How to get the sleep you need: An argument with the experts
Those of us who have trouble sleeping get tired of hearing the same old advice, the same half dozen rules we read everywhere. Avoid caffeine, alcohol, and big meals late at night. Don’t exercise or engage in stimulating activities near bedtime, such as reading or watching TV in bed. Try taking a hot bath or writing a “worry list.” When you can’t sleep, get out of bed and do something else. Get up at the same time every day, no matter how little sleep you’ve had—and don’t nap. And don’t worry —you’re probably getting all the sleep you need.
As someone who’s lived with insomnia for half a century, who’s spent six years interviewing sleep researchers and fellow insomniacs, writing INSOMNIAC, I found that some of this advice may help some people some of the time, but there is no one-size- fits-all-solution.
About caffeine, alcohol, and big meals close to sleep, the experts are right. Caffeine sets the stress hormones flowing, speeds the heart, and raises blood pressure. The half life of caffeine, the time it takes for half of it to be broken down, is between 3 and 7 hours—so if your last cup was at 1 PM, you still have a quarter of it left in your system at 3 AM. If you drink it daily and are on the slow side of metabolizing it, it never leaves your system—and we get slower as we age, so if you could drink coffee when you were 35, that doesn’t mean you can at 50. A woman between ovulation and menstruation takes about 25 percent longer to eliminate it. A woman on birth control pills takes twice as long, according to a 1993 study by M.J. Arnaud. But if life without caffeine is just too bleak, consider tea, which has about half the caffeine of coffee and has, besides, a substance that damps down the stress system. And if black tea is still too strong, green tea has about a third the caffeine content of that.
Alcohol is confusing. It’s a complex, “messy” drug that works on several systems, acting as a depressant but also stimulating the stress system. But even when it seems to help you sleep, it breaks down into by-products that come back to bite you, which is why you may wake up a few hours later with a bad buzz. And even if you don’t wake up, the EEG shows shallower sleep. You might want to rethink that nightcap.
Avoid big meals close to bedtime—so say the experts, and so say I. Digestion is an active, intense, heat-generating process, not something you want to initiate close to sleep. The consumption of calories raises body temperature, and as a general rule, anything that raises your temperature—like an electric blanket, a warm room—may wreck sleep, since core body temperature needs to decline for sleep to be initiated and maintained.
Exercise, of course, raises temperature in a big way, which is why we’re told to avoid it in the evening. But I’ve found that if I leave a few hours between exercise and bedtime, evening exercise may actually help. When I swim within a few hours of bedtime, I get a lovely wave of sleepiness an hour or two later—maybe for the same reason that a hot bath helps, because it raises the body temperature so that so that the rapid decline that occurs afterward signals the body it’s time for sleep. My swimming tends to be relatively relaxed, however, and a strenuous aerobic workout that close to bedtime might have bad effects. You have to find what works for you.
But in the hours just preceding sleep, you need to find ways of chilling out—I mean, literally, cooling down. This means no more trips to the kitchen, no late night emails or anxiety-provoking conversations or projects, physical or mental, nothing that speeds the heart and raises body temperature. Find some way of making a barrier between the day and sleep. Leave the day at the bedroom door.
The experts tell us we should practice nightly sleep rituals, but the unwinding activities people find are actually more various than expert advice allows. Many people find reading bed or watching TV a necessary part of relaxing. Insomniacs tell me that reading computer manuals, or Emmnual Kant, works beautifully. Not for me—my mind has to be at least somewhat engaged. The New York Times works well, sometimes a novel, though no page-turners or cliff-hangers. And nothing work-related.
My preferred way of unwinding is a DVD. Nothing action-packed or too adrenalin-pumping, though. Chick flicks work best, things like The Holiday, The Devil Wears Prada, The Jane Austen Book Club— pretty to look at and they have happy endings. A friend swears she can’t sleep without watching a half hour of Sex and the City every night. Travel documentaries work well, too, sending me to sleep with visions of other places, other lives, dancing through my head.
Many people have success with worry lists or journal writing as a way of decompressing. Not me: I don’t want anything to do with words, and nothing to do with the computer. I work with words all day long, I have words enough buzzing through my head. Besides, when I write, I conjure, bring to life—the last thing I want to do with a worry. No, give me a chick flick.
