INSOMNIA
You brush your teeth, turn out the lights, snuggle with
your honey for a sweet moment, then kiss good night. Your
spouse falls asleep immediately. Meanwhile, you lie awake,
tossing and turning as the minutes, the hours tick by. It’s
the nightly battle to slip into what Shakespeare called
“innocent sleep...the balm of hurt minds...chief nourisher
in life’s feast.”
Or perhaps you fall asleep easily, but wake up at 3 a.m.
and can’t fall back asleep. Or maybe you wake up and fall
asleep several times each night, but rarely get one long,
uninterrupted stretch of restful, refreshing sleep. All
these problems are insomnia.
“People think that insomnia just means trouble falling
asleep,” says Peter Hauri, Ph.D., director of the Mayo
Clinic Insomnia Program in Rochester, Minnesota, and
co-author (with Shirley Linde, Ph.D.) of No More Sleepless
Nights. “Actually, it’s any problem with falling or staying
asleep.”
What’s Going On?
More than 100 million Americans experience occasional
insomnia. That is why at 2 a.m., some 20 million are
watching television, according to the A.C. Neilsen Company,
which tracks TV viewing. An estimated 30 to 60 million
Americans—mostly women—suffer chronic sleeplessness, and 10
million consult doctors for the problem. Half of the
nation’s adults have taken sleep medication at some point
in life, and millions use sleeping pills frequently.
Insomnia’s costs extend beyond the bedroom. Compared with
normal sleepers, insomniacs are less productive at work,
have twice as many auto accidents, and also report
generally poorer health because sleep is critical to immune
function. No wonder that in the Bible, insomnia was one of
the trials of Job.
“Insomnia is so common,” says William Dement, M.D., a
professor of psychiatry and behavioral sciences at Stanford
University, director of the Stanford Sleep Disorder Clinic,
and chair of the National Commission on Sleep Disorders
Research (NCSDR), “that it’s accepted—mistakenly—as a
normal part of growing older.”
Insomnia can have many of causes, Dr. Hauri explains:
• Drugs. Caffeine is a powerful stimulant. Alcohol disrupts
sleep. Many other over-the-counter and prescription drugs
do the same.
• Smoking. Nicotine is a stimulant.
• Poor diet, or sleep-disturbing dining habits. High-fat
foods are hard to digest and may disrupt sleep. Eating too
late at night can do the same.
• Lack of exercise. Exercise gets you tired and helps you
fall asleep. A sedentary lifestyle does not.
• Your bedroom environment. Light, noise, and a small,
uncomfortable bed can all keep you awake.
• Poor sleep habits. If you go to bed at different times
every night, and wake up at different times each morning,
your body’s natural sleep-wake rhythm can become disrupted
enough to cause insomnia.
• Stress. If you’re tense, anxious, or worried, sleep
suffers.
• Illness. Illnesses that restricut breathing (colds, flu,
allergies), and conditions that cause pain (arthritis,
injuries) often disturb sleep.
But if you suffer what the poet, John Keats called
“unwilling sleep,” there’s hope. Sleep specialists
typically help about 80 percent of even chronic insomniacs
fairly quickly with a program that combines home remedies,
mainstream medicine, and complementary therapies.
Best Choices
Home Remedies
• Keep a sleep diary. A sleep diary is an important first
step to overcoming sleep problems, says Katherine Albert,
M.D., Ph.D. director of the Sleep Laboratory at New York
Hospital-Cornell Medical Center in New York City and author
of Get a Good Night’s Sleep. It can reveal patterns that
might otherwise remain hidden. For example, based on recall
alone, you might underestimate the amount of caffeine or
alcohol you consume. For two weeks, simply jot down what
and when you eat, drink, and do everything else during the
day, plus your emotional stressors, any drugs you take, and
how long and well you sleep. Look for connections between
nights when you sleep poorly and what’s going on in the
rest of your life.
• Ditch the double bed. If you and your spouse sleep in a
double bed, you each have no more room than a baby has in a
crib. Switch to a queen- or king-size bed, Dr. Hauri
advises: “Larger beds become especially important as you
age, because after about 40, you sleep less soundly, and
are more likely to be disturbed by a restless bedmate.” If
you were happy with a queen-size bed 10 years ago, but
haven’t been sleeping well lately, it may be time for a
king.
• Pamper yourself in bed. You spend one-third of your life
in bed. Invest in that time, Dr. Dement suggests, and
you’ll probably sleep better. Get comfortable pillows and
sheets. Test different types of mattresses. Splurge on
sleepwear that feels just right for you. If you have
arthritis or a bad back, try extra pillows, or specially
shaped therapeutic pillows. If heartburn is a problem,
elevate the head of your bed a few inches.
