Sleep problems are a hallmark of modern American life—perhaps never more so than recently. In 2016, the Centers for Disease Control and Prevention found that a third of Americans were getting too little sleep. But then came the stressors of the pandemic, job losses, disrupted schedules, and closed schools, which kept record numbers of Americans up at night. According to a survey by the American Psychological Association, during the pandemic’s second year, as many as 2 in 3 Americans reported getting either too little sleep. And though some parts of life are now returning to normal, the insomnia of the past two years may be stubbornly hanging on: Many people continue having more trouble falling asleep or staying asleep, or have seen unusual shifts in their sleep schedules.
Most people, having busy schedules, often resort to cutting down on their hours of sleep. But even minimal sleep loss takes a toll on your mood, energy, and ability to handle stress. The quality of your sleep directly affects the quality of your waking life, including your mental sharpness, productivity, emotional balance, creativity, physical vitality, and even your weight. No other activity delivers so many benefits with so little effort.
Sleep isn’t exactly a time when your body and brain shut off. While you rest, your brain stays busy, overseeing biological maintenance that keeps your body running in top condition, preparing you for the day ahead. Without enough hours of restorative sleep, you won’t be able to work, learn, create, and communicate at a level even close to your true potential. As you start getting the sleep you need, your energy and efficiency will go up. In fact, you’re likely to find that you actually get more done during the day than when you were skimping on shuteye. You may not be noticeably sleepy during the day, but losing even one hour of sleep can affect your ability to think properly and respond quickly. It also compromises your cardiovascular health, energy balance, and ability to fight infections. Loss of sleep during the week leads to accumulated “sleep debt” that can only be partially repaid by extra sleeping during weekends.
Both the quantity and quality of sleep are important. Some people sleep eight or nine hours a night but don’t feel well rested when they wake up because the quality of their sleep is poor. The best way to figure out if you’re meeting your sleep needs is to evaluate how you feel as you go about your day. If you’re logging enough sleep hours, you’ll feel energetic and alert all day long, from the moment you wake up until your regular bedtime. Extra sleep nightly can relieve problems of excessive daytime fatigue. Some people can avoid a sleep deficit by taking short daytime naps. Older adults also often have trouble sleeping sufficiently long at night; daytime naps can help fill in the gap.
How Much Sleep Do You Need?
Although there is some genetic variation, most adults require 7 to 9 hours of sleep per 24-hour period to function optimally. One way to find your optimal sleep time is by setting aside several days (perhaps during a vacation) to allow sleeping as long as possible. After this time is determined, it’s best to allot that amount of time in one’s daily schedule for sleep.
Health Dangers of Inadequate Sleep
Previous studies have shown that inadequate amounts of sleep are associated with a higher long-term mortality risk. In a National Institutes of Health Study, researchers examined associations among sleep duration and various causes of death. They studied cardiovascular disease and cancer mortality among 239,896 US men and women aged 51-72 years who were free of any of these diseases at the beginning of study. They evaluated the influence of moderate-to-vigorous regular physical activity, television viewing, and body weight on the interplay between sleep and mortality.
Compared with 7-8 hours of sleep per day, shorter sleep durations were associated with higher total mortality, especially due to cardiovascular diseases. Especially noteworthy was a higher cardiovascular mortality in those with lesser sleep among overweight and obese people, suggesting a special interaction between reduced sleep and overweight. People in the unhealthy categories of all four risk of the following factors—sleep less than 7 hours/day, less than one hour of vigorous physical activity weekly, television viewing greater than 3 hours/day, and moderate to severe overweight—had an all-cause greater risk of dying approaching 50% greater than that of those lacking any of these factors. Although deaths in this group were most likely attributable to cardiovascular disease, they surprisingly also had higher than normal rates of cancer.
So how can we get the sleep we need? It’s not easy to just flip a switch and start sleeping soundly again—if you ever did in the first place. Here’s how to solve common problems that can interfere with your rest and your health:
Problem: You often wake up in the middle of the night or early in the morning and then can’t get back to sleep.
Solution: If light coming into your bedroom is the issue, light-blocking products like blackout curtains or a sleep mask may do the trick. You might also want to cut back on—or cut out—caffeine (which can keep you perky long after you’ve consumed it) and alcohol (which can interfere with deep sleep). Many people, however, sleep lightly because of “hypervigilance,” which refers to focusing too much on what might disrupt your slumber—before you doze off and even while you’re sleeping. This leads to an acute awareness of your environment and, paradoxically, can make it harder to sleep. One aggressive way to address this is a form of cognitive behavioral therapy (CBT) known as CBT-I—the “I” stands for insomnia, a physician directed means that can help you identify and modify thinking patterns and habits that keep you from sleeping. Though you can ask a sleep doctor about CBT-I, you can learn to do it on your own. Consider using an app, like CBT-i Coach, which Stanford University developed in collaboration with the federal government. You can also teach yourself strategies to employ when you can’t fall back asleep, for example, people who spend 9 hours in bed at night but only 6 hours sleeping might be instructed to lessen their in-bed time by 2½ hours for a week. If that cuts down on unwanted wake-ups, they may slowly add back in-bed hours.
