Helping Yourself to a Good Night's Sleep

Difficulty falling or staying asleep is a common problem. About half of Americans report sleep difficulty at least occasionally, according to National Sleep Foundation surveys. These woes - called insomnia by doctors - have far-reaching effects: a negative impact on concentration, productivity and mood.

Fortunately, there are many things you can do to improve your sleep. The first step requires some detective work. You'll need to examine your diet, exercise patterns, sleeping environment, personal habits, lifestyle and current concerns. As you begin to see the connection between, for example, what and/or when you eat and nights of poor sleep, you can develop your own good sleep plan.

Keep in mind that good sleep doesn't always just happen. Like a successful play, a restful night of ZZZs demands a strong director's hand and a stage set appropriately. If you've been sleeping poorly for some time, you may have fallen into some bad sleep habits that reinforce your problem. Read on to learn more about sleep.

All too often, we eat and drink without thinking about the effects. That afternoon cup of coffee seems like a good idea at the time. The dinnertime wine may appear a fitting celebration of the day's success. But that same drink can prove an enemy of restful sleep.

Coffee contains caffeine, as do many teas, chocolate and cola drinks. Caffeine is a stimulant, which means it has an alerting or wake-up effect. For some people, a small amount of caffeine early in the day can cause problems falling asleep ten to 12 hours later. Others have learned to avoid caffeine-containing drinks and foods within six hours of bedtime.

How you respond to caffeine is individual; it is also related to how much caffeine you have regularly. For example, the more coffee you drink each day, the less powerful its effect as a stimulant.

How to determine caffeine's effect on you? Try eliminating caffeinated food and drink after lunch for a few weeks. Are you sleeping better? If so, you may have identified the culprit.

Alcohol, in contrast, is often thought of as a sedative: a calming drug. However, while alcohol may speed the beginning of sleep, it actually increases the number of times you awaken in the later half of the night. If your sleep isn't restful, alcohol (beer, wine, hard liquor) may be the cause. Skip the nightcap and see if your sleep improves.

Caffeine and alcohol aren't the only substances that affect your sleep. Everything you eat can affect nighttime slumber. For example, tomato products and spicy foods give many people heartburn (as does eating too fast). What does heartburn have to do with sleep? Lying down makes heartburn worse, and heartburn itself makes falling asleep more difficult. Heartburn also awakens sleepers with middle-of-the-night discomfort.

Drinking too much of any beverage can lead to more awakenings because of the need to urinate during the night. Also, the older we get, the more we experience these nighttime awakenings.

Try to restrict your fluids before bedtime to help promote an uninterrupted night's sleep. If the problem persists, talk to your doctor.

Another cause of sleep problems can be eating too much - of any food - that can make sleep difficult. A heavy meal close to bedtime may make you less comfortable when you settle down for your night's rest. At the same time, going to bed hungry can be just as disruptive to sleep as going to bed too full.

• Do not eat or drink too much close to bedtime.
• Consider a small snack to ease bedtime hunger pains.

Smokers and nonsmokers alike may not be aware that nicotine, like caffeine, is a stimulant. And when smokers go to sleep, they experience nicotine withdrawal. Research suggests that nicotine is linked to difficulty falling asleep and problems waking up. Smokers may also experience more nightmares. Giving up smoking may cause more sleep problems at first, but the long-term effect on sleep and health is much better. So kick those cigarettes goodbye.

The next place to look for the cause of a sleep problem is your exercise routine. Exercise can be a boon for good sleep, especially when done regularly in the afternoon and not too close to bedtime. If you don't exercise regularly, add good sleep to a long list of reasons why you should take up the practice.

Why not try an afternoon brisk walk, run or bicycle ride instead of a coffee break? Consider combining aerobic (activity that increases the heart rate) exercise with a weight-bearing or resistance workout. (Be sure to check with your physician before beginning any exercise routine.) Research suggests that exercise at this time can help deepen your sleep, which means that you spend more time in deeper stages of sleep. During the lighter stages of sleep, awakenings are more common. Also, people who exercise may take less time to fall asleep than people who don't.

