By Ronald L. Kotler, MD, DABSM
A MAN, NINETY YEARS OLD, was asked to what he attributed his longevity. “I reckon,” he said with a twinkle in his eye, “it’s because most nights I went to bed and slept when I should have sat up and worried.” That little tale, true or not, was a favorite of Dorothea Kent, an actress who hit her prime in the 1930s. Kent frequently played the quintessential dumb blonde, but she was smart if she thought that there was an association between long life and sleep. In fact, she got it exactly right.
Anyone can tell you that getting a good night’s sleep makes you look and feel better, but now we also know for certain that lack of sleep predisposes you to several life-shortening diseases. Research shows, for instance, that it doesn’t take long for someone with a sleep deficit to begin developing problems related to obesity. Not only does the body’s ability to process sugar become impaired, but the hormone that makes you hungry increases and the one that tells you you’re full decreases, setting the stage for ample weight gain. There’s also evidence that getting less than six hours of sleep per night can increase your risk of heart disease, stroke, and depression. Finnish researchers have even found that getting less than seven hours of sleep increases the risk of early death by 26 percent in men and 21 percent in women.
Sleep is like the air we breathe; we need it to be healthy in virtually every way, as well as to be safe. Skimping on the proverbial forty winks can lead to serious injury, sometimes even premature death. The National Highway Traffic Safety Administration estimates that each year more than 100,000 people crash on the highways because of drowsy driving. Many are killed or permanently injured.
So getting enough sleep doesn’t just make you look and feel better—it’s powerful preventive medicine. Just as you eat healthfully and exercise to improve and maintain your well-being, it’s essential to follow a regimen that promotes adequate and restful sleep.
A lot happens while you’re sleeping. During the day when you’re active, your energy resources are directed toward maintaining your body. But at night, the construction crew gets to work. It’s thought that the body regenerates bone and muscle as you sleep while also repairing and synthesizing proteins that are critical to every part of the body, from the immune system to the skin. Regeneration of connections in the brain and consolidation of memories and emotions are also believed to take place during sleep, undoubtedly one reason cognition is better when you’re well rested.
One of the biggest myths is that you need less sleep as you get older. That’s simply not true. In general, adults past the age of about eighteen need seven to nine hours of sleep. It’s thought that exactly how much each individual needs is genetically determined, and it’s important to figure out exactly what works for you. Aim for the amount of sleep that makes you feel refreshed throughout the day. While there are rare individuals known as “short sleepers” who can get by with fewer hours of nightly slumber, most people who sleep less than seven hours per night build up a sleep debt and have trouble staying awake during the afternoon. This is your body’s way of telling you not to sacrifice your much-needed sleep.
Interestingly, there is evidence that regularly sleeping more than nine hours may put you at risk for life-threatening diseases such as diabetes and obesity. But this isn’t nearly as big a problem as not getting enough sleep, particularly as you get older. As you age, you need just as much sleep but it becomes increasingly difficult to get as much sleep. Age-related changes in the sleep cycle diminish the amount of deep, restorative slumber you experience each night, which not only affects the quality of your sleep but also makes it harder to sleep through the night without waking. Waking wouldn’t be so bad if you could fall immediately back to sleep; however, it’s common for people to have trouble dozing off again. People with insomnia often find themselves tossing and turning, worrying about not getting enough sleep—a self-perpetuating cycle if there ever was one.
Dire as that sounds, there’s actually a lot you can do to compensate for changes in the sleep cycle and improve both the quantity and the quality of your sleep. In chapter 4, Dr. Lancer talked about skin hygiene; here, I’m going to talk about sleep hygiene: healthful practices that help you nod off at night and maintain restorative sleep. Sleep hygiene is actually connected to skin hygiene, just as it’s linked to healthy eating, exercise, and other anti-aging topics in this book. When you’re well rested, you’re going to have the energy and inclination to exercise and cook nutritious meals, as well as be less likely to shrug off your skin care regimen. Your skin is going to look more refreshed, too. Being well rested will also put you in a more positive frame of mind, helping you cope better with youth-sapping stress. Sleep simply gets you operating in high gear.