• Keep it quiet. You can probably sleep though steady
noise, Dr. Hauri explains, for example, the hum of a nearby
freeway. But you’re likely to get rudely awakened by
sudden, intermittent noises: a cat fight in a neighbor’s
yard, or a motorcycle roaring up the street. For quiet, try
foam earplugs. They’re cheap and available at pharmacies.
Or consider replacing those rattling windows with
high-tech, double-pane, noise-reducing windows. If
intermittent noises are a problem, consider a noise screen,
a steady sound that drowns out the occasional police
siren—a fan or a radio tuned to the static between
stations.
• Do it in the dark. For a darker bedroom, Dian [Note: No
“e” on Dian] Buchman, Ph.D., author of The Complete Guide
to Natural Sleep, suggests investing in blackout drapes,
blinds, or shades. Or wear a sleep mask, available at
pharmacies.
• Banish your bedroom clock. “Many insomniacs have big,
illuminated digital clocks staring at them all night—and
making them anxious,” Dr. Hauri says, “For most people, the
bedroom should be a time-free environment.” If you use an
alarm clock, place it so that you can’t see the time while
you’re in bed.
• Never confuse sex and sleep. What if you like it quiet
and dark, but your honey can’t sleep without an open window
that lets in noise and light? What if one of you likes a
hard foam mattress, but the other prefers a waterbed? Many
couples with very different sleep styles feel obligated to
share the same bed. Perhaps it’s not worth it. Consider
twin beds or different bedrooms. “You may have to endure
some teasing from friends,” says Louanne Cole-Weston,
Ph.D., a sex and marital therapist in Fair Oaks,
California, “but who cares? You’ll both sleep better, and
probably feel more loving toward one another, which can
lead to better sex.”
• Get out of bed. Many insomniacs stay in bed too long. If
you need seven hours of sleep, but are in bed for nine,
you’ll toss and turn for two. In one study, Dr. Hauri
instructed 62 insomniacs to retire one hour later than
usual. Ninety percent reported improved sleep.
• Never work at falling asleep. Sleep is like love: It
arrives only when you don’t try to force it. Think about
something else. Years ago, the traditional advice was to
count sheep. Do that if you like, but today most people
prefer to read, watch TV, or listen to music. A recent
Gallup survey showed that one-third of American adults read
themselves to sleep.
• Get regular. Every sleep expert agrees: Go to bed and
wake up at the same time every day, even on weekends. “Many
people need regular sleep-wake cycles,” Dr. Hauri says,
“and have trouble sleeping if they don’t stick to them.”
Getting regular is particularly important if you suffer
from “Sunday night insomnia,” the inability to fall asleep
on Sunday night. Most people assume that anxieties about
the upcoming work week cause this problem. Perhaps, but if
you have Sunday night insomnia, you may actually suffer
from a sleep-rhythm disturbance similar to jet lag. Let’s
say you retire at 10:30 and wake up at 6:00 Monday through
Friday. Then you stay up until midnight or 1 a.m. Friday
and Saturday nights and and wake up at 10:00 on Saturday
and Sunday mornings. By Sunday, you’ve subtlely shifted you
internal biological clock, as you do when flying across
several time zones. When your clock says 10:30 on Sunday
night, your body just isn’t ready to sleep. “Maintain your
weekday schedule on the weekend,” Dr. Hauri says, “and you
may find relief from Sunday night insomnia.”
• Adopt bedtime rituals. Bedtime rituals help you wind down
toward sleep. Most people change into pajamas, lock up,
brush their teeth, and turn out the lights. If you have
trouble sleeping, add a few more rituals: Drink a cup of
herb tea, chat with your spouse, do some light reading, or
take a hot bath (see below).
• Keep a “To Do” list. Here’s another helpful ritual: If
you lie awake worrying that you might forget what you have
to do the next day, make a “to do” list of everything you
need to remember before you retire. Then let go of your
list until morning.
• Think about what you gain from insomnia. “I don’t gain
anything,” most insomniacs quickly retort. “I hate my
insomnia.” Of course you do, Dr. Hauri explains, but you
still might gain something from it, perhaps sympathy or an
excuse for poor productivity. What might change for the
worse if you slept better? Work to resolve those issues,
and you might relieve your insomnia.
