The Consequences of a Sedentary Lifestyle
Our evolution over tens of thousands of years involved regular physical activity. Indeed, our early ancestors’ day-to-day survival required physical activity in the form of hunting and gathering food. Daily physical activity was required later in our evolution to plant, sow, and harvest crops.
Yet consider how, in a remarkably short period of time, we have
dramatically reduced our level of physical activity. Although there are many reasons, indoor work environments, computers, laborsaving devices, automobiles, and televisions are the primary culprits. These modern technological advances were intended to make life easier; in reality they have led to a mechanized lifestyle in which we sit at desks, in cars, or in front of the television set. We didn’t evolve to inhabit the couch, yet many of us don’t even change the channels on our televisions or open our garage doors ourselves.
Despite the public awareness of the negative consequences of a sedentary lifestyle, physical inactivity is epidemic in the United States. At least 25 percent of adults (and an alarming number of children) are inactive and overweight. Consequently, a significant percentage of Americans have chronic medical problems directly related to physical inactivity and obesity, including heart disease, high blood pressure, diabetes, and some types of cancer.
It is not surprising that individuals with these health problems are also at significantly increased risk of dying prematurely. At least one in ten deaths in the United States each year is attributable to a lack of physical activity.
The Many Benefits of Exercise
If sedentary adults would adopt a more physically active lifestyle, they would experience a wide array of physical and mental benefits, including:
• Weight loss, improved physical appearance, and positive body image
• Lessened anxiety, stress, and depression
• Improved mood, energy, and sense of well-being
• Improved self-esteem, confidence, and feelings of self-control
• Improved health, longevity, and quality of life
• Reduced pain and disability
Regular exercise enhances health by improving cardiovascular functioning, bone density, and immune functioning, and by reducing blood pressure and cholesterol. People who are physically active are
much less likely to suffer from coronary heart disease, hypertension, diabetes, osteoporosis, obesity, back problems, and colon cancer.
Exercise also improves psychological functioning. Exercise is an outlet for the body’s excessive tension, providing a healthy way to release anger and anxiety. Exercise has a tranquilizing effect that reduces anxiety more effectively than many antianxiety medications. Studies have found that the tranquilizing effect follows within five to ten minutes of completing exercise and lasts for at least four hours. Therefore, physically active people are less likely to develop mental health problems such as anxiety and depression.
Exercise is an effective treatment for people suffering from depression. In one study, mild to moderately depressed people reported feeling better within one week of beginning an exercise program; they also improved more over time than mild to moderately depressed people who received either short- or long-term psychotherapy. Exercise also improves emotional well-being by enhancing self-esteem. People who exercise feel better about themselves and their bodies. And, because exercise improves appearance, others’ compliments about physical improvements from exercise further enhance one’s self-esteem.
Exercise has such a wide range of physical and mental benefits that, if it were a pill, it would undoubtedly be the most widely prescribed of all medications. It is amazing that, despite this evidence and the public’s apparent acceptance of the importance of physical activity, millions of American adults remain sedentary.
Exercise as a Sleep Aid
Two findings about exercise are particularly relevant to insomniacs. One, insomniacs lead more sedentary lives than good sleepers. The lack of physical activity can contribute to insomnia by inhibiting the daily rise and fall of the body-temperature rhythm. As a result, many people get caught in a cycle of insomnia, reduced energy and physical activity, and worsened insomnia.
Two, exercise improves sleep by producing a significant rise in body temperature, followed by a compensatory drop a few hours
later. The drop in body temperature, which persists for two to four hours after exercise, makes it easier to fall asleep and stay asleep.
The beneficial effect of exercise on sleep is greatest when exercise occurs within three to six hours of bedtime. Exercising less than three hours before bedtime, however, can make it more difficult to fall asleep, for body temperature may then be too elevated.
Exercise also improves sleep because it is a physical stressor to the body. The brain compensates for physical stress by increasing deep sleep. Therefore, we sleep more deeply and soundly after exercise. Exercise may also improve sleep because people often exercise outdoors during the day, which increases exposure to sunlight. We will shortly explore how exposure to sunlight improves sleep by synchronizing our body-temperature rhythm.