The tenets of sleep hygiene will make a lot more sense once you understand the different phases of sleep and the biological rhythms that govern them.
Whether or not you’re aware of it, your body runs on a clock; several clocks, in fact. An area of the brain called the hypothalamus generates what’s known as biorhythms, cyclical patterns that regulate just about every physiological process in the body. The menstrual cycle is an example of a monthly biorhythm; appetite, body temperature, blood pressure—and sleep—are all influenced by daily biorhythms. When we talk about sleep, we refer to its biorhythm as a circadian rhythm (circa means “around,” dian means “day”). The sleep-wake circadian rhythm is determined by a highly complex interaction between light and neurotransmitters in the brain. When it’s dark, our bodies are programmed to seek sleep, and when it’s light they’re programmed to stay awake. Our use of light bulbs to light up our night has skewed things slightly, but when everything is working properly, our bodies are still inclined to follow the sleep-wake schedule we evolved with: on average, sixteen hours of wakefulness and eight hours of sleep.
To stick to this schedule, the body releases chemicals that wake you up with the morning’s light and keep you alert for several hours thereafter. Between one and six p.m.—the exact time can vary from person to person—you’ll probably feel a dip in energy and maybe even feel like falling asleep. It’s so predictable that many countries build a midafternoon break (the siesta) into their day, and if you don’t nap you’ve probably developed some way of coping, perhaps taking a coffee break, visiting the office vending machines, or walking around the block to shake off drowsiness. As the day goes on, you get a second wind, but you also build up what’s known as a sleep drive—a desire to sleep that gradually increases as you stay awake. During the evening, further biochemical changes in the body increase the sleep drive until finally, by about eleven p.m. for most people, you want—and need—to go to bed.
The sleep-wake circadian rhythm is an elegant, well-designed system; however, it does change at different times of life. Adolescents and teenagers, for instance, experience a shift that cues them to go to sleep later and wake up later. Aging has an impact on the circadian rhythm, too. It’s very common for people ages sixty-five and up to experience the opposite of the adolescent/teenage phenomenon: Their circadian rhythms tell them to go to sleep earlier and wake up earlier.
If you’re getting enough high-quality sleep, it doesn’t necessarily matter when you go to bed and get up. But other age-related physiological changes can make getting enough high-quality sleep challenging. And what is high-quality sleep? Stage 3 sleep, also known as deep or slow-wave sleep.
When you’re asleep, your brain exists in one of two states: non-REM sleep or REM sleep. REM stands for rapid eye movement and it describes the stage of sleep in which most dreaming occurs. The complete cycle of non-REM and REM sleep takes about ninety minutes, then starts all over again. During REM sleep you’re virtually immobilized; you might twitch a bit, but you have limited movements in your arms and legs. When you first nod off, you go immediately into non-REM sleep, then you go into REM sleep, toggling between the two so that you go into REM sleep about four to six times per night. The first bout of REM is only one to five minutes long, but REM sleep gets progressively longer through the night so that you’re in it an average of eighteen to twenty-two minutes per episode. REM sleep makes up about 20 to 25 percent of an adult’s night sleep, and that figure stays pretty constant as you age. The reason that REM sleep is important is not fully understood, but it’s believed to contribute to overall emotional and psychological well-being.
Non-REM sleep is the type of sleep you need for repair and restoration of the body. Unlike REM sleep, non-REM sleep changes as you get older, beginning at around age thirty. Non-REM sleep is divided into three stages, 1, 2, and 3. Stages 1 and 2 are the lighter stages of sleep. Stage 3 is known as deep or slow-wave sleep (each phase of sleep has distinctive brain waves that are measurable on high-tech monitors), and it’s what you need to feel refreshed in the morning. For some reason that has yet to be discovered, deep sleep diminishes greatly as you age. By the time you reach your seventies and eighties, your slow-wave sleep can be minimal or totally absent. What’s more, the slow-wave sleep you do have isn’t as deep as it was when you were younger.
