General ways to improve sleep

Many things can interfere with sleep, ranging from anxiety to an unusual work schedule. People who have difficulty sleeping often discover that their daily routine holds the key to nighttime woes. Before examining specific sleep problems, let's look at some common enemies of sleep and some tips for dealing with them.

Cut down on caffeine

Caffeine drinkers may find it difficult to fall asleep. Once they drift off, their sleep is shorter and lighter. For some people, a single cup of coffee in the morning means a sleepless night. That may be because caffeine blocks the effects of adenosine, a neurotransmitter thought to promote sleep. Caffeine can also interrupt sleep by increasing the need to urinate during the night.

People who suffer from insomnia should avoid caffeine as much as possible, since its effects can endure for many hours. Because caffeine withdrawal can cause headache, irritability, and extreme fatigue, some people find it easier to cut back gradually than to go cold turkey. Those who can't or don't want to give up caffeine should avoid it after 2 p.m., or noon if they are especially caffeine-sensitive.

Stop smoking or chewing tobacco

Nicotine is a central nervous system stimulant that can cause insomnia. This potent drug makes it harder to fall asleep because it speeds your heart rate, raises blood pressure, and stimulates fast brain wave activity that indicates wakefulness. In people addicted to nicotine, a few hours without it is enough to induce withdrawal symptoms; the craving can even wake a smoker at night. People who kick the habit fall asleep more quickly and wake less often during the night. Sleep disturbance and daytime fatigue may occur during the initial withdrawal from nicotine, but even during this period, many former users report improvements in sleep. Quitting also offers many other health benefits, including a lower risk for cancer, heart disease, and stroke. If you continue to use tobacco, avoid smoking or chewing it for at least one to two hours before bedtime.

Use alcohol cautiously

Alcohol depresses the nervous system, so a nightcap can help some people fall asleep. However, the quality of this sleep is abnormal. Alcohol suppresses REM sleep, and the soporific effects disappear after a few hours. Drinkers have frequent awakenings and sometimes frightening dreams. Alcohol may be responsible for up to 10% of chronic insomnia cases. Also, because alcohol relaxes throat muscles and interferes with brain control mechanisms, it can worsen snoring and other nocturnal breathing problems, sometimes to a dangerous extent.

Besides contributing to middle-of-the-night wakefulness, alcohol can cause dangerous drowsiness during the day or evening. Drinking during one of the body's intrinsic sleepy times — midafternoon or at night — will induce more sleepiness than imbibing at other times of day. Even one drink can make a sleep-deprived person drowsy. In an automobile, the combined effect of alcohol and sleepiness can be deadly, with the two factors significantly increasing a person's chances of having an accident.

Avoid a sedentary life

Research has repeatedly shown that regular aerobic exercise like walking, running, or swimming provides three important sleep benefits: You fall asleep faster, attain a higher percentage of deep sleep, and awaken less often during the night. Exercise seems to be of particular benefit to older people. According to a Duke University study, physically fit older men fell asleep in less than half the time it took for sedentary men, and they woke up less often during the night.

Exercise is the only known way for healthy adults to boost the amount of deep sleep they get. Researchers from the University of Washington found that older men and women who reported sleeping normally could still increase the amount of time they spent in deep sleep if they engaged in aerobic activity.

One important caveat is that you should not exercise too close to bedtime because exercise is stimulating and can make it harder to fall asleep. If you finish exercising at least two hours before bedtime, you'll eliminate this risk.

Improve your sleep surroundings

Like Pavlov's dogs, humans learn to respond to environmental cues. Removing the television, telephone, and office equipment from the bedroom is a good way to reinforce that this room is meant for sleeping.

An ideal environment is quiet, dark, and relatively cool, with a comfortable bed and a minimal amount of clutter from daytime responsibilities. Reminders or discussions of stressful issues should be banished to another room.

Ways to control bedroom noise

A quiet bedroom can help contribute to a good night's sleep, particularly among older adults, who spend less time in deep sleep and, therefore, are more easily awakened by noises. Here are some ways to reduce or disguise noises that can interfere with sleep:

Use earplugs.

Decorate with heavy curtains and rugs, which absorb sounds.

Install double-paned windows.

Use a fan or other appliance that produces a steady "white noise." White noise devices, designed specifically to provide this kind of steady hum, are available in stores, as are tapes and CDs that provide soothing sounds.

Maintain a regular schedule

A regular sleep schedule keeps the circadian sleep/wake cycle synchronized (see "Your internal clock"). People with the most regular sleep habits report the fewest problems with insomnia and the least feelings of depression. Experts advise getting up at about the same time every day, even after a late-night party or fitful sleep. Napping during the day can also make it harder to get to sleep at night.

Keep a sleep diary

Keeping a sleep diary may help you uncover some clues about what's disturbing your sleep. If possible, you should do this for a month, but even a week's worth of entries can be beneficial.

Use strategic naps

If your goal is to sleep longer at night, napping is a bad idea. Because your daily sleep requirement remains constant, naps take away from evening sleep.

But if your goal is to improve your alertness during the day, a scheduled nap may be just the thing. If an insomniac is anxious about getting enough sleep, then a scheduled nap may improve the quality of nighttime sleep by reducing anxiety (although it will reduce the time spent asleep at night).

If possible, napping should take place shortly after lunch. People who snooze later in the afternoon fall into a deeper sleep, which causes greater disruption at night. An ideal nap lasts no longer than an hour, and even a 15- to 20-minute nap has significant alertness benefits. Naps that produce lingering grogginess should be shortened or eliminated.

Tips for a better night's sleep

Hygiene is the application of scientific knowledge to maintain good health. These procedures are known as "sleep hygiene," because they represent scientific thinking about maintaining healthy sleep patterns.

Go to bed and wake up at the same time every day, even on weekends.

Use the bed only for sleeping or sex.

Forgo naps, especially close to bedtime.

Limit the time you spend in bed. Turn in only when you're sleepy. If you don't fall asleep within 15 minutes or if you wake up and can't fall back to sleep within that amount of time, get out of bed and do something relaxing until you feel sleepy again.

Avoid caffeine-containing beverages (coffee, many teas, chocolate, and cola drinks) after 2 p.m., or noon if you're caffeine-sensitive.

Avoid eating foods that contribute to heartburn.

Don't drink alcohol for at least two hours before bedtime.

Limit fluids before bedtime to minimize nighttime trips to the bathroom.

Stop smoking, or at least do not smoke for one to two hours before turning in for the night.

Exercise regularly (but not within two hours of bedtime).

Keep the bedroom cool, dark, and as quiet as possible.

Replace a worn-out or uncomfortable mattress.

Take a hot bath before bedtime.

Use relaxation techniques before bedtime.

Review Date: 2007-10-01

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