Mary Ellen was one of my patients whose story illustrates the beneficial effect of exercise on sleep. She is a forty-year-old housewife who came to my insomnia program complaining of difficulty falling and staying asleep. Mary Ellen’s sleep diaries revealed that she required an average of one hour per night to fall asleep and that her nighttime awakenings averaged ninety minutes.
Because she was sedentary, Mary Ellen was advised to begin an exercise program. She chose to walk briskly for thirty minutes late in the day. Within a few weeks she was falling asleep within thirty minutes each night, and she reduced the frequency and length of her nighttime awakenings by about 50 percent. She felt more rested; her mood and daily functioning began to improve.
Although exercise alone didn’t cure Mary Ellen’s insomnia, it had a significant positive effect on her sleep.
In another example of the beneficial effect of exercise on sleep, Stanford University School of Medicine researchers studied the effects of exercise on the sleep patterns of adults aged fifty-five to seventy-five who were sedentary and troubled by insomnia. These adults were asked to exercise for twenty to thirty minutes every other day in the afternoon by walking, engaging in low-impact aerobics, and riding a stationary bicycle. The result? The time required to fall
asleep was reduced by half, and sleep time increased by almost one hour.
Physical Activity Versus Intense Exercise
With all the benefits associated with exercise, why do so few American adults exercise? There are many reasons; some of the more common ones include:
“I am too busy and don’t have the time.”
“I don’t like discomfort or sweat.”
“Exercise is too boring or is too much work.”
“The weather’s bad.”
“I don’t enjoy exercise.”
Perhaps the major reason people don’t exercise is the misperception that exercise means sweat-soaked, exhausting, torturous physical exertion. This concept is partially the result of an overemphasis on the importance of engaging in twenty to thirty minutes of high-intensity exercise three to five times per week, which has discouraged many.
Scientific evidence clearly indicates that moderate physical activity, not just intense exercise, provides substantial health benefits. Guidelines involving a gentler, easier exercise program of daily physical activity were recommended in 1996 by the surgeon general and by experts. The program encourages adults to become and remain active. The guidelines recommend at least thirty minutes of moderate-intensity physical activity on most, if not all, days. This activity can come in the form of many of our normal daily activities: washing the car, taking the stairs instead of the elevator, or riding a bicycle instead of driving.
These activities can be broken up into several shorter sessions that, during the day, add up to thirty minutes—enough physical activity to expend about 200 calories daily. The total amount of activity is more important than whether it involves intense physical exercise or moderate-intensity activity.
The good news: you don’t have to join a health club, use a Stairmaster, do aerobics, or work up a sweat to obtain health benefits from exercise!
Listed below are moderate-intensity physical activities:
• Home care, general cleaning, mowing the lawn with a nonriding mower
• Home repair and painting, gardening, raking leaves
• Climbing steps
• Playing actively with children
• Washing the car, windows, or floors
• Pushing a stroller
• Walking briskly, three to four miles per hour
• Bicycling for pleasure or transportation
• Table tennis or doubles tennis
• Golf (carrying or pulling clubs), fishing, canoeing
Here are some examples of activities that are more vigorous and will produce even greater health benefits:
• Walking briskly uphill or with a load
• Hand mowing a lawn or moving furniture
• Day hiking or backpacking
• Dancing or fast bicycling
• Vigorous swimming
• Basketball, singles tennis, running
• Racquetball, ski machine, treadmill, Stairmaster
• Aerobics or cross-country skiing
Experts agree that most adults do not need to see their physician before beginning a moderate-intensity physical activity program. However, it is a good idea to build up levels of physical activity by starting with low-intensity activities for short durations a few times a week, then gradually increasing the duration and frequency.
Those who plan to start more vigorous physical exercise or who have a chronic health problem should first consult their physician to
plan a safe, effective program. Vigorous exercise should also be preceded and followed by a few minutes of stretching to work out muscle tightness and reduce the risk of muscle injury.
