Q: I've been having problems falling asleep. Are there things I can try other than taking sleeping pills?
A: Many things can interfere with sleep, ranging from anxiety to an unusual work schedule. But people who have difficulty sleeping often discover that their daily routine holds the key to nighttime woes. Below are 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. People who suffer from insomnia should avoid caffeine as much as possible, since its effects can last for many hours. Those who can’t or don’t want to give up caffeine should avoid it after 2pm, or noon if they are especially caffeine-sensitive.
– Stop smoking or chewing tobacco. Nicotine is a potent drug that speeds your heart rate, raises blood pressure, and stimulates brain activity. In people addicted to nicotine, a few hours without it is enough to induce withdrawal symptoms. Cravings can even wake a smoker at night. People who kick the habit fall asleep more quickly and wake less often during the night. They may be more tired during the day at first, but many former users say they sleep better. Quitting also offers many other health benefits, including a lower risk for cancer, heart disease and stroke. But those who continue to use tobacco should avoid smoking or chewing it for at least one to two hours before bedtime.
– Use alcohol cautiously. Alcohol affects sleep in two different ways. Because it makes you sleepy for an hour or two, a nightcap can help some people doze off. But after that, alcohol can cause frequent awakenings as it suppresses deep sleep, reducing the quality of your sleep. Experts blame alcohol for 10 percent of chronic insomnia cases.
Some people fail to get even the short-term benefit from a nightcap because alcohol raises a hormone in the body that makes falling asleep difficult. Because alcohol relaxes throat muscles and interferes with brain control mechanisms, it can worsen snoring and other nocturnal breathing problems, which can sometimes be dangerous.
– Avoid a sedentary life. Aerobic exercise like walking, running or swimming promotes restfulness by helping you to fall asleep more easily and to sleep more soundly. One study found that 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. Timing is important: Exercising five or six hours before bedtime will encourage drowsiness when it’s time to go to sleep. But strenuous activity within two hours before bedtime can keep you awake. If you can’t exercise several hours before bedtime, exercising earlier in the day can also help you sleep better.
– Improve your sleep surroundings. An ideal sleep 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. Removing the television, telephone and office equipment from the bedroom is a good way to reinforce that this room is meant for sleeping.
– Keep a regular schedule. People with the most regular sleep habits report the fewest problems with insomnia and the least feelings of depression. Experts advise going to sleep at the same time on most nights, and 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 you’re anxious about getting enough sleep, then a scheduled nap may help you feel better at night by helping you feel less anxious. If possible, nap shortly after lunch and no longer than an hour. Even a 15- to 20-minute nap can make you feel more alert.
You may also find it helpful to make sure your bedroom is quiet (see graphic). If you try all of these suggestions and still have sleep problems, talk to your health-care provider.
By The Faculty of Harvard Medical School
The Harvard Medical School Adviser
Tuesday, January 10, 2006