to
Kryger.
The
solution: "Some people can have one drink before bed; others need to
cut it out," says Mark Mahowald, a neurologist and director of the
Minnesota Regional Sleep Disorders Center.
Why
it works: "Alcohol changes your sleep patterns, and once it clears your
system — usually four to five hours after you fall asleep — the brain
becomes hyperaroused, and you wake up," Kryger says. Plus, this
hyperaroused state can persist for several hours.
The
challenge: Although we missed the dreamy feeling our bedtime glass of
wine inspired, we did find that avoiding it helped. We also found we
could still have a drink — as long as we finished it in the early
evening — without negatively affecting our sleep.
Reset your body clock
The
problem: Anyone who often lies awake until 2 a.m. has problems with the
clock, but not the one ticking on the side table. "If you can't fall
asleep until late and have trouble waking up, your body clock may be
out of sync with day and night," Maas says. This can be caused by an
erratic sleep schedule.
The solution: Get 20 minutes of bright light
(from the sun or an outdoor-light simulator, such as the Litebook)
within 15 minutes of awakening. You should be back on schedule within a
week.
Why it
works: "When bright morning light hits your eyes, it prompts a drop in
melatonin, the hormone that promotes sleep," Zee says. Melatonin is
typically suppressed for about 12 hours, then it rises gradually until
you feel a strong urge to sleep 15 or 16 hours later.
The
challenge: After using the Litebook every morning for four days, we
found we were dozing off almost as soon as our head hit the pillow at
11 p.m.
Take a supplement
The
problem: Melatonin, known as the Dracula of hormones because it comes
out in the dark (the pineal gland starts secreting it at about 9 p.m.),
decreases as you age and may be low in women with certain illnesses,
including bulimia and fibromyalgia. If you have trouble falling or
staying asleep, your body may not produce enough — or may secrete it
late.
The solution: Take a melatonin supplement in the evening to fall asleep faster.
Why
it works: In normal sleepers, the body produces enough melatonin at
night to induce drowsiness. Melatonin supplements may promote sleep for
those who have trouble falling asleep, Zee says. One caveat: While it
doesn't affect the content of dreams, it can make nightmares more vivid.
The challenge: Our significant other clocked
us falling asleep only about five minutes faster after taking
melatonin. We still woke up twice during the night.
Investigate sleeping pills
The problem: You lie in bed, unable to fall asleep until 2 or 3 a.m. — and this has been going on for a full week.
The
solution: Although the latest sleeping pill ads make it sound like
medication is a panacea, it’s not. "Ambien and other drugs that are
similar, like Lunesta, are best for acute situational insomnia — to use
for a few days if you're going through a stressful time or as a
treatment for jet lag," Mahowald says. "They're expensive — $3 to $4
per tablet — and in some people they cause odd behavior during sleep,
like eating or driving. It doesn't happen often, but it's a
possibility."
Why it works: Nonbenzodiazepines such as
Ambien, Lunesta, and Sonata bind with receptors in the brain that
trigger sleep. "Medication can prevent a short-term problem from
becoming entrenched," Mahowald says. But don't expect miracles. An
analysis of sleeping-pill studies financed by the National Institutes
of Health shows that these pills reduce the average time it takes to
get to sleep by 12.8 minutes compared with a placebo and increase total
sleep time by 11.4 minutes. People may think they work better than that
because they might cause mild amnesia, says Daniel Kripke, a professor
of psychiatry at the University of California San Diego and the
codirector of research at the Scripps Clinic Sleep Center in San Diego
— you can't remember if you woke up. The newest sleep medication,
Rozerem, stimulates melatonin receptors in the part of the brain that
controls circadian rhythms, so it may help people whose body clocks are
off. But it only gets you to sleep 7 to 16 minutes faster than a
placebo, and increases total sleep time 11 to 19 minutes, according to
one analysis. (Rozerem reportedly is not likely to cause amnesia.)The
challenge: We tried Ambien for three nights during a spell of
sleeplessness, and it seemed to knock us out every time — and we felt
refreshed the next day. We also tried it on a plane — and zonked out
until, four hours later, the flight attendant jerked our seat back to
its original upright position.
Adjust your attitude
The
problem: If sleep has eluded you for at least three weeks and you find
yourself extremely anxious about lying awake at night, you might
benefit from cognitive behavioral therapy. "People who have had
insomnia for a while often start worrying about sleep," Zee says. "They
tell themselves, 'I"ll never get to sleep tonight, and I'll be
exhausted tomorrow morning.' That's how short-term insomnia becomes a
more entrenched problem." CBT can work for a variety of issues —
trouble falling or staying asleep, and restless sleep.
The solution: CBT is designed to address the
factors that underlie chronic insomnia. "For instance, people think
there's something wrong with them if they wake up in the middle of the
night, so when it happens, they look at the clock and start to worry,
which prevents them from getting back to sleep," Walsleben says. A CBT
therapist would explain that sleep is made up of both deep and light
phases, and it can be perfectly normal to awaken every 90 minutes or
so. "Instead of worrying, we tell patients to congratulate themselves
for sleeping so normally and let their bodies drift off again,"
Walsleben says.
Why
it works: "CBT gives you the basic skills you need to sleep better —
and it helps you understand the structure of sleep, which is enormously
reassuring," Walsleben says. Researchers from the VA Medical Center in
Durham, North Carolina, recently reported that after just four sessions
of CBT, nearly 60 percent of people saw a significant improvement.
The
challenge: We've often wondered whether our panic about never sleeping
well was a self-fulfilling prophecy — and it turns out, it was. We
found we tossed and turned less once we told ourselves that we didn't
have a larger sleep issue.
Restrict sleep
The
problem: You lie in bed for eight hours, but you sleep five — and
you're exhausted come morning. "After a few nights of insomnia, some
people associate their bed with being awake, and they can't fall
asleep," Mahowald says.
The solution: Figure out how much time you
actually sleep at night, and then start limiting your total time in bed
to just below that amount. If you normally sleep five hours, say,
restrict yourself to four in bed. After a few days, you’ll get so
tired, you'll start sleeping the whole time you're in bed. Then, go to
bed 15 minutes earlier each night until you're sleeping seven or eight
hours. If you start tossing and turning, reduce your time in bed by 15
minutes and build up again gradually.
Why
it works: "This works because you build up a sleep debt — your body's
homeostatic drive to sleep becomes stronger and stronger when you're
sleep-deprived — so you end up spending more of your time in bed
actually sleeping," Mahowald says. "After a few nights, you start
associating your bed with sleep instead of insomnia."
The
challenge: Like a strict diet, this approach felt nearly Draconian. We
forced ourselves to restrict our sleep to four hours for five days, and
we felt exhausted and depressed — and we came down with a cold. But,
like a strict diet, it started working. After two weeks, we were
sleeping seven hours a night.