Pillow Talk
Having trouble hitting the hay? You’re not alone. Learn how to sleep better with our experts’ sound advice
In this modern age of digital distractions, conflicting schedules, and endless to-do lists, a good night’s sleep can appear as distant as those metaphorical sheep we’ve been counting. As a species, humans are chronically sleep-deprived — and our busy agendas may be at fault. Unfortunately, skimping on shut-eye comes at a dangerous price. While the occasional all-nighter might leave us susceptible to mood swings, headaches, and a decreased attention span, consistently poor sleep habits have been linked to a host of more serious health issues: obesity, diabetes, depression, heart disease, and high blood pressure, among others. Sleep is nature’s very own cure-all, a chance for the body and brain to repair all of the damage we accumulate during waking hours. In fact, certain brain functions — like the regulation of emotions and removal of destructive toxins — can only happen while we’re asleep. Still, despite what we know about the harm in skipping Z’s and the powerful benefits in catching them, the National Institutes of Health estimates that nearly 70 million of us experience sleep problems on a regular basis. Sound familiar? Here’s the good news: Getting those 40 winks might be easier than you think. Fueled by the evaluation of our own sleep patterns, we asked local medical experts to weigh in on the complex sciences of sleep. The findings, we hope, will help put your sleepless nights to rest.
Stage gap
From the minute we start to nod off, the brain begins its journey through five phases of the sleep cycle, each one categorized by differences in brain wave activity. Years ago, sleep was thought to be a relatively passive neurological state, but it’s quite the opposite. Not only is the brain incredibly active during sleep; it is performing functions that are vital to human survival.
Perhaps the best known stage in the sleep cycle, rapid eye movement, or REM, is classified by quick, shallow breathing; an increased heart rate; and sporadic twitching of the eyes. It’s also the only stage in which we dream.
“Your brain is just as active [during REM sleep] as when you’re awake, except that your muscle tone is completely at zero,” says Anne Germain, associate professor of psychiatry and psychology at the University of Pittsburgh School of Medicine. “You’re technically paralyzed, which is a good thing — it prevents you from acting out your dreams.”
Germain says that the entire sleep cycle, from light sleep through REM, takes 75 to 90 minutes for most adults. Those without sleep interruptions will typically complete four to five cycles per night, meaning they’ll also have four to five dreams.
Regardless of whether we’re able to recall them, everyone dreams. Says Germain, “Usually, we only recall one dream, and it’s the one we had right before we woke up. If you wake up too quickly and immediately start thinking about the day ahead, you may not have time to consolidate the memory of having dreams.”
Power hours
Tracking what happens to the brain and body during sleep allows us to better understand why snoozing is so important. It also raises the holy grail of sleep mysteries: How much do we need, exactly?
According to researchers, seven is the new eight. But, as with any medical finding, there are exceptions. “Most adults report feeling sufficiently rested when they’ve slept between 6 1/2 and 7 1/2 hours a night, but there are also [very few] people who say they need only four or five hours [of sleep], and others who genuinely need 10 to 12 hours to feel completely rested,” says Germain. Certainly, there’s a fine line between how much sleep we get and how much sleep we need, and the two are not necessarily closely related.
Although we’ve been practically hardwired to regard eight hours as the norm, Leslie Bonci, director of sports nutrition at UPMC’s Center for Sports Medicine, says there really isn’t a universal benchmark. “We do know that it’s better to routinely get more than six hours a night. Anything less than that is definitely a concern,” she says. Perhaps more surprisingly, there also seems to be some concern with oversleeping. Germain notes that sleeping less than six or more than nine hours a night is likely an indicator of a chronic sleep problem or other medical complication: “If you’re at either end of that spectrum, something is going on with your sleep that’s worth exploring.”
When it comes to getting a healthy dose of R&R, experts agree that there’s no “one size fits all” approach. Germain says that as long as your sleep is consolidated — meaning, you complete multiple sleep cycles with minimal or zero interruptions throughout the night — and you feel rested enough in the morning to tackle the day ahead, it’s fairly safe to assume you’re sleeping efficiently. By instinct, most of us know when we’ve had a good night’s sleep based on how we feel physically, but there are some fail-safe ways to tell for sure: Look for improvements in concentration, short-term memory, productivity, and mood.
