Good Sleep: Can It Still Be Simple?

All's quiet, yet you still can't sleep. Do you really need a NASA-designed pillow or a computerized bed to fix your sleep problems?

From the WebMD Archives

Want a good night's sleep? It is not as easy as it may seem, but fortunately, these days there are plenty of aids to help with sleep problems.

You can buy an "insomnia relief" face mask filled with sweet-smelling herbs, Forbes magazine reports. Or a specially rigged pillow that lulls you to slumber with soothing tunes. A bracelet will gently massage your wrist as you drift off.

Another option: Check into the "snoozing suites"or "catnap rooms" that are popping up around the country. These are rent-by-the-minute resting spots, so weary travelers and shoppers can catch a few winks.

Getting a good night's sleep - a perfectly natural human function -- has become quite complicated. Do we really need all these extra creature comforts to eke out some quality Zzz's?

Setting Your Sleep Goals

For sleep to be restorative, we need several "complete sleep cycles" every night, says Dalia Lorenzo, MD, instructor of neurology in the Sleep Disorders Center at the University of Miami Veterans Affairs Hospital.

"Sleep is not about just shutting your eyes and opening them in the morning," she tells WebMD. "There's stuff going on, regeneration of the brain, consolidation of memories, and that only happens if the architecture of sleep is good." By sleep architecture, she refers to the pattern of sleep cycles that one completes in a night's time.

Sleep is prompted by natural cycles of brain activity and consists of two basic states: rapid eye movement (REM) sleep and nonrapid eye movement sleep, which consists of stages 1 through 4. Each cycle lasts about 90 minutes, she explains. "You do that cycle several times night, you've had a good night's sleep," Lorenzo tells WebMD. "Anything that interrupts that pattern will cause sleepiness the next day."

Insomnia 101

Insomnia, indeed, is a complex issue in our 24/7 society, says Lorenzo. "Insomnia varies much from person to person," she tells WebMD. "Some people have trouble falling asleep. Others wake up and can't get back to sleep. When you're talking about insomnia, you need to talk about the thing that's causing the insomnia."

Continued

Insomnia takes many forms: trouble falling asleep; waking up often during the night -- and having trouble going back to sleep; waking up too early in the morning -- and feeling tired when you wake up.

Physical problems such as ulcers or back pain can cause insomnia, as can medical issues such as asthma, allergies, medications, and sleep apnea. Emotional problems like depression and anxiety can be a cause. Irritations in our sleep environment -- bothersome lights and noises, for example -- can keep us awake. So can lifestyle issues such as caffeine, nicotine, alcohol, or exercise late in the day.

Creating Your Comfort Zone

Creating the perfect sleep-inducing scenario is called "sleep hygiene" -- and it's a well-researched science, says Lorenzo. "There's a whole body of literature on how to promote sleep at the right time.

A comfortable sleep environment is an important factor in getting a good night's sleep, Lorenzo adds. After all, we're such sensitive creatures: Our comfort is critical to whether we can sleep or not. The bedroom's temperature - if it's too warm or too cold - can make it difficult to sleep, she says. "Also, hunger is very activating and can make it difficult to sleep."

Indeed, what soothes you to sleep is very personal, says Michael Twery, MD, acting director of the NIH's National Center on Sleep Disorders Research. "For children, a teddy bear may help; for adults, listening to relaxing music is a sedative. Part of being sleepy is not being alert. If you're very worried, if your sleep environment is hostile, your body will produce stress hormones that keep you awake."

That's why in a strange environment -- like a hotel -- we have trouble sleeping, he notes. "Certain smells can be bothersome for some people. Others are very sensitive to sound. Some will need white noise or a rhythmic sound to help them sleep, while another person finds those sounds annoying. We're all wired differently."

Sleep Products May Help

Eye masks have been used for decades by the sleep-challenged, Twery says. "Light on the eyes affects the biological clock in our brain, which drives wakefulness," he tells WebMD. "It's not to say we can't sleep in the presence of light, but it might make for disturbed sleep."

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White-noise generators -- which typically produce "sea wave" or "waterfall" sounds -- are aimed at stimulus control, says Lorenzo. "They produce a constant level of low noise that masks other little noises that come onto your radar at night," she explains. "They don't allow the brain to pick up on little noises that can arouse you at night."

Science has investigated how smells and sounds are connected with brain circuitry, says Twery. "But how they control sleep and wakefulness is less understood," he tells WebMD. "That doesn't mean these products don't have merit. They've probably been tested to find if there's value. These products may actually help someone sleep. It's mostly about personal comfort."

As for mattresses, comfort certainly rules. "For people with chronic pain, a good mattress is important," Lorenzo notes. "But for an ordinary insomniac, an expensive mattress won't make that much difference."

Traveling in Comfort

When it comes to sleep, "we're creatures of habit," says Russell Rosenberg, PhD, director of the Northside Hospital Sleep Medicine Institute in Atlanta. "When you're traveling, you want a sense of familiarity... sounds, smells, bedclothing. Some people travel with a modified version of the pillow they use at home."

