Trouble sleeping? An expert on melatonin, sleep apnea, and more
Almost everyone is familiar with the sensation of tossing and turning in bed, finding sleep elusive.
For some, this is a rare occurrence. For others, it’s every night.
There are countless reasons. biology. Life time. Diseases.
But for most people, there are ways to improve the quantity and quality of sleep.
These strategies require knowledge, discipline, creativity and maybe a good fan — not drugs or gadgets and gizmos, according to experts. The vast majority of people can continue with their caffeine habits. At least in moderation and in the morning.
“The best sleep comes when we practice healthy sleep strategies that set us up for success at night,” said Rebecca Robbins, a researcher in the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston.
How to fall asleep quickly: “Don’t try too hard”
For the roughly 15 percent of people who struggle to consistently get a good night’s sleep, researchers like Harvard’s Dr. Charles Chesler have plenty of advice, starting with a simple suggestion: Don’t worry too much.
Many people who think they’re terrible sleepers have unrealistic expectations of what a good night’s sleep means, and they’re likely remembering years gone by, when they could sleep like a rock for half a day. He and others said that’s simply not realistic in middle age.
If you have to get up in the middle of the night to go to the bathroom or find yourself waking up several times, so be it, experts say. “In modern society, we all want to be able to sleep efficiently, and we get impatient when we don’t,” said Czesler, who directs the division of sleep medicine at Harvard Medical School.
Historical research suggests that before the Industrial Revolution put a value on the workday, our ancestors slept in two with a gap of a few hours in between.
Some people may think they can’t sleep well because they don’t take into account their body’s natural desire for this gap, Chesler said.
“Maybe they’re not putting in enough time in bed to get the amount of sleep they need. They want to be asleep 95 percent of the time they do sleep, which they’ll minimize,” he said.
Czesler and others call for patience.
Even a well-rested person takes 15 to 20 minutes to fall asleep, and older people take the same amount of time to fall asleep or return to sleep as younger people. “It’s important not to give up at night just because you woke up,” Chesler said.
Many experts said that tracking sleep with wearable devices may help some people, but more often than not, it becomes a source of stress.
Sleep is not a perfect time.
“We want people to sleep in bed feeling like sleep can happen,” said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at UCLA. “Eventually, they have to stop trying so hard.”
The term “sleep hygiene” refers to good habits and practices that can help people sleep well most nights.
While the details of when to go to bed and when to wake up will vary from person to person based on their individual needs and the demands of daily life, the basic principles apply to everyone.
“All of these behavioral changes are the secret sauce to healthy sleep,” Robbins said.
Here are some basics:
- Go to bed and wake up at about the same time every night. Drastically different sleep times will confuse your body clock and make it difficult for you to fall asleep.
- While some people may need to eat a snack before bed in order to fall asleep, others find eating before bed troublesome. “Breakfast for kings, lunch for princes, and dinner for paupers” suits most people, Robbins said. In other words, eat plenty of food in the morning, moderately in the middle of the day, and not too much at night.
- Avoid “night drinks.” While alcohol at night may help people sleep initially, it has been shown to later disrupt sleep and make sleep apnea worse.
- If you are sensitive to caffeine, avoid consuming too much of it, especially in the afternoon. If you’re not sure, try a trial for a week, reduce it or eliminate it altogether.
- Stress control. Meditation or breathing exercises can help relieve stress.
- Keep naps short and not too close to bedtime.
- Get as much natural light as possible in the morning. This adjusts circadian rhythms and helps with morning alertness.
- Some sleep researchers have special lights in their homes or programs on their computers (f.lux is one of them) to limit blue light exposure in the evening. The blue light is what signals “morning!” To the brain.
- Have a bedtime routine. This includes turning off devices such as phones, bright lights, and other stimulating activities for a period of time.
- Feel the need to make noise? Choose a fan, not the TV, said Dr. James Rowley, chairman of the American Academy of Sleep Medicine. “No screaming and no car crashes,” tweeted one fan. Even reading can be too stimulating for some.
- The phone “should be face down on the side of the bed being charged, and should not be with you,” Rowley said.
Medications can work, but at a cost
Rowley said drugs developed as sedatives work well in the short term.
