A Dream, Perchance, of Sleep

A Dream, Perchance, of Sleep

Preparing for a good night’s sleep means creating a calming environment, limiting caffeine intake, and slowing down.

Sleep is a basic human need, as crucial to our survival as food, air, and water—essential for our physical health and vital to our emotional well-being. But for millions of us, a good night’s sleep can be painfully elusive. Insomnia routinely affects about 10 to 15 percent of American adults, and 54 percent of us report experiencing at least one symptom of insomnia several times each week, according to the National Sleep Foundation. Our sleepiness affects our mood and ability to concentrate, which in turn affects our family life, work performance, and safety behind the wheel. Sleep deprivation also raises our risk of heart attacks, strokes, and other health problems. Why is it so hard to sleep? And what can we do about chronic sleep problems?

Getting a good night’s sleep wasn’t an issue for our predecessors. In the 19th century—before electric light and urban racket, and before we began spending so much time at work and home sitting on our butts—a good night’s sleep was the natural outcome of a physically strenuous day and a dark and silent night. But nowadays, nighttime assaults of noise and illumination (many of which we cannot control), mental stress, and lack of exercise all play a role in sleep problems. Add in allergies, modern fabrics, and even homes that are too well-heated, and the factors conspiring against restful, recharging sleep are daunting.

Pursuing a good night’s sleep is not a hopeless endeavor, however. Experts say most of us can achieve a solid, refreshing night of slumber by following a few simple steps—like sticking to a regular hour for lights out, airing out our dirty linen, investing in a good mattress, and committing to more exercise and less caffeine. Part poetry and part calculation, pinpointing and tackling our individual sleep disrupters can be a life-changing process. Building good sleep routines begins at birth; practicing good sleep habits is a lifelong commitment.

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The first step, according to sleep experts, is maintaining a regular sleep schedule. A schedule doesn’t mean hitting the sack as soon as the sun sets, but it does mean consistently retiring when our bodies are tired and when we feel drowsy. It also means allowing ourselves enough time under the covers to garner the recommended hours of sleep, which vary according to age. Newborns require almost 17 hours of sleep every day. Children between the ages of 1 and 10 need between 10 to 14 hours of sleep daily, depending on their age. Teenagers need, but rarely get, at least eight to nine hours. Adults also need between seven to nine hours every night.

Once we identify our ideal amount of sleep, we need to set the stage for good quality sleep. Daniel Weiner, a clinical psychologist at the San Francisco Bay Area Center for Cognitive Therapy in Oakland, who specializes in insomnia, offers some sound advice when it comes to good sleep hygiene. We need to go to bed about the same time every night, even on weekends; our bodies don’t know the difference between Monday and Saturday, after all. “Bedrooms and beds should be for sleep and sex only,” he says. “That means no computer or work-related equipment and no watching TV.” For those of us who like to turn a few pages before turning in, Weiner cautions us to avoid material that is too stimulating or disturbing.

In addition to avoiding vigorous exercise immediately before bedtime and limiting alcohol consumption, Weiner has a recommendation for those suffering from sleep disturbances. “No caffeine, at all, after 1 p.m.” Otherwise, he says, we risk a vicious cycle: poor night’s sleep, mid-afternoon slump, caffeine injection thanks to coffee or soda, poor night’s sleep. Weiner says to counter the mid-afternoon slump with healthy carbohydrates, a walk, or a brief nap very early in the afternoon. And think natural, soothing, and calming activities as regular preludes to sleep. Weiner suggests trying one of the following: gentle stretching, herbal teas, soft music, or warm milk. The scent of lavender is restful for some and can be spritzed on sheets. Or you might experiment with meditation before sleep, and focusing on the breath during the night if sleep is disturbed, to relax body and mind.

There is no denying that as we approach bedtime, our mental attitudes are just as important as our physical habits. “Many view insomnia as a catastrophe,” says Weiner. “We need to have a shift in attitude about the consequences of sleep loss. Airline pilots and those in the military rarely experience ideal sleep and are still able to operate.” If bedtime looms as threatening and potentially disastrous and we climb under the blankets thinking, “I will be a wreck at work tomorrow if I can’t sleep tonight,” guess what? Our anxious brains trigger a rapid heartbeat which can lead to tossing and turning and, voilà, a self-fulfilling prophecy.

