My entire life, I feel like I’ve always been a bad sleeper. I remember growing up it was always a joke in our family when we would go on road trips and have to share a bed. “I’m not sleeping with Jenni.” I was known to kick the walls, kick my bed partner, talk in my sleep, shout loudly in my sleep, and that’s just the beginning. Now that I’m older, I think I’ve kind of settled into sleeping a little bit better, but I do still suffer from what I call “sleep issues." My current one is having the worst time falling asleep. I know I’m tired. I feel tired. I’m yawning. I know it’s time for bed, but as soon as I turn out the light and nestle in, that’s when it starts. The mind racing. I start thinking about work the next day, my daughter, did I turn on the dishwasher? So many thoughts, so many minutes of just lying in the bed not falling asleep. Is it stress? Am I just a bad sleeper? HELP! To get to the bottom of these and other questions about sleep and insomnia, I reached out to Karthik Kanagarajan, MD
, and Jennifer Krumpelbeck, CNP
, from The Christ Hospital Physicians - Sleep Medicine
Are there any tricks to falling asleep faster if it takes me a long time? Dr. Kanagarajan & Jennifer:
Tricks to falling asleep include starting and maintaining a sleep routine and practicing good sleep hygiene by doing or not doing the following:
- Fixed bed and wake-up times are important and should not vary more than 30 minutes, even over the weekends. Do not nap after 3 p.m.
- Avoid caffeine after noon. Some are more sensitive to caffeine than others and may have to stop even earlier.
- Turn off your phone, tablets, TV, or computer 1-2 hours before bed. The blue light that these devices emit can cause a decrease in Melatonin release in your brain and thereby result in difficulty falling asleep. Using orange glasses or keeping the background light dim on the tablets or phones might help.
- Avoid larger meals close to bedtime.
- Do not exercise within 3 hours of sleep. Practice relaxation techniques at bedtime such as muscular relaxation, yoga etc.
- Higher bedroom temperatures are associated with longer time to fall asleep. Keeping the bedroom cool, dark, and quiet is very important.
Can stress and anxiety (especially during the pandemic) impact my sleep?Dr. Kanagarajan & Jennifer: Yes. Almost every patient we speak with now has insomnia (difficulty falling or staying asleep). With the COVID-19 pandemic we also have an epidemic of insomnia that we call COVID-somnia. The disruption in daily life due to social distancing, school closures, quarantines, working from home, etc., all causes stress and anxiety that can lead to trouble sleeping.
What are some other causes for insomnia?
Dr. Kanagarajan & Jennifer: Insomnia can be a primary cause on its own, but common causes for insomnia include:
- Sleep-related disorders like sleep apnea, restless leg syndrome, stress and anxiety
- Chronic pain
- Seasonal allergies causing cough and congestion
- Bladder problems that causes frequent urination
- Certain medications - Excedrin, prescription diet pills, steroids, beta blockers, nasal decongestants that contain stimulants, thyroid hormones, some antidepressants and some asthma inhalers that have stimulating effects.
Studies have also shown that long term Marijuana use can impair sleep by reducing REM sleep time.
If wake up in the middle of the night, what should I do?Dr. Kanagarajan & Jennifer:
If you have trouble falling back asleep, then practice the "half hour rule:. If you do not fall back asleep in 20-30 minutes, go to another room and engage in a quiet, relaxing activity. Reading a pleasant book might lull you back to sleep. Do this until you feel drowsy for 30 minutes, then return to bed. Again, do not turn on tablets, phone, e-reader or TV.
If you wake up close to your planned time to get up for the day and you feel refreshed, then it's a good idea to go ahead and get up.
How much sleep should an adult get every night? Dr. Kanagarajan & Jennifer:
Sleep requirements vary between individuals and we don’t believe in the eight-hour sleep myth promoted by pharmaceuticals and some sleep scientists. Pre-industrial hunter/gather societies slept approximately six and a half hours per night and had almost no heart disease, diabetes, or obesity. People who live the longest sleep, on average, five to seven hours each night. High mortality rates are linked to those who sleep longer than nine hours a night. As long as if you feel refreshed the next day after a good night sleep, don't pressure yourself to sleep for a specific amount of time; this might increase stress and anxiety that impair sleep.
I love to nap! Are naps good for you? How much of a nap is too much?Dr. Kanagarajan & Jennifer:
A short nap of 20-30 minutes is usually recommended. A nap can improve short-term alertness, enhance performance and reduce mistakes and accidents. We prescribe scheduled naps and caffeine for narcolepsy patients, shift workers and drowsy drivers. Inspite of these benefits, napping is not for everyone. Longer naps (>20-30 minutes) or napping late in the day can affect night time sleep and cause or worsen insomnia.
Is snoring a sign that I have a sleep issue? Does everyone snore?Dr. Kanagarajan & Jennifer:
Everyone snores occasionally. But loud, habitual snoring is often associated with a sleep disorder called Obstructive Sleep Apnea (OSA). Other signs that indicate you might have OSA include: excessive daytime sleepiness, fatigue, difficulty sleeping at night due to gasping for air, restless sleep, frequent urination at night and morning headaches.
What are some signs that I need to see someone for my sleep issue? Dr. Kanagarajan & Jennifer:
Restless sleep, difficulty falling asleep and staying asleep lasting more than few weeks, feeling always tired and exhausted, excessive daytime sleepiness, or loud habitual snoring as mentioned above, might indicate there is an underlying sleep issue that you need to see someone for help.
What are some treatment options for sleep issues?Dr. Kanagarajan & Jennifer:
Treatment options for sleep issues vary depending on the diagnosis. If your insomnia becomes a pattern, we recommend CBT-I ( Cognitive Behavioral therapy for Insomnia), which is a first-line therapy that not only includes behavioral changes, but also we add a "thinking" component about overall expectations regarding your sleep to help treat insomnia. In studies, if you have OSA, we might recommend a CPAP (continuous positive airway pressure) machine to treat. We treat Restless Leg Syndrome (RLS) with medications, and look for iron and B12 deficiency that might contribute to RLS. Narcolepsy is a disorder that causes significant sleepiness in young adults that can be diagnosed and treated with medications as well.
What are your thoughts about Melatonin? Is it habit forming, and do you have to take more over time in order for it to work?
Dr. Kanagarajan & Jennifer:
Melatonin supplements are generally considered safe and non-habit-forming. However, it’s important to know when you take it, what problems you are taking it for and how much to take. Melatonin is a "hormone of darkness" signaling the brain to fall asleep and it doesn't itself make you sleep, so it works great for sleep disruption resulting from circadian rhythm issues like jet lag and shift work. For this, we would recommend 0.5-1mg two to three hours before bed time. For people with insomnia it does help to reduce the time to fall asleep and increase overall sleep time. We would recommend taking not more than 5mg 30 minutes before bed time for this. Sleep is so important to our overall wellbeing. I don’t know about you, but when I have a great night’s sleep it definitely helps me get through the day. Since, I’ve always been such a horrible sleeper, I am hopeful the tips and possibly Melatonin will help me to become a regularly well-rested person. If you’ve been having trouble falling asleep or think you may have a sleep issue, learn more about how The Christ Hospital Sleep Medicine program can help.