2004-10-25
R.J. Ignelzi - UNION-TRIBUNE

Bidding adieu to daylight-saving time, we'll turn our clocks back Saturday night and burrow deep under the comforter for an extra hour of blissful sleep.

Sounds like a good thing, right?

Not to the more than 70 million Americans who suffer from insomnia. To the chronically blurry-eyed and sleep deprived, any shift in the sleeping schedule can be a nightmare.

"Even though in October you're getting an extra hour of sleep, it can throw some people off. If you already are troubled by falling asleep or early awakening, your problem is likely to be made more severe for a while," says Dr. Daniel F. Kripke, a UCSD research professor in the psychiatry department who specializes in sleep disorders.

More than 60 percent of adults in the United States experience symptoms of insomnia a few nights a week or more, says the National Sleep Foundation, a Washington, D.C.-based research and information group.

Sleeping just half an hour less than you need – which can vary from six to nine hours for individuals – can make you feel less alert the next day. Without enough sleep, your ability to learn, solve problems, speak, write and react can all decline. Your immune system may not work as efficiently without sufficient rest and you may be more vulnerable to colds, flu and other viruses.

You're more likely to become tense and moody and may have trouble getting along with others. Such fatigue can not only be unpleasant, it also can be dangerous. According to the National Highway Traffic Safety Administration, sleepiness contributes to as many as 200,000 auto accidents each year.

"As the population shortens their sleep time to stay active, many are operating with significant sleep debt," says Dr. Lawrence Kline, medical director for the Scripps Sleep Clinic. "People are impaired when they don't get enough sleep, but the problem is they often don't know it. They can stay up and think they are OK, but if tested, they'd find impairments with sustained concentration."

Sleep experts evaluate the following snooze inducers.

Exercise: Working out may promote wakefulness by causing the release of nerve-stimulating hormones and elevating the body's core temperature.

"Regular exercise, especially exercise that's done at about the same time each day, can help the body stay in rhythm with the sleep/wake cycle," says Kline, who cautions against any vigorous activity within four hours of bedtime.

The temperature rise caused by working out leads to a corresponding fall in temperature five to six hours later, which makes sleep easier then. Late afternoon may be the perfect time for that three-mile run or Spin class.

Let the sunshine in: Daylight is an essential element in helping us synchronize our body clock.

Owls, or people who can't fall asleep and then have trouble waking up early, need to get their sunlight first thing in the morning. Larks, those folks who can't stay awake for "The Apprentice" at 9 p.m. and wake up very early, need to get their light in the late afternoon.

The longer the exposure to sunlight, the better. Ten minutes is better than nothing, but two hours is optimal.

"You don't need a bright sunny day. You can get all the light you need even on a cloudy day. And, you don't have to look directly into the sun. Just don't wear sunglasses," says Kline, who notes the light is absorbed through the eyes.

And, if getting outdoors at the appropriate time is impossible, try sitting next to an untinted window as the sun streams in or using a light box, available at specialty lighting stores and on the Internet.

Caffeine: The tolerance for caffeine differs from person to person. Some people can drink coffee and tea until dinner and have no problem falling asleep a few hours later. For others, a latte at lunch means a sleepless night.

Sleep experts suggest experimenting with the times you cut off your caffeine supply. If you have sleep troubles, stop drinking coffee and tea three to four hours earlier than you normally do and see if it helps.

Alcohol: Although a nightcap may help you fall asleep, it should be avoided near bedtime since it disrupts sleep, especially deep REM (rapid eye movement) sleep. Plus, it could increase the trips to the bathroom during the night.

Nicotine: Like caffeine, nicotine is a stimulant. And, when smokers go to sleep, they experience nicotine withdrawal which has been linked to difficulty falling asleep and problems waking up. Smokers may also experience more nightmares. While giving up smoking may cause additional sleep problems at first, the long-term effect on sleep and health is much better.

Foods: Pigging out at an all-you-can-eat buffet a couple of hours before bedtime probably isn't a great idea. Heartburn and digestive disturbances can cause sleep interruptions. Instead, have a nutritionally balanced dinner several hours before turning in. And, if hunger pangs start to gnaw at you, add a light bedtime snack.

Warm milk: In addition to being soothing, milk and dairy products contain tryptophan, a natural sleep enhancer. Plus, the warmth may temporarily increase your body temperature and the subsequent drop may make you a bit sleepy.

Warm bath: A warm bath not only relaxes your muscles, but it also elevates the body's temperature and then cools it down, which induces sleepiness.

However, if the bath is too hot, it can have the opposite effect.

"If it's too warm, it can raise your core body temperature enough so you're more awake than sleepy," says Ellie Hoey, senior sleep technologist at Sharp-Grossmont Hospital Sleep Disorder Center, who notes that a soak in mildly warm water about an hour before bedtime may give you drowsy results.

Warm feet/cold room: Create an environment that's conducive to sleep.

"Personal comfort is very diverse but also very important. Some people want to sleep with socks, some with one leg out of the blanket, some with pajamas, others with no clothing. Same thing with the temperature of the room," Kline says. "What's important is that you do whatever makes you comfortable enough to fall asleep."

To minimize noise and light, close the curtains, use light-blocking shades, install double-pane windows, wear an eye mask, use earplugs or a white-noise device and turn off the radio and TV.

Sleep punctuality: Establish a regular sleep-wake schedule. Get up at the same time every day of the week – yes, even on weekends – no matter how much you've slept the night before and go to bed at about the same time each night.

The bed is for sleeping (and sex): Don't read, watch TV, work or use your laptop while in bed.

"People who cut down their time in bed, sleep more and sleep more deeply," Kripke says. "We advise people who are lying in bed and can't get back to sleep, to get out of bed and do something relaxing."

Napping: Avoid daytime napping if sleeping at night is a problem. If you absolutely can't keep your eyes open during the day, take an early afternoon snooze, not lasting more than 30 minutes.

"Natural" sleep aids: While some dietary supplements such as melatonin, valerian root and kava are touted for their sleep-inducing qualities, sleep experts don't recommend them.

Melatonin is a naturally occurring hormone that helps regulate sleep. While a few small trials have found that taking melatonin pills at certain times of the day may hasten sleep, the effect is very modest.

Kline says it's not worth the risks since melatonin has been shown to be a gonad suppressant, and it can cause testicular atrophy and reduced sperm counts in men.

Limited research suggests that valerian root and kava could act as mild sedatives. However, kava can interact with several medications and impair coordination and blur vision in some people. Moreover, the optimal dosages of these products is unclear. And, since herbal remedies are not regulated, there is no guarantee of purity or potency.

Prescription sleep aids: Although the latest prescription sleep aids (Ambien and Sonata are two of the most popular) won't give you that groggy sleep hangover that many other older-style sleeping pills do, they're still not an answer to chronic sleep problems.

"The first question you should ask before using a sleep aid, is why do you need it? If you try to chemically induce sleep with an aid, then that sleep process is not a normal biological process," Kline says. "For short-term periods, a sleep aid is reasonable. But these agents are not meant to be used on a long-term basis."

http://www.signonsandiego.com/news/features/20041025-9999-1c25sleep.html