When you exercise, whether you are physically fit and a regular or occasional exerciser, the type of exercise you select, and your age or sex may all affect sleep. Some studies suggest that exercise 2-3 hours before bedtime can keep sleep at bay.

Traditionally, sleep experts have cautioned people to avoid strenuous exercise right before sleep and even up to three hours before bedtime. That's because exercise has an alerting effect and raises your body temperature. This rise leads to a corresponding fall in temperature five to six hours later, which makes sleep easier then. That's why late afternoon may be the perfect time for your exercise. If you've been exercising close to bedtime and having trouble falling or staying asleep, try to arrange your workout earlier in the day.

Want a better night's sleep? Try the following:

• Consume less or no caffeine and avoid alcohol.
• Drink less fluids before going to sleep.
• Avoid heavy meals close to bedtime.
• Avoid nicotine.
• Exercise regularly, but do so in the daytime, preferably after noon.
• Try a relaxing routine, like soaking in hot water (a hot tub or bath) before bedtime.
• Establish a regular bedtime and waketime schedule.
• Keep a sleep diary before and after you try these tips. (See NSF Sleep Diary .) If the quality of your sleep does not improve, share this diary with your doctor.

Finding and maintaining the right temperature for sleep sounds easy...but it isn't. Even sleep researchers fail to agree on the ideal temperature. In general, most sleep scientists believe that a slightly cool room contributes to good sleep. That's because it matches what occurs deep inside the body, when the body's internal temperature drops during the night to its lowest level. (For good sleepers, this occurs about four hours after they begin sleeping.)

But how cool should the bedroom be? And what should couples do who share a bed but disagree about the desired sleep temperature? Turning the thermostat down at night in cold weather saves on fuel bills and sets the stage for sleep. Blankets or comforters can lock in heat without feeling too heavy or confining. An electric blanket may help. Or the heat-seeking partner might dress in warmer bedclothes (even socks!), while the warmer partner might shun sleep clothes or bed covering.

In summer, a room that's too hot can also be disruptive. In fact, research suggests that a hot sleeping environment leads to more wake time and light sleep at night, while awakenings multiply. An air conditioner or fan can help.

Remember the common summer complaint: It's not the heat, it's the humidity? If excess humidity is a problem, consider a dehumidifier.

If too dry an environment is your problem, consider a humidifier. Clues like awakening with a sore throat, dryness in your nose, or even a nose bleed are signs of too little humidity. Note: Be sure to change the water daily.

Interestingly, body-heating can have a very different effect from a warm room during sleep. Some studies suggest that soaking in hot water (such as a hot tub or bath) before retiring to bed can ease the transition into a deeper sleep.

This may be due to a temperature shift (core body temperature drops after leaving the tub, which may signal the body it's time to sleep). Or the sleep improvement may be related to the water's relaxing properties, which may also have sleep- promoting effects.

A pre-bedtime bath may set the mood for children and adults alike. Why not try soaking in hot water to ease your journey to sleep?

People who work at night know all too well the problem of trying to sleep when the world around them is wide awake. When the sun's rays come streaming in, it's even harder. But the sun is more than a sign that it's daytime. Light - strong light, like sunlight - is the most powerful regulator of our biological clock. The biological clock influences when we feel sleepy and when we are alert.

When do you get your sunlight exposure? People who are housebound get little. In fact, the cause of your sleep difficulty may be just that: too little exposure to sunlight.

If you find yourself waking earlier than you'd like, why not try increasing your exposure to bright light in the evening? If sunlight isn't available, consider a lightbox (or light visor) available from a specialty store. Either way, as little as one to two hours of evening bright light exposure appears to help you to sleep longer in the morning. This may be especially helpful for the elderly.

During sleep, bright lights can disturb your sleep. Keep your bedroom dark (consider light-blocking shades, lined drapes, even an eye mask) so light doesn't interfere with your passage to slumber.

A sleep specialist can help determine whether changing your exposure to light might improve your sleep, and when would be the best time for you to experience bright light.

