How to Get a Better Night's Sleep

Sleep is one of those things that should come naturally. And for many of us, it does. For some individuals, however, getting a good night’s sleep can be a struggle that leads to drowsiness, an inability to focus, and low energy during the day. Over a long period of time, lack of sleep may lead to an increased risk of depression and heart trouble. You may have trouble falling asleep and/or sleeping through the night, wake up earlier than desired, or feel tired upon awakening. These symptoms may be classified by their duration: transient (less than 1 week), short term (1-3 weeks), or chronic (more than 3 weeks). If you have chronic insomnia with daily symptoms and you are waking several times each night, or if your insomnia is caused by other medical conditions, see your health care provider (HCP) for treatment. See Table 1 for medical conditions that cause insomnia. If your insomnia can be classified as short term, several changes in lifestyle may be helpful.

The first step is to get in sync with your body’s natural sleep-wake cycle by following these practices:

• Set and stick to a bedtime schedule. Go to bed at about the same time every night and wake up at the same time every day to set your body’s internal clock. This includes weekends and holidays.
• Avoid late-day naps. Late afternoon naps can make falling asleep or staying asleep at night more difficult. If you do take naps, avoid napping after 3 pm and limit them to 15 to 20 minutes.
• Don’t sleep in on weekends. If your weekend and weekday sleep schedules differ, you may find your natural sleep-wake cycle is easily disturbed.

LIGHT EXPOSURE AND THE SLEEPWAKE CYCLE

Melatonin, the naturally occurring hormone that makes you feel sleepy at night, is controlled by daylight, darkness, and the amount of light your eyes are exposed to. Melatonin levels are lowest during the day because your eyes detect large amounts of light through specialized cells of the retina. During the nighttime hours, melatonin levels peak, inducing physiological changes that promote sleep, such as decreased body temperature and respiration rate. In addition to sunlight, artificial lighting can be bright enough to prevent the release of melatonin, which can interfere with the sleep-wake cycle.

Here are some simple tips for optimizing the sleep-wake cycle:

• Spend more daytime hours outside or in lightfilled rooms. Exposure to sunlight during the day will help you fall asleep later on when it’s time for bed because light inhibition of melatonin production stimulates wakefulness and alertness throughout the day. Get outside early in the morning or have your breakfast near a sunny window. During the day, exercise outside or take your dog for a walk and open curtains and blinds in your house and workplace to expose yourself to plenty of light.
• Make your bedroom dark for better sleep. Block all sources of artificial light, including street lamps or outside house lights with heavy curtains or blinds, and cover up the glow from light-emitting electronics and bright alarm clocks.

Consider these other factors that affect sleep:

• Limit caffeine, tea, and nicotine before bedtime. In addition, avoid drinking large amounts of liquids in the evening because it may cause you to have to get up several times during the night to use the restroom. Although alcohol may make you feel tired at first, it may actually compromise the quality of your sleep and should be avoided, especially if you have been having trouble getting a good night’s sleep.
• Create a comfortable sleeping environment and pay attention to the temperature, noise and light in your room, as the bedroom environment can have a significant influence on sleep quality and quantity. This may mean reducing the temperature, turning off the TV, and avoiding computers, iPads, TVs, or work in the bedroom. The bedroom should be reserved for sleep.
• Get ready for bed with a regular routine. Engage in relaxing activities in the hours just before bed, such as light reading and listening to soothing music.
• Make sure your bed is comfortable and use it only for sleep. Avoid watching TV or working in bed.
• Exercise regularly. If timed right, exercise helps promote restful sleep. Engage in strenuous exercise (jogging, swimming, brisk walking, etc.) during the day, especially the day after a bad night’s sleep. However, you need to pay attention to what time you exercise. If you exercise too late in the day, you may have difficulty falling asleep. Try to finish exercising at least 3 hours before bed; however, a gentle stretching routine before bed can also help you to relax and induce sleep.
• Avoid heavy meals within 2 to 4 hours of bedtime. If your body is working to digest a large meal, your sleep may be disturbed— although a little food in your stomach may help you sleep. If you must eat before bed, try to limit your meal to a light snack and avoid protein-rich, high-fat foods near bedtime. See Table 2 for a list of foods to avoid for a good night’s sleep.
• If possible, avoid medications that disrupt sleep. Certain commonly used prescription and OTC medicines contain ingredients that can make it difficult to fall asleep, cause more awakenings during the night, and affect the quality of your sleep. These ingredients include decongestants, steroids, and caffeine in headache medicines. Antihistamines and prescription medications including betablockers, alpha-blockers, asthma treatments, and antidepressants can also affect sleep. If you have trouble sleeping, talk to your pharmacist to see whether any drugs you’re taking might be disrupting your sleep and whether they can be taken at other times in the day. Don’t stop taking prescription drugs or adjust your dosing schedule without talking to your pharmacist or HCP first.

If you’re still having trouble sleeping, you may be tempted to reach for a supplement or an OTC sleep aid. So when is it time to try a sleep aid? The answer is different for every individual because sleep problems are caused by a variety of different factors. For example, certain medications, night-shift work, and jet lag can throw off the sleep-wake cycle. A sleep medication may be an option when improving your sleep habits hasn’t worked, the cause of your sleep problem is known and is best treated with medication, or sleep troubles are making daily activities difficult to perform and the insomnia is expected to be temporary. Although sleep aids can help you fall asleep on occasional sleepless nights, it is best to talk to your HCP or pharmacist about taking any sleep aids or supplements like melatonin or valerian root extract. Supplements, because they are not recognized as drugs, are not regulated by the FDA, so it can be hard to pinpoint the exact melatonin or valerian root extract dosage that works best.

END NOTE

It is normal to have an occasional sleepless night, but if you find yourself having trouble falling sleep or staying asleep on a regular basis, speak to your HCP and don’t get discouraged. Together you can create a plan to help you get the rest you need.

RECOMMENDED READING

• Smith M, Robinson L, Segal R. How to sleep better. Helpguide .org website. helpguide.org/articles/sleep/how-to-sleep-better. htm. Accessed July 28, 2016.
• Brain basics: understanding sleep. National Institute of Neurological Disorders and Stroke website. ninds.nih.gov/disorders/ brain_basics/understanding_sleep.htm#Tips. Updated July 25, 2014. Accessed July 28, 2016.
• Insomnia. National Sleep Foundation website. sleepfoundation .org/insomnia/content/what-is-insomnia. Accessed July 28, 2016.
• Sleep and chronic disease. CDC website. cdc.gov/sleep/about_ sleep/chronic_disease.html. Updated July 1, 2013. Accessed July 29, 2016.
• Insomnia fact sheet. Office on Women’s Health website. womenshealth. gov/publications/our-publications/fact-sheet/insomnia. html. Updated July 16, 2012. Accessed July 29, 2016.

Beth is a clinical pharmacist and medical editor residing in northern California.