Have you ever longed to “sleep like a baby?” Not the ones who wake up all night! Who doesn’t dream of drifting off to sleep with soothing lullabies, blissfully unaware of life’s headaches. If you struggle with nodding off or staying asleep, you are not alone. Neuroscientist Michael Walker in Why We Sleep: Unlocking the Power of Sleep and Dreams, says we are the only species who procrastinates over going to bed. How can a seemingly simple task become more a challenge than a super-power? About 50-70 million Americans suffer from a sleep disorder or deficit- myself included. Countless articles and books have been written on this topic. But have you ever pondered an overnight sleep study? You might want to first tweak your sleep routines before attempting such an ordeal. Perhaps my adventures in a quest towards a better night’s sleep will help motivate you.
Sleep is a sensitive subject for me, having wrestled with it since my early 30s. I likely had an undiagnosed disorder long before. I was continually dozing off in school and church. Or more dangerous locations like the bathtub or the back of a motorcycle. At one particularly trying time of insomnia, I was so discouraged about sleep that I put adoption plans on hold. I asked the agency to remove my introductory letter and photo pages from the selection book of waiting families. Since I was having such trouble dozing myself, I wondered how I’d raise a baby and get them to snooze through the night. Little did I know, a birth mom had already chosen my husband and me. And the sleep deficit that resulted from having a newborn improved my sleep!
In fact, building a sleep deficit is one of the strategies that sleep professionals use to help improve sleep quality. (You gradually reduce your sleep time by 15 minutes at either end of the night. Depending on whether you are a night owl or an early bird. This eventually makes sleep more productive, or as they say in sleep lingo, improves your sleep efficacy.) But before getting to the advanced sleep strategies, let’s review the top ten typical pointers recommended by health care professionals. The good news is, as evidenced by my sleep studies over the years, is that we usually get more sleep than we think we do. And along the way, I have learned that sometimes rest is almost as good as sleeping. Even on a rough night, I must trust that I will get enough sustenance for each day.
Sleep Hygiene 101
- Keep a consistent sleep schedule or bedtime and wake up-time.
- Create a bedtime routine that signals your brain you are about to go to sleep.
- Avoid food/alcohol two hours before bed, work three hours before and screen time, one hour.
- Add room darkening shades, turn down the heat, remove electronic light sources.
- Use sound-muffling or soothing devices like fans or air purifiers to cut noise.
- Journal, write down worries, meditate, take baths or other calming activities.
- Get some sunshine during the day and create an exercise routine.
- Restrict lengthy daytime naps and use the bedroom only for sleeping.
- Create a comfortable, decluttered sleep environment. And keep the clock away from the bed.
- If you are awake over 20 minutes, get up a while and return to sleep (hard for chronic insomnia)
And, of course, avoid caffeine several hours before bed. Some sleep experts say to avoid it five to ten hours before, Whereas, my husband can consume caffeine like a nightcap and still have no trouble sleeping. However, I notice the effects immediately and require half a day for it to fully leave my system. After a long night of fragmented sleep, I wracked my brain to see what could have triggered such a relapse. Suddenly I thought to check the new Bigelow Spearmint tea box I had just purchased. Typically, I drink their herbal Mint Medley Spearmint version, but I had decided to try the new “Perfectly Spearmint” flavor. It contained up to 60 mg of caffeine- almost as much as a cup of coffee!
Mattress commercials will say upgrading your mattress is the ticket to a better night’s sleep. But sometimes, it is not the mattress but the foundation. I once was ready to ditch my sloping mattress, after waking up frequently with a sore back. I stiffly eased down to peer under the bed and saw that some of the bedframe screws had loosened. They were no longer attached to the frame, causing the support slats to sag. A quick repair fixed that problem!
Sleep Improvement Strategies
Many articles focus on what NOT to do before bed. But we also need to consider what we can do in the daytime, to keep us less frazzled at nighttime. Building more buffers in the day, with less dashing from one thing to the next, helps me. Programs like Sleep Reset that offer monthly coaching programs, where you log your sleep and watch short video clips, can be helpful. A coach will work with you online, to decipher daily patterns and habits and analyze where the breakdown is occurring. It is all about changing old habits and developing and maintaining new ones. Typically, it takes up to eight weeks to establish new habits.
