No matter how well you eat, how often you exercise, and how much time you spend planning and cooking your meals, you can never be truly healthy if you don’t get enough quality sleep. Lack of sleep can alter your metabolism, making you prone to weight gain, diabetes, and heart disease. It can interfere with your ability to learn and perform at your peak. It can rev up your stress hormones and make you depressed. It can dampen your immune response, leaving you susceptible to colds and flu. Not getting enough sleep can make you feel so overwhelmed and exhausted that you stop making good choices and end up doing what is easiest at the time.
If you are one of the fortunate few who can put your head down on your pillow at night and wake up 8 hours later feeling revived, count your blessings and keep doing what you’re doing. If, however, you are one of the 70 million or so Americans who struggle with sleep, who have difficulty either falling asleep or staying asleep, and who often wake up feeling exhausted, then you need to reevaluate your “sleep style.”
So what’s keeping you up? If you’ve had a longstanding problem with sleep, this may be a difficult question for you to answer. For you, not sleeping has become a way of life. You are so accustomed to being a fitful sleeper that you no longer even expect to have a good night’s sleep. One of my missions is to raise your expectations: There is no reason why most people can’t get a good night’s sleep, but it may take a bit of effort on your part to get there.
Some people are kept awake by bona fide sleep disorders, like sleep apnea, which I discussed in Chapter 9. If you snore loudly and suspect you have apnea, consult with your doctor or see a sleep specialist. There are many effective treatments for sleep apnea, and you don’t have to live with it. Nor should you suffer in silence if you are up at night in pain. If you have arthritis, restless leg syndrome, or any other medical condition that could be interfering with your sleep, see your doctor.
There are times in all of our lives when we experience emotional turmoil that interferes with our ability to sleep. The loss of a loved one or an illness in the family can be very upsetting. Don’t suffer alone. Walking around exhausted will only make matters worse. There are some excellent sleep medications that can be used on a temporary basis to restore sleep. This is a time to seek help from your doctor.
In the vast majority of cases, however, people are sabotaging their own sleep because they don’t know any better. For most of us, sleep medication is not necessary. Very often, making some simple changes in lifestyle and environment can help resolve typical sleep problems over time.
So how do you know what’s standing between you and a good night’s sleep? Is it something that you’re doing or eating or drinking during the day? We provide a Sleep Quiz at southbeachdiet.com/wakeupcall to help you analyze your sleep habits, as well as a Sleep Log to help you keep track of how long and how well you sleep at night and what aspects of your lifestyle may be disrupting your sleep.
You spend (or should be spending) a third of your life in your bedroom. So it’s important to make it a pleasant, relaxing environment that is conducive to good sleep. If you’ve followed our suggestions in Strategy 1 for de-cluttering the room and removing electronic equipment at night, you’ve already made a good start.
A comfortable bed is essential. After a long day, you should look forward to crawling into your bed for 8 hours of restorative sleep. If that’s not the case, is it because your bed isn’t comfortable? Do you wake up with aches and pains? Is your mattress sagging or too hard or lumpy? Can you feel the coils when you lie down? Are there uncomfortable patches of mattress that you avoid? If any of these problems exist, maybe it’s time to buy a new mattress and box spring. The rule of thumb is that a mattress should be replaced every 7 to 10 years; however, if you’re not getting the sleep you need and think your mattress may be contributing to the problem, you should consider doing it sooner. If you can afford to purchase a new one, go to a department store or bedding store and try out a few mattresses to see which ones you find comfortable. Ideally, bring your sleep partner with you. A bed can feel different when there is someone lying next to you. If your partner’s tossing and turning is keeping you awake, consider purchasing a mattress made from memory foam, a type of material that doesn’t shift when you change position.
If you can’t afford to buy a new mattress, try a foam or down mattress topper, which, as its name suggests, you place on top of your mattress to make it more comfortable. A mattress topper is a lot cheaper than a whole new mattress; however, it does need to be replaced every few years.
Keep your room cool but not cold. The ideal temperature for sleeping is somewhere between 65°F and 72°F; some people prefer a cooler room, and others like it warmer. If you are constantly throwing the covers off at night, consider turning the thermostat down a few degrees. If you are freezing, turn the heat up a few degrees. A room that is either too warm or too cool (below 60°F) will disrupt sleep, so it is important to find the right temperature for you.
Make sure your room is quiet. If outside noise is keeping you awake, consider moving your bedroom to another, quieter room if you have one, or invest in double-glazed windows, which can shut out street noise, and/or heavy drapes. If you are hearing noisy neighbors, move your bed to a quieter part of the bedroom. If you are extremely noise sensitive, try using a white noise machine, which muffles ambient sound.
