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10 strategies for a more restful night's sleep

/ Source: Allure

The brown bat sleeps for nearly 20 hours each day. Humans function best on a comparatively thrifty seven to nine, but more and more people are having trouble getting even that. The National Sleep Foundation recently found that just 25 percent of Americans get at least eight hours of rest on weekdays and that 60 percent of women say they often sleep poorly.

"Insomnia is a bona fide health problem," says Rubin Naiman, clinical assistant professor of medicine at the University of Arizona's Program in Integrative Medicine and sleep director at the Miraval Resort in Tucson. "Skimping on sleep has a price, including weight gain, diminished immune responses, lack of concentration, irritability, and depression."

Why should something that seems to come naturally to other creatures prove so elusive for us? "Our society doesn't value sleep," says Phyllis Zee, a professor of neurology at and director of Northwestern University's Sleep Disorders Center. "We see it as a sign of laziness or a waste of time" — so much so that sleeplessness has become something to brag about. Plus, "the culture we've created is geared to keeping us awake," Zee says. Our minds are constantly aroused by stress, caffeine, and even e-mail. "Scans of metabolic activity in the brain show that people who suffer from insomnia have more activity than people without sleep problems when they're trying to get to sleep," Zee says. "When people say, 'I can't turn my brain off at night,' they're actually right."

It probably doesn't help that we're all preoccupied with our sleep problems and inundated with pills, gadgets, and treatments that claim to cure them. We asked experts to tell us which solutions they recommend, and then we put them to the test with bleary-eyed women. After all, sleep is the birthright of most animals; but to toss and turn is uniquely human.

Free your mind

The problem: Anxiety. You're alone with your thoughts for the first time all day, and you become so fretful that you feel like a character in a Woody Allen movie. "Worrying prompts your body to produce the adrenaline-like chemical epinephrine, which keeps you awake," says Joyce Walsleben, associate professor of medicine at the New York University School of Medicine, who has studied sleep extensively. It also constricts your blood vessels, making your extremities cold — and it's easier to fall asleep when they're warm.

The solution: Imagine placing all your negative thoughts in a bubble and then watching them drift away, Walsleben says. Replace each worry with a restful thought of a beach or spa. Other calming ideas: Take a warm bath an hour before you turn in, and put on a pair of socks before slipping into bed.

The challenge: We tried to inject our worries into a bubble, but found that they just kept leaking back out again. Plus, we started to fret about why we weren't able to do it. But the bath really worked — we began to feel drowsy minutes after climbing out of the tub.

Get physically tired

The problem: You simply haven't been active enough to feel sleepy.

The solution: Shoot for at least a half-hour of moderate aerobic activity every day, even if it's only brisk walking, says James Maas, a professor of psychology at Cornell University and author of "Power Sleep" (HarperCollins).

Why it works: "The body must exert energy to get physically tired," Maas says. Studies show that a half-hour of exercise can improve sleep about as well as benzodiazepines (sleeping pills sold under the brand names Restoril, Halcion, and Valium), which are pre-Ambien and are still prescribed. In addition, "exercise over the long-term can help you lose weight and reduce stress, both of which can inhibit sleep," says Shelley Tworoger, assistant professor of medicine and epidemiology at the Brigham and Women's Hospital in Boston and the Harvard School of Public Health, who has studied the effects of exercise on sleep.

The challenge: The results were immediate and dramatic: After never working out, we found that we fell asleep far more quickly and slept far longer on days when we jogged for 30 minutes on the treadmill. We also woke up during the night just once — rather than two or three times — on those days.

Increase darkness

The problem: Even the light level in most living rooms (100 lux) can suppress melatonin, making it hard to sleep, reported researchers from Brigham and Women's Hospital in Boston in 2005.

The solution: An hour before bed, dim the lights and turn off the TV and computer, then make your bedroom as dark as possible, Zee says. If outside light keeps you up, buy blackout shades.

