Sleep Is More Important Than You Think
(Note: portions of the following information derived from WebMD Medical News, 2004)

Just can't get to sleep? Can't stay asleep? Waking up too early? Not feeling refreshed and restored in the morning? Not functioning well during the day? Not sleeping enough and not sleeping well is not ok. The stresses of daily life may intrude upon our ability to sleep well. After a typical night's sleep, you may not feel restored and refreshed and be sleepy during the day, but be totally unaware that these are related to poor sleep. You might think, "it's just the stress of work or the kids," or you might have "always felt this way" and had no idea that you should feel differently. This lack of awareness compounds the consequences, because so many people assume their interrupted sleep patterns are quite normal. As a matter of fact, there is quite a price to pay, which may significantly affect your health, performance and pocketbook.

Now, let's look at some of the consequences related to poor or interrupted sleep:

1. Poor quality sleep induces significant reductions in performance and alertness. It may surprise you to learn that reducing your nighttime sleep by as little as one and a half hours for just one night could result in a reduction of daytime alertness by as much as 32%.

2. It may also decrease alertness and promote excessive daytime sleepiness, which impairs your memory and your cognitive ability.

3. Disruption of a bed partner's sleep due to your restlessness may cause significant problems for a relationship (for example, separate bedrooms, conflicts, moodiness, etc.).

4. You may experience a poor quality of life. For example, you might be unable to participate in certain activities that require sustained attention, like going to the movies, seeing your child in a school play, or watching a favorite TV show.

5. Excessive sleepiness also contributes to a greater than two-fold higher risk of sustaining an occupational injury. The National Highway Traffic Safety Administration (NHTSA) estimates conservatively that each year drowsy driving is responsible for at least 100,000 automobile crashes, 71,000 injuries, and 1,550 fatalities.

6. Studies show an increased health risk for those reporting less than either six or seven hours per night. One study found that reduced sleep time is a greater risk than smoking, high blood pressure, and heart disease.

7. Sleep loss may also be a contributing factor to obesity. John Winkelman, MD, PhD, Medical Director of the Sleep Health Center at Brigham and Women's Hospital and Assistant Professor of Psychiatry at Harvard Medical School sums up this finding nicely: "What most people do not realize is that better sleep habits may be instrumental to the success of any weight management plan." And Michael Thorpy, MD, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York adds, "Any American making a resolution to lose weight ... should probably consider a parallel commitment for getting more sleep."

While it may be very difficult to get to sleep at bedtime, you find yourself "out like a light" in front of the TV, at a movie, reading, or even driving. And anticipating getting a poor night's sleep as well as developing rituals and behaviors you think will help your sleep (going to bed earlier) may actually have the opposite effect -- and make the problem worse.

Many of us may also experience temporary sleep disturbances that usually results from normal daily events such as: a stressful event, emotional stress, illness, temporary pain and disruptions to our circadian rhythms (the 24-hour rhythmic regulation of our body processes). When these stressful situations are resolved, then sleep usually improves.

Healthy Lifestyle Habits
Although the specific causes of poor sleep differ from one person to the next, there are some general habits you can adopt that may help you sleep better. Not each of these practices may apply to everyone, so you may want to focus on one or two that seem particularly relevant to your situation.

Developing healthy living habits is very important for quality sleep. For example, smoking, drinking, and exercise can affect your sleep dramatically. What you actually do in bed (like reading or watching TV), the temperature of room, noise levels, the timing and amount of fluids you drink, and the food you eat significantly impact your sleep pattern. Also, exposure to light in the evening (looking at a bright computer screen, turning on the light to go to the bathroom) may alter your circadian rhythms.

Circadian Rhythm
We all have a day-night cycle of about 24 hours called the circadian rhythm. It greatly influences when we sleep and the quantity and the quality of our sleep. The more stable and consistent our circadian rhythm, the better our sleep. This cycle may be altered by the timing of various factors, including naps, bedtime, exercise, and especially exposure to light (from traveling across time zones to staring at that laptop in bed at night). Circadian rhythm disruptions like shift work and jet lag may contribute to poor sleeping performance because the times you fall asleep and wake up are temporarily shifted. Your exposure to the amount of and timing of light can usually help re-set your circadian rhythm cycle.

Aging
Aging also plays a role in sleep. After the age of 40 our sleep patterns change, and we have many more nocturnal awakenings than in our younger years. These awakenings not only directly affect the quality of our sleep, but they also interact with any other condition that may cause awakenings, like the withdrawal syndrome that occurs after drinking alcohol close to bedtime. The less the awakenings we have at night, the more likely we will awaken feeling renewed and invigorated.

Psychological Stresses
Psychological stresses like deadlines, exams, marital conflict, and job crises may prevent us from falling asleep or wake us from sleep throughout the night. It takes time to "turn off" all the noise from the day. If you work right up to the time you turn out the lights, or are reviewing all the day's events and planning tomorrow (sound familiar?), you simply cannot just "flip a switch" and drop off to a blissful night's sleep.