The food and drink that you consume during the day and evening can have a significant impact on how well you sleep at night.
Snack but don’t gorge before bedtime. A big meal at night can rev up your metabolism and make it hard for your body to wind down. So eat light at night, but don’t go to bed hungry. Hunger pangs will make it difficult to get to sleep and to stay asleep. Some foods have a slightly soporific effect, like turkey, hummus, dairy, pumpkin seeds, whole grains, hazelnuts, and bananas, which contain the amino acid tryptophan, known to induce mild sleepiness. Other foods, especially those that are spicy, can induce wakefulness. Eating highly spiced meals at night can cause heartburn or aggravate gastric reflux, both major causes of sleep problems.
Limit caffeine in the afternoon. We live in a caffeinated world, where up to 90 percent of the population ingests this stimulant in one form or another. Caffeine perks up your central nervous system, making you feel more focused and alert. Found naturally in coffee, tea, chocolate, and the cola nut, caffeine is added to many brands of soda and energy drinks. In fact, caffeine is so ubiquitous in our food supply that it’s hard to keep track of how much you are ingesting unless you make a conscious effort to do so.
Even then, it’s difficult to really know how much caffeine is in a particular product because manufacturers are not required to list it on the label. For example, some brands of brewed coffee have 75 grams of caffeine per serving, but others can have 120 or more grams; instant coffee typically has about a third less than most brewed coffees. Even decaf coffee has a few milligrams per cup, which could affect caffeine-sensitive people. Tea contains between 20 and 90 milligrams of caffeine, depending on the type. If you drink a lot of diet cola with caffeine, be aware that many brands have a whopping 45 grams of caffeine per serving (diet orange soda has 40 grams). I usually advise patients to avoid caffeinated foods and beverages at least 6 hours before bedtime, and even longer if they find that an early-afternoon cup of coffee or iced tea makes it difficult for them to sleep. If you are having sleep problems, be vigilant about limiting your caffeine intake after noon and see if it helps. Maintaining a sleep diary can help you keep track of your caffeine intake to see whether there is any correlation between caffeine consumption and disordered sleep.
But don’t cut out caffeinated beverages cold turkey; it could cause caffeine withdrawal, which includes some uncomfortable symptoms like headache, nausea, anxiety, and even panic attacks in some people. If you are a habitual user—that is, you have a cup or two of coffee or consume other caffeinated products on a daily basis—gradually taper off by cutting back by half a cup of coffee or diet soda daily until your body gets accustomed to less caffeine.
Say no to nightcaps. For most people, a glass of wine at dinner is fine, but it’s best not to drink alcohol right before you go to bed. Although a drink may make you drowsy at first, in some people it can disrupt normal sleep cycles and leave them wide awake a few hours later. In highly sensitive people, drinking alcohol up to 6 hours before bedtime could cause wakefulness. On the South Beach Diet, we suggest no more than one drink daily for women and two for men (beginning on Phase 2). If you are having trouble sleeping, try cutting out the alcohol altogether for a while and see if it helps.
Your body and mind need time to transition from alert to drowsy. If you are upset or revved up over things that have occurred during the day, sleep will not come easy. An hour or two before bedtime, begin winding down in preparation for sleep.
Put out that cigarette. First of all, don’t smoke. Smoking is the worst thing that you can do for your health, and if you are still smoking, you should make every effort to stop. Having said that, I know that there are people who say that they “must” have a cigarette at night to calm down. Although the act of smoking a cigarette may initially relax you, in reality the nicotine is a stimulant that can interfere with sleep. Another reason to quit.
Get enough physical activity, but at the right time. Several studies have shown inactivity to be a major cause of insomnia. Among my patients, I have found that people who complain of insomnia are often “cured” when they take up exercise. My only caveat is that you shouldn’t exercise too close to bedtime because it can be overly stimulating.
Sex before bedtime can be relaxing … or not. Some people find that having sex at bedtime helps them to sleep better, but others tell me that it excites them so much that they have difficulty sleeping. There are no rules here; do what works best for you. If you find that you need to unwind after having sex, suggest to your partner that you enjoy sex earlier in the evening. If both of you find that you are wide awake afterward, consider having sex in the morning.