Diet
• Eliminate caffeine. “Caffeine causes more sleep problems
than most people realize,” Dr. Albert explains. “Many
insomniacs are exceptionally sensitive to caffeine and have
trouble sleeping after even one cup of tea or a chocolate
bar in the afternoon.” But don’t eliminate caffeine cold
turkey, or you’ll suffer withdrawal symptoms, notably a
headache that can last several days. Instead, Maryland
botanist/herbalist James Duke, Ph.D., author of The Green
Pharmacy, advises tapering off over a few weeks by mixing
decreasing proportions of regular with increasing
proportions of decaf. In addition, sip less regular tea and
more herb teas, and drink fewer caffeinated soft drinks and
more that are caffeine-free.
• Confirm that it’s decaf. If a restaurant server makes a
mistake and gives you regular coffee instead of decaf, you
could be up all night. When you’re served what you think is
decaf, make sure. Ask, “This is decaf, isn’t it?”
• Nightcap no-no. “Doctors used to tell insomniacs to have
a cocktail or glass of wine before bedtime,” Dr. Hauri
explains, “but many people find that drinking keeps them
from sleeping, and in nearly everyone, drinking late in the
evening produces troubled, fragmented sleep.” A glass of
wine with dinner won’t hurt, but don’t drink alcohol within
a few hours of retiring.
• Watch what you eat. The healthier you are, the better you
sleep. The healthiest diet is low-fat and near-vegetarian,
based on salads, vegetables, fruits, beans, and whole
grains. Go easy on fatty, hard-to-digest foods: meats, fast
foods, deep-fried foods, and greasy snacks.
• Watch when you eat. Bedtime snacks are fine, as long as
they’re small and light. Don’t eat a large, heavy supper,
or anything heavy within an hour or two of bedtime, Dr.
Hauri advises. Digestive processes can disturb sleep.
• Eat more tryptophan. Tryptophan, an amino acid, is an
ingredient of serotonin, a chemical messenger
(neurotransmitter) in the brain that helps induce sleep.
“In pill form, tryptophan induces sleep in about half
insomniacs,” Dr. Buchman says. But in 1988, the FDA banned
it after contaminated tryptophan caused several injuries.
In 1996, the FDA lifted its ban, but made the amino acid a
prescription-only item. Ask your doctor for a prescription
if you like—or get your tryptophan from foods high in it,
notably: tuna, cottage cheese, rice, oatmeal, eggs, peanut
butter, and milk (which may explain the popular ritual of
drinking warm milk before bed).
Exercise
• Sweat, then sleep. Regular exercise is “one of the best
things you can do to sleep soundly,” Dr. Hauri says. Any
exercise helps, but he especially recommends
walking--several, brisk, half-hour walks per week, ideally,
one a day.
What’s the most sleep-inducing time of day to exercise? The
late afternoon, Dr. Albert says, after work but before
dinner. “Exercising in the late afternoon releases the
day’s stress and decreases your appetite for dinner, which
helps you stick to the light supper sleep experts
recommend. Just don’t exercise too close to bedtime. That’s
stimulating, and can keep you up.”
Relaxation Therapies
• Breathe yourself to sleep. Deep breathing is a
fundamental relaxation technique. In addition to its ritual
value, five to 20 minutes of sitting quietly and breathing
deeply before bed might help you fall asleep, Dr. Hauri
says.
• Focus on a Zzzz’s mantra. Recently, a panel of experts
with the National Institutes of Health (NIH) investigated
nondrug approaches to treating insomnia. They concluded
that relaxation therapies are quite helpful, notably
meditation, which produces “significant improvements” in
sleep.”
• Slip into slumber with biofeedback. The NIH panel also
gave high marks to biofeedback relaxation training as a
sleep aid. Biofeedback is similar to meditation.
• Visualize yourself in dreamland. “Visualization therapy
can be a powerful tool for inducing sleep,” says Martin
Rossman, M.D., co-director of the Academy for Guided
Imagery in Mill Valley, California. The Academy’s Imagery
Store offers an audio cassette, “A Restful Sleep.” Write
the Academy at P.O. Box 2070, Mill Valley, CA 94942
• Entice the Sandman with the scent of lavender. Oil of
lavender is an aromatherapy favorite for relaxation and
insomnia. At the University of Vienna, researchers showed
that a whiff of lavender oil relaxes caffeine-stimulated
mice. And researchers at the University of Leicester in
England, found that suffusing bedrooms in a nursing home
with the fragrance of lavender helps residents sleep.
Lavender oil is available at many health food stores. To
use it, place a few chips of rock salt in a small, capped
vial. Add a few drops of lavender oil. The salt absorbs the
oil. Uncap the vial and inhale as needed.