One must develop some kind of pre-sleep ritual to break the connection between all the stress and bedtime. This is perhaps even more important for children. These rituals can be as short as 10 minutes or as long as an hour. Some find relief in making a list of all the stresses of the day, along with a plan to deal with them, as it serves to end the day. Combining this with a period of relaxation, perhaps by reading something light, meditating, or taking a hot bath can also help you get better sleep. And don't look at that clock! That tick-tock will tick you off.

Behavioral Strategies
Establish a regular bedtime routine and a regular sleep-wake schedule. That means getting up at the same time every day of the week, no matter how much you’ve slept the night before, and going to bed at the same time. Don’t spend too much time in bed. Your time in bed should be about the same as the amount of time you can actually sleep during the night. You can’t force yourself to sleep by spending more time in bed.

You should restrict where you sleep to your bedroom bed. The idea here is that you should sleep only in your normal bed and try not to lie awake for hours hoping to fall asleep. If you do not fall asleep after about 25 minutes, get out of bed and do something calming, like reading a book. This helps reduce the anxiety-provoking association of being awake while in bed, and ultimately may create the positive association of sleeping well in bed. When restricting sleep in this manner, you may eventually become so tired that you become sleepy earlier in the evening, thus producing a better quality of sleep. Also make your bedroom your normal place for sleep -- no TV-watching, for example. This again tries to create associations to help train your mind. The best strategy of all is to try and relax your mind and body, making it easier to fall asleep and stay asleep.

The following are some sleep tips that sleep experts recommend to help you relax, fall asleep, stay asleep, and get better sleep so that you wake up refreshed and alert:

1. Avoid watching TV, eating, and discussing emotional issues in bed. When we associate the bed with these activities and it often becomes difficult to fall asleep.

2. Minimize noise, light, and temperature extremes during sleep. Consider using ear plugs, close window blinds, and use an electric blanket or air conditioner for comfort. If your room is too hot (above 75 degrees) or too cold (below 54 degrees), these extremes could disrupt your sleep.

3. Try not to drink fluids after 8 p.m. This may reduce awakenings due to urination.

4. Avoid naps, except for a brief 10-15 minutes about eight hours after you awake. But if you have problems falling asleep, then no naps for you.

5. Do not expose your self to bright light if you need to get up at night. Use a small night-light instead.

6. Nicotine is a stimulant and should be avoided particularly near bedtime and upon night awakenings. Having a smoke before bed, although it feels relaxing, is actually putting a stimulant into your bloodstream.

7. Caffeine is also a stimulant and is present in coffee (100-200 mg), soda (50-75 mg), tea (50-75 mg), chocolate, and various over-the-counter medications. Caffeine should be discontinued at least four to six hours before bedtime. If you consume large amounts of caffeine and you cut your self off too quickly, beware; you may get headaches that could keep you awake.

8. Although alcohol is a depressant and may help you fall asleep, the subsequent metabolism that clears it from your body when you are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats.

9. A light snack may be sleep-inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates or dairy products. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep. So milk and cookies or crackers (without chocolate) may be useful and taste good as well.

10. Do not exercise vigorously just before bed. If you are the type of person who is aroused by exercise, it may be best to exercise late in the afternoon (preferably an aerobic workout, like running or walking). Some studies have shown that exercise right before bed is not as bad as once thought, unless you are the type of person who becomes more alert with exercise.

11. Does your pet sleep with you? This, too, may cause arousals from either allergies or their movements in the bed. Thus, Fido and Kitty may be better off on the floor than on your sheets.

Good lifestyle behaviors can have a tremendous impact upon getting better sleep. You should wake-up feeling refreshed and alert, and you should generally not feel sleepy during the day. Since it is clear how critical sound sleep is to your health and well-being, if you are not sleeping well, see your doctor or a sleep specialist.

Social Drugs
Social drugs like caffeine, nicotine, and alcohol may have a larger impact on your sleep than you realize. Caffeine, which can stay in your system as long as 14 hours, increases the number of times you awaken at night and decreases the total amount of sleep time. This may subsequently affect daytime anxiety and performance. The effects of nicotine are similar to those of caffeine, with a difference being that at low doses, nicotine tends to act as a sedative, while at high doses it causes arousals during sleep.

Alcohol may initially sedate you, making it easier to fall asleep; however, as it is metabolized and cleared from your system during sleep, it causes arousals that can last as long as two to three hours after it has been eliminated. These arousals disturb sleep, often causing intense dreaming, sweating, and headache. Smoking while drinking caffeine and alcohol can interact to affect your sleep dramatically. These sleep disturbances may be most apparent upon awakening, feeling unrefreshed, groggy, or hungover. It is important to realize that not getting the proper amount of and the best quality sleep may have serious short-term and long-term consequences.

Over-the-Counter (OTC) Medications:
Non-prescription, over-the-counter sleep aids are often antihistamines prescribed for allergies. They are readily available and may be useful for some individuals in some situations, but you should be aware of side effects such as prolonged sleepiness or the possibility of interactions with other medications.

A Final Recommendation:
It is always best to consult a physician for advice on treating your sleep problem.