Patricia Santiago, 34, says she was beginning to think she had Alzheimer’s.
“Put the pillow on your head,” she told her 4-year-old son one recent night while helping him get ready for bed.
“He was laughing at me, and I didn’t know why,” Santiago says. “I thought I said, ‘Put the pillow on the bed.’ “
Earlier that week, after loading her son and two daughters, ages 12 and 7, into the car, Santiago turned to them and said, “Put on your pajamas.”
“I meant ‘seat belts,’ but for some reason ‘pajamas’ came out. This keeps happening. My kids think I’m nuts,” says Santiago, who also works full time as a health educator at a community clinic.
Sleepiness rather than Alzheimer’s probably has more to do with Santiago’s muddled words. She says she rarely gets enough rest at night.
Experts say that takes its toll.
“I have people come in whose memory is really gone,” says Joyce A. Walsleben, director of the Sleep Disorders Center at New York University’s School of Medicine and co-author of “A Woman’s Guide to Sleep: Guaranteed Solutions for a Good Night’s Rest,” along with Rita Baron-Faust (Crown Publishers, $24). “Their ability to concentrate is lessened. They’re not thinking properly. Their reaction time is slowed. All of these are symptoms of sleep deprivation.”
The average woman age 30 to 60 sleeps only 6 hours and 41 minutes per night during the work week, according to the National Sleep Foundation, though doctors agree eight hours is the average amount needed.
Many women say they simply can’t find the time to sleep eight hours each day. The dual demands of a career and children keep them away from bed. So do TV and the Internet, which cause 43 percent of adults to stay up later than they should. Forty-five percent of adults also agree they will sleep less in order to accomplish more, according to the NSF’s 2000 Sleep in America Poll.
Other women may be able to cobble together the eight hours they need, but their sleep is of poor quality. Depression, pain and stress, which disproportionately affect women, also contribute to restless nights, as do physical symptoms that occur during pregnancy, menopause and the menstrual cycle.
The sleep foundation says women are twice as likely to report depression as men. It also says that 25 percent of women report pain disrupts sleep versus 13 percent of men, and 26 percent of women report stress disrupts sleep versus 16 percent of men. Often, low quantity and quality combine to drain women. For instance, Pat Santiago goes to bed at 11 p.m. and gets up at 5:45 a.m.–a short night that is disrupted further if she gets up to attend to one of her children, as frequently happens.
“I can tell when I get a good night’s sleep,” Santiago says. “I’m full of energy and alert. That happens less than half the time.”
“Most people think [sleep] is a waste of time and they’ll get rid of it,” Walsleben says. “If they could understand the importance of it, and recognize that their performance and mood are so much improved–even adding 15 minutes a night would help.”
Fifty-one percent of Americans report that sleepiness on the job interferes with the amount of work they get done. Sixty-eight percent say that sleepiness interferes with their concentration, and 66 percent say it makes handling stress on the job more difficult, according to the NSF poll.
Making sleep a priority is the first order of business. After that, women can keep several things in mind to promote a good night’s rest. Dr. Joan Shaver, a sleep researcher and dean of the College of Nursing at the University of Illinois at Chicago, calls these the four R’s:
Regular sleep-wake patterns. “Go to bed and get up at the same time each day,” Shaver says. Avoid naps, unless they are regular and only 20 minutes or so in duration. Try to sleep the same amount each night.
Ritual cues for good sleep. Use the bedroom only for sleeping, not for working or watching television. Keep the environment quiet, dark and cool. Go to bed only when you’re sleepy. “Don’t lie in bed longer than 10 or 15 minutes,” Shaver suggests. “If you can’t go to sleep, get up and go to another room and engage in an activity that is relaxing, preferably boring. When you feel drowsy, go back to bed.”
Relaxation. Find ways to reduce stress and control tension. “It doesn’t matter what you use–tapes, transcendental meditation. Get in a comfortable position and clear your mind of intrusive thoughts,” Shaver says. “Women are really good at revving up their minds as soon as they lie down to go to sleep. They’re the ultimate coordinators of family life, so they’re making all their plans for the next day or agonizing over whatever happened earlier. For [relaxation techniques] to work, you have to practice routinely. Do it 15 to 20 minutes twice per day.”
Resistance of behaviors that interfere with sleep. “Don’t eat a lot right before bed,” Shaver advises. “Don’t engage in heavy-duty exercise before bed.” And keep away from alcohol, tobacco and caffeine at least three hours before bedtime.
For women like Nora Abboreno, 53, a teacher from Oak Park, the four R’s can deeply affect the quality of life. Abboreno has fibromyalgia, a rheumatic disorder that causes severe muscle pain and stiffness.
“If I don’t get enough sleep, the pain gets worse,” Abboreno says, “so I’ve learned behaviors that help my sleep. I consciously de-stress before I go to bed. Every night at 9:30 my husband, son and I sit down and have Sleepytime tea. We don’t watch any heavy news. I try to go to bed between 10 and 10:30 [on weeknights], and on Friday and Saturday I rarely go to bed later than 11.”
What happens if the four R’s don’t work? After four to six weeks, the American Academy of Sleep Medicine suggests seeing a doctor for possible diagnosis of a sleep disorder. There are nearly 80 known ones, and most can be treated or controlled successfully.
