Sleep problems are an endemic challenge in our culture. When we don’t get enough sleep (for adults, 7 – 9 hours each night is optimal) experts say that we are at risk for all kinds of health problems including weight gain, increased risk of heart disease and high blood pressure, greater anxiety, depression, and irritability, and a general depletion of joy.
In the last couple of months, the NY Times posted a series of articles about sleep problems that occur throughout the life cycle (links below). For those who don’t want to read the articles, I offer here a list of suggestions the Times cited, except for one that wasn’t developed adequately enough but which affects 22 million Americans and one I have experienced personally that has made a substantial difference in my life.
There are many reasons for a bad night’s sleep. Stress and our inability to manage it effectively make getting a good night’s sleep difficult. According to The American Institute of Stress, about 33 percent of people report feeling extreme stress. 77 percent experience stress that affects their physical health. And 73 percent have stress that impacts their mental health (see statistical details at https://www.stress.org/stress-research). Managing stress is a complex matter, and I’m not addressing that here except to say how important it is that we get help in managing it for the sake of our physical, mental, emotional, and spiritual well-being.
Here is the list of suggestions cited in the NY Times articles that I gleaned from the numerous articles published. I spell out the last one in more detail because I believe that most of us know little about it:
- The room in which we sleep should be cooled to 60 to 65 degrees F (15 to 18 degrees C). This cooling effect helps us achieve the restorative stage of sleep known as slow-wave sleep or REM sleep (Rapid Eye Movement – Not getting enough REM sleep can affect mood, memory, and the ability to learn).
- Develop a night-time routine (i.e. get into bed consistently at the same time each night).
- Avoid eating large meals within three hours of sleep, though a bedtime snack is fine.
- Alcohol might enable you to fall asleep quickly, but drinking often leads to fragmented sleep.
- Don’t consume caffeine after 12 noon as it can linger in the brain for 8 to 10 hours at sufficient enough levels to disrupt sleep.
- Avoid aerobic exercise close to bedtime.
- Limit your water intake in the hour or so before bedtime to avoid having an overactive bladder, a condition in which many have the urge to urinate more frequently.
- For older adults, take appropriate caution when using drugs and supplements for sleep, as many sleep medications have side effects, one of which is falling.
- Block out 30 minutes to relax and wind down before bed. Avoid scrolling on the IPhone before falling asleep or reading a book on an IPad.
- Darken the room and/or wear an eye-mask to cut out extraneous light that triggers the body’s natural production of melatonin.
- Remove “blue light” devices from the bedside, and turn-off cell-phones and IPads (see for a description of “blue light” – https://www.webmd.com/eye-health/blue-light-health).
- Do something calming such as reading a book, meditating, or knitting.
- If you find yourself unable to fall back asleep, don’t stay in bed. Try going to a different place and do a calming activity, such as reading a few pages of a print book or trying a brief meditation until you are ready to return to sleep.
- Women have issues around sleep that men do not have (see article links below).
- Find out if you suffer from Obstructive Sleep Apnea (OSA) – The word “apnea” comes from the Greek word for “short breath.”
If you do all or most of the above and nothing works, schedule an appointment with a physician who may direct you to a pulmonologist, an MD who specializes in the respiratory system from the windpipe to the lungs.
The NYT articles note a condition that afflicts far more Americans than most people realize:
“Middle age is when many people develop sleep apnea, an often un-diagnosed disorder that involves snoring, choking and gasping throughout the night. Those with sleep apnea may wake up with headaches and feel drained and depleted even if they got enough sleep. In some instances of sleep apnea, the muscles in the head and neck relax during sleep, leading to an obstruction of air through the windpipe; in others, the brain doesn’t deliver the signals necessary to prompt the body to continue breathing during sleep. A few risk factors can predispose people to sleep apnea, including regularly drinking alcohol, obesity, and family history.”
Obstructive Sleep Apnea (OSA) afflicts 22 million Americans. The OSA rate significantly increases as we age. Ten percent of men age 30-49 are so afflicted and 3 percent of women in the same age range are likely to have OSA. Seventeen percent of men and 9 percent of women age 50-70 are likely to be afflicted. Fifty-six percent of people age 65 and over have a high risk for OSA.
When I was first diagnosed with OSA 25 years ago in my late 40s, I was prescribed a mouth-piece that brought my lower jaw forward and opened my windpipe. That sufficed, or so I thought, to address the problem over the long term. Wrong! As the years passed, I felt consistently tired regardless of the number of hours I slept. I figured that full-time work as a congregational rabbi was the source of my ongoing weariness. After I retired four years ago, however, I still felt tired no matter how much I slept (6 to 8 hours each night).