The age-related ebb of slow-wave sleep presents a few different problems. With less deep sleep, you spend more time in the lighter stages of sleep, so not only do you get less refreshing sleep, but you’re often in a stage from which you can be easily awoken. And because the depth, not just the length, of your deep sleep changes with age, you can be more easily awoken in stage 3 sleep, too. A creak in the floor, the slam of a neighbor’s car door, and you’re up.
Your vulnerability to being prematurely awakened changes through the years. When my son was about two years old, we took him to a wedding. During the reception, he crawled under the table and fell fast asleep. Despite blasting music and people dancing all around us, he remained in a deep sleep. At age two, he had the luxury of having plenty of stage 3 sleep. Now consider a fifty-four-year-old man, who as an empty nester decides along with his wife that it might be nice to leave their quiet, tree-lined suburban home and spend a few nights a week in the city. On the first night in their little studio apartment, it becomes clear that sleeping is going to be a challenge. The sound of sirens, traffic, people talking and partying in the street—sounds that probably wouldn’t have bothered him if he were in his twenties—wake him up repeatedly. Now every time he spends the night in the city, he wears earplugs.
When you become a lighter sleeper, you are susceptible not only to external disturbances (e.g., honking horns and car alarms) but to internal ones as well. So if, like many people as they age, you have some sort of medical condition or complaint, it becomes increasingly likely that pain or discomfort will wake you up. Gastric reflux (otherwise known as heartburn), arthritis, a bum knee or other orthopedic problem, breathlessness from heart or lung disease, hot flashes associated with menopause, prostate issues that create the urge to urinate—any of these can leave you staring at the ceiling at two a.m. And as you get older, you may be more likely to take medications that disturb sleep. Asthma medicines, for instance, can be stimulating. Some antidepressants and heart and blood pressure medications can cause wakefulness, and diuretics can make the urge to urinate hard to ignore.
Good restorative sleep habits are your best defense against disrupted sleep, but there are some conditions that can’t be fixed with good sleep practices alone. If you think any of the following three problems might be causing you to lose sleep, it’s important to find ways to cure or cope with them as you simultaneously begin implementing the sleep hygiene advice I outline in this chapter.
According to the American Sleep Apnea Association, sleep apnea affects about 12 million Americans, but the vast majority of cases goes undiagnosed. If you have sleep apnea, you might lie down, fall asleep, and progress into stages 1 and 2. Then, just as you’re getting ready to descend into deep slow-wave sleep, the muscles in the back of your airway collapse, obstructing breathing. At first this just causes snoring, but as the airway narrows and airflow becomes either partially or fully blocked, the brain responds by sending a powerful message to the airway muscles to open up—and they do. However, the brain’s message also triggers the release of catecholamines, stimulating hormones that prepare the body to either fight or flee a potentially harmful situation (the “fight or flight” response). This not only disrupts the normal progression of sleep but also increases the risk of high blood pressure, heart attack, and stroke.
Obstructive sleep apnea can hit at any age, and the likelihood of developing it increases as you get older. Like a lot of areas in the body, the airway muscles can begin to sag as you get older, increasing the risk that when they relax (everyone’s airway muscles relax during sleep; it’s just a question of how much) they’ll block the flow of air. Being overweight makes you more prone to sleep apnea. If you aren’t feeling refreshed when you wake up, are feeling extremely fatigued, wake yourself (or your bed partner) up by snoring, or have been witnessed to stop breathing as you sleep, it’s essential that you see your physician.
