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 do get slower as we age: if you could tolerate 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 produces sleepiness, because it raises the body temperature 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 in 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 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 (as long as you leave time for the effects to wear off before morning). 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. I'm lucky--I can 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 sync 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, studies show that it's good for the mind, memory, and the heart. 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 related to the timing of sleep.

You and you alone can be the judge of how much sleep you need. You and you alone can figure out the ways to get that sleep. Listen to your body, become a careful observer of your sleep 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.htmlhttps://www.ucsfhealth.org/adult/health_library/news/2009/08/121644.html

http://sciencenow.sciencemag.org/cgi/content/full/sciencenow;2009/813/2http://sciencenow.sciencemag.org/cgi/content/full/sciencenow;2009/813/2

http://www.timesonline.co.uk/tol/life_and_style/health/article6795361.ecehttp://www.timesonline.co.uk/tol/life_and_style/health/article6795361.ece

http://sleepeducation.blogspot.com/2009/06/sleep-deprivation-your-genetic.htmlhttp://sleepeducation.blogspot.com/2009/06/sleep-deprivation-your-genetic.html

http://www.futurepundit.com/archives/006320.html http://www.futurepundit.com/archives/006320.html

 

Comments

[arjuna108]

As Sleep Medicine grows, I think it would be helpful to facilitate dialog between the experts and insomniacs, rather than arguments. There are reasons for the suggestions and there is an appreciation for individual differences that is supported by the genetic evidence. Hopefully, more dialog will lead to more research and a better understanding of insomnia, leading to better treatments in the future for those who suffer because of insomnia.
I apologize for the length of my comments and thank you all for indulging my verbosity. :-)

[arjuna108]

I think that most sleep experts who advise getting up from bed if unable to initiate sleep would also discourage light exposure in the middle of the night due to the effect it may have on circadian rhythm. So staring at a light emitting box is discouraged and reading ought to be done in dim light. It doesn't take a lot of light to stimulate a phase shift. Also, blue light is most effective shifter and I assume your more likely to be getting blues looking at the TV then from a dim white reading light although I don't know if that has been studied. If you encourage anything that might phase shift people who already have insomnia at their preferred bedtime it could make things worse. Of course, if the person has a lifestyle that allows them to free run their cycle they might be fine if you force them into desynchrony.
I think people do have to find what works for them but we also know that certain things can be counterproductive in the long term. I think that the sleep experts I know are aware of the individual variations in sensitivity to sleep modulating substances, light exposure and lifestyle. Studies consistently show that insomniacs underestimate their total sleep time and so I think it is perfectly acceptable to reassure then that, in all likelihood, they do sleep more than they experience.

[arjuna108]

In terms of how long caffeine effects people, I think it is important to note that getting it out of your system is not the end point of the return to normal levels of sleepiness. Adenosine seems to be a "somnogen" that builds up during wakefulness and whose level drops during sleep. Caffeine blocks the adenosine 2A receptor and impedes the production of adenosine. Eliminating the caffeine is just the start. You then need to catch up with the generation of adenosine which may take longer. So just as there may be differences in the half life of caffeine (as you said 3 to 7 hours) depending on your genetic ability to metabolize it, what else you may have taken with it, etc., there are also differences in how quickly we might regenerate that adenosine. I think that the experts know that some people can drink a cup of coffee and sleep a few hours later and some people can't sleep for 12 hours. So I agree with you that caffeine is generally bad for sleep but there are many people who drink coffee right up to bedtime and sleep fine. So, it would seem consistent with the thrust of your argument that you point out that caffeine isn't an all or nothing sleep effector either.

[arjuna108]

It is great that you have found what works for you and within your lifestyle you are able to accommodate it, but that doesn't mean that everyone else can be just as successful nor does it mean that everyone improves by doing what works in the short term. I'm sure you can agree that humans often make short term compensations that are harmful in the long run. In many of the points above you aren't arguing with sleep experts per se, but with the rather solid evidence that underlies some of these suggestions. You have every right to do that but it helps us compare the variance in suggestions if you tell us what fault you find with that data and what data (beyond your personal testimonial) supports your alternate suggestion.
Some things to consider to follow...