Tired of being tired?
It’s normal to experience some tossing and turning in bed every now and then. After all, letting go of a stressful day is easier said than done. If restlessness persists, though, you may be dealing with a more serious sleep condition.
Insomnia — the inability to fall or stay asleep — is the most common sleep disorder among adults. In fact, nearly 30 percent will report symptoms at some point in their lives. “If you lie awake in bed without feeling sleepy, wake up frequently throughout the night, or wake up a few times per night for more than 30 minutes at a time, there’s definitely a sleep problem present,” says Germain.
When insomnia becomes chronic, it affects not only your ability to achieve or maintain sleep, but also your daytime functioning. Beware of physical symptoms such as headaches, muscle aches, gastrointestinal issues, short-term memory deficiencies, or extreme lack of energy, all of which are almost always directly related to insomnia.
Before you self-diagnose, keep in mind that this disorder is very different from intentional sleep restriction, or deprivation. “With sleep deprivation, you can easily fall asleep and stay asleep — you just aren’t giving yourself enough time to sleep,” Germain explains. If this more accurately describes your bedtime patterns, try adjusting your schedule to allow for more shut-eye. Even if it means waiting until morning to send those emails or watching one less episode of Game of Thrones, your health is well worth the effort in the long run.
If your sleep (or lack thereof) is critically concerning to your daily functioning, see your doctor. Germain says that insomnia is oftentimes mistaken for an existing medical condition that also disrupts sleep, like sleep apnea.
By the same token, researchers have recently discovered that sleep disorders are a precursor for other health problems — not the other way around. “That was a really important finding,” says Brant Hasler, assistant professor of psychiatry at the University of Pittsburgh School of Medicine. “We used to think that people with depression almost always had sleep problems, and [that] if you just treated the depression, the sleep problems would go away.” As it turns out, however, poor sleep habits are actually a catalyst for depression. This is not great news for insomniacs, who are twice as likely to become depressed than their sound-sleeping counterparts. Among these findings, sleep problems have also been linked to substance abuse, obesity, and diabetes.
Around the (internal) clock
Sleeplessness is typically caused by two things: poor sleep habits and stress. However, our sleep patterns are also largely determined by internal processes beyond our control. Long before alarm clocks, sleeping pills, and coffee, our ancient ancestors knew exactly when to go to sleep and when to wake up, all-the-while having enough energy to combat the physical challenges of the day. How? Circadian rhythms: naturally occurring changes to our biology that operate on 24-hour cycles.
“The basic purpose of circadian rhythms is to make sure that what’s happening inside our body and brain is appropriately timed with the outside world, particularly the light-dark cycle,” says Hasler. Essentially, they are responsible for signaling to the body when it’s time to perform certain activities, including sleep. Hours before we’re ready to call it a night, our bodies are preparing for bed, too. The brain produces higher levels of melatonin, a hormone that tells us to settle down. Consequently, our core body temperature drops, and we might feel noticeably sleepier or less alert.
Since the majority of human circadian rhythms react to darkness, these cues for sleep routinely happen at night, but not always. Sometimes, Hasler says, there are individual differences in rhythms, which explains why some people feel more productive at various times throughout the day. While “morning types” are early birds who prefer to rise with the sun, “evening types,” or night owls, feel their best after dark. Unfortunately, our predominantly 9-to-5 culture leaves little flexibility for evening types, who typically have more sleep-associated health problems than morning people. Says Hasler, “[With evening types], there’s a mismatch between their environment and what their brain and body want to do, especially in the morning, when they’re forced to get up earlier and try to function.”
One night at a time
Everyone sleeps. So, shouldn’t we learn how to do it better? Sleep researchers agree that most of us — sleep disorder or not — need more quality time with our pillows, and rightfully so. With the Centers for Disease Control and Prevention labeling our nation’s lack of sleep a public health epidemic, it is imperative, now more than ever, to re-evaluate our sleep habits, reinstate healthier practices, and recharge our brains and bodies properly. While there is not a quick fix for sleep problems, sweeter slumber can be achieved over time by incorporating a few minor, yet significant, lifestyle changes.