A sleep study is necessary to confirm the diagnosis of obstructive sleep apnea and to determine its severity. During a sleep study, you spend the night at a sleep center, where you’re hooked up to various monitoring devices. (Make sure your sleep study is performed at a center accredited by the American Academy of Sleep Medicine—www.aasmnet.org.) If you do have obstructive sleep apnea, the primary treatment is nasal CPAP (continuous positive airway pressure). This is a device that blows air through your nose to the back of your throat and keeps your airway from collapsing while you sleep. Sleep apnea can also be treated by the use of an oral appliance typically made by a dentist, removal of the tonsils, or surgical correction of a deviated nasal septum. If you’re overweight, weight loss alone can lead to a dramatic improvement. Depending on the severity of your sleep apnea, your physician may advise you to wear CPAP as you sleep while you work on losing weight.
The most obvious menopausal symptom to disrupt sleep is hot flashes. But you don’t have to have hot flashes to suffer from menopausal-related sleep problems. I have seen plenty of patients who were great sleepers all their lives suddenly experience insomnia even though they’re not having hot flashes. Fluctuating estrogen and progesterone levels can be wildly disruptive to regular sleep patterns and make it difficult to drift off at night. When a woman has hot flashes to boot, it’s a double whammy, with hormonal changes making it hard to fall asleep and the hot flashes making it hard to stay asleep.
Some women find relief with the help of a light sleeping pill. Hormone replacement therapy is another option, though it’s important to discuss the risks with your physician (see here for more on HRT). If you’re looking for a natural solution, you might try black cohosh, a Native American herb that can help with hot flashes. Hot flashes can also be less disruptive if you wear very light clothes to bed (there are even special pajamas and nightgowns in “dry” wicking fabrics manufactured for people with night sweats), avoid spicy foods, and use a fan to cool you down.
One of my patients likes to tell me that when he was a teenager he could eat a Philly cheese steak and half a pizza at midnight, go to bed, and sleep like a baby. Now in his fifties, he has to wait four hours from his last bite in the evening before he can go to bed. Otherwise, he lies down and the next thing you know, he’s starting to cough and has an acid taste in his mouth—heartburn, the more common name for gastric reflux.
Gastric reflux, which occurs when food and stomach acid come back up into the esophagus, is yet another malady that becomes more common as we age. There are a couple of reasons why. One is that it’s not unusual for the tiny hole in the diaphragm that allows the esophagus to connect to the stomach to become defective with age. The hole gets bigger and the stomach pushes up into the chest—it’s called a hiatal hernia—allowing the food and acid that should be going south to move north. Gastric reflux can also occur when a little muscle called the esophageal sphincter, which separates the esophagus from the stomach, becomes stretched out. The sphincter usually does a good job of keeping the contents of the stomach from moving back up, but when it’s compromised, heartburn happens.
Since gastric reflux is worse when you’re reclining, it can make sleep difficult to achieve and maintain. And there can be more serious consequences. I have had patients whose reflux led them to bring up food and acid that then went through their vocal cords and into their lungs while they were sleeping. They ended up in the emergency room at three a.m. with pneumonia. Anything like that, however, is less likely to happen if you take preventive measures. Like my former cheese-steak-and-pizza-eating patient, give yourself a three- or four-hour stretch between your last bite and bedtime. If that’s not possible, start your night’s slumber in a comfortable chair so you don’t lie in bed wide awake because of the discomfort.
You’ll be less likely to experience reflux if you shift the bulk of your calories to the earlier part of the day (a good practice regardless) and eat a relatively small dinner made up of low-fat, non-fried foods—meals, in other words, in line with the recommendations in chapter 3. Skip acidic fruits and vegetables, mints, candy, alcohol, and caffeine at night. Use antacids as necessary, but if you’re using them every night, you need to see your physician. A doctor can diagnose the cause of the problem and suggest remedies. Some prescription medications such as H2 blockers and proton pump inhibitors can suppress acid production and be very helpful. If medication doesn’t work, discuss surgical options with your physician.
There are other problems beyond these three that can lead to disrupted sleep. Restless legs syndrome, which produces uncomfortable sensations in the legs and a desire to move them, is one. A condition called propriospinal myoclonus, which involves sudden movement that keeps you from falling asleep, night terrors, and sleepwalking are other conditions to see a sleep specialist about.