Insomnia is the most common problem, and affects women more than men (61 percent vs. 53 percent, according to the NSF 2000 poll). Sufferers regularly experience difficulty falling or staying asleep.
“Insomnia usually is a symptom of something else,” Walsleben says. For some women, “it’s strictly lifestyle stresses. For others, it’s linked to depression. For a huge group, it’s linked to menopausal causes,” mainly hot flashes that interrupt sleep. Sleep apnea is another common disorder. Sufferers stop breathing for several seconds, then jar themselves awake snorting and gasping for air. Loud snoring is a common symptom.
“Two to four percent of females have apnea,” Walsleben says. “Whereas we used to think it was 8-to-1 men to women, it’s now 2-to-1. We’re finding it more and more, particularly among post-menopausal women,” because after menopause women lose female hor-mones that protect against breathing problems.
Other disorders include narcolepsy, which involves sudden, frequent “sleep attacks” that last from a few seconds to 30 minutes or more; and restless leg syndrome, in which tingling, crawling or prickling sensations in the legs disturb sleep.
A disproportionate number of those with sleep problems, especially insomnia, are night and shift workers. Because it’s hard for the body clock to turn itself around quickly, Shaver recommends that workers do the shift in a permanent fashion, or at least in two-week increments.
There are many treatments for sleep problems.
Doctors may recommend prescription medication as a short-term intervention until self-help measures begin working. This can include sleeping pills like Sonata or Ambien, or low doses of antidepressants like Remeron or Desyrel.
Abboreno’s doctor gave her a small dose of an antidepressant during a sleepless stretch while she learned to control complications from her fibromyalgia. “It was temporary, and allowed me deep sleep until my sleep pattern kicked back in,” Abboreno says.
Over-the-counter sleep aids contain antihistamines. These remedies are marginally effective and can leave the user dry-mouthed and hung over, Walsleben says. Plus, she says, “you don’t know if you’ll have an interaction with some other medication you’re on.”
Herbs–such as valerian and kava kava–have proved effective in European studies, where herbal supplements are well-controlled, Walsleben says. In the U.S. they are not, and “we have no way to know that what is on the label is in fact in the bottle,” she says.
In Shaver’s view, “I think they aren’t very harmful, so it’s worth trying.”
As for taking a supplement of melatonin, a naturally occurring hormone that is cued by changing light levels, Walsleben says, “I don’t think you get more from it than you would from the sun. They both shift the time of sleep. I prefer people use bright lights” [for therapy].
Foods rich in the amino acid tryptophan give sleep a boost, including Mom’s old remedy–warm milk–and cheese, bananas, turkey and fish, according to Walsleben’s book. Calcium and magnesium appear to have a sedative effect; a good time to take calcium supplements is in the evening.
On the flip side: A low-carbohydrate diet may hamper sleep, because carbs help send tryptophan to the brain.
One of the best ways to conk out is to take a hot bath an hour or more before bedtime and soak for 30 minutes. This raises the body temperature, then induces deeper sleep as the temperature declines.
DOGGED DAYS OF WINTER
Why is it so hard to get out of bed on dark winter mornings? Is it our imagination that we feel more tired?
Not at all, says sleep expert Joyce A. Walsleben. “Our sleep cycles are tightly linked to a biological clock that responds to light and dark. Bright light anchors that clock, and reinforces the body’s sense of daytime/wake-time.”
Winter’s dark days shortchange us of light, so we tend to sleep more and sometimes feel tired during the day. For some people this tiredness is combined with a seasonal depression called seasonal affective disorder.
Light therapy can help. “Purchase or rent a bank of shielded fluorescent lights, about 10,000 lux, [a unit of illumination] and use them for 20 minutes within 10 minutes of your wake time,” Walsleben recommends.
For a list of companies that manufacture such lights, go to the Web site of the Society for Light Treatment and Biological Rhythms, a not-for-profit organization based in San Francisco, at www.sltbr.org.
HOW TO SILENCE THE SNORING
As many as 40 million Americans snore loudly enough to wake their bedmates. A 1999 study by the Mayo Clinic found that people whose bed partners snore lose an hour of sleep per night.
Women are more likely to fall victim to a male partner’s snoring than vice versa.
“We’ve had folks come in and tell us that their neighbor reported they were snoring–and their neighbor lives in another house,” says sleep expert Joyce A. Walsleben.
Of course, many people refuse to believe they snore, in which case Walsleben suggests: “Tape-record them.”
To help stop the noise for your partner or you:
– Nudge the offender to roll over, off his back.
– Encourage the snorer to lose weight. (Even a few pounds can make a difference.)
– Try Breathe Right strips, available without a prescription at drugstores, or similar products to widen nostrils and aid breathing.
– Use nasal sprays to reduce sinus tissue congestion.
– Use a humidifier to increase moisture in a heated room.
– Avoid alcohol and sedating medications before bed.
– If loud snoring persists, see an ear, nose and throat specialist or a sleep specialist to find out if you have apnea.
— Compiled by Karla Zimmerman, from “A Woman’s Guide to Sleep”
