Getting Quality Sleep

By Kimberly Olsen

You roll over and glance up at the bedside clock. It's 3:17 a.m. Six minutes since the last time you checked. If you can fall asleep right now, you tell yourself, you can get four hours of shut-eye. But at 4:28, you're still tossing and turning, worries churning through your head.

If you have a tough time getting to Dreamland, you're not alone. Each year, 20 million Americans experience occasional sleeping problems, and another 40 million suffer from long-term sleep disorders.

Experts aren't yet certain how sleep rejuvenates us, but some believe it gives neurons a much-needed break so they can repair themselves. Racking up too many restless nights can lead to drowsiness, decreased concentration, impaired memory, poor physical performance, irritability and depression. In fact, in a recent poll conducted by the National Sleep Foundation, 37 percent of respondents admitted that daytime sleepiness makes it difficult for them to function at least a few days each month. Sleepiness can even be deadly. The National Highway Traffic Safety Administration and the National Center on Sleep Disorders Research estimate that drowsy drivers cause 40,000 injuries and 1,550 deaths each year.

So how much sleep do you need? It depends. "Most adults need seven to eight hours of sleep, but some require only four hours and others need 12," says Ruzica Ristanovic, M.D., M.S., medical director of the Sleep Disorders Center at Evanston Hospital. "If you feel drowsy or crave sleep during the day, you're probably sleep deprived." Sleeplessness, also known as insomnia, can be caused by acute stress, noisy environments, medical or psychiatric illness, and even some medications. If you have a difficult time falling asleep or awaken often during the night, you may have insomnia, which is a roller coaster that's tough to dismount.

"People with chronic insomnia may get sleepy at night, but as soon as their head hits the pillow-bingo!-they're more aroused than ever," Dr. Ristanovic says. "Then their anxiety level goes up and they anticipate another bad night. This anticipation of failure leads to more arousal, and the prophecy of a sleepless night is self-fulfilled."

But don't lose heart. There are specific steps you can take to rack up a better night's sleep. If you can't get your insomnia under control on your own, a psychologist can use cognitive therapy or teach you behavior-modification techniques that may help.

Some medical conditions, such as sleep apnea and restless legs syndrome (RLS), also keep the Sandman away. People with sleep apnea actually stop breathing temporarily when they sleep. The upper airway closes up and cuts off the person's air supply-usually due to loss of muscle tone in the windpipe-and he or she may be without air for up to a minute. In the struggle for breath, the person wakes up. This may happen hundreds of time each night, leading to severe daytime sleepiness, as well as increased risk for high blood pressure, heart attack and stroke.

Signs of sleep apnea include loud snoring and pauses in breathing. It rarely goes away on its own, but can often be controlled using a continuous positive airway pressure machine, which pushes pressurized air through the airway to keep it open. Oral appliances, which are similar to the mouth guards used by boxers and football players, are another option. They gradually move the lower jaw forward, increasing the airway space. In some cases, surgery is recommended.

RLS robs up to 5 percent of the population of needed sleep. Sufferers experience a creepy-crawly sensation in their legs and feel an overwhelming urge to move them, which can delay or fragment sleep. Some cases of RLS appear to be inherited, while others may be caused by nerve damage. In any case, several families of medications-including benzodiazepines, dopaminergic drugs, opiates and some antiepileptic drugs-can help.

Studies in Sleep

Having trouble nodding off? Follow these tips to get your mind primed for bedtime:

• Go to bed only when you're drowsy, and get up at the same time each day.
• Avoid watching television, having telephone conversations and doing work in the bedroom. It will be easier to sleep if you associate the bedroom with rest.
• Avoid napping for more than a few minutes during the day.
• Try a relaxing pre-sleep ritual, like taking a lukewarm bath, to cue your mind for sleep.
• Exercise regularly, but avoid working out within four hours before bedtime.
• Steer clear of caffeine, nicotine and alcohol before bedtime. While alcohol is a Sedative, it can actually cause sleep disturbances throughout the night.

Rhythms of the Night
Our ancestors followed the earth's natural rhythms, waking at sunrise and retiring at sunset. But the electric light bulb changed everything.

Although today we simply flip on a light switch and continue working or playing long after nightfall, our bodies are naturally hardwired to follow 24-hour cycles, called circadian rhythms.

"Sleep tendency relates to our circadian rhythms, which are governed by a biological clock at the base of our brain," explains Ruzica Ristanovic, M.D., M.S., medical director of the Sleep Disorders Center at Evanston Hospital and associate professor of neurology at Northwestern University's Feinberg School of Medicine. "That clock is sensitive to the light-dark cycle and tries to tune our body rhythms to this pattern."

It's no surprise, then, that night-shift workers and others who have irregular schedules often have sleeping problems. A person who works night shifts five nights a week, for example, will likely switch to daytime activity on his or her days off. This causes them to work-and sleep-against their biological clock. As a result, they may suffer from insomnia, sleepiness during waking hours, indigestion, irritability and poor concentration.

"There's a lot of work being done in this area with light therapy and also melatonin, but we don't have the magic bullet yet," Dr. Ristanovic says. "Within a few years, though, we hope to have more definite answers to our questions."