So far, we haven’t found a way to shift the balance of light and deep sleep in older people back to its younger and more restful ratio. But we have found that there are many ways to compensate, and if you maintain healthy sleep practices, you can still get all the rejuvenating sleep you need to fight disease and ensure that your body functions in top form regardless of age. The following sleep hygiene tips are tried and true. Check them off your list and you’ll raise the odds considerably of getting a good night’s sleep. Believe me, you’re going to find that they work a whole lot better than counting sheep.
The best way to make certain that you get seven to nine hours of sleep each night is to go to bed and wake up at the same time every day—or close to it. Even if you pride yourself on being a free-spirited, spontaneous kind of person, your body yearns for a regular schedule. A bedtime that zigzags from eleven p.m. one night to three a.m. the next, then back to eleven p.m.—with a corresponding crisscross of wake-up times—throws your system off and can lead to sleep disruption.
When it comes to consistency, I really try to practice what I preach. I get to bed about eleven p.m. weeknights and get up at about seven a.m. On the weekends I might go to bed an hour later and sleep an hour later, but I try not to vary it more than that. Think about what happens when you stay up until two: to get eight hours of sleep in, you don’t get up until ten. Maybe you’ll try to return to your regular schedule and go to bed at eleven, but because you woke up at ten that morning, you’re not tired at eleven, so you stay up a few more hours… You see where I’m going with this. Diverting too far from a regular pattern sets you up for a vicious cycle of insomnia and disturbed sleep.
As part of your consistency plan, try to get outside every morning (or sit by a window) so that you have some exposure to light. Morning is a great time to exercise outdoors. Morning light exposure helps set your clock for the day, helping you to feel tired enough to sleep when bedtime rolls around.
Have you ever felt absolutely exhausted, dropped into bed, then had trouble falling asleep? This is a common scenario, because even if you feel tired, your brain needs time to wind down before it can slip into sleep. It’s not enough to have a relaxed body; you also need a relaxed brain. Very few people can work on the computer, answer e-mails, or watch TV until eleven p.m., then turn off their brains, roll over, and fall fast asleep. And this is particularly true of people prone to insomnia. One reason it’s so difficult to do is because many of the devices we use in the evening involve light, which, as you’ll remember, cues the brain to stay awake. It doesn’t help that your mind will likely be aroused by what you’ve been reading or watching, adding another barrier to sleep.
Your first line of defense should be to organize your day in a way that’s conducive to helping you slow down in the evening. Take care of all the computer and phone work you need to do earlier in the day, and if you have to have any stressful conversations, make sure you have them well before it’s time for bed. Also, create a schedule for yourself that ensures that you don’t eat dinner or exercise too close to lights-out (I’ll talk more about these in a minute).
Then get into the habit of quieting down in the evening. Dim the lights as the night wears on and give yourself a pre-bed ritual. It might involve straightening up a bit, setting aside things you’ll need in the morning, brushing your teeth, flossing, and going through your skin care routine (Dr. Lancer’s polish-cleanse-nourish method!). If you have the time and inclination, take a warm bath—it’s been shown to help hurry sleep onset. Adding a lavender scent to the water has been proven to be relaxing, too. Reading in bed is another good way to get your brain to ease into sleep. Many people find this to be a very soothing activity, especially if the material isn’t too exciting. When you go through the same routine every night, it’s going to signal your brain that it’s time for sleep. If you have difficulty falling or staying asleep, consider reading in a room other than your bedroom using a low-watt light.
Only use your bed or bedroom for sleep (the exception, as just noted, being reading if it helps you drift off to sleep). If it doesn’t lead to a persistent state of arousal, sex is okay, too. Pavlov conditioned dogs to hear a bell and salivate because they associated the bell with food. Our brains react similarly to suggestion. If you condition your brain to see your bed as a place for sleep, as soon as you walk into the bedroom biochemical changes are going to occur that increase the likelihood that you’ll fall asleep. Conversely, if you watch TV, work on the computer (or your smart phone), or have upsetting phone conversations with your mother-in-law in the bedroom, your brain is going to associate your bedroom with stimulation. For most people, sex can lead to a state of deep relaxation and help ease you into sleep. But there are some people who have trouble falling asleep after sex. Coordinate the timing of intimacy with your partner so that you can both get a good night’s sleep.