Better Bedroom Basics

After we have the fundamentals of good sleep hygiene down, we need to focus on the dynamics of our sleeping environment. Sleep experts say the ideal bedtime room temperature is about 65 degrees Fahrenheit. “Temperature and humidity rates are both important for a good night’s sleep,” says Mike Lavin, president of the Berkeley-based European Sleep Works. “Humidity may be more important because even while we are sleeping we sweat an ounce an hour,” he adds. Nothing can disrupt dream time more than feeling too hot and clammy. “Some mattresses hold heat and moisture against the body. Natural materials like wool allow ventilation,” says Lavin. He notes that Western Europeans are way ahead of us on sleep science, particularly when it comes to ideal lung volume for healthy sleep breathing, temperature and humidity levels, and bedding for adequate ventilation. He should know. He’s been collecting European sleep studies for years.

Lavin offers these helpful tips: bigger and harder is not better when it comes to mattresses. Aim for 10 inches deep or less and look for a mattress that is supportive but not too firm. Judge mattresses by their inner beauty—mattress materials that circulate air not only help control temperature and moisture, they also discourage microscopic dust mites.

Drafty rooms and unmade beds, says Lavin, are also bad for dust mites, the pests that feed on flakes of human skin, and are second only to pollen in triggering allergic reactions that include nasal congestion, coughing, wheezing, sneezing, and snoring. It’s actually dust mite poop that causes the problem and over time, pillows can accumulate pounds of the stuff. Do as the Japanese and Germans do and air out your bedding by pulling back the covers and throwing open a window for an hour or so, even in winter. Dust mites hate dry conditions and sunlight so to thwart them, pillows should be rotated frequently and when not in use, pitched in the dryer, or hung in the sun.

There are other low-tech ways to improve sleep for allergy-prone family members. “Wrap beds with cotton blankets and sheets as a barrier to chemicals and dust mite allergens in mattresses. Plastic protectors that seal mattresses don’t breathe and can make the problem worse,” says Lavin. And he encourages parents to monitor the sleep quality of even their youngest children. Allergy reactions can trigger snoring and even sleep apnea in kids, and the resulting fatigue and health problems can set them back in school.

Breathing easy: People with sleep apnea rest better with the help of a special breathing mask called a CPAP device. Photo by Brian Chase.

The Sound of Silence

Even with the best sleep habits and ideal bedroom environment, serious health issues can still disrupt sleep. Snoring may sound funny at night, but it is no joke. Sleep apnea, which often resembles extreme snoring mixed with total silence, interrupted by gasping and choking, is a condition that is more than annoying—it can be downright terrifying for sleep partners. The irony is that people who snore or experience sleep apnea, and who often complain of daytime sleepiness, are not aware of their breathing problems during the night. But, says Michael Salemi, a registered sleep technology expert and the general manager of the Alameda-based California Center for Sleep Disorders, both these breathing disruptions can have serious health consequences. Potential problems include increased risk for heart attack, stroke, hypertension, and automobile and work accidents.

Snoring is simply loud, snorting breathing. Sleep apnea is the cessation of breathing—sometimes up to 100 times per night—and it affects almost 20 million adults. Sleep apnea, often identified by disgruntled sleep partners, is diagnosed at sleep centers like the California Center for Sleep Disorders. “There is no such thing as benign snoring,” says Salemi. “Snoring and apnea arouse us from deep sleep and stress our bodies by increasing the effort of breathing.” Patients referred to the Center by either their physicians or dentists may undergo a split-night study. The first half of the night is spent sleeping normally so technicians can identify sleep problems, including apnea. The second half of the night entails treatment, often with Continuous Positive Airway Pressure, known as CPAP. This method uses a mask worn over the nose to supply consistent airflow so the sleeper can maintain normal respiration during the night.

“Treating sleep apnea is a matter of public safety,” Salemi says. “Airplane pilots must treat diagnosed sleep apnea and be certified to retain their professions.” Alertness testing is another strategy for evaluating the effectiveness of ongoing treatment, and that’s something you might want to try testing yourself. During daytime hours, can you fall asleep sitting in a quiet room for 20 minutes? If you can, don’t blame old age. “Just because you’re 50 doesn’t mean you should be more tired,” says Salemi, who has been diagnosed with sleep apnea himself and uses the CPAP system. Proper treatment of sleep apnea can be life-changing by boosting wakefulness, energy levels, and mood.

People who use CPAP therapy have cute nicknames for their devices, and for each other. Daniel Levy, president of SomniHealth (a source of these machines, oxygen pillows, and other sleep aids) in Alameda, refers to himself as “hose head” and is quick to introduce himself as such when he sees travelers toting their CPAP machines in the airport. Levy suffered from the effects of sleep apnea for 20 years before his wife insisted he check himself into a sleep clinic. “I got used to feeling tired and still functioning,” he says. “Now I am used to feeling alert.” Levy notes that sleep disorders tend to run in families, and childhood sleep apnea may be linked to obesity and learning problems. Women are more apt to suffer from sleep apnea during pregnancy and after menopause. And being overweight, while increasing the likelihood of sleep apnea, is not the only cause. Perfectly slim men, women, and children can experience breathing problems as a result of the shape of their mouths, throats, jaws, and necks.

