Updated July 24, 2006

Getting the Sleep You Need

by David Spero, R.N.

Things that keep us awake
As many as 36% of Americans have some type of sleep disorder. That’s a huge number. Why is sleeping so difficult? Sleep specialists have identified the following reasons, among others.

Substances. Sleep specialist Peter Hauri, Ph.D., Co-Director of the Mayo Clinic Sleep Disorders Center, says, “There are three things that have an excellent chance of helping you sleep, no matter what other factors are involved. These things are reducing caffeine, limiting alcohol, and stopping smoking.”

Although coffee and soft drinks are the most commonly recognized sources of caffeine, chocolate, some teas, and some medicines also contain caffeine. Even one cup of tea or a chocolate bar in the afternoon can keep some people up after midnight. Dr. Hauri suggests cutting all caffeine out of your diet. Once you get some normal sleep going, you can try slowly adding the caffeine back. If you smoke, nicotine cravings don’t stop at night, and they can wake you up. The only way out of this trap is to stop smoking completely. Of course, smoking and diabetes are a horrible combination anyway, so if getting a good night’s sleep encourages you to quit, it’s a win–win proposition.

People used to think an alcoholic drink was a good sleep aid, hence the term “nightcap.” But Dr. Hauri says, “Drinking alcohol late in the evening produces troubled and fragmented sleep. The person does not sleep soundly but wakes up several times and does not get back to sleep promptly. By morning, there invariably is less sleep than without alcohol.” Some foods, especially spicy foods, also cause insomnia in some people.

Sleeping pills. Almost all sleep specialists now try to avoid prescribing sleeping pills for people with chronic sleep problems. Although they can be useful for treating some short-term sleep disturbances, hypnotics (sleeping pills) are not usually given to people with chronic insomnia because they can become habit-forming, and people may even experience a rebound effect of more pronounced insomnia when the drugs are stopped. People also rapidly build up a tolerance to many sleep medicines, needing more and more over time to get to sleep. In addition, with some drugs, you can wake up in the morning feeling as tired as if you hadn’t slept at all. You’re also in danger of falling if you wake up in the night to go to the bathroom with sedatives in your system. This is a major cause of broken hips and other injuries for older people, especially people in nursing homes. Over-the-counter sleep medicines are just as bad, according to Dr. Buda.

Depression. Both insomnia and “hypersomnia” (sleeping too much) are classic symptoms of depression. If you lie in bed having thoughts of hopelessness or worthlessness, especially in the early morning, you may be depressed. Because depression is a risk factor for other problems and because it is treatable, you should seek professional help.

Sleep apnea. A number of medical conditions interfere with sleep. One is sleep apnea, where the person experiences interruptions of breathing during the night. Sleep apnea normally happens to heavy snorers, who are usually, but not always, overweight. Sleep apnea is typically observed when loud snoring is interrupted by about 10 seconds or more of silence as breathing stops and then starts again—often with a loud snort or gasp—which may wake you. (Some people think they woke to go to the bathroom, when actually it was sleep apnea.) This pattern may repeat many times an hour throughout the night. If you have a bed partner, he or she would probably notice the signs of sleep apnea first. You could also spend a night in a sleep lab for an official diagnosis. It’s worth checking out, because sleep apnea is associated with serious health problems, including diabetes and heart disease.

Other medical conditions. Gastroesophageal reflux disease (GERD) is commonly known as heartburn. When people with GERD lie down, acid from the stomach can leak back into the esophagus, causing pain and, sometimes, severe damage. Other people have periodic limb movements or restless legs syndrome, in which jumping of the legs makes sleep difficult. (Sometimes it’s even more difficult for the bed partner!) Older men may develop a benign enlargement of the prostate, which can cause more frequent urges to urinate, waking them several times a night. These conditions are treatable and should be checked out by a physician.

Also in this article:
Sleep Resources

David Spero is the author of The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House, 2002). Find out more about his classes and articles at www.davidsperorn.com.

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