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According to sleep experts, I'm doing everything wrong. I don't have a regular bedtime and often stay up way too late. There's always one more TV show to watch, one more e-mail to send, one more newspaper article to read. By the time I finally crawl under the covers it's after midnight, and even then sleep sometimes eludes me. Some nights I toss and turn and fluff and re-fluff pillows for what seems like hours, in search of that sweet spot for slumber. All too soon the alarm clock jolts me out of a pleasant dream. In a fog of fatigue, I hit the snooze button over and over, desperate to catch a few more zzz's.
That's my version of our national exhaustion epidemic. Sixty percent of American women sleep poorly most nights of the week, and 43 percent are so drowsy during the day that it interferes with normal activities, according to a 2007 poll by the National Sleep Foundation (NSF). Weariest of all are working moms. Not only do these women spend the least time in bed -- averaging fewer than six hours a night -- they're also the likeliest to suffer from insomnia. Stay-at-home moms don't get off so easily, either. They are likely to complain of waking frequently at night and not feeling refreshed in the morning.
The NSF poll paints a grim picture of the toll insufficient shut-eye takes on virtually every aspect of women's lives. Sleep-deprived women are likelier to be stressed-out (79 percent), late for work more than once in the past month (20 percent), and too tired for socializing (39 percent) or sex (33 percent). They fight daytime drowsiness with caffeine and do nothing special to wind down at night. In fact, frazzled moms typically spend the last hour of the evening multitasking -- finishing chores, squeezing in some time with their spouse and kids, catching up on work -- often while also watching TV.
A hectic lifestyle can sabotage sleep, says Carol Ash, DO, director of Sleep for Life, in Hillsboro, New Jersey. "A lot of my patients lie awake at night with racing thoughts. They're exhausted but their brain just won't stop humming. As they toss and turn they get increasingly anxious about not sleeping, which only makes the problem worse."
Stress isn't the sole reason for restless nights. Misunderstanding what helps -- or hinders -- slumber also plays a key role, according to Dr. Ash. But sleep problems can be solved -- in many cases without pills. The following surprisingly simple natural solutions work by enhancing your body's own mechanisms for lulling you into soothing, satisfying sleep.
Light, especially sunlight, has such a potent effect on your body's internal clock, or circadian rhythms, that you can use it to reset your sleep cycle, says Phyllis C. Zee, MD, PhD, director of the Sleep Disorders Center at Northwestern University. "If you tend to be a night owl who can't get to sleep until 1 a.m., you may have delayed circadian rhythms. To shift to an earlier schedule -- and make it easier to get to bed and get up on time -- soak up as much sunlight as possible between 6 and 8 a.m." Force yourself to wake up early and sit in a sunny room or take a post-sunrise walk. When it's warm, try eating breakfast outdoors. Basking in early-morning rays prompts your body to suppress production of melatonin -- the sleep hormone -- during the day and release it earlier in the evening, so falling asleep isn't such a struggle. A light box of the type used for people with seasonal affective disorder can help. "Look for one with broad-spectrum light and with a UV filter," recommends Dr. Zee.
Though it's known that exercising within three hours of bedtime can leave you too wired to slumber soundly, a recent study by Dr. Zee finds a place for evening workouts. Exercising at least three times a week around 5 to 7 p.m. helped people improve their sleep. It may be that working out then creates a pleasant tiredness that helps the body prepare for sleep. Or it could be that exercise helps women unwind after work or a hectic day at home with the kids and they feel less stressed when they curl up under the covers.
"Your body is primed to sleep when it's dark," says Marcel Hungs, MD, PhD, director of the Center for Sleep Medicine at the University of California, Irvine. "I encourage patients to dine by candlelight and turn down the lights in their home starting around 7 or 8 p.m." Avoid surfing the Web or checking e-mail close to bedtime, because the glare from the computer screen can stimulate your brain instead of letting it slow down for slumber. And turn off the tube at least half an hour before you go to bed, adds Dr. Hungs. "Many people doze off with the TV on, only to find themselves wide awake later in the night," he says. "That's because the bright, flashing images and noises are mentally stimulating on a subconscious level." The better bedtime wind-down choice: read (something printed on paper, not an e-book).