How to Succeed at Exercise
In addition to focusing on moderate physical activity, these guidelines will increase the likelihood of becoming and remaining physically active:
• Choose activities that you enjoy and that give a sense of satisfaction. What works for some is torture for others. Some people listen to music or watch television while they exercise to make it more enjoyable.
• View physical activity and exercise as a break from your daily routine. Use the time as an opportunity to focus on your surroundings and the present rather than the past, the future, and problems and worries.
• Focus on the activity, not your performance (for example, how fast or how many miles you have walked).
• Vary the types of activities and exercise that you engage in. Having several options relieves boredom.
• Avoid laborsaving devices such as riding lawn mowers, leaf blowers, remote controls, and chain saws.
• Exercise with your family or friends and you will be more likely to receive support and encouragement and view exercise as “quality” time. Bicycling is a great example of family exercise.
• Expect occasional periods when you can’t exercise, such as during an illness or when you are injured or not feeling well.
• During periods of extreme heat or cold, move indoors or change the timing of exercise to adjust to your environment. During the winter months, many adults have turned to mall walking as a regular form of exercise. Many malls now open very early to allow walkers to beat the shoppers and begin their day with a brisk walk. Because malls are air-conditioned, they are also ideal places to exercise on hot summer days.
Can’t Exercise? Try a Bath
Several studies have demonstrated that, like exercise, a hot bath causes a rise and fall in body temperature that can make it easier to fall asleep and stay asleep. The bath must be hot and kept hot for about twenty-five minutes. Also, because the temperature drop after a bath occurs more quickly than after exercise, the bath should be taken about two hours before bedtime (baths taken too close to bedtime can make it harder to fall asleep because body temperature may be too elevated).
A hot bath can aid sleep but it is usually not as effective as exercise at improving sleep, for baths do not cause as much of a rise and fall in body temperature. However, a hot bath is a great way to relax before bedtime and a good substitute on days when you can’t exercise.
Exercising the Brain
Just as we need to be physically active to sleep well, we also need to be mentally active (though not at bedtime). Boredom can reduce the pressure for sleep and contribute to insomnia, for the brain is not being stimulated. Some people also attempt to escape boredom by spending more time in bed, which, as we have explored, contributes to insomnia.
To alleviate boredom, don’t sit at home, a couch potato, watching television. Instead, take courses, learn to use a computer, investigate new hobbies or activities, read books, travel, socialize. Studies have shown that mental and intellectual stimulation increases the pressure for sleep. You will also add some excitement to your life!
The Sunlight-Sleep Connection
As we have seen, sleep and body temperature are directly influenced by the effect of the daily cycles of light and darkness on melatonin, a naturally occurring hormone found in the brain. When sunlight enters
the eyes, melatonin levels decrease, which signals body temperature to rise and promotes wakefulness. Darkness causes melatonin levels to increase and body temperature to fall, which promotes sleep.
Consider how, for almost our entire evolution as huntergatherers, we were exposed to the natural cycle of sunlight during the day and darkness at night. However, with the advent of modern technology, we have significantly altered our exposure to light and darkness. Studies have shown that, no matter where people live, they obtain only one hour of sunlight on average during the day. The nighttime lighting of urban environments means that many people also don’t receive exposure to true darkness anymore.
The main reason we obtain so little sunlight is that most of us work indoors. A brightly lit room has about 500 luxes of light (a lux is the equivalent of the light from one candle) compared to 10,000 luxes at sunrise and 100,000 at noon on a summer day. To the brain, spending the day indoors is equivalent to spending the day in darkness!
By reducing our exposure to bright natural light and true darkness, melatonin secretion and the body-temperature rhythm are altered, which can exacerbate sleep difficulties. That’s why up to 90 percent of blind people experience sleep problems. Likewise, lack of exposure to bright light can also adversely affect daytime mood, energy, and alertness level. For example, studies show that mood and energy are poorest during the winter months, which have the shortest days and therefore the least amount of sunlight. Furthermore, people in northern latitudes, where there is less sunlight in the wintertime, are more prone to seasonal affective disorder, which is characterized by depression and sleep disturbance in the winter months. Indeed, some scientists believe that the lack of exposure to sunlight may be contributing to an overall increase in mood disorders in the general population. Since lack of exposure to sunlight can disturb mood, it can also make it harder to cope with the daytime effects of insomnia.
