Recent discussions with my friends and patients in New York City suggest that a good night's sleep might be something of the past, a fond memory of sorts. Some poor souls can't get anywhere near the mattress, busying themselves with energizing activities, rituals, and email. Others anticipate with dread the experience of getting into bed and having their minds click on with worries, reasonable concerns or non-sensical scenarios. For others, it's the horrific middle of the night or early morning awakenings (which may or may not be accompanied by some passage of urine) that they can look forward to. Last but not least, the myriad of known and unknown things that go bump in the night, which have an impact on sleep quality... sleepwalking, sleep-talking, snoring, teeth grinding and clenching, nightmares, kicking etc.
Why is everyone sleeping so poorly, one could ask. Presumably, the New York stress experience (i.e., noise, neon, crowding) doesn't help, as is evidenced by the improved sleep scene in the Hamptons.
In the good old days, sleep researchers used to tell neurotic insomniacs to take a chill pill and not get a diaper rash every time they slept poorly. However, in the past ten years we have seen studies suggesting that chronic insomnia will lead to anything from obesity to a broad range of cognitive impairments (e.g., memory deficits) and an overall tendency toward advanced aging. And so, the very thing that often causes sleep difficulties, i.e. anxiety about sleep, has effectively been regenerated. While everyone knows that they feel better and live better when they sleep more, it is not often a priority above late night dinner dates, drinks and socializing. What is a busy New Yorker to do?
At the very least it may be helpful to remember a couple of themes in training yourself to sleep better. It goes without saying that you need to establish some sort of wind down time before even attempting to get into bed. After all, planes need runways. It doesn't help that New Yorkers often go to dinner at 9 pm and cram as much food and booze down their gullets as possible. Anything you can do to withdraw from the mean, cruel world (including computers, movies about kids and cancer, exciting sports events and even telephone calls) seems to matter. It is fine to watch T.V., read a novel or a hobby magazine before bed but it is important to avoid stressors so don't open any credit card bills for at least an hour before you go to bed. Turn the clock away and assume that if you don't sleep well, while you may feel less than grand the next day, you will probably be able to do everything you need to do and death is unlikely.
People who get anxious or frustrated with their inability to sleep don't sleep well, as we all know. Only by accepting that you cannot control sleep perfectly and therefore may feel less than great some days can you ultimately relax and sleep better. On some level, the relinquishing of control necessary to fall asleep is crucial in so many others areas, including sex. To quote Masters and Johnson, "try harder, get softer." Similarly with sleep, the more you try to sleep, the more elusive it is.
One of the basic rules for whipping your sleep back into shape is not to lie in bed tossing and turning. As soon as you realize it ain't happenin', get up and read or watch T.V. and only return to lights-off when you feel tired again. While you may feel like a yo-yo the first few days, with the getting up and down multiple times, you will eventually learn to get into bed and pass out, which is the goal, right? Last but not least, stay up later if you are experiencing difficulties with waking up during the night. Instead of getting into bed earlier, purposely stay up later and in a few days you will quickly pass out and stay out through the whole night. Then you can allow yourself, in 30 minute increments, to gradually go to bed earlier. These methods, when applied firmly, will make most people sleep better.
If you are taking sleeping pills and not sleeping well, you don't have to be an Einstein to realize that the pills have not solved the problem and may be paradoxically increasing the amount of sedation you experience the next day. It always struck me as ludicrous that if you ask the average insomniac why they suffer so, they will complain about how tired they are the next day. Yet all sleeping pills increase fatigue the next day. We haven't come up with any magic bullets just yet but people who suck on Ambian all night can expect to be irritable, moody and exhausted so work on gradually getting off the pills and booze and learn to sleep more naturally.
If you are snoring like a banshee or behaving unusually during the night, whether it is cooking meals or kicking your partner, you might need to go to a sleep lab. Certain conditions like sleep apnea are eminently treatable and should be treated. However, don't be surprised if you go to a sleep lab, spend a couple thou, and get a report back telling you that you are a lousy sleeper.
As it has been said, hang on and let go. If you can accept that you are not such a hot sleeper and take steps to improve your sleep that is probably as good as it gets. To quote my lovely ex-mother-in-law when I was complaining about difficulties sleeping, "What are you complaining about, all successful men sleep poorly." I guess that means I'm successful, right?