Stress and anxiety can prevent you from falling asleep by making it hard to slip into that relaxed-brain mode I was just talking about. They can also wake you up in the middle of the night, as anyone who’s found himself panicking about mortgage payments at four in the morning can tell you. Before you go to bed (or after you’ve gone to bed but cannot sleep because your mind’s on overdrive), sit quietly in a room other than your bedroom and write down all of the things you need to attend to the next day. Realize, too, that these are things you can’t work on right now. You can’t call the mortgage company. You can’t talk to your boss right now (and don’t even think about sending her an e-mail!). You can’t discuss the washing machine problem with your soundly sleeping spouse. So write it all down—that will give you some peace of mind, because now you’re not going to forget anything tomorrow. Leave the piece of paper in the other room and go to bed.
If you need another reason not to smoke besides that it’s the absolute worst thing you can do for your health, consider that smoking also interferes with sleep: Nicotine’s stimulating effect can keep you up at night. What’s more, research suggests that smokers take in less oxygen while they sleep, which may lead to a variety of conditions that can cause premature death.
Caffeine, as you probably already know, is also a stimulant, but what you may not know is that it can stay in your body for as long as fourteen hours. If you’re very sensitive to caffeine, avoid coffee, tea, chocolate, and caffeinated sodas for ten or twelve hours before bedtime. It’s also a good idea to avoid alcohol in the late afternoon and evening if you typically have trouble sleeping (moderate drinking is okay if it doesn’t seem to bother you). Though it initially acts as a sedative, as alcohol is metabolized it has a stimulating effect on the body that may make it hard to fall asleep or may wake you up. Alcohol also exacerbates snoring and sleep apnea. If you must have a nightcap, make it something soothing, such as chamomile tea, or a beverage that contains calcium, such as milk or a yogurt drink. Calcium works as a natural sedative for some people.
Like alcohol, a big meal might make you sleepy at first, but you will suffer for it later. If you try to go to sleep after a big meal, your body is going to be too busy digesting the food to sufficiently move into relaxation mode. Likewise, eating anything high in fat or protein close to bedtime may keep you awake (they take longer to digest than carbohydrates). If you’re prone to reflux (see here), you also run the risk of ending up with an insomnia-inducing case of heartburn.
Exercise, and cardiovascular exercise in particular, is probably the best natural sleep aid you can find. Regularly getting your heart rate up triggers the release of endorphins and may have a positive effect on serotonin levels, both of which help relieve stress and promote deep, restorative sleep. For those same reasons, exercise also helps lower the risk of depression and one of its side effects: insomnia. Yet to get the sleep benefits of exercise, timing is everything. Vigorous physical activity causes the release of adrenaline, putting your body in an excited state that makes it hard for you to drop off. It also elevates body temperature, another obstacle to falling asleep. Try to get your workout in earlier in the day, or at the latest no closer than three hours before bed. If, however, you’re game to do some gentle stretching or a stroll around the block before bed, I’d recommend it. Any movements that help you relax without raising your body temperature can help send you off into dreamland. Just make sure that prior to starting a vigorous exercise program you check with your physician to make sure it is safe to do so. For more on exercise, check out chapter 2.
