Almost everyone is familiar with the feeling of tossing and turning in bed and not being able to fall asleep.
For some, that is a rare event. For others, it’s every night.
There are countless reasons. Biology. Time of life. Diseases.
But for most people, there are ways to improve both the quantity and quality of sleep.
These strategies require knowledge, discipline, ingenuity and maybe a good ventilator, not drugs or gadgets or gadgets, experts say. The vast majority of people can even continue their caffeine habits. At least, in moderation and in the morning.
“The best sleep occurs when we practice healthy sleep strategies that set us up for success during the 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 so hard’
For him approximately 15% of people For those who struggle to get a good night’s sleep, researchers like Dr. Charles Czeisler of Harvard University have plenty of advice, starting with a simple suggestion: Don’t worry so much.
Many people who think they sleep terribly have unrealistic expectations of what a good night’s sleep is, and probably remember previous years when they could sleep like a rock for half the day. That’s simply not realistic in midlife, he and others said.
If you have to get up in the middle of the night to go to the bathroom or wake up multiple times, so be it, experts say. In modern society, we all want to be able to sleep efficiently and become impatient when we don’t, said Czeisler, director of the Division of Sleep Medicine at Harvard Medical School.
Before the Industrial Revolution gave value to the working day, our ancestors used to sleep in two parts with an interval of a few hours between them, historical research suggests.
Some people may think they can’t sleep well, Czeisler said, because they don’t take into account their body’s natural desire for this interval.
“They may simply not be spending enough time in bed to get as much sleep as they need. They want to be asleep for 95 percent of their sleeping time, which they’re going to minimize,” he said.
Instead, Czeisler and others advocate patience.
Even a well-rested person takes 15 to 20 minutes to fall asleep, and older people take the same time to fall or return to sleep as younger people. “It’s important not to throw in the towel at night just because you woke up,” Czeisler said.
Sleep tracking with wearable devices might help some people, several experts said, but too often they become a source of stress.
Sleep is not a time for perfectionism.
“We want people to go to bed feeling like they can sleep,” said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “Ultimately, 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 be different for each person based on their individual needs and demands of daily life, the basic principles apply to everyone.
“All of these behavioral changes are the secret ingredient to healthy sleep,” Robbins said.
Here are some basics:
◾ Go to bed and get up at about the same time every night. Drastically different bedtimes will confuse your body clock and make it harder to fall asleep.
◾ While some people may need a snack before bed to fall asleep, others find eating before bed harmful. “Breakfast of kings, lunch of princes, dinner of the poor” works best for most people, Robbins said. That is, eat a lot in the morning, modestly at noon and less at night.
◾ Avoid drinking “sleeping drinks.” While alcohol at night may help people fall asleep initially, it has been shown to disrupt sleep later and worsen sleep apnea.
◾ If you are sensitive to caffeine, avoid consuming too much, especially in the afternoon. If you’re unsure, try an experiment for a week, reducing it or eliminating it completely.
◾ Manage stress. Meditation or breathing exercises can help decompress.
◾ Keep naps short and not close to bedtime.
◾ Get as much natural light as you can in the morning. This sets circadian rhythms and helps you stay alert in the morning.
◾ Some sleep researchers have special lights in their homes or software on their computers (flow is one) to limit exposure to blue light at night. The blue light is what indicates “tomorrow!” to the brain.
◾ Have a bedtime routine. This includes turning off devices like phones and bright lights and other stimulating activities for a period of time.
◾ Do you feel the need for noise? Opt for a fan, not the TV, said Dr. James Rowley, president of the board of directors of the American Academy of Sleep Medicine. “There’s no screaming or car accidents,” says one fan. Even reading can be too stimulating for some.
◾ A phone “should be face down on the side of the bed that is being charged and should not be on top of you,” Rowley said.
Medications can work but at a cost
Drugs developed as sedatives work quite well in the short term, Rowley said.