“When they say someone died peacefully in his sleep, it may have actually been a stroke triggered by sleep apnea,” says Levy.

Sleeping pills can seem like an attractive option if nothing else is working. But experts warn that there are some real downsides to sleeping pill use, particularly on a long-term basis. Sleeping pills can mask treatable problems like sleep apnea. Because sleeping pills, also known as sedative-hypnotics, depress the brain and central nervous system, they can reduce anxiety and produce a sense of calm. However, they also affect how quickly and clearly our minds work, and our reaction time to physical demands, even hours later. The FDA recently warned that some prescription sleep aids have produced unpredictable side effects, like driving or eating with no memory of the event.

In addition to the proven ability of sleeping pills to create dependency, the medical community has raised other alarms as well. “The increased risk of death with taking sleeping pills every night was about the same as the increased risk of smoking one or two packs of cigarettes a day,” reported Daniel Kripke, a psychiatry professor at the University of California, San Diego, in a 2000 Science Today interview. Kripke, who has conducted studies comparing extended periods of sleeping pill use and early death from cigarette smoking, concludes that more study needs to be done, and recommends avoiding the extended use of prescription sleeping pills.

It can be tricky deciding when you need professional help to solve sleep problems. When you have tried every natural strategy you can think of for a good night’s sleep—including following the rules for good sleep hygiene and creating an environment conducive to seven or eight undisturbed hours of shut-eye—and still find yourself experiencing daytime fatigue, regular nightly waking, and your sleep partner’s complaints about your snoring, you may need to take a more aggressive approach. Take the sleep quiz (see sidebar) as a quick way to measure your daytime sleepiness.

Sometimes it seems we take a certain perverse pleasure in our poor sleep. Tossing and turning all night means we are important, busy people leading hectic but significant lives. When was the last time any of us bragged about what a great night’s sleep we had the night before? But poor sleep has a price—many increased health risks, as well as grumpy, dangerous behavior on the roads and in our workplaces and homes. Good sleep is not pure science; it is also part art, part experiment. And it is definitely worth pursuing. After all, it is one-third of our lives. It pays to get it right.

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Noelle Robbins is The Monthly’s health columnist.


Snooze News

SLEEP ORGANIZATIONS

California Center for Sleep Disorders, 985 Atlantic Ave., Suite 250, Alameda, (510) 263-3302; www.sleepsmart.com.

European Sleep Works, 2966 Adeline St., Berkeley, (510) 841-5340; www.sleepworks.com.

San Francisco Bay Area Center for Cognitive Therapy, 5435 College Ave., #102, Oakland, (510) 652-4455; www.sfbacct.com.

SomniHealth, 1926 Broadway, Alameda, (510) 864-4800; www.somnihealth.com.

WEBSITES
National Sleep Foundation; www.sleepfoundation.org

Better Sleep Council; www.bettersleep.org

SleepEducation.com; www.sleepeducation.com

Sleep for Kids; www.sleepforkids.org

Healthy Sleep; www.healthysleep.com

BEDSIDE SLEEPY-TIME READING:
The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health, Happiness and a Good Night’s Sleep, by William C. Dement and Christopher Vaughan (Dell, 2000)

The Harvard Medical School Guide to a Good Night’s Sleep, by Lawrence Epstein and Steven Mardon (McGraw-Hill, 2006)

Take a Nap! Change Your Life, by Sara Mednick, Ph.D. and Mark Ehrman (Workman Publishing Company, 2006)

HOW SLEEPY ARE YOU? TAKE THIS QUIZ
The Epworth Sleepiness Scale, developed by researchers in Australia, is used by sleep experts around the world to calculate the level of sleep deprivation and daytime sleepiness. A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene, and/or need to see a sleep specialist. These issues should be discussed with your personal physician.
Use the following scale to choose the most appropriate number for each situation:
0 = would never doze or sleep.
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping

Situation Chance of Dozing or Sleeping:
____ Sitting and reading
____ Watching TV
____ Sitting inactive in a public place
____ Being a passenger in a motor vehicle for an hour or more
____ Lying down in the afternoon
____ Sitting and talking to someone
____ Sitting quietly after lunch (no alcohol)
____ Stopped for a few minutes in traffic while driving
____ Total score (add up the above scores)
Source: University of Maryland Medical Center: www.umm.edu/sleep/epworth_sleep

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