`O sleep! O gentle sleep! Nature’s soft nurse . . . ” wrote Shakespeare in “Henry IV, Part II.” But for many Americans sleep comes neither gently nor softly.
In fact, according to a Gallup Poll conducted for the National Sleep Foundation, it’s estimated that 30 million to 40 million Americans suffer from insomnia, a catch-all term that can cover a wide variety of sleep disorders.
Poor sleep can lead to poor production at work, and as a wide range of consequences, from irritability with co-workers and family to increased risks during such activities as driving.
Fortunately, in the last decadey, researchers have learned a great deal about what happens during sleep, along with common-sense ways to attain better rest.
There are basically two broad categories of sleep disorders: people who can’t fall or stay asleep at night and people who cannot stay awake during the day. Dr. Edward Stepanski, associate professor of clinical psychology in medicine at the University of Illinois at Chicago, says the first thing that must done in either case is to try to isolate the causes.
“We look at medical and psychological reasons,” says Stepanski, “because this will determine what we’ll do. For instance, people may know that they’re under tremendous stress either at home or work. That’s different from someone who has no idea why they’re not sleeping. In the case of somebody who seems to understand what the reasons for poor sleep are, we would probably think about treatment that will address their sleep habits.”
The best place to start, says Stepanski, is to make sure that your biological clock is set to the right time. People often make the mistake of setting their bedtime according to the time that they want to arise. For instance, if they have to catch a flight early in the morning, they’ll go to bed early at night. Unfortunately, that strategy doesn’t work.
“If you’re body clock is set to fall asleep at midnight, then that’s when it will fall asleep,” notes Stepanski.
One method that sleep specialists use is sleep restriction therapy, in which patients stay up later and try to condense their sleep. Sometimes people go through stressful times and what they don’t realize is that they can get by with less sleep over a short-term period. People who find themselves lying awake for hours will try to stay in bed longer to make up for the time. That’s the worst thing you can do, says Stepanski.
“If you’re going through a time when your body is not able to sleep easily, you really want to push back your bedtime because it will be much more likely that you’ll be able to fall asleep faster at 1 in the morning than at 11 p.m. It may not be what you’re used to or what you want, but you’ll have a better chance of getting five or six hours of good sleep and eventually your body will get back into the pattern where it can sleep longer.”
One question that commonly arises is how long a person should lie awake in bed. Dr. Phyllis C. Zee, director of sleep disorders at Northwestern University, says that if you’re not asleep in 35 minutes or so, get out of bed, go into another room and perform relaxation exercises such as mental relaxation or muscle relaxation until you feel sleepy. Then return to the bed.
“What happens is that the longer you stay in bed, the more anxious you get about not being able to fall asleep. So behaviorally one begins to condition the room and the bed with not being able to fall asleep. If you’re a good sleeper, you go to bed and expect to fall asleep. But if you’re not, then bedtime becomes an anxious period. So we try to decondition this, and re-establish the bed as a place where you can fall asleep easily.”
Zee offers a variety of tips for what she calls “good sleep hygiene.” Among these are:
– Keep a regular time out of bed seven days a week.
– Keep your clock face turned away, so you can’t see what time it is when you wake up at night.
– Learn simple self-hypnosis to use if you wake up at night. Do not try too hard to sleep; instead, concentrate on the pleasant feeling of relaxation.
– Do not eat or drink heavily for three hours before bedtime. A light bedtime snack may help.
– Exercise regularly, preferably 40 minutes each day of an activity that causes sweating. It is best to finish exercise at least six hours before bedtime.
Depending on the reasons for poor sleep, naps can play a role in getting rest. “If you’re having the kind of insomnia where you lie in bed and can’t sleep,” says Stepanski, “then we discourage napping because any sleep during the day will discourage sleep at night.
“Where naps play an important role is with a separate problem, and that is chronic insufficient sleep. This happens when people could sleep for eight hours, but they don’t get the chance, either because they’re working a lot or have too much going on. In that case, taking a nap can really make a difference, because a sleep debt is building up and if they get a nap it will increase their performance and improve their functioning afterward.
“The bottom line is that people should start worrying about lost sleep when it begins to impair their daytime performance. If it’s at the point where people cannot function during the day, then that is the time when they should talk to their doctor. Sometimes people go through periods where they can’t sleep much, but it doesn’t affect them too much during the day. So they should see if they can ride it out and it will get better by itself. Otherwise, they need to talk to their doctor.”
The National Sleep Foundation offers individual booklets on specific sleep problems and issues, including insomnia, sleep apnea, narcolepsy, restless legs syndrome and other topics. The foundation can be reached on the World Wide Web at http://www.sleepfoundation.org/ or by writing the National Sleep Foundation, 729 15th Street, N.W., 4th Floor, Washington, D.C. 20005.
