Healthy "Artful Living" Moment #27: Sleeping Better

There are four basic pillars of good health: 1. Eat healthy food; 2. Get exercise; 3. Don’t harm your body with cigarettes, drugs, and other toxins (including air- and water-borne ones); and 4. Get an average of 7 to 9 hours of sleep per night.

The pillar over which we seem to have the least amount of voluntary control is sleep. Sometimes, no matter how much we want to sleep, we can’t. I have literally had nights when I had absolutely no sleep at all. In my defense, it is true that as we get older our sleep cycles get shorter and more shallow. Older adults get less deep sleep and are subject to more frequent awakenings (I wake up about every 45 minutes to an hour). But, older adults need the same amount of sleep as younger ones, so don’t brush off a tendency to get less than 7 hours of sleep by saying that it is “natural” for older adults.

Of course, you have to give yourself a fighting chance. You can't consistently turn off the lights at midnight and set your alarm for 6:00 am and expect to get your minimum 7 hours sleep. So the prerequisite for getting the necessary amount of sleep is to make sure you try to give yourself a long enough window of opportunity each night for your desired amount of sleep. 

I have developed some techniques that usually work for me and that permit me to generally get about 7 hours of sleep which I will share with you in the hope that they might help you too, but first let’s start with what science tells us about getting a better night’s sleep.

You are probably already familiar with most of these experimentally-validated sleep suggestions:

1. Turn off your visual electronics, including the TV, cell phone screens, Ipads, etc. at least an hour before going to sleep, because the blue light from these visual electronics suppress melatonin, a hormone that promotes sleep.

If you are like most people, you have to do something to help you get sleepy. So that leads to my first personal tip:

2. Read a good book or some other non-electronic source of information. Most any government or financial document can help you fall asleep quickly (only half kidding!). This might be an excellent reason to pick up that college Economics text that you never read when you were in school.
3. Don’t eat or drink alcohol just before going to bed. Eating before sleep can trigger heartburn and alcohol can help you get to sleep, but it will also tend to cause you to wake up in the middle of the night because it interferes with your ability to stay asleep. Also, when you do eat, try to consume more fiber and less fat because a study published in the Journal of Clinical Sleep Medicine (2016) found that subjects who reported eating high fiber, low fat foods fell asleep faster and reported better-quality sleep than those who consumed foods higher in fat and lower in fiber (see my blog #21 What’s The Deal With Fiber?). Eating more fiber and less fat also helps you to build on healthy living pillar #1.
4. Exercise at least four times per week (which also helps you to establish healthy living pillar #2) because exercise boosts the effect of sleep hormones like melatonin. A 2010 study in the journal Sleep Medicine found that people 55 and older who exercised about four times a week for about a half-hour had an easier time falling asleep than those who did not exercise.
5. Set up a good “going to sleep” routine: dim the lights, cool down the temperature in the bedroom, and read a book or listen to soothing music or turn on white noise to help quiet your mind.
6. Don’t take more than an hour nap during the day, and not after 2:00 pm.

OK, you say, what about just taking a sleeping pill? That seems so much easier than all this rigmarole. Well, studies of sleep medicines tend to demonstrate that they are less effective and more dangerous than we think they are. For example, in a study commissioned by Consumer Reports, people who took a 15- or 20-mg dose of suvorexant (Belsomra and generic) every night for three months fell asleep just 6 minutes faster on average than those who took a placebo, and they slept only about 16 minutes longer than the placebo group. Maybe taking a sugar pill at bedtime would work almost as well as a sleeping pill. The problem with sleeping pills is that they stay in your body for longer than 8 hours, and taking them is associated with mental confusion and memory problems, as well as increasing the risk of falls. Over-the-counter sleep aids like diphenhydramine (Benedryl Allergy, Sominex and generic) have been linked to poorer cognitive ability, and possibly dementia, in people over 65 (JAMA Internal Medicine, 2015). And prescription benzodiazepines (Xanax and generic) have been linked to more than doubling the risk of a car accident or fall in older adults.

So, what else can you do? Sometimes, unusual techniques can work. For example, I noticed that on long driving trips I tended to get very sleepy. Driving while sleepy is not a good idea, so I got in the habit of pulling off at the next rest stop and taking a short nap. When I drive I like to listen to recorded books, and I found that during my car nap, it helped if I left the car running (for the heat or air conditioning) and the recorded book playing. I would generally wake up after 10 or 15 minutes quite refreshed (and have to find my place in the book again where I fell asleep). So, I decided to try this technique at home. I listen to recorded books when I turn out the light, and with the exception of certain books that tend to keep me awake (I am not sure why) listening to the book usually keeps my mind off things that would otherwise tend to keep me awake. When I inevitably wake up during the middle of the night I just turn the book on again and usually fall right back to sleep.

This technique can by tricky if you are sleeping with a partner, so you may have to invest in some innovative sleep aids like earphones designed for sleeping (which can also be used to listen to music, of course). But you may want to try this technique if you think it might help.

Do you have any "tricks" for getting a good night's sleep that you would like to share? Please feel free to do so by "commenting" on this blog.

If you try all of these suggestions with no positive results, you may want to have a sleep study done, during which you will be monitored for sleep disorders (like excessive snoring or obstructive sleep apnea). But at the very least, if nothing seems to work you should discuss your problem with your physician because it may be due to prescription drugs you may be taking and your doctor may be able to prescribe an alternative drug with fewer negative side effects that affect your sleep. Your doctor may also suggest cognitive-behavioral therapy which focuses (a little more intently than we have) on changing sleep-disrupting habits. The American Academy of Sleep Medicine now recommends CBT-I over sleep drugs as the treatment of first resort for chronic insomnia.

Or, you can consider an online program such as SHUTi (myshuti.com). According to a study published last year in JAMA Psychiatry, more than half of chronic insomniacs who used SHUTi saw improvements after nine weeks and were sleeping normally a year later.

Good luck! Sleep is one of the pillars I continue to struggle with, but by following these suggestions I am able to get about 7 hours of sleep most nights. I am trying to push that to 7 and ½ hours in order to feel even better than I do now. Let’s keep all of our fingers crossed that we all can enjoy a good night’s sleep most nights.