In sleep therapy programs, coaches follow guidelines for CBT-I Cognitive Behavioral Therapy for Insomnia, the gold standard for sleep improvement. Whether you have difficulty falling asleep, or staying asleep, coaches can tweak a personalized plan that works best for you. Or you can choose support groups to change behaviors groups surrounding sleep, if group therapy is your thing. Personally, I was too much of an empath to hear insomnia horror stories while trying to solve my own problems.
My husband could make sleeping a hobby, as he enjoys it so much. He needs lots of shut-eye to function best; he retires to bed at 10 o’clock and rises at 6:30. However, he would still catch up on weekends, as if perpetually sleep-deprived. And the walls practically shook from his snoring. Eventually I convinced him to be tested for Obstructive Sleep Apnea (OSA). This is a condition where you stop breathing for periods of ten seconds or more. And even up to a minute or two! It is normal for your airways to relax and collapse during sleep, up to five times per hour. But if the episodes last too long, or occur more frequently, it can be a sign of sleep apnea.
Sleep Apnea Treatment
Years ago, I led a sleep apnea support group for PAMF, a major medical group. Ironically, I was the only one who had not yet surrendered to using a CPAP machine, the gold standard of treatment. It stands for Continuous Positive Airway Pressure, and it delivers a continuous stream of air. This prevents the airways from collapsing and disrupting your sleep. Masks at that time were very restrictive and I suffered from claustrophobia. Whenever I tried strapping on the full-face mask before, it felt like I was launching into orbit. And the smell of the silicon rubber and sound of the hose distracted me from sleep. Now they offer less-confining mask options from Dreamwear, which resembles a cushion under your nose. There is an attachment on top of the strap, to connect the hose: like a snorkel poking from your head.
While my first sleep study revealed I had mild apnea, I also had many more breathing interruptions of shorter duration. This can result in the same kind of sleep deficit. Eventually, I coaxed my husband to have a sleep study as well, and he was diagnosed with moderate to severe apnea, where he stopped breathing up to 36 times per hour! (Moderate is considered, 15-30 times per hour, and severe is 60-100 episodes!) When you spend more time not breathing than breathing, one wonders how the brain functions in the daytime! Or how people manage to stay alive, when not breathing for up to two minutes at a time. People who snore may joke about their noisy nocturnal habit, but it’s no laughing matter when people can die of apnea. Now we both resemble unicorns in bed, but we do sleep better.
When is it time to seek help?
The night my husband once awoke gasping for air, was when he finally surrendered to a sleep study. Upon hearing about the amount of choking and coughing he did in the night, the sleep doctor sent him home with a home monitor. She did not even bother to have him come in for a monitored study, she was so certain he had apnea. He did the easier at-home version. How my husband could remain a brilliant engineer and teacher with a witty pleasant personality, I do not know. But I eventually convinced him to get tested and treated for sleep apnea. This made it less necessary for him to sleep in for so long on weekends. According the American Medical Association, about 30 million Americans suffer from apnea, but only about 6 million are properly diagnosed with the condition.
I was the more typical patient who became irritable, gloomy, and scattered on subpar sleep. When a colonoscopy procedure starts looking like a good way to catch up on sleep, you know you need help! As I felt less and less like my happy, energetic self, and my normal efforts to induce sleep no longer worked, I turned to the professionals. An Ear Nose Throat specialist confirmed my facial anatomy could contribute to sleep apnea. He recommended a sleep study to this rule out. For those of you who have never had the fun experience of an overnight sleep study, these are not for the faint of heart. (Judging from the amount of over-the-counter sleep aides available on the market today, clearly I am not alone with sleep issues.) However, few willingly commit to such an unpleasant sleep intrusion as a monitored study, unless desperate for relief.
The Most Uninviting Sleep Center
I reported dutifully to the unmarked back door of the sleep center at the appointed hour. At precisely 7 pm, I hit the button 3 times as directed. It felt rather clandestine, as if I was embarking in a form of illicit activity. A woman in a white coat came to fetch me and she led me silently to my room, with barely a greeting. The bed was really a cot, with a scratchy wool, military-style blanket on top. And a sheet of plastic that crinkled when you sat down. No mint or fluffed up bathrobe awaited me on the pathetic pillow; this was no night at the Ritz! The nightstand contained an intimidating tangle of wires and electrodes. A few posters with exit instruction and flu prevention tips provided the sole decorations. The only color in the place came from the flaming red hair of the technician.