This is an especially important part of sleep hygiene for anyone in midlife and older. Now that you spend longer amounts of time in the light sleep stages and your deep sleep isn’t as deep as it used to be, you need to anticipate noise, movement, and other disruptions that can jolt you awake. Close the drapes, shut your bedroom door, turn off or remove any electronics giving off ambient light—you might even go as far as installing soundproof windows or blackout curtains. An eye mask, earplugs, and some kind of noise-blocking machine with soothing sounds can also help. One patient of mine has lights with a motion sensor in her backyard. Any time a neighborhood cat or her own dog is out there prowling around in the middle of the night, the lights flick on, often awakening her. This is the kind of situation in which a mask can help. And speaking of animals, just say no to dogs and cats sleeping on your bed. Not only can their propensity to hog space and move around at their leisure be disturbing, but they can also leave behind hair and dander that stir up allergies and asthma. Love your pet, but get him his own bed. The importance of darkness, quiet, and the absence of movement in your bedroom can’t be overstated.
Snoring can be a sign of sleep apnea, which I discuss here, as well as physiological irregularities (such as large tonsils) that cause breathing to vibrate the soft palate in the back of the mouth. It’s always wise to have your doctor evaluate you to determine the underlying cause of your snoring, even if it’s not disturbing your sleep. Some people snore loudly and don’t wake themselves up (although their bed partners aren’t always so fortunate).
If your snoring isn’t associated with a health problem such as obstructive sleep apnea and you’re just seeking ways to lessen your bed partner’s sleep disruption, there are a few remedies you can try. One is to nix alcohol at night, which can exacerbate snoring. Another is to lose weight if needed: Overweight people tend to be more susceptible to snoring (and sleep apnea). You might also try sleeping on your stomach or side (sleeping on your stomach does make your face more prone to wrinkles, but it can also decrease snoring). If you can’t seem to stay off your back, try sleeping in a T-shirt with a tennis ball sewn into a pocket between your shoulder blades. Nasal strips have also been shown to help diminish snoring by increasing airflow through the nostrils. For stubborn cases, there are surgical options. Some ear, nose, and throat specialists even offer “snoreplasty,” a procedure that involves injecting a stiffening agent into the soft palate.
Comfort is key to a good night’s sleep. Pillows are a personal preference—some people like hard, flat ones; others like them soft and fluffy—but make sure that you buy one that won’t aggravate allergies or asthma if you have either. Look for pillows without feathers or those billed as “hypoallergenic.” You can also purchase pillow casings that block out dust mites, which can lead to allergy or asthma reactions, too. If you have arthritis in your neck, check out cervical pillows, specially made curved supports for the neck.
Like pillows, mattresses too are a personal preference. However, whatever kind you choose, be certain that it allows your head and spine to be aligned when you lie down (your hips shouldn’t sink). Consider a memory foam mattress. It is designed to mold to the curves of your body. This can put less stress on your bones and muscles and decrease orthopedic-related aches and pains that develop with age. An added benefit to memory foam is that you won’t disrupt your bed partner’s sleep as you change positions through the night.
When you shop for a mattress, test it out by lying down in your typical sleep position, then before you buy make sure the mattress has a thirty-day warranty. That way if it turns out to be not so comfortable after all, you can exchange it for another.
Sleeping pills can be very helpful as a short-term treatment for insomnia. Sometimes an emotional event—say you’ve lost a spouse or are getting married—can trigger acute insomnia; once you’ve gotten over the worst part of grieving or the excitement of a wedding, the bad sleeping habits you developed may remain and lead to a chronic problem with insomnia. Many modern sleeping pills are effective and nonaddictive, and they can be just the thing to get your sleep back on track if you’re going through a rough patch.
Sleeping pills, though, shouldn’t be the first thing you try when you’re having chronic trouble sleeping—make sure you have all the other sleep hygiene habits in place first. Another option is to consider several thirty-minute sessions of cognitive behavioral therapy (CBT). Psychiatrists, psychologists, and other trained counselors often use CBT to treat insomnia related to anxiety and distorted thinking (i.e., you tend to blow small problems out of proportion). It can be very helpful and may end your need for sleeping pills altogether.