Why it works: "We all suffer from light pollution — we have lights on 24/7, which keeps our brains chronically aroused," Naiman says. "Most people don't recognize how essential darkness is for a sound night's sleep." Indeed, in the days before Edison invented the light bulb, people slept ten hours a night.

The challenge: An hour before bedtime, we dimmed the lights, switched off our TV and laptop, and transformed our bedroom — normally ablaze from city lights outside — into a cave by putting up blackout shades. We tossed a scarf over our alarm clock … and the next thing we knew, it was 11 hours later.

Cut back on caffeine

The problem: Caffeine stays in the body at least four to eight hours, and researchers in Mexico recently reported that in people prone to insomnia, the stimulating effect may be more intense.

The solution: Drink half a cup less coffee each day — until you quit entirely. That should minimize the killer headaches that often accompany caffeine withdrawal. If that's too daunting, at least abstain after noon.

Why it works: "Caffeine is more stimulating than most of us think," says Meir Kryger, director of research at the Gaylord Sleep Center at Gaylord Hospital in Wallingford, Connecticut, and author of "A Woman's Guide to Sleep Disorders" (McGraw-Hill). By keeping your brain in a semi-awake state, it can increase the number of times you awaken and decrease your total sleep time. "I've had so many people say, 'Caffeine doesn't affect me,' and yet they're sitting in my office complaining that they can't sleep," Kryger says. "Eliminating it can really help your brain and body relax."

The challenge: We scaled back our normal five cups of coffee a day by a half-cup per day as prescribed, but we still had pretty vicious headaches. And although it did help our ability to fall — and stay — asleep at night, we felt tired all day. On the fifth day, the headaches subsided, but the general fatigue did not. After day ten, we chose to go back to two cups per day and not after noon — and our sleep is still better.

Limit alcohol

The problem: More people use alcohol to sleep than any other substance, but a nightcap can cause insomnia in the middle of the night, according to Kryger.

The solution: "Some people can have one drink before bed; others need to cut it out," says Mark Mahowald, a neurologist and director of the Minnesota Regional Sleep Disorders Center.

Why it works: "Alcohol changes your sleep patterns, and once it clears your system — usually four to five hours after you fall asleep — the brain becomes hyperaroused, and you wake up," Kryger says. Plus, this hyperaroused state can persist for several hours.

The challenge: Although we missed the dreamy feeling our bedtime glass of wine inspired, we did find that avoiding it helped. We also found we could still have a drink — as long as we finished it in the early evening — without negatively affecting our sleep.

Reset your body clock

The problem: Anyone who often lies awake until 2 a.m. has problems with the clock, but not the one ticking on the side table. "If you can't fall asleep until late and have trouble waking up, your body clock may be out of sync with day and night," Maas says. This can be caused by an erratic sleep schedule.

The solution: Get 20 minutes of bright light (from the sun or an outdoor-light simulator, such as the Litebook) within 15 minutes of awakening. You should be back on schedule within a week.

Why it works: "When bright morning light hits your eyes, it prompts a drop in melatonin, the hormone that promotes sleep," Zee says. Melatonin is typically suppressed for about 12 hours, then it rises gradually until you feel a strong urge to sleep 15 or 16 hours later.

The challenge: After using the Litebook every morning for four days, we found we were dozing off almost as soon as our head hit the pillow at 11 p.m.

Take a supplement

The problem: Melatonin, known as the Dracula of hormones because it comes out in the dark (the pineal gland starts secreting it at about 9 p.m.), decreases as you age and may be low in women with certain illnesses, including bulimia and fibromyalgia. If you have trouble falling or staying asleep, your body may not produce enough — or may secrete it late.

The solution: Take a melatonin supplement in the evening to fall asleep faster.

Why it works: In normal sleepers, the body produces enough melatonin at night to induce drowsiness. Melatonin supplements may promote sleep for those who have trouble falling asleep, Zee says. One caveat: While it doesn't affect the content of dreams, it can make nightmares more vivid.

The challenge: Our significant other clocked us falling asleep only about five minutes faster after taking melatonin. We still woke up twice during the night.