“If you can’t sleep, get out of bed and do something else”—this is advice we hear all the time. But it never works for me: when I get up and turn on the light, I’m up for the night. What does sometimes work is listening to a recorded book, which lets me lie in the dark but gets my mind onto someone else’s story. Memoirs work best for sleep, and quiet kinds of novels, but they have to be interesting and pleasurable moment to moment, with characters I want to spend time with, nothing that leaves me hanging on, waiting for what comes next. Listening to a book lets me lie in the dark in a restful state, eyes closed, drifting in and out—and this may be have restorative effects. A series of fascinating studies done in the nineties by National Institutes of Health researcher Thomas Wehr looked at subjects dozing in the dark, and found that levels of sleep hormones melatonin and prolactin remain elevated (prolactin is a tranquility-promoting hormone that’s associated with lactation and that keeps birds still as they brood their eggs).
If you’re lying there listening to the sound of your wheels spinning, though, you’ll get no restorative effects from that— better to get out of bed and do something else. But whether you get out of bed or stay in it, try to see it as a choice, not an affliction. If you stay in bed, tell yourself, how lucky I am not to have to get up, how lovely and restful it is to be lying in the dark, all these nice healing hormones. If you get up, think of that as a choice, too— view it as an opportunity to do yoga or meditation or music or read a few more pages of a novel. And if you end up taking a low dose of a fast-acting sleeping pill for a few more hours sleep, well, okay, that’s a choice, too (just leave time for the morning effects of the pill to wear off). Be glad we live in a time when we have such medications. Generations past did not such a wide range of meds to choose from.
Experts tell us we should adhere to a regular sleep schedule, get up at the same time every day to an alarm, even if we haven’t slept enough. Sorry, there is no way I will sacrifice sleep to regularity. Sleep is such a shy and fleeting presence in my life, and is so essential to my mood and functioning, that, no, I won’t scare it away with an alarm. So my schedule sometimes drifts way late. But I’m an academic, I get to schedule classes late in the day. If your work allows it, if you’re retired or a student or self-employed, why feel you have to march to the world’s time? True, you don’t want to drift entirely out of synch with the world. But people in the not so distant past, as recently as the nineteenth century, slept in segments, and people in traditional cultures today drift in and out of sleep more fluidly than we do. The consolidated 8-hour block may actually be an artifact of industrialization and artificial lightning.
So I say, sleep when you can. As for napping, even a few minutes can recharge the batteries.
“You probably don’t need as much sleep as you think you do” –I’ve heard this all my life. But when you talk to people about their sleep, as I did, writing INSOMNIAC, you find out how different we all are in terms of the sleep we need and how well we bear up under sleep loss. Research that came out earlier this year suggests that our differences are inborn and genetic, and there’s not a lot we can do about them. Scientists at the University of California, San Francisco, found that those who function well on less than six hours have a certain kind of genetic mutation. Researchers at the University of Liege in Belgium and the University of Surrey found that how well people weather sleep deprivation is related to the short or long variant of a gene that governs the timing of sleep.
So don’t tell me I’m getting all the sleep I need. Let me be the judge of that.
For most people, sleep is not an issue: you turn off the lights, you go to sleep, what’s the big deal? I think these are the people who wrote the sleep rules. But if you’re one of the sleep-stressed, like me, it’s a lot more complicated. You need to become a careful observer of your sleep, listen to your body, learn how your sleep reacts to food, drink, light, medications. Figure out what times you sleep best and worst. Read around, get on the web and find out what works for others. Then cobble together a set of practices that works.
There are no ten rules to better sleep. There is only what you can find that works.
Links to 2009 genetic research:
http://www.sciencenews.org/view/generic/id/46390/title/A_gene_for_a_short_night’s_sleep
https://www.ucsfhealth.org/adult/health_library/news/2009/08/121644.html
http://sciencenow.sciencemag.org/cgi/content/full/sciencenow;2009/813/2
http://www.timesonline.co.uk/tol/life_and_style/health/article6795361.ece
http://sleepeducation.blogspot.com/2009/06/sleep-deprivation-your-genetic.html
http://www.futurepundit.com/archives/006320.html
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Thanks for the links on recent research. I hope sleep scientists will someday have a better understanding of a subject that still holds many mysteries.
