From A to ZZZZZs

Top tips for getting a good night’s sleep

About 35 million Americans experience frequent or extended bouts of insomnia every year. If you’re among them, you probably know the vicious cycle of anxiety that lack of sleep can create: The more you worry about it, the harder it is to sleep.

For many people, sleeplessness is an occasional occurrence, brought on by stress or poor sleeping habits. For others, it is a chronic condition, which may be caused by an underlying medical problem or a disorder such as sleep apnea (see below). “Severe insomnia is often related to psychological issues,” says Christopher Brown, M.D., medical director at the California Pacific Medical Center(CPMC) Sleep Health Center. “So it’s important for those patients to get the appropriate psychological care.”

Sleep deprivation can adversely impact one’s physical and mental well-being, so addressing the root cause is essential. If sleep problems are impairing your quality of life, talk to your physician; he or she may refer you to a sleep specialist.

Coping with insomnia

“Because there are many possible causes of insomnia, I begin treating patients by looking at their overall health, lifestyle and habits,” says Brandon Lu, M.D., a physician with the Sleep Health Center. “Lifestyle changes and behavioral modification are always my first line of treatment, before prescribing medications.”

Experts concur that a multipronged approach to sleeplessness can be highly effective. They frequently recommend stress-management techniques, such as meditation and yoga, to help calm anxious minds. In addition, they suggest creating a sleep-friendly environment and avoiding certain stimuli prior to bedtime. “Getting sufficient sleep is a big part of being healthy,” says Dr. Lu. “Think of it as a cornerstone of a healthy lifestyle.”

How to improve your slumber

1. Get on schedule:“Keep a consistent bedtime and awakening time — this will help synchronize your body’s circadian rhythm,” says Clete Kushida, M.D., president of the American Academy of Sleep Medicine and acting medical director of the Stanford Sleep Medicine Center.
2. See the light: “Get exposed to bright light or sunlight in the morning,” says Dr. Kushida, “ideally within five minutes of waking up. The light puts a time stamp on the part of your brain that governs your biological clock, telling it to wake up.”
3. Use the 20-minute rule: If you don’t fall asleep within 20 minutes, get out of bed and move to another room. Come back to bed only when you feel sleepy.
4. Create a sanctuary: Make sure your bedroom is pleasant and inviting. Experts recommend a quiet, dark and comfortably cool environment.
5. Nix napping: Napping can interfere with your ability to fall asleep at night. If you must nap, try not to do so too close to bedtime or for more than an hour.
6. Avoid and conquer: Avoid stimulants such as caffeine and nicotine within at least several hours of bedtime.
7. Lose the booze: A nightcap may help you fall asleep, but sleep can be disrupted as the body metabolizes alcohol and its effects wear off. So drink in moderation, if at all.
8. Exercise earlier: “Regular exercise has been shown to improve sleep for patients with insomnia,” says Dr. Lu. “But don’t do a strenuous workout in the evening. I recommend patients get their cardiovascular exercise in the afternoon.”
9. Set worries aside: “It’s often helpful for people under stress to write a to-do list, or ‘worry list,’ several hours before bedtime so they don’t lie awake and compose it in bed,” says Dr. Kushida.
10. Chill out: Try to relax before bedtime. Listen to soft music or drink a soothing cup of tea. Don’t engage in potentially stressful activities, such as balancing your checkbook or writing e-mails. “I encourage patients to avoid ‘screens’ before bedtime,” says Dr. Brown. “Computers, video games and even TV can get them jazzed up when they should be winding down.”

The 411 on sleep apnea

Sleep apnea is one of the most common sleep disorders, affecting about 5 percent of Americans. It is caused by the narrowing of the upper airway during the night and is often related to obesity and aging. Symptoms include interrupted breathing, gasping and disruptive snoring. It’s common for people with sleep apnea to wake up many times over the course of a night and feel excessively sleepy the following day.

“Some cases can be successfully treated through weight loss,” says Dr. Brown, “and some patients may never need any other form of treatment.” However, sleep apnea patients commonly require a medical device or procedure to help them breathe. The most widely used options are:

• CPAP (Continuous Positive Airway Pressure) nasal mask, which helps patients breathe while they sleep
• Custom-fitted oral appliances, which prevent airway obstruction
• Surgery to remove soft tissue, which frees up space in the posterior airway