Eight Surprising Sleep Stealers

Becky is a 39-year-old woman who works as a paralegal for a busy Philadelphia law firm.  Her primary complaint at our last visit was that she has not been sleeping enough at night and wanted to know how to fix the problem.  She reported that on typical week nights she would try to catch up on work with her home computer until she felt like “crashing” at about 11 pm; however, when she actually crawled into bed she would lay there awake for a couple hours or more.

Becky’s problem is not unusual.  Many of us walk around during the day with red eyes, masking our yawns with too much caffeine and other “energy” products. In fact, as many as 47 million Americans are sleep deprived each day. As a whole, we are getting about 20% less sleep than our ancestors of 100 years ago, even though our need for sleep certainly has not decreased.  This epidemic of sleep deprivation is a big problem because sleep is important for our restoration, mental focus, ability to ward off infections, mood, and virtually everything else.  Not getting enough sleep even can contribute to high blood pressure, heart disease, and obesity.  It’s important to understand the causes of too little sleep and to have a set of strategies to get the Z’s you need.

What are the common causes of insomnia?

Most bouts of short-term insomnia are caused by lifestyle:

•    Medications – taken for chronic medical conditions, such as antihistamines for asthma or NSAIDs for arthritis, and antidepressants can disrupt sleep patterns.

•   Stress – such as family or relationship worries, financial problems, and professional situations may trigger acute physical or emotional responses, which can result in sleep disturbances.

•    Stimulation Overload– we are on the move or in front of a screen from sunup to sundown.  It can be very challenging to get prepared for restful, restorative sleep when our brains and bodies are running on overdrive until a few minutes before bedtime.

•   A Bad Bed – causing poor structural support can cause increased tossing and turning and more frequent awakenings throughout the night.

As we age, some physical problems commonly contribute to persistent insomnia:

•    Hormonal changes responsible for menopause (see previous blog) and andropause (topic of next blog!) also are critical for regulating normal sleep-wake cycles.

•    The body’s production of melatonin decreases with age.  Darkness triggers the production of melatonin by the pineal gland, and its release lowers body temperature, slows heart rate and makes us sleepy.  Levels of melatonin are highest during childhood, slowly declining as we age, often with a steep drop around age 50.

•    Restless Leg Syndrome (RLS) typically strikes during midlife.  RLS is characterized by an uncomfortable urge to move your legs, and it gets worse when you are lying down.  People with RLS may experience a tingling feeling – and in some cases pain – in their legs. Consult your physician if you have these symptoms.

•    Teeth grinding – called bruxism – can also keep you up at night.  In severe cases, bruxism can cause headaches and problems with your neck and jaw.  If you suffer from bruxism, make an appointment with your dentist to determine the root cause.

11 tips to help you get a restful night’s sleep:

In order to get the restorative sleep required to look and feel good, try doing the following:

1.   Make your bedroom as dark and as quiet as possible. The darkness is particularly important for the production of melatonin, the hormone that regulates sleep.

2.    Turn off the television and computer at least 45 minutes before you go to bed.

3.    Try a cup of chamomile tea before bedtime to help with relaxation.

4.    Invest in a quality mattress that supports your back in a way that isn’t too hard or too soft. Take the time to try out as many as possible before committing to one. The right bed and the right pillow are critical for a good night’s sleep.

5.    Make the bedroom a sanctuary. Make your bed and keep the surroundings neat, clean and comfortable so it becomes a place you look forward to.  Invest in high quality sheets and consider some soothing aromatherapy like a lavender-scented candle.  Go to the bedroom at least 30-60 minutes before you actually want to be asleep so that you can settle in and listen to a soothing CD or have an intimate conversation with your significant other.

6.   Establish a sleep pattern in which you try to get sleep at the same time each night and wake up at the same time every morning.

7.    Avoid drinking caffeinated beverages after 2 o’clock in the afternoon.  Try not to eat a heavy meal at night, and avoid spicy foods and foods high in sugar.

8.    If you must eat in the evening, have a light and healthy snack before bedtime: a piece of fruit, a small salad, or a home-baked oatmeal cookie.

9.    Regular exercise is always high on my recommendation list – it can help normalize sleep cycles – but be sure to not exercise too late in the day, which can have a stimulating effect on some.

10.    Melatonin supplements are sometimes effective. They can be purchased in most pharmacies and health food stores.  I usually suggest starting with 2-3 milligrams of melatonin before bedtime, though some people will require a higher dose.  As with all supplements, discuss with your doctor before using.

11.    If stress is the problem, breathing exercises and other relaxation techniques can be helpful. I often recommend to my patients the mindfulness-based stress reduction program at Jefferson’s Mindfulness Institute – it is an excellent 8-week program with a proven track record. In terms of stress supplements, I prefer something mild and without side-effects, like Lucentia’s Stress Support 911 (www.mylucentia.com).

If insomnia persists for more than a couple weeks or if it is associated with any other physical symptoms, consult your physician for next steps.

Our Philadelphia paralegal tried some of the above steps and after a couple weeks she was sleeping soundly.  She also felt empowered with a few tools (e.g., meditation techniques, Stress Support 911, etc.), which helped her to feel at ease about going to bed at night.  Research has shown that anticipation that one will not be able to sleep contributes to the vicious cycle of insomnia. Having tools that work (including medication sleep aids for more difficult cases) decreases the anticipatory fear and increases the chances of a successful night’s sleep.

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Dr. Monti is Director of the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University Hospital and the author of “The Great Life Makeover”. Read more about him here.