In a thick Russian accent, she ordered me to disrobe. And then fill out one of the endless sleep survey forms sleep doctors always want to see. (They are fascinated with the time you go to sleep, awaken, return to sleep, and rise. Yet, they always advise not to look at the clock.) I had barely completed it when she returned with a tube in hand. “Are you ready” she asked, rolling her Rs. “For what?” I asked nervously. “To measure reflux,” she announced in a no-nonsense tone, as she attempted to insert a tube down my throat and into my esophagus. She thoughtfully placed a bucket nearby and draped me with a plastic sheet, should I start to gag and hurl. After several failed attempts, she mercifully abandoned her efforts. And then proceeded to snake wires and sensors down my legs and secure patches to my skin and skull.
It is not surprising that a few cowardly souls had ditched this dreary den before attempting to spend the night. Not only did I have the no-nonsense tech waiting in the next room, but had cameras and microphones strategically mounted around the room, monitoring every snore and twitch. I carefully eased back into the bed, taking my tangle of wires with me. It was only 8:30 pm and I typically went to sleep between 11 and 11:30 pm. I was ordered to sleep. There was no nightlight provided, so I had only the digital clock on the thermostat for entertainment. The brochure mentioned a call-button, but there was none in sight. So, if I needed something, I could only call out into the darkness, hoping someone would respond. A fan droned from side to side, rustling papers in its wake. At 2:30 am, I begged the tech to unplug it.
Sleep Study Results
While my breathing interruptions were not super lengthy, the sleep study revealed that I had many interruptions throughout the night. I was diagnosed with upper airway restricted breathing (UARS), sleep apnea and fragmented sleep. And all the strategically placed sensors and electrodes confirmed that I had severe restless leg syndrome- 300 leg movements in five hours. Thankfully this is less of an issue today, perhaps due to the iron supplements and B12 injections I took for a while, or maybe my frequent long bouts of exercise calmed my restless legs! My sleep was also fragmented, and I had minimal time in the deep restorative sleep stages.
Sleep Cycles
We typically cycle through a series of different sleep stages several times a night. These progress from partial alertness to increasingly deep NREM (non-REM) sleep, until we achieve REM sleep (Rapid Eye Movement). Everyone spends different lengths of time in each sleep stage and typically completes four to six cycles a night. We all have a sweet spot of optimal time spent asleep, and have our own 24-hour circadian rhythm of wake-sleep cycles. Not everyone functions best at a magic number of eight hours of snooze time per night, but most sleep experts recommend at least eight hours. Travel, night shifts, new time zones, daylight savings time, or stress can all disrupt this cycle.
People with sleep apnea reach deep levels of sleep less often-leaving less time for muscle repair, learning and memory formation. And it leads to more fatigue or brain fog on waking up or throughout the day. A drowsy drive back from a triathlon, two hours from home, finally made me resort to using a CPAP machine. These rigorous athletic events require you to waken at ridiculous hours and plunge into frigid water to swim, then bike and run various distances. But once the adrenalin of racing wears off, fatigue can set in. I was catching a catnap in a parking lot off the freeway, and who should pull up next to me, but a CPAP Machine salesman. It felt like divine intervention.
Eventually I upgraded to a BiPAP machine, which provides a variable pressure and adjusts to your inhale AND exhale, unlike the more commonly used CPAP machines. It took some experimenting and acclimating, and a second sleep study to tweak it (while wearing the machine), but it was worth the effort. I initially felt like I had to catch my breath to match the rhythm of the machine, but now I find it oddly calming. Isn’t that true for many things that are ultimately good for us?
Change is Possible!
We resist, when change feels hard, and try to do things our way. And we tend to fixate on one source of the problem. Perhaps the biggest culprit is a loss of confidence in our ability to change. If we think we cannot sleep, we may bring on the very thing we fear. It is normal to wake up at night; the key is to not get too hyper-aroused and anxious. Now, when I can’t sleep, I don’t count sheep: I pray for all the countries and people who need prayer, starting from A-Z. Or Z-A. Sometimes we need to be brought to our knees, to take the next step towards better health. Or in my case, a parking spot next to a CPAP salesman. What is holding you back from achieving the rest you deserve?