I am probably one of those persons who is genetically “wired” for short sleep. For many years I have been unable to sleep more than four to five hours at a time. After waking in the middle of the night I seldom get back to sleep. I am retired now but for many years I would drag myself to the office and somehow manage to get through the day. (I never had to set an alarm clock to get to work on time.) At the time it didn’t seem to have much effect on my health but now I am finding that these sleep-short nights are robbing me of energy and making me feel distinctly “off.” On the one hand we are told that we probably don’t need all the sleep we think we need, and on the other hand we are told that not getting enough sleep is bad for our health. While it would not surprise me that different individuals have different sleep requirements I would like to know how a person determines their own sleep requirements to maintain good health. I still can’t believe that four or five hours is all I really need.
In the meantime I have been experimenting with my own “rules” for sleep hygiene. I observe most of the standard guidelines and still have trouble sleeping. For a while I tried a little bit of alcohol in the middle of the night to help me get back to sleep but in the end I concluded it didn’t really help. Ditto warm milk. Reading doesn’t usually do the trick but at least it is time well spent. I avoid television and the computer because I would find them too stimulating. Lately I have gone back to using an over-the-counter sleep aid (active ingredient: diphenhydramine HCl) if I awaken before 3:00 a.m. (since I’m retired it doesn’t matter when I wake up). I never use it two nights in a row because in the past I found that this drug caused heart palpitations when I used it too often. Now I wonder if even this will eventually become ineffective.
The search continues.
By the way, I read “Insomniac” in December and I thought it was the best book I have yet read on this subject. Many thanks.
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Hi everyone - I have had insomnia for over 40 years and was being treated by
a psychiatrist, but for only 20 minutes - medication only and then if I need
to talk I talk to a psychologist NOT HIM. So,anyway I had enough of this and
went to another psychiatrist. She prescribed lamotrigine for me which is an
antiseizure medication and goes up to a maximum of 400 mg - however, it is
also used as a mood stabilizer. I told this doc when I don¹t sleep I get so
nervous and have so much anxiety the next day and therefore the more I go
without sleep the more anxiety I suffer - I have been on Ativan on and off
for many years, but as you know it is very addicting and after a while you
have to up the dose for it to be effective. She was shocked that no one ever
gave me this medication - it has been out since 1984. It is generic for
Lamictal and costs me nothing - insurance pays for it. Anyway I have been on
it for almost 2 months and feel great and am calm every day no matter what
happens to me in that day. I was started on 25 mg and now take 50 mg. It
goes up to 400 but don¹t think I will go much higher - maybe 75 or 100 mg
but think that should do it. By going up slowly with the dosage it almost
guarantees you wont get a rash but like I said is very rare. I am a
hyperarousal personality and the dr said this will calm me down. There are
no side effects and you do not need to check your blood plasma either. The
only big side effect and your pharmacist will tell you about the rash - if
you get the rash you stop and you are fine. However, my doc told me it is
VERY rare to get this rash and also told me that 2/3 of her patients are
helped with this drug. I wanted to share this with all of you and ask your
doctor about this medication as I think it can help all.
> From: Barbara Anschutz
> Date: Fri, 1 Oct 2010 14:51:33 -0500
> To: Gayle Greene
> Subject: Re: Comment on Sleep Starved
>
> Can you copy and paste it to me via email as I can’t remember all I said but
> know it was pretty thorough - if you can’t let me know - it is significant
> and it should be posted as I feel calm all day long and that is not a bad
> feeling - thanks.
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Something I’d like to amplify is how condescending it feels when you tell a doctor you have battled something for decades and get a “worry list” as something to try. Okay, it may work for some people, but if it worked for me I would have solved my problem during the Reagan administration. When I heard this from an MD at the sleep clinic here in Seattle, I think it was only fatigue that kept me from pulling his little stool toward me so I could reach his little neck. Even MDs at a sleep clinic can lack any real understanding of how persistent and acute this can be. What’s worse, when it is going badly it is so hard to make myself go to a doctor or professional and then articulate what is going on. If you have someone living with you who witnesses what is going on, TAKE THEM WITH YOU, have them speak to the situation. A lesson it took me far too many years to learn.