Consequently, increased exposure to sunlight at certain times of the day can minimize sleep-onset insomnia and early morning awakenings. We have seen that sleep-onset insomnia is characterized by a body-temperature rhythm that falls too late at night. Because sunlight causes body temperature to rise, sleep-onset insomniacs can cause
their body temperature to rise earlier and fall earlier, and therefore fall asleep more easily, by increasing exposure to early morning sunlight. This can be accomplished by using these basic strategies:
• Open the drapes or shades immediately upon awakening
• Eat breakfast near a sun-exposed window
• Avoid dark sunglasses in the morning
• Take an early morning walk
In contrast to sleep-onset insomnia, individuals who experience early morning awakenings often exhibit a body-temperature rhythm that rises too early in the morning. Several studies have shown that increasing exposure to evening bright light can minimize early morning awakenings by delaying the body-temperature rhythm so that it doesn’t rise as soon. Simple techniques for increasing exposure to late-day sunlight include:
• Avoid dark sunglasses late in the day
• Take a late afternoon walk
• Sit near a sun-exposed window the hour before sunset
• Leave the drapes open until dark
Since bright light also improves energy and alertness, you may be able to tolerate the daytime effects of insomnia better by getting outside on your coffee break or lunch hour and thereby increasing your exposure to sunlight.
Artificial Bright Light: Bringing the Sun Indoors
Another method for increasing exposure to bright light is the use of artificial bright-light boxes. These devices contain special bulbs that emit 5,000-10,000 luxes of light, which is equivalent to a sunrise or sunset. They are used for about thirty minutes while reading or watching television to increase early or late exposure to bright light. Several studies have demonstrated that using bright-light boxes in the evening can delay the body-temperature rhythm and effectively minimize early morning insomnia.
By shifting body-temperature rhythms, bright-light boxes also seem to minimize the sleep disturbances associated with jet lag and shift work. One company has even developed a baseball-type cap that contains bright lights. When traveling, the caps can be programmed to turn on and off at certain times to adjust to another time zone, thereby minimizing jet lag. Bright-light boxes are also used as a primary treatment for seasonal affective disorder, and some companies are using them to increase the alertness of night shift workers during the early morning hours.
Light boxes can be rented from medical supply companies or purchased from an increasing number of manufacturers. Some insurance companies even reimburse the cost of light boxes if they are prescribed by a physician.
Caffeine: Society’s Stimulant
Caffeine is the most widely used drug in the world. Found primarily in coffee, tea, and cola, caffeine is a stimulant that speeds up brain waves, increases heart rate and blood pressure, and promotes alertness and reduces fatigue. These stimulant effects, which work in as little as fifteen minutes and can last for six or more hours, can also disturb sleep. Consequently, insomniacs who use caffeine to counteract afternoon or early evening fatigue can get caught in a cycle of caffeine use and insomnia.
Caffeine can also produce daytime anxiety symptoms such as nervousness, irritability, shakiness, and sweaty palms, and can also cause more frequent nighttime urination, which interrupts sleep. Because, as we will note shortly, nicotine is also a stimulant, individuals who smoke and drink coffee make it twice as difficult to fall asleep or stay asleep.
We vary greatly in our sensitivity to the stimulant effects of caffeine. Some of us have a natural tolerance to it and can fall asleep after drinking two cups in the evening, while others have trouble sleeping after drinking one cup in the afternoon. Insomniacs are
more likely to experience sleep disturbance from caffeine due to an overly sensitive sleep system, as are elderly adults, who metabolize caffeine more slowly.
If caffeine is consumed in large-enough quantities, it can also lead to dependency and withdrawal symptoms such as headaches, anxiety, irritability, and insomnia. A seven-ounce cup of coffee contains an average of 110mg of caffeine (in comparison, a cup of tea and a twelve-ounce soft drink contain about 50 mg each), but the average cup of coffee sold today by coffee specialty stores is twelve ounces, which means that if you drink three of these cups of coffee a day you may be consuming more than 500 mg of caffeine. This can lead to dependency and withdrawal symptoms that can disturb sleep.