• Soak yourself to sleep. “Hot water soothes both the mind
and body,” Dr. Buchman says. Bathing is a traditional
relaxing bedtime ritual. Recently, researchers at the
University of California at Santa Barbara put it to the
test. Not surprisingly, their study showed that compared
with non-bathers, people who took a hot bath an hour or so
before bed fell asleep faster.
• Try sex. “Lovemaking is deeply relaxing,” Dr. Cole-Weston
says. “It combines deep breathing, massage, and
visualization, and has a well-deserved reputation for
improving sleep.”
But not all sex works. “It depends on how the sex makes you
feel,” Dr. Hauri explains. “If you feel loved and cared
for, sex can help you sleep. But if it’s unsatisfying or
takes place in a problematic relationship, it might be the
prelude to a very poor night’s sleep.”
Behavior Therapy
• Boost sleep with the Bootzin Technique. This behavior
therapy program was developed in the 1970s by Richard
Bootzin, Ph.D., then a professor of psychology at
Northwestern University in Chicago. It’s often quite
helpful:
Step 1: Go to bed only when you feel sleepy. Ignore the
clock. Tune into to how you feel.
Step 2: Use your bed only for sleeping and sex. No eating,
reading, TV, phone conversations, or anything else.
Step 3: If you go to bed but can’t fall asleep, get up and
leave the bedroom. Read, watch TV, listen to music,
whatever until you feel sleepy again, and then return to
bed.
Step 4: Repeat step 3 as often as necessary throughout the
night.
Step 5: No matter when you go to sleep, set an alarm for
the same time every morning.
Step 6: Don’t nap during the day.
The first night or two, you may repeat Step 3 several time.
But over a few nights, repetitions typically diminish, and
often disappear. If your sleep problem recurs after a
period of sleeping well, simply return to the six steps.
Supplements
• Try melatonin. This hormone is involved in regulating
sleep. Several studies have demonstrated its sedative
effect. In one, Israeli researchers divided 12 elderly
insomniacs into two groups. One took a placebo, the other,
2 mg of melatonin shortly before bed. The melatonin group
fell asleep significantly faster and slept more soundly,
with fewer wee-hour awakenings. Then the researchers
switched the two group’s treatments (a “crossover trial”).
Again, the melatonin group showed less insomnia. In another
study, researchers asked a dozen healthy young volunteers
to try to nap from 6 to 8 p.m. Compared with those who took
a placebo, participants who took 3 mg of melatonin 30 to 90
minutes before laying down fell asleep significantly faster
and slept more sountly.
But melatonin has been used as a sleep aid for only a few
years. Its long-term safety is still unknown. Nonetheless,
it’s available over-the-counter at health food stores,
supplement shops, and most pharmacies. Dr. Buchman suggests
starting with 0.5 mg one to two hours before bedtime. If
necessary, you can take up to 3 mg. Melatonin should not be
used by women who are pregnant or breastfeeding or
considering pregnancy, or by anyone prone to depression,
taking an antidepressant, or with diabetes, epilepsy,
migraine headaches, or rheumatoid arthritis. Possible side
effects include: nausea, headache, giddiness, difficulty
concentrating, and daytime sleepiness.
• Take your vitamins. “Deficiencies in the B vitamins,
calcium, copper, iron, magnesium, and zinc can all
contribute to sleep problems,” Dr. Hauri says. In addition
to a healthy diet, New York clinical nutritionist Shari
Lieberman, Ph.D., recommends a multi-vitamin-and-mineral
formula that contains all these nutrients.
Herbal Medicine
• Take tea and sleep. Many medicinal herbs are gentle
sedatives. Dr. Duke recommends: chamomile (Matricaria
chamomilla or Anthemis nobilis), catnip (Nepeta cataria),
hops (Humulus lupulus), lavender (Lavandula angustifolia),
lemon balm (Melissa officinanlis), passionflower
(Passiflora incarnata), and valerian (Valeriana
officinalis).
Except for valerian, enjoy herbs in teas either
individually or in combination—1 to 2 teaspoons of plant
material per cup of boiled water. Steep 10 minutes.
As for valerian, it ranks among the most widely used sleep
herbs, particularly in Europe, where virtually every
pharmacy carries valerian-based sleep preparations--and
with good reason. At the Foellinge Health Center in Sweden,
researchers gave either a placebo or a valerian preparation
to a large number of bad sleepers. The placebo group
reported only slight improvement in sleep, but 89 percent
of the valerian group called their sleep “improved,” and 44
percent called it “perfect.”
