The Quest for Rest

May 24, 2006 - Posted at 12:33 p.m. CST

SPECIAL REPORT -- Before Thomas Edison's invention of the light bulb, people slept an average of 10 hours a night. Today, Americans average 6.9 hours of sleep on weeknights and 7.5 hours per night on weekends and inn a 24-7 society, sleep has become lower on the list of priorities for most people.

"We hear it all...sleeping too much, sleeping too little, can't get enough sleep," said sleep specialist Dr. David Nichols, "Snoring, which may be their complaint or their bed partner's complaint, and the other thing is doing funny things while they sleep. Those four areas would usually lead us down a path to make a diagnosis."

A diagnosis of a sleep of the most common is sleep apnea. It's estimated that 18 million Americans have sleep apnea, a potentially life-threatening condition that causes a person to stop breathing during sleep. Sleep apnea occurs in all age groups and both sexes but is more common in men, people over 40 years of age and possibly young African Americans.

"Some of this is more genetic on the size of necks, the short jaws, broad base of tongue. People with troubled obstruction and even with children, because this is a very common problem with young children having obstructive sleep apnea," said Ear, Nose and Throat Physician Dr. William Bulkley.

Sleep clinics help diagnosis apnea, measuring sleep cycles and brain waves. The test is called a Polysomnography and it electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. Check with your insurance company to see if a visit is covered.

Then there's the other big problem that literally keeps people up at night, insomnia. According to the National Institutes of Health, insomnia affects more than 70 million Americans, with women twice as likely to suffer as men. Direct costs of insomnia are estimated at nearly $14 billion annually...pretty pricey for a few hours of sleep.

The National Sleep Foundation's 2002 Sleep in America poll shows that 58% of adults in the U.S. experience symptoms of insomnia a few nights a week or more.

"It's highly related to things like respiratory problems at night, maybe tied into painful, chronic pain situations," said Nichols, "It may be tied into psychiatric diseases like depression or anxiety. If they are at the root of it, they have to be primarily treated."

Prescription medications are often used to treat insomnia, but not all insurance companies will cover the drugs.

"To have someone have a deep understanding of why they have the insomnia, what habits they can learn to correct it and go on with a lifetime of better sleep," said Nichols, "Drugs are easy to use. They are probably overused many times as the solution."

There are plenty of remedies available for restlessness, but establishing what Dr. Nichols calls "good sleep hygiene" can make a big difference.

"Not having a regular sleep schedule, I think is a very big part of sleep hygiene," said Nichols, "Taking naps in the daytime because you didn't sleep well at night, just continues to play a role of having those things interfere with getting consolidated sleep at a time when you would like it."

Creating an environment where you want to sleep can help make those eye-lids heavy. Calming lotions, linen sprays and eye masks may help and even sleeping with your head facing north could make a difference. Also, avoid caffeine and exercising close to bedtime and leave the TV in the living room.

"It certainly is worthwhile coming in, talking about it, discussing it and trying to decide if there is something that can be both done to help it, whether there is something about that that is a potential threat to the rest of your health," said Nichols.

The National Sleep Foundation suggests these 10 rules for getting a better nights sleep.

1. Maintain a regular bed and wake time schedule including weekends.

Our sleep-wake cycle is regulated by a "circadian clock" in our brain and the body's need to balance both sleep time and wake time. A regular waking time in the morning strengthens the circadian function and can help with sleep onset at night. That is also why it is important to keep a regular bedtime and wake-time, even on the weekends when there is the temptation to sleep-in.

2. Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.

A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep. Avoid arousing activities before bedtime like working, paying bills, engaging in competitive games or family problem-solving. Some studies suggest that soaking in hot water (such as a hot tub or bath) before retiring to bed can ease the transition into deeper sleep, but it should be done early enough that you are no longer sweating or over-heated. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional. Finally, avoid exposure to bright before bedtime because it signals the neurons that help control the sleep-wake cycle that it is time to awaken, not to sleep.

3. Create a sleep-conducive environment that is dark, quiet, comfortable and cool.

Design your sleep environment to establish the conditions you need for sleep - cool, quiet, dark, comfortable and free of interruptions. Also make your bedroom reflective of the value you place on sleep. Check your room for noise or other distractions, including a bed partner's sleep disruptions such as snoring, light, and a dry or hot environment. Consider using blackout curtains, eye shades, ear plugs, "white noise," humidifiers, fans and other devices.

4. Sleep on a comfortable mattress and pillows.

Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy - about 9 or 10 years for most good quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up during the night.

5. Use your bedroom only for sleep and sex.

It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine. For example, if looking at a bedroom clock makes you anxious about how much time you have before you must get up, move the clock out of sight. Do not engage in activities that cause you anxiety and prevent you from sleeping.

6. Finish eating at least 2-3 hours before your regular bedtime.

Eating or drinking too much may make you less comfortable when settling down for bed. It is best to avoid a heavy meal too close to bedtime. Also, spicy foods may cause heartburn, which leads to difficulty falling asleep and discomfort during the night. Try to restrict fluids close to bedtime to prevent nighttime awakenings to go to the bathroom, though some people find milk or herbal, non-caffeinated teas to be soothing and a helpful part of a bedtime routine.

7. Exercise regularly.

It is best to complete your workout at least a few hours before bedtime. In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. However, exercising sporadically or right before going to bed will make falling asleep more difficult. In addition to making us more alert, our body temperature rises during exercise, and takes as much as 6 hours to begin to drop. A cooler body temperature is associated with sleep onset... Finish your exercise at least 3 hours before bedtime. Late afternoon exercise is the perfect way to help you fall asleep at night.

8. Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime.

It can keep you awake. Caffeine is a stimulant, which means it can produce an alerting effect. Caffeine products, such as coffee, tea, colas and chocolate, remain in the body on average from 3 to 5 hours, but they can affect some people up to 12 hours later. Even if you do not think caffeine affects you, it may be disrupting and changing the quality of your sleep. Avoiding caffeine within 6-8 hours of going to bed can help improve sleep quality.

9. Avoid nicotine (e.g. cigarettes, tobacco products).

Used close to bedtime, it can lead to poor sleep. Nicotine is also a stimulant. Smoking before bed makes it more difficult to fall asleep. When smokers go to sleep, they experience withdrawal symptoms from nicotine, which also cause sleep problems. Nicotine can cause difficulty falling asleep, problems waking in the morning, and may also cause nightmares. Difficulty sleeping is just one more reason to quit smoking. And never smoke in bed or when sleepy!

10. Avoid alcohol close to bedtime.

Although many people think of alcohol as a sedative, it actually disrupts sleep, causing nighttime awakenings. Consuming alcohol leads to a night of less restful sleep. If you have sleep problems... Use a sleep diary and talk to your doctor. Note what type of sleep problem is affecting your sleep or if you are sleepy when you wish to be awake and alert.

Try these tips and record your sleep and sleep-related activities in a sleep diary. If problems continue, discuss the sleep diary with your doctor. There may be an underlying cause and you will want to be properly diagnosed. Your doctor will help treat the problem or may refer you to a sleep specialist.