Does all this mean that insomniacs should give up caffeine altogether? Probably not, for drinking one or two cups of coffee in the morning is unlikely to affect nighttime sleep. However, since caffeine’s stimulant effects may affect some individuals for six hours or longer, and the withdrawal effects for people who are dependent upon caffeine can last even longer, it should be avoided after lunchtime.
If you believe you are caffeine dependent, attempt to reduce caffeine intake gradually by mixing caffeinated coffee with decaffeinated (decaffeinated coffee actually contains about 2 mg of caffeine, which is not enough to affect sleep). This gradual approach to reducing caffeine consumption will minimize the likelihood of withdrawal symptoms such as headaches, jitteriness, and insomnia. Reducing caffeine consumption can also reduce daytime anxiety and nighttime awakenings due to frequent urination.
In addition to coffee, tea, and soft drinks, caffeine is also found in the following:
• Foods such as ice cream and yogurt, cocoa and chocolate
• Some analgesics, such as Anacin and Excedrin
• Some prescription migraine medications
• Many diet and cold remedies
One final word of caution about caffeine: make sure your children don’t drink caffeinated beverages in the afternoon. When a
child drinks a can of cola, the caffeine intake is comparable to four cups of coffee for an adult. As a result, your child may not be able to fall asleep at night.
Nicotine and Sleep
The issue of substance abuse is usually associated with illicit drugs such as heroin and cocaine. In reality, nicotine is more addictive and costly to society than such illegal drugs. Nicotine represents the nation’s number one chemical-dependency problem.
Cigarette smoking is also more deadly than illicit drugs. Smoking is the leading cause of preventable disease and death in the United States, contributing to over 400,000 deaths annually, and it is directly linked to premature death from heart disease, emphysema, hypertension, stroke, diabetes, and many types of cancer.
Nicotine also harms sleep. The effects of nicotine are similar to those of caffeine and include faster brain waves, heart rate, and breathing rate, and increased amounts of stress hormones. These stimulant effects, which last for several hours after smoking a cigarette, can make it harder to fall asleep and stay asleep.
Smokers also experience nicotine-withdrawal effects during sleep that cause lighter sleep and more awakenings. Smoking also irritates the upper air passage and can exacerbate snoring and diminish sleep quality. That’s why smokers sleep more poorly than nonsmokers and why insomnia ranks as one of the major health complaints of smokers. In short, smokers cannot expect to sleep well.
If you smoke, you will have the greatest beneficial effect on your sleep if you stop altogether. Numerous studies have shown that when smokers quit they sleep better in spite of temporary withdrawal symptoms such as restlessness, irritability, anxiety, difficulty concentrating, and headaches, which can persist for about ten days. Once the withdrawal symptoms end, sleep improves even more dramatically.
Only a small percentage of smokers quit permanently, and those who do usually do it “cold turkey.” However, an increasing percentage are quitting successfully by using nicotine patches, which are substituted for cigarettes. The patches, which are placed on the skin
and worn for most of the day, prevent the physical nicotine-withdrawal symptoms from occurring by administering nicotine through the skin in a gradual, decreasing dose.
Nicotine patches are effective in helping some smokers to quit. However, they are more effective when combined with behavioral strategies such as these:
• Gradually reducing the number of cigarettes smoked
• Selecting a target quit date
• Recognizing triggers for smoking (such as stress, eating, driving, caffeine, and alcohol) and substituting healthy behavioral alternatives such as the relaxation techniques described in part III
• Avoiding people or situations that encourage smoking
• Mentally reinforcing the consequences of smoking and the benefits of quitting
• Enlisting social support and reinforcement from family and friends
If you are a smoker, talk to your physician about these approaches. The National Cancer Institute, the American Heart Association, and the American Lung Association provide written materials that describe behavioral strategies for smoking cessation. If you can’t quit, then try to eliminate smoking near bedtime or during the night. You will minimize the stimulant and withdrawal effects of nicotine and will sleep better.