Follow a bedtime ritual. Doing the same thing every night before sleep will signal to your brain that you are prepping for bedtime. Turn on soothing music, take a lavender-scented bath, read an entertaining but not-too-exciting book or magazine article, do some mild stretching or deep breathing. Now is not the time to have family arguments or engage in stressful activities like paying bills or preparing your tax returns. Obviously, if you live with other people, you need to get their cooperation; teens have to agree not to blare loud music after a certain time of night, and a spouse must commit to not bringing his or her laptop into bed.
Turn down the lights. You know that you sleep better in a dark room, but you may not know why. Darkness—or rather, the absence of light—triggers the production of melatonin, a hormone that regulates sleep-wake cycles in addition to lowering blood pressure and body temperature in preparation for sleep. Under ideal circumstances, your body produces ample amounts of melatonin at night to allow you to sleep and then curtails production by morning so that you can wake up. Exposure to artificial light late in the evening, however, can suppress and shorten the duration of melatonin production, which could contribute to difficulty falling asleep and staying asleep.
As I discussed in Chapter 9, lack of sleep not only makes you feel lousy, but can also disrupt normal metabolism and increase the risk for weight gain and diabetes. Interestingly, contact with light at night might play a role. In a recent study, mice exposed to a dim light (like from a clock radio) while they slept gained 50 percent more weight over an 8-week period than mice sleeping in total darkness, even though they got the same amount of food and exercise. It’s possible that even the dim light disrupted the cycling of melatonin, which could be at the root of the metabolic problem that caused the weight gain. Remember, this is a mouse study, but it is food for thought.
You can try to keep your own melatonin production robust by dimming the lights an hour or two before bedtime and sleeping in a dark room. As noted earlier, avoid using a computer, watching TV, or even looking at your smart phone screen. After you go to sleep, avoid exposure to ambient light. Don’t sleep near a lit screen (like an alarm clock); get drapes or blinds to block out light from the street; and if you get up at night to use the bathroom, use a night light instead of turning on a bright light.
Stick to a schedule. Each of us has a biological clock that regulates our bodily processes. This internal clock works best when we stick to a predictable schedule. Try to go to bed around the same time every night and awaken at roughly the same time every morning. There are days, however, when this may not be possible; often when work interferes or social engagements keep you up way past your bedtime. When this does happen, strive to get up around your usual time anyway. You may be a bit sleepier than normal when you awaken, so as quickly as possible, go outside and let your brain register that it’s daylight. This will help reduce the drowsiness. Sleeping in will only further disrupt your schedule, and could interfere with your ability to fall asleep that night, which could trigger a cycle of disrupted sleep.
If you want to party late into the night on the weekend, it’s better to do it on Friday than on Saturday. If you stay in bed a bit longer on Saturday morning but go to sleep Saturday night within an hour or so of your normal bedtime, you can awaken at your regular time on Sunday. This will enable you to go to sleep at your normal time Sunday night, so that you can wake up at your regular time on Monday and not feel exhausted at the beginning of the work or school week.
Make your bedroom a worry-free zone. You need to create a barrier between the “real world” and the world of sleep. We all have worries that can keep us up at night, but in our saner moments it’s important to recognize that sleep deprivation is not conducive to problem solving or performing well. So leave anxiety outside the bedroom door. I mean this quite literally. If there is something nagging at you, write your thoughts down in a journal to be addressed the next day, and then stash it away somewhere outside your bedroom. When your head hits the pillow and you close your eyes, create a relaxing mental image that becomes your internal “screen saver.” Think of walking on a beach, or hiking, or sleeping in a hammock, or whatever your ideal de-stressing scenario might be. Focus on it, don’t allow your mind to wander, and allow yourself to drift off to sleep.
If your bed partner’s snoring is keeping you awake, it’s a real problem for both of you. First, he or she should be examined by a physician to see if it’s due to a medical problem. It could be sleep apnea (see pages 148–51), which can be treated. If it is simply loud snoring, which is not life threatening to the person doing the snoring, there are some simple things that can be done that may improve matters:
Alcohol can aggravate snoring by relaxing the muscles in the airways, which makes breathing harder. Eliminating alcohol at night may help silence the snorer.
A stuffed nose or clogged nasal passages can make snoring worse by causing the snorer to breathe through his or her mouth. A nasal strip worn on the bridge of the nose can open nasal passages, which could reduce the need for mouth breathing.
Dry heat can trigger snoring. A humidifier can help keep the room moist, and therefore prevent the mouth and nose from drying out.
Losing even a few pounds can help reduce snoring.
An anti-snoring mouthpiece may help reposition the mouth and jaw so that the snorer has an easier time breathing and thus makes less noise. There are many different types of over-the-counter mouthpieces to choose from. If the problem is severe, a mouthpiece made specifically for the individual by a dentist or sleep specialist is best.