German researchers compared a valerian-lemon balm
preparation with Halcion, a sedative/hypnotic similar to
Valium, in 20 volunteers. Both medicines produced similar
improvement in sleep, but the Halcion users reported a
morning-after hangover and suffered a loss of mental acuity
as measured by standard psychological tests. The
valerian-balm group reported no hangover and did not lose
their mental edge.
Unfortunately, valerian has a very unpleasant taste, and in
tea, this valuable herb is virtually undrinkable. Buy
capsules or a tincture at a health food store, supplement
shop, or pharmacy, and follow the package directions.
Bad Habits
• Quit smoking. As if you need another reason to quit,
where there’s smoking, there’s often insomnia. Nicotine is
a powerful stimulant, and insomnia is a frequent complaint
among smokers.
Other Good Choices
Expert Consultations
• See your pharmacist. In addition to coffee, tea, soda,
and chocolate, caffeine is also an ingredient in a
surprisingly large number of drugs, including many pain and
weight-loss medications. Drugs may also contain noncaffeine
stimulants, for example, the decongestants in cold
formulas. Other drugs that can cause insomnia include:
asthma medications, some antidepressants, some blood
pressure and thyroid medications, and steroids. Ask your
pharmacist about the possible stimulant effects of every
medication you take.
• See your doctor. Not for sleeping pills--at least not
initially--but to check you for the many illnesses that can
interfere with sleep, among them: asthma, allergies,
heartburn, discomforts of pregnancy and menopause, and
anything that causes itching or pain.
One of the most common and insidious sleep disrupters is
depression. The myth is that people who are depressed sleep
most of the day. Some do, but others hardly sleep at all.
Ironically, Dr. Albert says, depression-related insomnia
often responds to a counter-intuitive solution--sleeping
less: “Reduce your sleep time half an hour every two to
three weeks until you limit your sleep to five hours a
night. That often helps. You sleep less, but you sleep
fairly deeply, and most people call it an improvement.”
Unfortunately, if you have depression-related insomnia, the
antidepressants your doctor prescribes might make it worse.
The most popular family of antidepressants (Prozac, Paxil,
Zoloft) often disrupt sleep. A newer drug, Serzone, does
not.
• Try tryptophan. Now that the FDA has partially lifted its
tryptophan ban, ask your doctor for a prescription. Dr.
Buchman recommends starting with 500 mg a night one hour
before bedtime, and gradually increasing your dose to 2,000
mg. a night. She suggests taking tryptophan for three
nights in a row, and then taking four nights off.
Chinese Medicine
• Point your way to sleep. Chinese physicians use
acupuncture to treat insomnia. But you can’t get needled
every night at 11 p.m. Self-massage with acupressure is a
good alternative. Instead of inserting needles, acupressure
uses steady penetrating finger pressure at the same points.
Michael Reed Gach, founder and director of the Acupressure
Institute of America in Berkeley, California, recommends
pressing each point for three minutes. There are several to
choose from:
• Bladder 62: Located in the first indentation directly
below the outer anklebone.
• Kidney 6: Directly below the inner anklebone in the
slight indentation.
• Governing Vessel 24: Between the eyebrows in the
indentation where the bridge of the nose meets the
forehead.
• Heart 7: On the inside wrist crease in line with the
little finger.
• Restore Heart tranquility. If it’s not caused by some
other medical problem, Chinese medicine views insomnia as a
lack of harmony in the Heart organ system, which includes
the mind, according to San Francisco Chinese physician
Efrem Korngold, O.M.D., co-author (with Harriet Beinfield,
L.Ac.) of Between Heaven and Earth: A Guide to Chinese
Medicine. To calm the Heart and mind, Dr. Korngold
recommends pacifying herbs, among them: Ziziphus seed,
jujube seed, poria fungus, gardenia fruit, and schisandra
fruit.
Homeopathy
• A microdose might help. Depending on your specific
insomnia symptoms, says Berkeley, California, homeopath
Dana Ullman, M.P.H., author of The Consumer’s Guide to
Homeopathy, a homeopath might prescribe any of a dozen
microdose medicines, among them: Arsenicum (arsenious
acid), Coffea (coffee), Ignata (St. Ignatius bean),
Lycopodium (club moss), and Nux vomica (poison nut). If
you’d rather not consult a homeopath, homeopathic sleep
aids are increasingly available over the counter at health
food stores and pharmacies.
An Afternoon Nap
• Catch 40 winks. The conventional wisdom is that napping
disrupts sleep that night. Naps are forbidden in the
Bootzin Technique (above). “Most insomniacs sleep better
when they don’t nap,” ” Dr. Hauri explains, “but this isn’t
true for everyone. Napping helps some people sleep better.
