Why am I so tired? A sleep expert explains the mystery of fatigue.
Get insights from Dr. Abhinav Singh on the importance of good sleep to health, the risks of untreated sleep apnea, and the natural state of circadian rhythms.
Almost everyone knows the feeling of tossing and turning in bed, unable to sleep.
For some, that is a rare occurrence. For others, it’s always night.
There are countless reasons. Biology. Life time. Illnesses.
But for most people, there are ways to improve the amount and quality of sleep.
These strategies take knowledge, discipline, ingenuity and perhaps a good fan — not drugs or gizmos and gadgets, experts say. Most people can even continue their caffeine habit. At least in moderation and in the morning.
“The best sleep comes when we practice healthy sleep patterns that set us up for success at night,” says Rebecca Robbins, a researcher in the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital in Boston.
How to fall asleep fast: ‘Don’t try too hard’
b Approximately 15% of people For those who constantly struggle to get a good night’s sleep, researchers like Harvard University’s Dr. Charles Chezler have a lot of advice, starting with a simple suggestion: Don’t worry too much.
Many people who think they sleep horribly have an unrealistic idea of what a good night’s sleep means, perhaps remembering the times in earlier years when they could sleep like a rock all day. He and others say this simply isn’t realistic in middle age.
If you have to get up in the middle of the night to go to the bathroom or find yourself waking up for a while, so be it, say the experts. “In today’s society, we all want to be able to sleep efficiently, and we become impatient when we don’t,” said Sessler, who directs the Department of Sleep Medicine at Harvard Medical School.
Historical research suggests that before the Industrial Revolution put a price on the workday, our ancestors slept in two parts, with a gap of a few hours between them.
Some people may think they can’t get a good night’s sleep, Chezler says, because they ignore their body’s natural need for this interval.
“You probably don’t spend enough time in bed to get as much sleep as you want. You want to sleep 95% of the time you decide to sleep, and you end up cutting it,” he says.
Instead, Chezler and others advocate patience.
Even a well-rested person takes 15 to 20 minutes to fall asleep, and older adults take about the same amount of time to fall asleep or stay asleep as younger adults. “It’s important not to throw in the towel at night just because you’re awake,” Chezler said.
Several experts say that tracking sleep with wearable devices can help some people, but it often becomes a source of anxiety.
Sleep is not a time to wait for perfection.
“We want people to sleep,” said Jennifer Martin, MD, a professor of medicine at UCLA’s David Geffen School of Medicine. “Finally, they have to stop trying so hard.”
Sleep hygiene
The term “sleep hygiene” refers to good habits and practices that help people get a good night’s sleep.
The specifics of when to go to bed and when to wake up will be different for each person based on individual needs and daily life needs, the basic principles apply to everyone.
“All of these behavioral changes are the secret sauce to healthy sleep,” Robbins said.
Here are some basics:
- Go to bed and wake up at roughly the same time every night. Very different bedtimes can confuse your body clock and make it harder to fall asleep.
- While some people may need a bedtime snack to fall asleep, others find bedtime food disturbing. “Breakfast of kings, lunch of princes, supper of paupers” works best for most people, Robbins said. In other words, eat more in the morning, less in the afternoon and more at night.
- Avoid drinking the “nightcap”. While alcohol may initially help people sleep at night, it has been shown to disrupt sleep later and worsen sleep apnea.
- If you are sensitive to caffeine, avoid overdosing, especially in the afternoon. If you’re not sure, try cutting back or eliminating completely for a week.
- Manage stress. Meditation or breathing exercises can help decompress.
- Keep naps short and stay close to bedtime.
- Get as much natural light as you can in the morning. This sets circadian rhythms and helps wake you up in the morning.
- Some sleep researchers have special lights in their homes or have software on their computers (f.lux is one) to limit exposure to blue light at night. Blue light “Morning!” It is a sign. to the brain.
- Have a bedtime routine. This includes turning off things like phones and bright lights and other stimulating activities for a period of time.
- Do you feel the need to shout? Choose a fan, not a television, says Dr. James Rowley, president of the board of directors of the American Academy of Sleep Medicine. Even reading “no noise and no car crashes” on the fan might be too motivating for some.