If sleeping pills remain a consideration, it’s worth consulting your doctor about benzodiazepine-like hypnotics (such as Ambien, Sonata, and Lunesta) and benzodiazepines (such as Restoril, Ativan, and Klonopin). Benzodiazepines have multiple uses—they’re also prescribed as muscle relaxants and anti-anxiety drugs—and they can be especially helpful if besides insomnia you have restless legs syndrome or another disorder called periodic limb movements, in which your legs move rhythmically at night. They’re a good choice if you also suffer from anxiety, but shouldn’t be used if you have sleep apnea (they can suppress respiration).
While both types of drugs can cause a dependency, benzodiazepine-like hypnotics cause fewer withdrawal symptoms. Bear in mind that both types of drugs can have side effects such as residual drowsiness during the day, a decrease in hand-eye coordination, and sleepwalking (and even sleep eating, cooking, and driving). You might also talk to your doctor about using other non-sleeping-pill medications to help you sleep. Antidepressants, other types of muscle relaxants, and antihistamines can all be useful for insomnia (although some antidepressants can have the opposite effect).
Melatonin supplements work for some people, too. Melatonin is a hormone naturally secreted by the body that plays a role in establishing the sleep-wake cycle and that declines with age. Whereas light tells the body to wake up, melatonin tells the body to go to sleep. If you’re going to try melatonin supplements, do so with caution, because melatonin can disturb your circadian rhythm more than you’d like. Start with a low dose (1.5 mg), then slowly increase the dosage if you find you need more. Don’t exceed 6 mg a day, and never take it if you’re pregnant or have a serious medical condition.
Valerian is another alternative sleep aid you might talk to your doctor about. It seems to have Valium-like effects in most people, but be aware that some find it stimulating. Be cautious; start with a dose lower than that recommended on the label (it comes in extract, tablet, and capsule form), and see how it goes before increasing your dosage.
If you cross time zones, you can end up with a temporary circadian rhythm disorder (jet lag). What happens is that your body stays in the time zone you just left even though there are cues around you (such as daylight or darkness) indicating that you’re now on a different schedule. As a result, you can end up overly sleepy or unable to sleep. You may even have gastrointestinal problems. To reduce jet lag when you’re flying east, once you reach your destination, seek exposure to light in the morning; this will help your circadian rhythm catch up. If you’re flying west, seek exposure to light (even artificial light) in the evening. Using a sleep aid to make it easier to get some shut-eye while you’re flying or to deal with the time change once you’ve arrived can also be helpful.
You can further help yourself push past jet lag by making sure your accommodations are conducive to a good night’s sleep. Call in advance to ask for a hotel room that’s quiet—no elevators, workout rooms, or ice machines next door, no windows overlooking the pool or flashing neon signs. In a city, ask to be on a high floor (farther away from traffic) and in a room that doesn’t face a busy street. Then, as much as possible, treat your hotel room as you do your own bedroom. Go through the same before-bed rituals you do at home.
As I said earlier, consistency is key in overcoming sleep obstacles. But on occasions when it’s impossible to maintain your regular habits, you can still catch up on sleep. This is known as paying your sleep debt. Sleeping longer on weekends or napping (see here) will let you make up for some of the hours you’ve lost; however, be aware that either can throw you off schedule again. Work on getting back into your regular routine and try to avoid the need to play catch up very often.
Remember, a good night’s sleep is something you can’t afford to take for granted. Deep, refreshing sleep is vital to your health and sense of well-being. It’s integral to fighting the effects of aging, including the risk of diseases that are more likely to crop up as you get older. Inadequate sleep can definitely shorten your life.
If you’re not motivated by the fear of a life-threatening disease, at least consider how much better you feel when you’re well rested. Sleep improves the quality of your life in every way. The brightness and resiliency of your skin. Your memory and ability to concentrate. Your mood. Your level of get-up-and-go. How well you eat. How much energy you have for exercise.
Use the suggestions in this chapter to help you develop good habits before difficulties arise. Just like all the other pillars of anti-aging in this book, effective sleep habits require discipline and commitment. You need to purposefully manage your day and evening, and you may even have to give up certain cherished rituals to get the results you need. But give yourself the gift of a good night’s sleep and you’re sure to improve your health and the overall quality of your life.