Two years ago my physician suggested that I ought to talk with a pulmonologist. He suggested that I take a home state-of-the-art sleep test. As it turned out, I had a “severe sleep apnea condition,” as he described it. My sleep was interrupted 48 times every hour. In each incident, I stopped breathing for 10 to 15 seconds (8 to 12 minutes hourly – 56 to 84 minutes per each night’s 7 to 8 hours of sleep).
The lack of oxygen I was denied during those times when I stopped breathing caused me to awaken automatically in order to resume my breathing normally, until the next interruption a little more than a minute later. All this was happening without my conscious knowledge.
Researchers say that sleep apnea may raise the risk of high blood pressure, onset diabetes, heart disease, and stroke. My pulmonologist explained that during every one of the 48 episodes per hour that I stopped breathing for 10 to 15 seconds, my brain was not receiving oxygen and my brain cells were dying. I was also not getting any adequate REM sleep. Was it any wonder why I always felt tired, even after getting 7 hours of “sleep?”
OSA has a number of causes – obesity and alcohol are chief among them. However, I’m not over-weight nor do I drink. I stopped consuming (most days) that 3rd cup of coffee in the early to mid-afternoon. I walk 3-4 miles daily, am in fairly decent shape, do not experience any of the stress I once had as a congregational rabbi, and follow the advice spelled out above as suggested in the NY Times. I take daily my share of medications (some do cause sleep problems), and always do what my doctors tell me – otherwise, why go to them?
When my pulmonologist told me that I had severe OSA and that the best way to address it was to use a CPAP machine (“Continuous Positive Airway Pressure”), I resisted because I didn’t want to wear a mask or be hooked up to the machine with an air-hose, nor did I want to experience the blowing of air into my nostrils and mouth all night long. He explained that CPAP is very quiet and it blows air continually (without my being aware of it) through my nose and mouth and down my wind pipe effectively stopping my snoring, eliminating the vast majority of hourly events (from 48 to an average of 5), restoring REM sleep, and normalizing oxygen saturation levels in my blood and brain. He said that CPAP would address effectively my sleep problem and I would get used to it.
He was right. Not only do I no longer snore or snort, the machine is exceptionally quiet and I’m now used to wearing the mask. The result is that I sleep 6-8 hours every night and average 5 incidents per hour, down from 48 (as already noted above). A monitor tells me each morning how many hours I slept hooked up to CPAP and how many incidents occurred. The monitor is linked to the internet so my physician can monitor exactly how well I’m doing. Most mornings, assuming I get at least 7 hours of sleep, I feel rested. To those whose partners complain about your snoring and you feel tired no matter how much you think you slept and how many of the items listed above you do, perhaps a visit to a pulmonologist and taking a sleep test is warranted. Check with your physician.
I hope that some of the above will help you get a better night’s sleep. We all need it in order to help manage the stress in our lives and to experience more positive energy and joyfulness.
In conclusion, I offer a few of my favorite quotations about the blessing of sleep:
“Sleep that knits up the ravell’d sleeve of care, / The death of each day’s life, sore labour’s bath, / Balm of hurt minds, great nature’s second course, / Chief nourisher in life’s feast.” –William Shakespeare, Macbeth (2.2.46-51)
“This is thy hour O Soul, thy free flight into the wordless, / Away from books, away from art, the day erased, the lesson done, / Thee fully forth emerging, silent, gazing, pondering the themes thou lovest best, / Night, sleep, death and the stars.” –Walt Whitman, final poem in the section “From Noon to Starry Night” in the seventh edition of Leaves of Grass (1881)
“The breath of my life / will bless, / the cells of my being / sing / in gratitude, / reawakening.” –Marcia Falk, The Book of Blessings, (San Francisco: Harper, 1996), p. 154.
Melissa Kirsch, July 7, 2023 “Sleep Changes with Age” – https://www.nytimes.com/2023/07/08/briefing/sleep-changes-with-age.html
Dani Blum, July 7, 2023 – “Sleep Better at Every Age” – https://www.nytimes.com/interactive/2023/07/07/well/live/sleep-better-age.html, Dani Blum
Lisa L. Lewis, June 19, 2023 – “Why do Women have more Sleep Issues than Men,” https://www.nytimes.com/2023/06/13/well/women-sleep-issues-hormones.html
More articles are listed here – https://www.nytimes.com/spotlight/sleep