One common mistake is keeping the alarm clock next to the bed, says Dr. Ash. "Then you wake up at night and check the time. Seeing that it's 2 a.m. or 4 a.m. only heightens your anxiety about not sleeping." She also cautions about the glow from the dial. "Even that little bit of light can signal your brain that it's time to get up." Instead, turn the clock to the wall, drape a towel over it, hide it under the bed, or find one without a lighted dial or glow-in-the-dark numbers.
Many studies suggest that valerian, a mild sedative herb sold over the counter as capsules or tea, improves sleep and helps people nod off quickly. But most of these studies didn't use a sleep lab and aren't considered conclusive proof of efficacy. It can take up to four weeks of nightly use to get the full benefit. Valerian is considered relatively safe for short-term use -- up to six weeks. The usual dose is 300 to 900 milligrams, taken 30 to 60 minutes before bed. It's not recommended for pregnant women or nursing mothers and can cause headaches, dizziness, or upset stomach. Another drawback: Some find its odor reminiscent of dirty socks.
Some fragrances can waft you into slumber, says Cherie Perez, RN, who teaches aromatherapy at Houston's M.D. Anderson Cancer Center's Place of Wellness. "Lavender is helpful for insomnia, stress, and migraines, while myrrh calms the mind and prepares you for sleep." Put a couple of drops of either oil on a handkerchief, then tuck it inside your pillowcase. Also use lavender for bath oil (see "relax in the Tub"): Mix two cups of Epsom salts with 15 drops each of lavender oil and orange (sedative/anti-anxiety) oil.
Soaking in warm water can ease the transition into sound sleep -- and not just because it relaxes tired muscles. It also triggers a shift in body temperature, a natural cue it's time for shut-eye, explains Rubin Naiman, PhD, the Tucson-based author of Healing Night: The Science and Spirit of Sleeping, Dreaming, and Awakening. "When the sun goes down, the outside temperature falls, and the same thing happens inside our bodies to prepare us for sleep. After you climb out of a hot bath, you feel a pleasant chill. With the right timing, you can catch that wave and ride it into deep, blissful sleep."
When you wake up at 3 a.m., it helps to have prepared relaxing activities ahead of time, says Dr. Ash. Put these in the next room:
Why These Help "The back-and-forth movement of your eyes as you knit, sew, read, or write helps trigger neuro-controls for sleep," says Dr. Ash. The sound of soft music is relaxing. "Go back to bed the minute you feel drowsy, not before. You want to teach your brain that the bedroom is a calm, comfortable environment for rest."
To avoid back or neck pain, elevate your head only one pillow high. "You want a pillow firm enough to hold your head and neck in alignment with your spine, just as they would be if you were standing up," says Jeffrey Goldstein, MD, director of Spine Service at the NYU Hospital for Joint Diseases.
Feathers, Fiberfill, or Foam?
Feathers Down, the fluffy undercoat of a goose or duck, is the softest, most expensive filling. For more support, choose a mixture of down and feathers or all feathers (firmest). Goose feathers are almost as fluffy as down, with curved quills that add spring. Duck feathers cost less but are less buoyant.
Fiberfill This polyester product is soft, pliant, and moderately priced but may lump during laundering.
Foam This makes the firmest pillow and comes in various shapes, including contoureds to cradle your head and neck. "Memory" foam molds itself to the shape of your head for extra comfort.
A Note About Allergies
"Hypoallergenic" synthetic pillows may not be the best choice -- unless you're allergic to feathers. British studies show feather pillows offer notably better protection from dust mites and pet allergens than synthetics do.
Firm or Soft? Depends on Your Sleeping Position
Back Sleeper Medium-firm pillows bolster your neck without flexing your head forward.
Side Thick, firm pillows give the best support.
Stomach Softer, flatter pillows prevent neck strain.