In cases of full-blown insomnia and/or circadian rhythm imbalances, experts recommend cognitive behavioral therapy: a method of treating insomnia that incorporates sleep-schedule adjustments rather than sleeping pills. “The most effective pharmacological aids are about equally effective as cognitive behavioral treatment in the short term,” says Hasler, “while most research suggests that CBT is better over time, and that medications are not as helpful.” Germain generally advises against the use of over-the-counter pills, which are potentially habit-forming, and says that sleep aids should only be considered under a doctor’s supervision. “There’s very little data to show whether [OTC sleep medications] actually work,” she adds.
Hasler says that while therapy may sound extreme for people with mild or occasional insomnia symptoms, “the principles of cognitive behavioral treatment for insomnia are really translatable to everybody.” For instance, sleep schedule regulation is shown to have tremendous effects on reducing sleeplessness. To start, Germain recommends waking up at the same time on both weekdays and weekends, regardless of how many hours you slept: “[Routine] helps to balance out your biological clock’s sleep wakefulness cycle.”
Alternatively, one factor that will surely throw your sleep-wake cycle off-kilter is the use of electronic devices in bed. In a world where watching television, using tablets, and texting in bed have become commonplace, it’s no surprise that our brains are having trouble powering down, too. “When you use electronics in the comfort of your bed, your brain and body start to learn that the bed is not a place for sleep. You’re creating this competition between sleeping and doing something that is fun and engaging,” Germain explains. That concept applies to non-electronic devices as well: In bed, activities like studying and reading — and even thinking — can compromise a healthy association between our beds and sleep. Germain’s advice? “If you can’t fall asleep in bed, go somewhere else. If you’re thinking too much, keep a journal of thoughts — but don’t try to find the answers until morning, when your brain is in a better place to sort them out.”
Food for thought
Contrary to the old wives’ tale, eating too much before bed won’t necessarily give us nightmares. It can, however, affect how easily we’re able to fall asleep. Bonci recommends curtailing food consumption at least 90 minutes before bedtime, being careful to avoid anything too heavy or high in fat. “The goal is to give the digestive tract a chance to settle down before we sleep. Not only do heavy, high-fat foods take longer to leave the stomach, but they also wake up the body and tend to make us feel more uncomfortable,” she says. Gravity plays a role in digestion as well, particularly for people prone to reflux, since lying horizontally may increase acid production and exacerbate symptoms.
If you feel that going to bed on an empty stomach will prevent you from drifting off, reach for lighter snacks that contain tryptophan, an amino acid that relaxes the body and prompts sleepiness. While turkey is conceivably the most popular food to be associated with tryptophan, there is actually just as much of this powerful substance in most other poultry. Bananas, peanuts, and dairy products, like milk and yogurt, also contain tryptophan and work well as light, before-bed snacks that won’t compromise digestion.
Another food that may be helpful for inducing sleep naturally is the tart cherry, “one of the few foods that ties in melatonin,” according to Bonci. She offers a tasty smoothie suggestion — frozen tart cherries, yogurt, and milk — which makes for a healthy nightcap. Also available in pill form, melatonin is a safer alternative to synthetic sleep medications because it lacks side effects and is non-habit-forming. “Physicians aren’t worried about people developing dependence [on melatonin], which is not the case with benzodiazepines or other drugs in the same category,” says Hasler.
One of the most important connections between food and sleep, experts report, is the strong possibility that sleeplessness leads to weight gain. Bonci explains the “total reversal of the hunger hormones” that occurs when we don’t get adequate amounts of sleep: “Ghrelin, which tells us when we’re hungry, goes off like a siren all day, whereas leptin, the hormone that tells us when to stop eating, is completely silent.” Of course, food is pivotal in fueling the body with energy, especially after a restless night. But the longer we’re awake, the more likely we are to take in unnecessary calories, starches, and sugars. “Loss of sleep greatly affects metabolism,” concurs Hasler. “People with irregular sleep patterns tend to consume more calories that — in terms of energy expenditure — are not accounted for during the increased time they’re awake.”