He suggests packing a few amenities for your hotel room:

  • An eye mask to block out light. If you travel overseas, this is a must.
  • A sound-generator to mask ambient noise. "Sharper Image stores carry one that reproduces wave and babbling brook sounds," he notes. "For hard-core city dwellers, there's one with honking cars and city noises."
  • A tiny battery-operated fan. It gives you the feeling of a breeze blowing over your body -- and creates a bit of white noise.
  • A neck pillow. It supports your neck on plane flights, so you snooze without straining it.
  • A scented plug-in candle. "It doesn't have to be any particular scent ... whatever makes you comfortable," says Rosenberg.

"These days, it's hard to travel with all sorts of gadgets, but one or two might help," he tells WebMD.

Also, if you're a sensitive sleeper, ask for a room away from the main corridor and vending machines, Rosenberg advises. "Ask which side of the building faces a major road - and whether your room can be back where the garden is."

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When Snoring Is the Issue

An assortment of snoring-stiflers (oils, sprays, nasal strips) are available over the counter, says Twery. "The problem is they may decrease the snoring sound. But if the breathing problem isn't corrected, that's a potentially serious medical condition. You need to discuss it with your primary care doctor to find out what might be an appropriate treatment. You may have sleep apnea or allergies."

There are pillows with space-age foam technology that can help, Twery suggests. Actually, propping any bed pillow behind you, so you don't roll flat on your back, can help reduce snoring, he says. "When you lay on your back, your tongue relaxes, falls backward, and obstructs the airway," he explains. "Sleeping on your side may or may not take care of your snoring problem. It just depends on what causes it."

If you're seriously snoring, see a sleep specialist, doctors advise. "Sometimes people go to a primary care physician who may not pick up on sleep apnea," says Lorenzo. "These people have been snoring all their lives, waking up all their lives, what's the big deal, they think. But sleep apnea gets worse with age -- typically in overweight men.

A Nod to Sleep Drugs

Medications can provide relief from insomnia, to get your biological clock back on track, says Lorenzo. "Sleeping pills should be a short-term answer -- five to 10 days max. But there are lots of patients who take them constantly, who depend on them year-round."

"Doctor and patient need to sort out the underlying cause of any sleep problem," Twery adds. "However, for some people, these medications may be something to get them back to their daily routine."

One class of drugs, the benzodiazepines, includes Klonopin, Valium, and Restoril. A relatively new class of sleep drugs called the non-benzodiazepine hypnotics (Lunesta, Ambien, Sonata) does not have the habit-forming risks of benzodiazepines, says Lorenzo. "But if you're using those pills for a long time, it makes better sense to see if anything else can treat the insomnia... to change some bad habits," she notes.

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Natural Sleep Remedies

One simple sleep potion: A glass of warm milk. Milk contains the sleep-inducing chemical tryptophan, Lorenzo says.

Many people try herbal supplements to tame their insomnia. "My patients come to me after they've tried valerian and chamomile tea," says Lorenzo. Some studies have suggested that valerian can help promote sleep, but it is not FDA-approved. Chamomile is commonly used and considered safe by the FDA.

Melatonin has shown great promise, Lorenzo says. Melatonin is a hormone the body naturally produces at night and is thought to help initiate sleep. Melatonin supplements have been available in health food stores for quite awhile, but they are not FDA-approved, so their purity and safety are not known, she notes.

A medication which works on the melatonin system, called Rozerem, was FDA-approved last year, Lorenzo tells WebMD. Rozerem works by stimulating the body's melatonin receptors. "Clinical studies have shown that it helps with insomnia. Since it doesn't work at all like sleeping pills, we won't have any dependency issues."

Research has shown that melatonin prompts brain neurons to regulate the biological clock, Twery says. "The advantage of melatonin is that it comes from natural sources. Synthetic melatonin brings purity and better safety in terms of accurate dosage. That's a nice step forward. However, the research hasn't fully worked out details about long-term use of synthetic melatonin."

What else can lull you to sleep? Getting regular exercise (no more than three or four hours before bedtime, so your body temperature has time to come back down, says Lorenzo). Relaxation and meditation can tame intrusive thoughts and tension. Acupuncture is used in traditional Chinese medicine to treat insomnia.

But if you think you have a chronic sleep problem, go to your doctor, Twery tells WebMD. "Discuss the nature of your condition. A doctor can look at your overall health and offer solutions that might work more completely. It can be very hard to sort these issues out and may take several visits to come up with the solutions."

Published March 6, 2006.

WebMD Feature Reviewed by Michael J. Breus, PhD on September 06, 2007

Sources

SOURCES: Wells, M. "The Sleep Racket." Forbes.com, Feb. 27, 2006. WebMD Feature: "The Power of Napping." http://www.webmd.com/content/article/99/105154.htm Select Comfort Sleep Number Bed. Dalia Lorenzo, MD, instructor of neurology, Sleep Disorders Center, University of Miami Veterans Affairs Hospital. Michael Twery, MD, acting director, National Center on Sleep Disorders Research, National Institutes of Health. Russell Rosenberg, PhD, director, Northside Hospital Sleep Medicine Institute, Atlanta. WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Insomnia." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Sleep Disorders." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Tips on Getting a Good Night's Sleep." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Causes of Sleep Disorders." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Drug Treatments." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Alternative Sleep Treatments."

© 2006 WebMD, Inc. All rights reserved.

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