Experiment for yourself.”
Over the Counter
• Savor a sedative side effect. Over-the-counter (OTC)
antihistamines are notorious for causing drowsiness. This
side effect can be a problem if you need to drive a long
distance, but it comes in handy if you have insomnia. OTC
sleep aids—Alka-Seltzer PM, Compoz, Excedrin PM, Nytol,
Sleep-eze, Sominex, Unisom, etc.—all contain the
antihistamine diphenhydramine. Follow package directions.
And, Finally...
• Try a sleeping pill. Sleeping pills knock you out, Dr.
Albert explains, but they “actually mitigate against good,
deep, refreshing sleep.” Sleeping pills can be helpful
short-term (for up to a week), she says, if you’re dealing
with a major trauma, for example, the death of a loved one.
But after a week, they begin to lose their effectiveness.
In addition, sleeping pills may become addictive. As a
result, many insomniacs shun them, or feel guilty about
using them, causing stress that might contribute to
sleeplessness.
Relax, Dr. Dement says. Years ago, when doctors prescribed
barbiturate sleeping pills, addiction was a real problem.
But current sleep aids carry much less risk of dependence.
Dr. Dement says today’s sleeping pills are rarely abused.
“In fact, they’re under-prescribed: A recent Gallup survey
showed that only 10 percent of people with serious insomnia
get prescriptions, and that few of them use sleeping pills
for more than five nights.” Dement prescribes Ambien (5 to
10 mg). Because of the small but real risk of abuse, he
prescribes 10 pills at a time, while working to find
nondrug solutions to the sleep problem. Refills are rarely
necessary.
• Visit a sleep center. If nothing seems to help, and you
find yourself asking for refills of your sleeping-pill
prescription, ask your doctor for something else—a referral
to an accredited sleep center. At the Stanford University
Sleep Disorders Clinic in California, new patients complete
a 400-item sleep questionnaire. “With some people,” says
staff neurologist Rafael Pelayo, M.D., “the diagnosis is
immediately apparent, but about two-thirds of our patients
need a sleep study.”
A sleep study means that you sleep at the clinic, monitored
by dozens of instruments. “We attach all kinds of sensors,”
Dr. Pelayo explains. “We measure breathing, snoring, heart
rate, brain waves, eye movements, and facial muscle
movements.”
When people get wired up, they inevitably have two
questions: How can I possibly fall asleep? And what if I
have to go to the bathroom? Dr. Pelayo’s answers: You fall
asleep just like you do (or don’t) at home. To use the
bathroom, you signal a staff technician. All the sensors
are bundled in one cable. The technician simply unplugs it
and then reconnects it when you return to bed.
Few people require more that three visits. “Clinical sleep
work is very gratifying,” Dr. Dement explains. “The vast
majority of insomniacs can be diagnosed and treated fairly
quickly, and then they feel great.”
The American Sleep Disorders Association makes referrals to
the more than 240 accredited sleep centers in the U.S. and
Canada. Send a stamped, self-addressed envelope to the
ASDA, 1610 14th St., N.W., Rochester, MN 55901.
Sidebar:
Snoring: How to Stop It
“Laugh and the world laughs with you," British novelist
Anthony Burgess once quipped. “Snore and you sleep alone.”
About half of all adults snore occasionally, and one in
four snores regularly. Men are more likely to snore than
premenopausal women, but after menopause, women almost
catch up to men. Even though both sexes snore, “Men snore
much more loudly than women,” says Peter Hauri, Ph.D.,
director of the Mayo Clinic Insomnia Program in Rochester,
Minnesota, and co-author (with Shirley Linde, Ph.D.) of No
More Sleepless Nights, “so women are more likely to suffer
sleep disruption.”
Snoring occurs when a partial obstruction in the back of
the throat restricts air flow during inhalation. Colds,
flu, and allergies cause general swelling of throat
tissues, which explains why people often snore when they
have these conditions.
Chronic snoring typically results from:
• Loss of muscle tone in the throat. Tissue sags into the
airway, restricting air flow.
• Extra pounds. Fat in the throat restrict air flow.
• Drugs. Alcohol, tranquilizers, and/or sedatives all relax
the muscles in the throat, and tissue sags.
• Anatomical abnormalities. Some snorers have nasal polyps,
or unusually fleshy soft palates.
Most snoring occurs when people sleep on their backs, Dr.