Alcohol: The Nightcap That Causes Insomnia
Physicians used to prescribe a nightcap for insomnia, and many people still think that alcohol is a cure for sleeplessness. Although alcohol does relax some people enough that they fall asleep more easily, others find that it stimulates them and makes it more difficult to fall asleep.
Even if alcohol makes it easier to fall asleep, it can make sleep lighter and more fragmented, for it suppresses deep sleep. Alcohol also suppresses dream sleep, which results in dream sleep “rebound”
in the form of intense dreaming or nightmares that can cause awakenings during the second half of the night.
Alcohol also disturbs sleep because, as it is metabolized during sleep, it produces mild withdrawal symptoms that cause sleep to become interrupted, shortened, and fragmented. These disruptions result in lighter sleep and more awakenings, particularly in the early morning. Alcohol also exacerbates snoring and sleep apnea because it relaxes the muscles in the throat. And remember: if you combine alcohol with sleeping pills, you are risking your life.
It requires about one and a half hours to metabolize one ounce of alcohol; the mild withdrawal effects last for another two to four hours. This means that a glass of wine with dinner will probably not affect sleep. However, one ounce of alcohol within two hours of bedtime or more than one ounce after dinner probably will disrupt sleep. Therefore, if you drink alcoholic beverages in the evening, you will minimize sleep problems if you limit yourself to one drink at least two hours before bedtime. If you are accustomed to having more than one drink in the evening, your sleep will improve if you cut back gradually to one.
Using alcohol to fall asleep also increases the risk of slipping into nightly alcohol use and becoming dependent upon it. In fact, 10 percent of all cases of alcoholism have been attributed to insomniacs who began using alcohol to aid sleep and then slipped into regular use.
Alcoholism can seriously disturb sleep. Alcoholics exhibit significant sleep disruptions that resemble those of older adults; these include diminished deep sleep, increased light sleep, and frequent awakenings. These sleep problems can last for months or years after alcoholics stop drinking, suggesting that chronic alcohol abuse may cause permanent and irreversible damage to the brain’s sleep system.
If you think you are dependent on alcohol, you should talk with your physician about obtaining professional help.
Although there has been little research on the effects of food on sleep, it appears that certain types of food promote sleep while others inhibit it.
For example, foods such as bread, bagels, and crackers that are high in complex carbohydrates have a mild sleep-enhancing effect because they increase serotonin, a brain neurotransmitter that promotes sleep. In contrast, foods such as meat that are high in protein can inhibit sleep by blocking the synthesis of serotonin, making us feel more alert. These effects were demonstrated in a study in which people reported feeling more alert following a high-protein lunch and sleepier following a high-carbohydrate lunch.
If you want to fall asleep more easily, eat a high-carbohydrate snack and avoid high-protein foods in the hour or two before bedtime. If you desire to minimize nighttime awakenings, eat a carbohydrate snack immediately before bedtime, which will increase serotonin levels during the night and help you stay asleep. Having a light carbohydrate snack before bedtime will also ensure that your sleep isn’t disturbed due to hunger.
Other types of foods can also disturb sleep and should be avoided before bedtime:
• Foods high in sugar and refined carbohydrates, which raise blood-sugar levels and can cause a burst of energy that disturbs sleep
• Foods that are likely to cause gas, heartburn, or indigestion, such as fatty or spicy foods, garlic-flavored foods, beans, cucumbers, and peanuts
• Monosodium glutamate (MSG), often found in Chinese food, which causes a stimulant reaction in some people
Because the digestive system slows at night, it is harder to digest late meals. The likelihood of indigestion increases, so avoid heavy meals before bedtime. Also reduce fluid intake after 8:00 P.M. and thus minimize the probability of waking up at night due to a full bladder.
Some research suggests that deficiencies in certain vitamins and minerals can also disrupt sleep. The research found that deficiencies in B vitamins and folic acid impair sleep; another study found that increasing dietary levels of B vitamins improves sleep. Deficiencies in calcium and magnesium, two minerals that produce calming effects
on the brain and that are essential for normal sleep, can also disturb sleep. If you think that your diet is deficient in these substances, you may want to talk with your physician about modifying your diet or adding dietary supplements.