She is more concerned about people using medications designed for other purposes, such as allergy or cold medications, which have sedation as a side effect. “That’s where a lot of us get angry,” Rowley said, speaking to the feelings of sleep specialists.
a patient, who recently visited his office, was taking an “all-natural” sleep aid that included about 15 ingredients, all of which could interact with other medications. “You have to be careful,” she said.
Melatonin has not been shown to be effective for insomnia in any research trials. Additionally, most people don’t use it correctly, either using too high a dose or taking it too close to bedtime to make a difference, Rowley said.
“If melatonin is going to help you, it will probably do so at doses of 0.5 to 3 (mg),” Rowley said. “Not that it’s good for insomnia, but if it’s something you want to try, low doses are probably better than high doses.”
Additionally, Martin said, “if you have a hard time staying asleep and you take melatonin at night, you could actually make your problem worse, not better.”
At least a new one The drug therapy is now in late-stage clinical trials.But researchers said they won’t make judgments until they see whether the new drugs work better than existing ones or behavioral changes.
So far, far better than medications is a type of talk therapy called cognitive behavioral therapy for insomnia, or CBT-I, Martin said.
CBT-I trains people to avoid behaviors and ways of thinking that make their insomnia worse.
“The way people think and the actions they take is what underpins their insomnia problems,” Martin said. “If we can help people go to bed with a better mindset and structure their sleep-wake habits and routines in a way that makes sleep more likely when they’re in bed, that seems to get people back on track.” “.
When to seek medical help: sleep apnea
People who have real sleep problems should see a specialist, experts said. Sleep problems are more common as you age.
Many physical and mental ailments are associated with sleep problems. People with ADHD, autism, or depression often report problems with sleep, for example. Getting help with sleeping problems can limit other symptoms.
A sleep problem that lasts more than three months usually needs to be treated, as does sleep apnea, which is often characterized by loud snoring and choking that wakes someone (and often the person next to them). side).
One study followed people with and without sleep apnea for 18 years, starting at age 48. In the group who had sleep apnea, only 58% were still alive at age 66, compared to 94% of those who did not have sleep apnea. That’s a 6- or 7-fold increased risk of death, primarily from heart attack and stroke, “so it’s really important to get treatment,” Czeisler said.
Standard therapy, called CPAP (continuous positive airway pressure), which uses a machine to keep the airways open, can be cumbersome and difficult to follow, but most patients can adapt over time, experts said. .
In 2021, a widely used brand was withdrawn from the market, stigmatizing the industry and confusing patients. Supply chain issues with the microchips used in the devices caused many people to be left without CPAP machines for long periods. Unfortunately, these barriers persist and limit treatment for a condition that is already complex and difficult to address, Robbins said.
Other treatments for apnea include implantable devices, increasingly covered by health insurance, and surgery.
Breaking myths about sleep
in a study published in 2020, Robbins and Czeisler, among other experts, analyzed 20 popular myths about sleep. Robbins recently offered insight into some of the most enduring.
Falling asleep anywhere at any time is not a sign of sleeping well. It’s the sign of someone who is sleep deprived.
Evidence suggests that sleeping seven to nine hours provides the most optimal health and well-being. People who think they can get away with sleeping less are probably setting themselves up for health problems later in life.
Older adults do not need to sleep less than younger adults, although they often sleep less because they do not sleep as well and are more likely to suffer from sleep disorders.
When your dream does matter. Eight hours of sleep in the middle of the day is not as relaxing as eight hours in the dark, although it is better than less sleep.
Lying in bed does not count as time sleeping.
Staying in bed is not a good idea if you can’t fall asleep. Instead, experts suggest changing your environment and engaging in low-stress activities for a while before trying to fall asleep again. That doesn’t mean picking up the phone or doing work, but maybe taking a warm shower 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 rather actively activates, eliminates waste, stores memories, and prepares for the day.
Overall, Robbins said, the public has begun to realize that sleep is as important as diet and exercise in maintaining health.
“Gone are the days of bragging about not getting enough,” he said.
Contact Karen Weintraub at firstname.lastname@example.org.
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