Hauri explains. Rolling over, which changes the position of
the tissue in the back of the throat, usually opens the
airway and stops the noise—hence those swift kicks in the
wee hours. But kicking your spouse costs you sleep. Try
these alternatives, instead:
• Get out your sewing kit. Sew a golf or tennis ball into a
special pocket on the back of the snorer’s pajamas. This
prevents supine sleeping—and the snoring associated with
it.
• Encourage weight loss. The less fat in the throat, the
less likelihood of airway constriction and snoring.
• Encourage allergy treatment. Allergies make the throat
swell.
• Discourage alcohol within four hours of retiring. Alcohol
relaxes the muscles in the throat.
• Discourage smoking. Smokers have chronically swollen
throat tissue.
• Discourage sedatives. Discuss possible alternatives with
your physician.
• Try elevating the head of your bed. This often helps
relieve cold-related snoring. Sometimes it works for
chronic snoring as well. Raise the head of your bed with
bricks or wood blocks.
• Encourage experimentation with anti-snore devices. Many
special pillows, jaw braces, and other devices are
available. “They all help some people,” Dr. Hauri says,
“but none is a sure cure.”
• Get yourself earplugs. Most pharmacies sell low-cost foam
earplugs.
• Sleep separately. If all else fails, this is your last
resort.
Sidebar:
Obstructive Sleep Apnea: Some Snoring Can Kill
One form of snoring, obstructive sleep apnea, is more than
just an annoyance. “Apnea” means “no breathing.” Ordinary
snoring does not affect your breathing, says William
Dement, M.D., a professor of psychiatry and behavioral
sciences at Stanford University, director of the Stanford
Sleep Disorder Clinic, and chair of the National Commission
on Sleep Disorders Research (NCSDR). But apnea does. If you
have it, you periodically suck your airway closed and stop
breathing, tuypically for a few seconds, but possibly for
up to a minute. When you stop breathing, a choking silence
replaces your snoring.
When your airway collapses, the lack of oxygen sets off an
internal alarm, and the brain rouses you, which restores
your breathing. But every apnea episode—typically dozens
each night—causes subtle physical harm. Your blood-oxygen
level plummets. To compensate, your heart pumps harder,
causing a sharp increase in your blood pressure, residual
high blood pressure during the day, and over time,
increased risk of heart attack and stroke.
Apnea also destroys your sleep. “People don’t wake up each
time they stop breathing,” Dr. Dement explains, “but they
get roused so often that they sleep terribly. They’re
constantly sleepy during the day, have trouble
concentrating, and are prone to dozing off when they
shouldn’t, for example, while driving.”
Obstructive sleep apnea is surprisingly common, affecting
about 18 million Americans particularly overweight
middle-aged men. Apnea affects many women as well. About 90
percent of people with apnea are undiagnosed, especially
women. “It’s tragic,” Dr. Dement says. “The National
Commission on Sleep Disorders Research estimated that
treating sleep apnea could prevent almost 38,000 deaths a
year from heart attack and stroke.”
Women often fear that apnea places a man in imminent danger
of dying on the spot during the silences that punctuate his
snoring. “That almost never happens,” says Peter Hauri,
Ph.D., director of the Mayo Clinic Insomnia Program in
Rochester, Minnesota, and co-author (with Shirley Linde,
Ph.D.) of No More Sleepless Nights. “The oxygen-deprived
brain rouses the person enough to re-establish breathing.
But apnea significantly increases risk of eventually
suffering heart attack or stroke, so it should be treated.”
Apnea is easy to diagnose. Just listen for a combination of
loud snoring and choking silences.
It’s also easy to treat. All it takes is a “continuous
positive airway pressure,” (C-PAP) machine. C-PAP devices
include a mask that fits over your nose connected to a
small pump that gently pushes extra oxygen into your lungs
with each breath. C-PAPs prevent airway collapse and
maintain a healthy level of oxygen in the blood. They cost
about $1,200 and are available from sleep centers. For a
referral to a sleep center near you, send a stamped
self-addressed envelope to the American Sleep Disorder
Association, 1610 - 14th St., N.W., Rochester, MN 55901.
Sidebar:
Wake Up, America! You Need More Sleep
Blame it on Thomas Edison. Before electric light, most
Americans took Ben Franklin’s advice: Early to bed, early
to rise. A 1910 survey showed that the average American
slept nine hours a night. Then in 1913, Edison introduced
his lightbulb. Americans continued to get up early, but
they started staying up later—and as a result, sleeping
less.
There is no “normal” amount of sleep. Individual needs
vary. But Dr. Dement says the vast majority of adults need
at least seven hours a night to function optimally, and
many need eight or more. Yet, about half of adults sleep
fewer than eight hours a night and 13 percent get by on
fewer than seven.
