You’re exhausted, but you can’t sleep. As you toss, turn, and try to will yourself into relaxation, your thoughts begin to pinball: Did you respond to your boss’s last e-mail? You should make a dentist appointment. When was the last time you went to the gym? The pillow feels hot, and of course, your partner beside you is sleeping like an angel (if angels’ snores are louder than chain saws, that is).
Sound familiar? According to the National Sleep Foundation, 48 percent of Americans report occasional insomnia, and 22 percent say they experience it every or almost every night. Crankiness is the least of the negative effects. Insufficient sleep is also associated with hypertension, obesity, diabetes, depression -- even car-accident fatalities. Individuals who don’t get enough sleep may also be more likely to suffer from cognitive decline.
Unfortunately, sleep problems are especially prevalent among women. Sixty percent of American women say they get a good night’s sleep only a few nights a week or fewer, and 43 percent say sleepiness interferes with their daily activities. “Part of this discrepancy has to do with women’s roles,” says Katherine M. Sharkey, a sleep researcher at the Alpert Medical School of Brown University, in Providence, Rhode Island. Mothers, most often, are the ones who respond to a crying child at 3 a.m. But physiology plays a role, too: Women report that the time during the month when their sleep is most troublesome is three to six days before their period. Furthermore, Sharkey explains, pregnancy and menopause are “major milestones that promote sleep challenges.”
Yes, hormones are at least partly to blame -- especially starting around age 40. As women’s bodies enter perimenopause, the ovaries start slowing their production of both progesterone and estrogen, which help promote sleep. To make matters worse, when true menopause hits, the hot flashes caused by hormone fluctuations can wake women, who then often have a harder time falling back asleep.
It may sound like a nightmare, but don’t despair. The good news is that scientists understand sleep better than ever -- and report that getting a good night’s rest doesn’t require drugs or self-hypnosis.
The Sleep Mind-Set
Whether your insomnia is a result of hormones or horrible work stress, a consistent bedtime routine will help. “People run around all day from appointment to appointment, and then approach bedtime like they’re sliding into third base,” says Sharkey. “But falling asleep is not like hitting a switch. People need to allow themselves a transitional period before bed.” Every night, an hour or so before your target sleep time, taper off any stimulating or stressful activities (e.g., reading work e-mails!) and begin a winddown routine. It can be an evening stroll, a warm bath, meditation, or reading -- whatever you find relaxing.
Though you may have heard that a television, tablet, or smartphone before bedtime is a no-go because the screen’s light can suppress your body’s production of the sleep-inducing hormone melatonin, not all doctors forbid them. “A bit of light before bed may not be that worrisome if it is being used for relaxation and transition to bedtime,” says Sharkey. And Lois E. Krahn, a psychiatrist and sleep expert at the Mayo Clinic in Phoenix, says, “TV before bed is fine—as long as it’s not too stimulating.” If you want to read on a phone or tablet, “just dim the screen a bit,” she says.
That said, avoid the habit of sleeping next to your phone, since every ping and notification can rob you of rest. “It’s our curiosity that’s a sleep killer,” says Krahn. “If you have the urge to read every last tweet or Facebook message, leave your phone in a different room.
Another word of wisdom: Don’t try to force shut-eye. “Some patients try to combat insomnia by simply going to bed earlier,” says Sharkey. “But what happens is they end up spending more hours awake in bed and sacrificing deeper, better sleep.” Counterintuitively, setting a later bedtime will increase your body’s natural drive to rest after being awake for a long period of time, and may leave you feeling more refreshed in the morning.
Of course, a tired body falls asleep more easily. Exercise earlier in the day has been shown to improve the sleep of chronic insomniacs. As for caffeine, Sharkey recommends cutting it off by noon. And stop drinking alcohol three hours before bed.
Ready the Room
It might sound obvious, but it bears repeating: A dark, quiet room will encourage sleep, and, if you’re awakened, set the stage for falling back asleep more easily. Blackout shades, white-noise machines, and earplugs can help. As for room temperature, “it’s personal preference, but keeping it cooler is generally better,” says Krahn. A warm environment often promotes initial drowsiness, but it can sabotage sleep when the individual overheats and wakes up. Women going through menopause -- and who are susceptible to hot flashes -- may want to dress in light pajamas and keep their room cool.
Tune Out Noise
Environmental factors that are more difficult to control are the sleep habits of one’s loved ones, both human and animal. Heavy snorers can significantly disturb their bedmate’s sleep. The sufferers are usually women, and, according to one study, they can lose an average of one hour of sleep a night due to this so-called form of “spousal-arousal syndrome.” If the snoring is a consistent problem, the snorer should consult a physician, who may recommend a CPAP breathing aid or even surgery. Earplugs have helped some couples; look for versions that comfortably fit your ear canal and reduce audible decibels by a noise-reduction rating (NRR) of 33 but still let you hear an alarm clock or fire alarm.
But it’s not just humans keeping us awake. Krahn’s research has found an increase in the number of people experiencing sleep disturbances due to their pets. (She has also noted a spike in the number of patients with multiple animals.) “People feel they are being disloyal when they blame their pets,” she says. “But they need to admit that it takes a toll when your dog is whimpering all night or trying to share your pillow.” Talk to an animal behaviorist about what kind of training might help prevent such issues.
With the heightened awareness of the health benefits of sleep, marketers have been busy trying to sell the public on sleep aids that promise a good night’s rest. “There’s a giant sleep industrial complex out there,” warns Sharkey, who does not recommend any of these gadgets. “These products are often unproven and can provoke more anxiety about sleeping.”
As for medication, most doctors advise trying behavioral techniques before resorting to drugs, either over-the-counter or prescription (see Our Favorite Sleep Aids and Supplements). “Medication can definitely help when other techniques fail, but overdoing the dose is very dangerous,” warns Krahn. The best approach is to use as weak a medicine as possible. Sharkey points out that bodies eventually develop a tolerance: “After a few months, the drug stops working and the patient is back in my office,” she says. “Behavioral modification is the way to go.”