Problem: Nature always calls in the middle of the night—often multiple times.
Solution: Waking up once during the night to use the bathroom is completely normal. But if you find that you awaken two or more times each night for restroom visits, try reducing the salt in your diet, because excess sodium—which your kidneys will try to flush out—can contribute. You may also want to avoid fluids in the 2 hours before bed, while making sure you hydrate well earlier in the day. If these steps have little effect, consult your doctor. The awakenings may be a symptom of an underlying issue such as diabetes or a kidney disorder. Treating a root medical problem may reduce your middle-of-the-night bathroom trips.
Problem: When you get into bed, your mind races, and it takes you too long to fall asleep.
Solution: Lying in bed with your bedroom dark, quiet, and at a comfortable temperature, try a short relaxation exercise—like tensing and then relaxing groups of muscles, starting at your feet and finishing with your neck and face. This may reduce physical tension in the body and help short-circuit thoughts that can interfere with sleep, according to the National Institutes of Health. If you’ve been in bed for a while and still can’t nod off, try going to another room and do a calming activity such as reading, rather than lying there watching the minutes tick by. Wait until you feel sleepy again before returning to your bedroom. Longer-term, have a plan for heading off nighttime fretting: Before getting under the covers, make a habit of writing down the next day’s tasks, rather than holding it all in your head. One small 2018 study found that people who spent 5 minutes creating a to-do list before bed fell asleep faster than a control group.
It’s also helpful to establish a consistent bedtime and wake time, so your body gets used to falling asleep when you need it to. And avoid all illuminated screens for at least a half-hour before bed. In addition to avoiding your TV and phone, consider shielding your eyes in a dark room, which aids your body’s production of melatonin, a hormone that helps signal to your brain that it’s time to sleep.
Problem: You get at least 7 hours of sleep but still wake up exhausted.
Solution: Since expert groups like the American Academy of Sleep Medicine recommend that most adults get 7 to 9 hours of sleep a night, if you’re getting only 7 hours, start by upping that to 8 or even 9.
Next, figure out whether you’re sleepy or fatigued. Sleepiness means you feel drowsy and have a hard time staying awake. Fatigue, in which you feel tired but don’t find staying awake difficult, is a symptom of many illnesses—including anemia, thyroid disease, and depression—that may not be directly related to sleep. Discuss ongoing fatigue with your primary care provider. And if you’re constantly sleepy, ask for a referral to a sleep specialist. It could be a sign of some form of sleep apnea, in which, together with snoring, breathing stops and starts during sleep. The doctor may also test you for other sleep disorders that leave you exhausted after a good night’s rest. Another problem, “bruxism” (clenching or grinding your teeth during sleep) can get in the way of rest. Headaches and jaw pain in the morning are telltale signs of such a problem. A dentist can check your teeth for wear and fit you with a mouth-guard that may help.
Problem: You always fall asleep in the living room after dinner, wake up, and then can’t fall asleep again at bedtime.
Solution: Brief naps are not necessarily a problem, especially if you take them after lunch or dinner. But nodding off on the couch in the evening for extended periods and then feeling wide awake once you get into bed can be typical patterns in chronic insomnia. If you can’t resist the lure of a comfy couch, try doing something active at that time, like taking a walk, may keep you from dozing off. But you may also need to reset your daytime rhythm. Here’s how: Get up at the same time each day, and make sure to get some sunlight each morning.
Problem: Your partner’s loud snoring and tossing and turning keep you awake.
For the common variety of snoring, a background a mechanical steady noise producer such as “white noise” (mixed frequencies), or a pleasant recording of sounds of the ocean, may be sufficient to replace the snoring sounds with a less obtrusive sonic form.
Allergies, congestion, or a deviated septum can cause snoring. But routine snoring can also be a sign of obstructive sleep apnea (OSA), in which a physical obstruction in the throat—often the tongue—interferes with breathing during sleep. This can have serious health consequences, like a higher risk of high blood pressure and stroke. Symptoms can also include daytime sleepiness. Helping your partner get to the root of their snoring will enable you to sleep and you may even save their life. So urge them to see a doctor. The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine, which sends a constant flow of air into your airway through a mask and tube attachment worn during sleep, and is often at least partially covered by insurance. These machines were once uniformly noisy and bulky, but many modern ones are far sleeker, smaller, and quieter. Once a CPAP user gets used to the device—and settles on a mask that fits properly, which can take a few tries—the snoring should completely stop. If not, adjustments to the device can help. If your partner moves around a lot and it’s ruining your sleep, consider whether it’s time for a new mattress, which can be tested for “stabilization” or bounciness—a measure of the likelihood that movement on one side of the bed will disturb someone on the other side. Consider trying mattresses together in a store to see how they feel when you move around. As a last resort, move to a separate bedroom.
Problem: You work irregular hours, which makes it hard to sleep when needed.