“When you need more sleep than you get,” Dr. Dement says,
“you develop a sleep debt, just as you would if you spent
more money than you have. Americans don’t get enough sleep.
The problem so pervasive, it’s not even perceived.” That
is, until you examine the evidence.
• Motor vehicle accidents. According to the National
Highway Transportation Safety Administration’s (NHTSA)
Office of Crash Avoidance Research, drowsiness is a factor
in 72,000 accidents a year, which cause 14,000 serious
injuries and 1,550 deaths annually. These figures are
conservative estimates. The actual number of
sleepiness-related accidents is much higher, the NHTSA
believes, because police tend to blame accidents on other
factors , primarily alcohol and bad weather. A NHTSA survey
backs this up: In a survey of 1,500 drivers, 69 percent
admitted having driven while drowsy, 10 percent admitted
having had an accident because they fell asleep at the
wheel, and another 10 percent said they’d had a near miss
while sleepy.
Of all drivers, truckers are among the sleepiest. Truck
drivers work long, irregular hours, and according to the
NCSDR, nodding off at the wheel is “pervasive” in the
trucking industry. An NTSB study showed that sleepiness is
the leading cause of fatal truck crashes—an even greater
hazard than drugs or alcohol. On average, every truck
driver who dies in an accident takes four other people to
the grave with him. “I’ve become very wary of trucks on the
highway,” Dr. Dement says. “I give them alot of room, and
if I see one swerving at all, I give it even more.”
• Medical errors. Medical training requires inordinately
long work hours, often 24- to 36-hour shifts, with time for
only short naps, if that. What happens to young doctors who
work under these conditions? Scottish researchers compared
the ability of doctors to remember strings of facts, for
example, their patients’ medical test results, after a good
night’s sleep, and after an all-night shift. The sleepy
doctors recalled 18 percent less. In other words, they
forgot about one fact in five.
German researchers asked doctors to interpret
electrocardiograms, tests of heart activity. Some were
normal; others were not and required immediate medical
attention. Heart disease is the nation’s leading cause of
death, so interpreting electrocardiograms is a key medical
skill. Compared with well-rested physicians, doctors coming
off an all-night shift were 14 percent more likely to
ignore abnormal tests. In other words, they blew one
diagnosis in seven.
Finally, researchers at Temple University in Philadelphia
investigated how sleep deprivation affects surgical
competence. They videotaped surgeons performing 33
operations. Some of the surgeons operated after a full
night’s sleep. The others had slept as little as two hours
the previous night. When the videos were analyzed, the most
sleep-deprived surgeons showed poor judgment 30 percent of
the time they were operating. Dr. Coren does not mince
words: “For nearly one-third of the time the patient was on
the table, the sleep-deprived surgeons were incompetent.”
• Major disasters. Dr. Dement says sleep-deprivation
contributed to four high-profile diasters: the 1979
near-meltdown of the Three Mile Island nuclear reactor in
Pennsylvania; the 1986 explosion of the space shuttle,
Challenger; the 1986 disaster at the Chernobyl nuclear
reactor in the Ukraine; and the 1989 grounding of the Exxon
Valdez, the nation’s worst maritime oil spill. “In every
one of those incidents, key managers were so severely
sleep-deprived that they simply could not see disaster
coming.”
Even minor sleep deprivation increases accident risk. At
the University of British Columbia, psychology professor
Stanley Coren, Ph.D., investigated auto accidents across
Canada before and after daylight savings time. Each spring,
when we set clocks forward one hour, we lose an hour of
sleep. Each autumn, when we set them back, we gain an extra
hour in bed. “Immediately following the spring shift, when
we lose sleep,” Coren explains, “traffic accidents
increased approximately 7 percent and took several days to
drop back to baseline. Immediately after the fall change,
when we gain sleep, traffic accidents fell about 7 percent,
and again took a few days to rise back up to baseline.”
“Many so-called ‘accidents’—perhaps most—are not accidents
at all,” Dr. Dement says, “They’re the inevitable
consequence of lack of sleep.”
Box:
Are You Sleep-Deprived?
Take this simple test developed by Dr. Dement. If you
answer “yes” to any question, you need more sleep:
• Do you have to rely on an alarm clock to get you up in
the morning?
• Do you ever sleep through your alarm?
• Is getting out of bed a struggle?
• Do you ever experience powerful waves of drowsiness in
school, at work, or at the movies or theaters?
• Do you ever fall asleep without intending to?
• Do you ever wonder where you get-up-and-go has gone?
• Does a single glass of beer or wine hit you unexpectedly
hard?