Pillows for Special Situations
Heartburn Wedge-shape slanted cushions raise the esophagus higher than the stomach, preventing the upward flow of stomach acid that causes this problem when you lie flat. Hot Flashes Choose a pillow that dispels heat; these brands usually have cool or chill in the name.
Some tasty ways to bring on zzz's:
Sometimes called a sleeping pill in a peel, this fruit is rich in tryptophan, an amino acid linked to healthy slumber, says Elisabetta Politi, MPH, RD, nutrition director at Duke Diet & Fitness, in Durham, North Carolina. "Tryptophan increases serotonin in your brain and blood, which can improve relaxation." Other good sources include dairy products, turkey, peanut butter, and tofu.
Relax with Rice
Eating jasmine rice four hours before bedtime helped people doze off more quickly, according to a small 2007 study in Australia. Other starchy foods, such as potatoes or cereal, also do the trick, adds Politi. "A lot of my clients say that when they're stressed out, pasta helps them sleep better, which makes sense because carbohydrates can raise serotonin."
Combine Unsweetened Carbs with Protein
A high-carbohydrate, low-protein snack seems to help the brain use tryptophan efficiently, so it produces more sedating serotonin. Try apple slices with peanut butter, a small bowl of oatmeal with low-fat milk, or crackers topped with slivers of turkey. Don't overdo the protein before bed, since foods like meat or cheese also contain tyrosine, an amino acid that can rev up brain activity.
Melatonin supplements are marketed as sleep aids, but how well they work depends on your needs, note researchers at Brigham and Women's Hospital, in Boston. If study subjects got melatonin at night, when their bodies naturally produce the hormone, the extra dose had no effect. But taken during daylight hours, it increased shut-eye by about 30 minutes, suggesting that it could be helpful for people who work the night shift or are jet-lagged after crossing several time zones. Potential side effects include headaches, stomach discomfort, and dizziness.
Women who slept five or fewer hours a night were 32 percent more prone to major weight gain (33 or more pounds) and 15 percent likelier to become obese over 16 years than those who got seven hours a night -- even though the seven-hour sleepers actually ate more -- according to the Nurses' Health Study, a long-term study tracking 68,183 women. Research shows insufficient sleep can increase levels of the appetite-stimulating hormone ghrelin and boost blood glucose and prediabetes risk.
Myth: If I didn't sleep well last night, I should catch extra zzz's whenever I can.
Why It's False: "Getting up three hours later gives you jet lag, like flying from new York to L.A.," says Jack Edinger, PhD, of Duke University Medical Center. So don't take a nap or sleep in on weekends.
What Is True: Naps can be healthy if you don't have insomnia. If you do they'll make it worse by leaving you less tired at night. No matter how tired you are, don't nap, and always get up at your regular time.
Myth: Everyone needs eight hours of sleep; I don't sleep that much so I must have insomnia.
Why It's False: Worrying about insomnia can make it harder to sleep -- or get back to sleep if you wake up in the middle of the night.
What Is True: Anywhere from six to nine hours is normal. If you feel rested, don't worry about how much shut-eye you're getting. And know that an occasional sleepless night is not harmful and doesn't mean you have a serious issue.
Myth: Even though I can't sleep, lying in bed at least provides some rest.
Why It's False: "Spending a long period lying awake in bed can make your bedroom feel like a torture chamber, as you get more and more frustrated about not sleeping," says Dr. Edinger.
What Is True: If you wake up for longer than 15 to 20 minutes, get up, go to another room and do something until you feel sleepy (see "Your Anti-Insomnia Kit"). Then go back to bed. This teaches you to associate sleepiness with bed and gives you tools to resolve your problems.
Myth: I know I won't be able to sleep tonight.
Why It's False: This expectation makes you anxious, setting you up for a bad night and a vicious cycle of expecting the worst and therefore being unable to relax while in bed.
What Is True: Knowing you will get up and do something enjoyable if you can't sleep helps you stop associating being unable to sleep with anxiety and unhappiness.
Originally published in Ladies' Home Journal, March 2008.