Investigate sleeping pills

The problem: You lie in bed, unable to fall asleep until 2 or 3 a.m. — and this has been going on for a full week.

Why it works: Nonbenzodiazepines such as Ambien, Lunesta, and Sonata bind with receptors in the brain that trigger sleep. "Medication can prevent a short-term problem from becoming entrenched," Mahowald says. But don't expect miracles. An analysis of sleeping-pill studies financed by the National Institutes of Health shows that these pills reduce the average time it takes to get to sleep by 12.8 minutes compared with a placebo and increase total sleep time by 11.4 minutes. People may think they work better than that because they might cause mild amnesia, says Daniel Kripke, a professor of psychiatry at the University of California San Diego and the codirector of research at the Scripps Clinic Sleep Center in San Diego — you can't remember if you woke up. The newest sleep medication, Rozerem, stimulates melatonin receptors in the part of the brain that controls circadian rhythms, so it may help people whose body clocks are off. But it only gets you to sleep 7 to 16 minutes faster than a placebo, and increases total sleep time 11 to 19 minutes, according to one analysis. (Rozerem reportedly is not likely to cause amnesia.)

The challenge: We tried Ambien for three nights during a spell of sleeplessness, and it seemed to knock us out every time — and we felt refreshed the next day. We also tried it on a plane — and zonked out until, four hours later, the flight attendant jerked our seat back to its original upright position.

Adjust your attitude

The problem: If sleep has eluded you for at least three weeks and you find yourself extremely anxious about lying awake at night, you might benefit from cognitive behavioral therapy. "People who have had insomnia for a while often start worrying about sleep," Zee says. "They tell themselves, 'I"ll never get to sleep tonight, and I'll be exhausted tomorrow morning.' That's how short-term insomnia becomes a more entrenched problem." CBT can work for a variety of issues — trouble falling or staying asleep, and restless sleep.

The solution: CBT is designed to address the factors that underlie chronic insomnia. "For instance, people think there's something wrong with them if they wake up in the middle of the night, so when it happens, they look at the clock and start to worry, which prevents them from getting back to sleep," Walsleben says. A CBT therapist would explain that sleep is made up of both deep and light phases, and it can be perfectly normal to awaken every 90 minutes or so. "Instead of worrying, we tell patients to congratulate themselves for sleeping so normally and let their bodies drift off again," Walsleben says.

Why it works: "CBT gives you the basic skills you need to sleep better — and it helps you understand the structure of sleep, which is enormously reassuring," Walsleben says. Researchers from the VA Medical Center in Durham, North Carolina, recently reported that after just four sessions of CBT, nearly 60 percent of people saw a significant improvement.

The challenge: We've often wondered whether our panic about never sleeping well was a self-fulfilling prophecy — and it turns out, it was. We found we tossed and turned less once we told ourselves that we didn't have a larger sleep issue.

Restrict sleep

The problem: You lie in bed for eight hours, but you sleep five — and you're exhausted come morning. "After a few nights of insomnia, some people associate their bed with being awake, and they can't fall asleep," Mahowald says.

The solution: Figure out how much time you actually sleep at night, and then start limiting your total time in bed to just below that amount. If you normally sleep five hours, say, restrict yourself to four in bed. After a few days, you’ll get so tired, you'll start sleeping the whole time you're in bed. Then, go to bed 15 minutes earlier each night until you're sleeping seven or eight hours. If you start tossing and turning, reduce your time in bed by 15 minutes and build up again gradually.

Why it works: "This works because you build up a sleep debt — your body's homeostatic drive to sleep becomes stronger and stronger when you're sleep-deprived — so you end up spending more of your time in bed actually sleeping," Mahowald says. "After a few nights, you start associating your bed with sleep instead of insomnia."

The challenge: Like a strict diet, this approach felt nearly Draconian. We forced ourselves to restrict our sleep to four hours for five days, and we felt exhausted and depressed — and we came down with a cold. But, like a strict diet, it started working. After two weeks, we were sleeping seven hours a night.