He’s more concerned about people using medications designed for other purposes such as allergy or cold medications that have the side effect of sedation. “This is where a lot of us get upset,” Rowley said of sleep specialists’ feelings.
One patient, Who recently came into his office was taking an “all-natural” sleep aid that included about 15 ingredients, all of which may interact with other medications. “You have to be careful,” he said.
Melatonin has not been shown to be effective in treating insomnia in any research trial. Additionally, most people don’t use it correctly, either using a dose that’s too high or taking it too close to bedtime to make a difference, Rowley said.
“If melatonin is going to help you, it’s probably going to help you at 0.5 to 3 (mg),” Rowley said. “It doesn’t mean it’s good for insomnia, but if you want to try it, lower doses are probably better than higher doses.”
Additionally, “if you have trouble staying asleep and you take melatonin in the evening, it may actually make your problem worse, not better,” Martin said.
At least one new drug treatment is now in late-stage clinical trials, but researchers said they are withholding judgment until they see whether the new drugs perform better than existing drugs or make behavioral changes.
Far better than medications so far, Martin said, is a type of talk therapy called cognitive behavioral therapy for insomnia, or CBT-I.
Cognitive behavioral therapy (CBT-I) trains people to avoid behaviors and ways of thinking that make their insomnia worse.
“It’s the way people think and the actions they take that perpetuate their insomnia problems,” Martin said. “If we can help people sleep with a better mindset and organize their sleep and wake habits and routines in such a way that sleep is more likely to happen when they are in bed, that seems to get people back on track.”
When to get medical help: Sleep apnea
Experts said people with real sleep problems need to be treated by a specialist. Sleep problems are more common with age.
Many physical and mental illnesses are associated with sleep problems. For example, people with ADHD, autism, or depression often report sleep problems. Getting help for sleep problems may reduce other symptoms.
Typically, a sleeping problem that lasts for more than about three months will need to be treated, as will sleep apnea, which is often characterized by loud snoring and choking that wakes the person (and often the person next to them).
One study followed people with and without sleep apnea for 18 years, starting at age 48. In the group that had sleep apnea, only 58% survived to age 66, compared to 94% of those without sleep apnea. This increases the risk of death by 6 or 7 times, mainly from heart attacks and strokes, “so it’s really important to treat them,” Czesler said.
Standard treatment, called CPAP (continuous positive airway pressure), which uses a machine to keep the airways open, can be cumbersome and difficult to adhere to, but most patients can adapt over time, experts said.
One widely used brand was recalled in 2021, stigmatizing the industry and confusing patients. Supply chain issues related to the microchips used in the devices have left many people without CPAP machines for long periods. Unfortunately, these barriers still exist and limit treatment for an already complex and difficult-to-treat condition, Robins said.
Other apnea treatments include implantable devices, which are increasingly covered by health insurance, and surgery.
Busting myths about sleep
In a study published in 2020, Robbins and Chesler, among other experts, evaluated 20 common myths about sleep. Robbins recently offered a look at some of the most enduring ones.
Sleeping anywhere, anytime is not a sign of good sleep. It is a sign of a sleep deprived person.
Evidence shows that sleeping seven to nine hours provides the best levels of health and well-being. People who think they can get away with less sleep are more likely to set themselves up for health problems later on.
Older people don’t need less sleep than younger people, although they often get less sleep, because they don’t sleep well and are more susceptible to sleep disturbances.
when Your sleep doesn’t matter. Eight hours of sleep in the middle of the day is not as restful as eight hours in the dark, although it is better than less sleep.
Lying in bed is not considered a time to sleep.
Staying in bed is not a good idea if you can’t sleep. Instead, experts suggest changing your environment, and doing low-stress activities for a short period before trying to sleep again. This doesn’t mean picking up your phone or getting work done, but maybe taking a warm bath or doing some stretches until you feel tired.
Finally, experts say sleep is not a time when the brain is “off.” The brain is not passive during sleep, but instead is actively engaged, removing waste, storing memories, and preparing for the day.
Overall, Robbins said, the public is beginning to realize that sleep is just as important as diet and exercise in maintaining health.
“The days of bragging about not getting enough are over,” she said.
Contact Karen Weintraub at firstname.lastname@example.org.
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