Do you find your sleep disrupted by noises such as the screech of sirens, the rumble of trains, the rise and fall of conversation, airplanes overhead, a dog's barking, or a partner's snoring? You may be surrounded by a steady stream of noise or it may occur in sudden peaks.

Older people may be particularly bothered by noise. Because their sleep may be frail, it is more likely to be disturbed by lower levels of noise.

If noise is disturbing your sleep, consider:

• ear plugs
• white noise, which comes from a noise-making machine such as a fan or generator
• rugs
• heavy curtains or drapes
• double-pane windows
• relaxing music or tapes

Many people change where they live or what they drive more often than they change their mattress or pillows. Yet nothing lasts forever.

Although there isn't much published research on mattresses, mattress quality may affect how sleep feels to the sleeper. Discomfort can make falling asleep more difficult and lead to restless slumber.

Does your mattress provide the support you like? Do you wake with your back aching? Is there enough room for you and your sleep partner? Do you sleep better, or worse, when you sleep away from home?

Mattresses may be made of inner springs, foam, fabric, water or air. They may be firmer or more responsive to your body. This, in turn, may affect body temperature and humidity, as well as comfort.

If you can fall asleep easily on your sofa or chair, and it is difficult to fall asleep in your own bed, you may be associating your bed with everything but sleep. Do you use your bed for work? Balance your checkbook while propped against the pillows? Watch television there? These are ways to tell your body to be alert in bed, not to go to sleep.

To teach patients to associate their bed and bedroom with sleep, sleep specialists advise a strategy called stimulus control, performed under the supervision of a specialist. Patients learn to use their bed only for sleep and to follow a regular wake-up schedule.

Another effective approach involves restricting your time in bed, initially, to the number of hours you actually sleep. Then, as you can rely on sleeping these hours regularly, you increase your time in bed by 15-30 minutes per night. A less dramatic approach would be to decrease your time in bed by 30 to 60 minutes.

• Use your bed only for sleep and sex.
• Only get into bed when you're tired.
• If you don't fall asleep within 15 minutes, get out of bed. When you're sleepy, go back to bed.
• While in bed, don't dwell on not sleeping or your anxiety will increase.
• Think relaxing thoughts: picture yourself soothed in a tub of hot water, or drifting to sleep, each muscle relaxed.

Some sleep specialists say that anxiously watching the clock while focusing on how much time you have yet to sleep may actually cause insomnia. Try setting your alarm, then hiding it and your watch before you go to bed.

The time you go to sleep and the time you rise may sometimes seem beyond your control. Consistent bedtimes and wake times are advisable for those experiencing insomnia. Sleeping in may make for a more enjoyable weekend, but Monday morning - and Sunday bedtime - may suffer as a result. You choose: sleep late on the weekends...or feel refreshed and alert every morning?

To nap or not to nap, that is the question. If you suffer from insomnia, try not taking a nap. If the goal is to sleep more during the night, napping may steal hours desired later on. However, napping can help promote short-term alertness, for example, to prepare for driving or in the middle of a long car trip.

• Plan on a nap of just 20-30 minutes.
• If driving, nap in a safe place, such as in your locked car in a well-lit rest stop.
• Don't use a nap to try to substitute for a good night's sleep. If you're a regular napper, and experiencing difficulty falling or staying asleep at night, give up the nap and see what happens.

Relaxing may mean choosing the bedtime ritual that's right for you. Does gentle music lull you to sleep? A calming soak in a warm bath or hot tub? Cozy pajamas? Cuddling with your partner? Meditation or a prayer? Find what works for you...and do it! Sweet dreams.

If you find your thoughts turning to worries when bedtime approaches, keep a worry book by your bedside. Jot down a brief note about what's on your mind. Schedule time the next day to focus on the problem and a solution. Problems often seem smaller in the daylight. However, if problems persist, consider talking to your doctor or a psychotherapist.

If your sleep problem persists, there may be an underlying cause that can be successfully treated or controlled once properly diagnosed. Sleep disorders centers are staffed by physicians and other medical professionals who specialize in helping people with persistent sleep problems.