What about the use of herbal remedies as sleep aids? The most common herb used for insomnia is valerian root. Although some insomniacs find that this is effective as a sleep aid, others find that it has little or no effect. As is the case with most herbal remedies, no sound scientific studies have been conducted on valerian root. Scant information exists concerning its long-term side effects on health.
And what about the old adage that a glass of warm milk before bedtime improves sleep? Although this has never been substantiated scientifically, milk contains calcium and may therefore have a mild sleep-promoting effect. It’s also likely that drinking warm milk creates a placebo effect that aids sleep.
Just as our work and home environments affect our moods, our bedroom environment can affect our sleep. An uncomfortable bed or a room that is either too noisy, too hot, or too cold can disturb even the soundest sleeper. By keeping the following guidelines in mind, you can create the ideal sleep environment.
A Warm Room Can Keep You Awake
Room temperature can have a significant effect on sleep. Recall that insomnia is associated with a failure of body temperature to fall either at bedtime or during the night. Sleeping in a warm room will make it even harder for your body temperature to decrease. This will make it more difficult to fall asleep, and because deep sleep will also be reduced, nighttime awakenings will be more likely to occur. This explains why sleep is poorer in the summer months for the general population.
On the other hand, body temperature shows a more rapid drop in cooler rooms. In fact, the lower the room temperature at which
we go to sleep, the greater the drop in body temperature and the easier it will be to fall asleep and stay asleep. That’s why, when the weather cools down, it’s common to hear weather forecasters say, “It’s going to be great sleeping weather tonight.”
Keep your room cool by turning the heat down, leaving a window open, or using a fan or air conditioner. If you have a partner who prefers a warmer bedroom, provide an extra blanket for that side of the bed.
Keep the Bedroom Dark and Quiet
Many types of noise such as traffic, loud music, a dripping faucet, a bed partner’s snoring, a neighbor’s barking dog, trains and airplanes, and neighbors can disturb sleep. Because insomniacs’ sleep systems are more sensitive overall, sleep is more easily disrupted by noise. Older individuals, who are more sensitive to noise in general and whose sleep is lighter as a consequence of aging, are also more likely to experience noise-induced sleep disturbance.
There are a number of ways to minimize bedroom noise. Earplugs work well for many people. For others, the hum of a fan, an air conditioner, or a commercially available sound conditioner is useful. These devices work by blocking distracting noises and by producing constant, soothing sounds like water or rain that relax the brain and induce sleep. Using a fan or air conditioner in the summertime also allows you to sleep with the windows closed, which will reduce noise.
Listening to music at bedtime helps some people fall asleep. If you do so, make sure that you set a timer so that the music turns off after about forty-five minutes. Otherwise, you are more likely to wake up during the night, because music, like all sound, prevents us from entering deep sleep.
Our sleep is more susceptible to being disturbed by noise when we sleep in an unfamiliar place such as a friend’s or relative’s home or a hotel room, particularly on the first night. Although sleep will usually improve on successive nights in a new place, be realistic and don’t expect to sleep as well in these circumstances. Using the fan or the air conditioner in a hotel room is a simple and effective way to mask unwanted noise and improve sleep.
A bedroom that is insufficiently dark can also disturb sleep. Keep your bedroom dark by using drapes, heavy shades, or an eyeshade if necessary.
Your Bed Can Make a Difference
We go through up to a dozen posture shifts per night in which we awaken briefly, move, then quickly fall back to sleep. When we sleep with a partner, we also awaken briefly in response to their posture shifts. Even though many people think they sleep better with a partner, sleep is actually lighter, more restless, and more disturbed.
If you sleep with a partner, particularly one who is a restless sleeper, your sleep will be less disturbed if you switch to a bigger bed or twin beds. Think of it this way: you may not feel as intimate, but you will be less disturbed by your partner’s movements, sleep more soundly, and wake less often. If your partner is a heavy snorer, separate bedrooms may be necessary if he or she is unwilling to seek medical treatment.