- “A phone should be face down on the charging side of the bed and not on top of you,” Rowley said.
Medicines can work, but at a price
Medications designed to act as sedatives work well in the short term, Rowley said.
People who use pain relievers for other purposes, such as allergy or cold medications, are more concerned about side effects. “That’s where a lot of us get angry,” Rowley said of the feelings of sleep specialists.
A patient, He recently came into the office and was taking an “all natural” sleep aid that contains about 15 ingredients, all of which may interact with other medications. “You have to be careful,” he said.
Melatonin has not been shown to be effective for insomnia in any research trial. Also, most people don’t use it properly, either using too high a dose or taking it too close to bedtime to make a difference, Rowley said.
“If melatonin is going to help you, maybe .5 to 3 (mg) will help,” Rowley said. “Not that it’s great for insomnia, but if it’s something you want to try, lower doses are probably better than higher doses.”
Also, Martin said, “If you have trouble sleeping and you take melatonin at night, it can make your problem worse, not better.”
At least one new Drug therapy is now in late-stage clinical trials.But researchers say they are reserving judgment until new drugs perform better than existing ones or show behavioral changes.
By far the best thing about drugs is a form of talk therapy called insomnia, or CBT-I, Martin said.
CBT-I trains people to eliminate behaviors and ways of thinking that make insomnia worse.
“The way people think and the way they act is what supports their sleep problems,” Martin said. “If we can get people to go to bed with a better mindset and structure their sleep and wake habits and habits when they’re in bed to induce sleep, it seems like it’s going to get people back on track.”
When to Get Medical Help: Sleep Apnea
People with real sleep problems should seek professional help, the experts said. And sleep problems are more common as we age.
Many physical and mental illnesses are related to sleep problems. People with ADHD, autism or depression often report sleep problems, for example. Getting help with sleep issues can limit other symptoms.
Sleep problems that typically last longer than about three months should be treated as sleep apnea, which is often characterized by loud snoring and suffocation (and often by the person next to them).
one The study followed people 18 years of sleep apnea with and without sleep apnea starting at age 48. Only 58% of the group with sleep apnea were alive at age 66 compared to 94% of those without sleep apnea. This increases the risk of death by 6 or 7 times, mainly from heart attack and stroke, “so it’s very important to be treated,” Zeisler said.
The standard therapy, called CPAP (continuous positive airway pressure), which uses a machine to keep the airway open, can be difficult and difficult, but most patients can adjust over time, experts said.
A recall of a widely used brand name in 2021 will stigmatize the industry and confuse patients. Supply chain problems with the microchips used in the devices have meant many people have gone without CPAP machines for too long. These barriers unfortunately persist and limit treatment, which is already complex and difficult to address, Robbins said.
Other apnea treatments that are covered by health insurance include implantable devices and surgery.
Myths about sleep
as if The study was published in 2020, Robbins and Chezler, along with other experts, weigh in on 20 popular myths about sleep. Robbins recently offered to take some of the most durable.
Falling asleep at any time is not a sign of good sleep. It is a sign of someone who has insomnia.
Evidence suggests that seven to nine hours of sleep provides optimal health and well-being. People who think they can get away with less sleep are setting themselves up for health problems later on.
Older adults do not need less sleep than young children, although they often get less, because they do not sleep well and it can disrupt sleep.
When It is important that you sleep. Eight hours of shut-eye in the middle of the day is eight hours without rest in the dark, though less than sleeping.
Lying in bed is not considered sleep time.
It’s not a good idea to stay in bed if you can’t sleep. Instead, before trying to fall asleep again, experts suggest changing your environment. This doesn’t mean picking up your phone or finishing work, but you can take a hot shower or stretch until you feel tired.
Finally, according to experts, sleep is not the time when the mind “turns off”. The brain is not passive during sleep, instead it is actively firing, cleaning up waste, storing memories and preparing for the day.
Overall, Robbins said, society is beginning to realize that healthy sleep is just as important as diet and exercise.
“Gone are the days of boasting that you can’t get enough,” she says.
Contact Karen Weintraub at kweintraub@usatoday.com.
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