Solution: Sleep issues are common among overnight workers and those with inconsistent schedules—going in, say, at 10 a.m. one day and 7 a.m. the next. If you need to sleep during the day so that you can work at night, keep your bedroom as dark as possible. Blackout curtains are a must. For overnight workers, a nap right before a shift (or even during, if it’s permitted) may boost alertness and performance. Limit these naps to 60 minutes, to reduce the chance you’ll enter deep sleep, for waking from deep sleep can be associated with grogginess and disorientation. You may want to consult with a sleep specialist to figure out what nap-time would help you most, based on your schedule. And modafinil (Provigil), which might not be for everyone, is a prescription wake-promoting medication approved by the Food and Drug Administration for shift-work sleep disorder and some other issues
When to See a Sleep Expert
If you have consistent sleep issues that interfere with your daily life, tell your doctor—who may refer you to a sleep specialist. If the doctor suspects issues like sleep-disordered breathing (such as obstructive sleep apnea), narcolepsy (daytime episodes of falling asleep suddenly), idiopathic hypersomnia (excessive daytime sleepiness), or periodic limb movement disorder (repetitive leg and foot movement during sleep), they are likely to advise an overnight sleep study for a definitive diagnosis. These studies usually take place at specially designed sleep centers, where you’ll have your own room and bathroom. As you sleep, technicians will typically record your brain waves, heart rate, breathing, blood oxygen levels, snoring, eye and leg movements, and more. In the case of suspected narcolepsy, you’ll also spend some daytime hours at the center. For sleep apnea, you may be able to do an at-home overnight study, with equipment lent to you. Insurance for sleep studies can vary, so check first. And if you’re simply interested in learning more about how you sleep, consider a smartwatch—like the Apple Watch Series 7—or fitness tracker with sleep-tracking capabilities.
Summarizing A Few General Tips for Better Sleep for everyone
For the reasons presented above, getting enough good-quality sleep is essential to staying healthy and aging well. It can also raise the risk of falling, particularly among older women, and, if you drive, it increases the likelihood of having a car accident. Insomnia might also leave you feeling anxious, depressed, or irritable. Paying attention, learning, or remembering can become difficult. So here are a few simple general steps that can help you overcome insomnia:
Stick To a Consistent Sleep Schedule and Routine
Go to bed at the same time each night and wake up at the same time each morning. A set sleep routine will “train” you to fall asleep and wake up more easily.
Use the Bed Only For Sleep and Sex
No explanation necessary.
Be Physically Active
Regular aerobic exercise like walking, running, or swimming provides three important sleep benefits: you fall asleep faster, attain a higher percentage of restorative deep sleep, and awaken less often during the night. But try not to exercise shortly (less than 3 hours) before retiring, for it temporarily raises your body’s temperature and metabolic rate, factors that can transiently interfere with sleep.
Limit Extended Daytime Naps
Prolonged napping can disrupt your natural sleep cycle and prevent you from feeling tired enough to fall asleep.
Improve Your Sleep Surroundings
Remove the television, telephone, and office equipment from the bedroom. This reinforces the idea that this room is meant for sleeping. An ideal environment is quiet, dark, and relatively cool, with a comfortable bed and minimal clutter. If you are accompanied by someone who snores loudly, use of earplugs or background steady noisemakers may be helpful, but moving to separate sleeping quarters may be required.
Try to Avoid Sleeping Pills
If you do take a prescription sleep medicine, work with your doctor to use it effectively and for as short a time as possible. If you must take medicine, I prefer a type of inexpensive medication is melatonin, a non-prescription substance normally produced in humans by the pineal gland, which is located in the center of the brain. Although not the sole regulator, it is involved in the sleep-wake cycle. Its production is inhibited by light and stimulated by darkness, which seems related to a mild ability to promote sleep.
Sleeping Pills are Especially Dangerous to The Elderly
Unfortunately, between 8 and 35 percent of the population over 65 consumes such pills, often on a regular basis. The so-called benzodiazepines are the most widely used for both insomnia and anxiety. The brand names include Ativan, Ambien, Halcion, Klonopin, Lunesta, Sonata, Valium, and Xanax. (Some, like Ambien and Lunesta, actually belong to a class of sister drugs but have the same effects on the brain.) But they all present a problem—especially given older users’ changing metabolisms and the likelihood that they’re taking many other drugs. Such people taking sleeping pills are five times more likely to report poor concentration and memory, and twice as likely to have hip fractures and car accidents. They also experience more incontinence.
Despite these risks, however, many older people keep taking these drugs because they’re psychologically addicted, believing they can’t function without them. They may have unrealistic ideas about how much sleep older adults actually need—most 80-year-olds will do fine with six hours a night. It’s normal for older people to wake up a couple of times a night, but they don’t like it. The best countering strategy—after the risks above are explained—is to wean them off the pills over 12 to 20 weeks, allowing the blood levels to go down slowly. In the process, there may be a few nights of trouble sleeping, so they should just plan their activities accordingly. Eventually, the body will catch up.