Bedding should also be comfortable and provide support. Beds that sag can disturb sleep by causing neck and back discomfort, while mattresses that are too hard can cause discomfort for people with arthritis. A simple way to create a firmer mattress is to place a sheet of half-inch plywood under it. Turning your mattress over and rotating it every six months can also be helpful. There is no evidence showing that sleep is different on a water bed rather than a regular mattress, so choose whichever is most comfortable for you.
Like many of the techniques in this program, the lifestyle practices described in this chapter require some effort, persistence, and time to work. The techniques become easier with practice; by using them regularly you will be promoting a longer, healthier life.
To help track your use of these practices and their beneficial effects on your sleep, a Week Three Progress Summary is included at the end of this chapter. Like the Week One and Week Two summaries,
it should be completed after you review your seven sleep diaries for the week.
The Week Three Progress Summary is similar to the Week Two summary; it contains the same items for assessing your current sleep pattern, sleep-medication use, and use of cognitive-restructuring, sleep-scheduling, and stimulus-control techniques. However, you will note that the Week Three Progress Summary also contains a new item for assessing your use of lifestyle practices as explored in this chapter.
If the progress summary indicates that you are not implementing these practices consistently, make a greater effort to do so—your sleep and health are worth it.
Now that you have finished the third week of this six-week program, it is appropriate to step back and assess the improvements you have made in your sleep. Notice that your progress summary contains a section that lists ten possible areas of improvement. After you have completed the Week Three Progress Summary, compare it to the Week One and Week Two summaries. Next, determine which of the ten areas of improvement apply to you, then check them off. This will help you to systematically track your improvement through the remainder of the program.
Remember, the degree of improvement in your sleep is directly related to how consistently you use these techniques, and by doing so, it is likely that you will experience positive changes in other areas of your life:
• Improved daytime mood, energy, and productivity
• Greater sense of control over sleep
• Increased sense of optimism, confidence, and self-esteem
• Greater sense of calm, more relaxation
• Improved sense of well-being
• Greater control over mind and body
Therefore, the progress summary also contains a section for summarizing these or any other positive changes you have experienced since beginning the program. By completing the summary each week, you will learn to recognize and reinforce positive changes. You will also become more empowered in the knowledge that you
can change yourself and your life in more fundamental and powerful ways.
WEEK THREE PROGRESS SUMMARY
1. Assess your sleep pattern this week by noting:
a. the number of good nights of sleep _____________________
b. the number of nights of core sleep (five and a half hours or more) _____________________________________
c. the number of insomnia nights _______________________
2. On how many daily sleep diaries did you record a positive sleep thought? _____________________________________
3. How often did you mentally practice cognitive restructuring this week (circle one)?
regularly
occasionally
never
4. Assess your sleep-medication use this week by noting:
a. the number of medication-free nights ____________________________
b. the number of reduced-dosage nights ___________________________
c. the number of usual-dosage nights ______________________________
5. Track your sleep efficiency by calculating:
a. your average sleep time (number of hours per night) _____
b. your average time in bed (number of hours per night) ____
c. your average sleep efficiency (your average sleep time divided by your average time in bed) __________________
6. Track your sleep quality and the consistency of your rising time by noting:
a. your average sleep-quality rating from your sleep diaries _____
b. the number of days you arose within half an hour of your desired rising time __________________________
7. How often did you practice sleep-scheduling and stimulus-control techniques this week (circle one)?
regularly
occasionally
never
8. How often did you engage in sleep-enhancing lifestyle practices this week (circle one)?
regularly
occasionally
never
9. Check all areas of progress listed below that you have made since beginning this program:
___ experiencing fewer insomnia nights
___ experiencing more nights of core sleep
___ experiencing more nights of good sleep
___ falling asleep faster
___ waking less often during the night
___ waking for shorter periods of time during the night
___ averaging more sleep time per night
___ improved quality of sleep
___ improved sleep efficiency
___ decreased sleep medication
10. Summarize any positive changes you have noticed in yourself and your life as a result of this program:
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