If all else fails, the nonsnoring partner can try wearing earplugs to shut out the noise or invest in a white noise machine to muffle the sound.
If you have children, it is absolutely critical for their mental and physical development that you make sure they are getting ample sleep. It is also essential for your own sanity. You can’t be a good parent if you are exhausted and resentful from not getting enough rest because the kids are going to bed late or getting up throughout the night.
Of course, new parents will lose sleep because it can take infants several months to get into a sleep routine. By the toddler years, however, children should know how to go to sleep and how to get themselves back to sleep if they awaken at night, at least most of the time.
Sleep “rules” are the same for young and old. Almost all the sleep tips that I provide in this chapter apply to children. It is especially important for parents to maintain an orderly, predictable bedtime ritual that helps children know when it’s time to wind down and prepare for bed. Kids should also understand that lights out means lights out, or else bedtime can drag on for hours into the night. Don’t get your child into the habit of needing you to fall asleep. Teach her how to comfort herself by playing or singing quietly until she falls asleep on her own.
Don’t ignore snoring. Sleep apnea often goes undiagnosed in children. If you have a child who snores loudly, alert your pediatrician. While it may not be apnea, snoring and breathing difficulties could be a sign of allergies or even asthma.
Watch the caffeine. Some adolescents and teens inadvertently consume large amounts of caffeine in soft drinks, coffee drinks, and in so-called energy drinks, which may contain as much caffeine as a cup or two of coffee. All these beverages can contribute not only to insomnia but also to anxiety and heart palpitations. Make sure that your children are aware of the potential dangers of these beverages and encourage them to stop drinking them.
Suggest a sleep log. If older children are having difficulty going to sleep or staying asleep, suggest that they keep a sleep log to see if there are things they’re doing that could be sabotaging their sleep. Keeping track of the foods and beverages they consume and the amount of exercise they get and when could provide some clues to sleep problems. By giving children a chance to track their behavior, you will give them a sense of control and more motivation to be part of the solution.
No bed sharing (including the dog). Kids should understand that they sleep in their own beds, and that a parent is available to them if need be. For example, if a child has a nightmare or feels ill, by all means he should be allowed to wake up a parent. But in general, it is not good for anyone in the family to be popping in and out of bed at all hours. Kids should be able to get back into their own beds after a reassuring hug.
By the way, don’t get into the habit of allowing a pet to share your child’s (or your own) bed. Many people who sleep with their pets find that they lose sleep because, believe it or not, dogs can snore as loudly as people, not to mention take up space. So do yourself and your pet a favor—get Buddy his own mattress.
Get the computer and smart phone out of the bedroom. Allowing a computer or smart phone in the bedroom all evening will make it too tempting for an adolescent to talk, text, tweet, or e-mail until late into the night. If your child has a desktop computer, establish a shutdown time. A better option for kids may be a laptop, which can be removed from the room at bedtime. And don’t forget to remove that smart phone. Older kids can hopefully be trusted.
Once you’ve completed the seven strategies of the South Beach Diet Wake-Up Program, your new healthy habits should be so seamlessly embedded into your life that that you can no longer imagine living any other way, nor should you want to. By now you should be reaping some of the many benefits of your new lifestyle: If you had some weight to lose, you should be well on your way to reaching your goal, thanks to shopping and eating better and avoiding fast-food venues. If you were tired and listless, you should be feeling more energized and alert from your improved diet, exercise, and sleep habits. If you were sitting all day, simply moving more has no doubt helped improve a litany of ailments. If you hardly saw your family before, hopefully you’re now growing closer and enjoying one another’s company, thanks to more frequent family dinners. Ideally, you and your children have cooked a few meals together, gone for walks after school, or planted a home garden that is beginning to bloom.
When it comes to making good health a permanent way of life, perhaps the most important piece of advice that I can give you is this: Don’t be discouraged if you and your family are not perfect. We all have setbacks. Perhaps you will overindulge at a party or skip exercise for a few days. Maybe during an especially hectic week you’ll eat out more than you should. Maybe you let the dog sleep in your bed. Things happen, but you shouldn’t give up and slip back into your old ways. Always pause when setbacks occur, take a deep breath, and get back on track at the earliest opportunity.
Please keep this book handy so that you can refer to it from time to time when you need a “wake-up call.” And do visit South Beach Diet Wake-Up Call online at southbeachdiet.com/wakeupcall for guidance and support and to become part of the larger community pledging to lead a healthier life.