Can't Fall Asleep? Top 10 Fixes
Do any of these scenarios sound familiar?
You wake in the wee hours because the cat's scratching at the door or you have to use the bathroom, then you toss and turn for three hours before dozing fitfully the rest of the night.
Despite being up late the night before, you're wide awake at 6 a.m., feeling like something the aforementioned cat dragged in.
You seem to get enough sleep, but you sleep poorly, wake up irritable, and feel tired all day.
No matter how your sleep drama is playing out, chances are there's a physical problem -- or more than one -- at the root of it. The good news is, that also means there's likely a solution. Here, the top ten sleep problems and solutions that really work.
1. Middle-of-the-night waking
The bane of post-menopausal women, repeated waking in the middle of the night sabotages your sleep in two ways: It prevents you from achieving deep, restful REM sleep; and the lost hours of sleep cut into your beauty rest.
What to do: As soon as you notice this happening, take steps to prevent it from becoming habitual. (Naturally, worrying that you won't be able to fall back asleep makes it harder to sleep.)
Keep the room dark when you wake up. Keep a small book light or mini flashlight next to your bed and use it to navigate your way to the bathroom, or put a dim night-light in the bathroom and leave the door cracked, so you can find your way there. Whatever you do, don't turn on the overhead light in the bathroom once you're there.
Don't turn on the TV or computer. Nope, not even for a few minutes -- the light from the screen "resets" your internal clock, stimulating your central nervous system and making it harder for you to fall back asleep.
Don't eat unless you're truly hungry. Getting your digestive system revved up can keep you awake, so avoid snacking unless a growling stomach is going to keep you awake. Better yet, learn the foods that help you sleep as well as the foods that interfere with sleeping .
Keep a pen and paper next to your bed. If you're often kept awake by racing thoughts and worries and you tend to make to-do lists in your head, keep a pen or pencil and a small pad of paper handy and write them down. As you put each item down on paper, imagine yourself setting aside that concern. (Again, use a book light; don't turn on the overhead or a bright bedside light to write.)
Do a simple isolation and relaxation exercise. Relax methodically, starting with your feet: Tense the muscles as hard as you can, then relax each area completely. Do the same with your calves, thighs, buttocks, hands, arms, and on up. By the time you get to your neck and head, you should have banished much of the tension.
Bruxism, or Teeth-Grinding
If you often wake up with a dull headache or sore jaw, you may be grinding your teeth or clenching your jaw while you sleep, a problem called bruxism. While less talked-about than many other conditions, bruxism is actually one of the most common sleep disorders.
What to do: See your dentist for an exam. Bite problems are often a cause of bruxism, and it's a good idea to check for damage to your teeth. It's likely she'll suggest lifestyle changes, such as cutting out alcohol before bed. If you chew gum, stop -- the habitual chewing action can make it more likely you'll grind your teeth at night. Wearing a dental guard or splint at night is usually the next step for bruxism. Your dentist will fit you with a device that prevents your jaw from clenching. Other treatments include Botox injections to the jaw muscle, and a biofeedback device called Grindcare.
Circadian Rhythm Disorders
The natural internal clock that controls our 24-hour cycle of sleep and waking, circadian rhythms are easily upset by changes in schedule, and they're greatly affected by light and darkness. Jet lag is the best known circadian rhythm disorder, but this sensitive inner clock can also be disrupted by changes in routine resulting in an erratic sleep schedule.
What to do: If you suspect you have a circadian rhythm disorder, take steps to get your body onto a regular sleep schedule. Choose a bedtime and wake-up time that work for you, and follow the same routine each day, even on weekends. This can be tough for those who have to get up early during the week but like to stay up later on weekends, but do your best to craft a compromise between your work week and weekend habits. The important thing is to avoid the trap of sleeping from 10 p.m. to 6 a.m. during the week, then suddenly shifting to late nights and late mornings on the weekends. This will inevitably leave you with insomnia on Sunday night, which in turn sets you up to start the week exhausted on Monday morning.
The other technique experts advise is to stimulate your circadian rhythms with bright light and exercise during the day. Go outside for a stint of bright sunlight in the afternoon, and get some aerobic exercise each day. Helping your body feel more "awake" during the day resets your circadian clock so that your body is ready for sleep at bedtime.
Waking up in the middle of the night to use the bathroom is such a common problem it has a name: nocturia . As we get older, our bodies' ability to hold fluids for long periods decreases, thanks to a decline in antidiuretic hormones. According to the National Sleep Foundation, 65 percent of older adults have sleep deprivation resulting from waking up frequently to use the bathroom.
What to do: The best way to approach this issue is to try not to wake up in the first place. To do that, look at how often you're waking up and what's contributing to that. Men: Get your prostate checked, since inflammation of the prostate, benign prostatic hyperplasia (BPN), and prostate tumors can all cause this symptom. In women, frequent urination can go hand in hand with urinary issues such as incontinence , an overactive bladder, urinary tract infections, or cystitis. So see your doctor to be checked for these problems. Urinary tract problems, such as an overactive bladder, can be helped with Kegel exercises. Both men and women can learn these exercises to strengthen the muscles at the neck of the bladder.
It's also possible, though, that normal aging is decreasing your body's ability to retain fluids. Here are the strategies experts suggest to relieve pressure on the bladder:
- Don't drink liquids for three hours before bedtime.
- Cut down consumption of coffee and tea , which irritate the bladder.
- Don't eat foods with high liquid content , such as soup or fruit, for dinner or after dinner.
A prescription antidiuretic can cut down on nighttime urination if this is the only problem.
Not all snoring is sleep apnea, though heavy snoring is a sign that you should have a sleep test for obstructive sleep apnea. It can also be, well, just snoring. But snoring itself can interrupt sleep enough to prevent you from getting enough restorative rest.
What to do: The medical procedures used to treat snoring are fairly invasive, so try lifestyle changes first. Changes you can make to prevent snoring include:
- Lose weight. Even taking off ten pounds can eradicate snoring, experts say.
- Change your sleep position. Use pillows to prop yourself on your side, or attach a tennis ball with a rubber band to the back of a T-shirt to keep from turning over on your back.
- Avoid alcohol. The deeper initial sleep and dehydration activate snoring.
- Don't use sleeping pills or sedatives. They relax the muscles of the throat, increasing snoring.
If these aren't enough, the doctor may recommend a dental appliance (one brand is Silent Nite Snore Guard); radiofrequency ablation of the soft palate, which clears tissue out of the way; or laser-assisted uvuloplasty, a surgical procedure that removes the uvula and surrounding tissue behind the palate, opening the airways.
If your snoring is loud and uneven, erupts in snorts, or you sound like you're catching your breath or there are gaps in your breathing, these are signs of obstructive sleep apnea, the most severe type of sleep-disordered breathing. People with sleep apnea stop breathing repeatedly during their sleep because of a blockage in the mouth or throat, most commonly the soft tissues in the back of the throat, which collapse and close off.
What to do: This condition requires evaluation by an otolaryngologist, who can look at your nose, mouth, and throat to see what's interrupting your breathing and how to repair that process. You'll also need a sleep test in which your oxygen levels are measured. Often, the first treatment doctors will recommend is a Continuous Positive Airway Pressure (CPAP) device, a specially designed nasal mask that blows air directly into your airways. Studies have shown CPAP masks to be extremely effective in treating sleep apnea. However, many people don't like wearing them -- and, of course, it doesn't work if you don't wear it.
If sleeping with a mask on doesn't work for you, other options are surgery; oral appliances; and newer, minimally invasive outpatient surgical treatments. These include the Pillar procedure, which involves using permanent stitches to firm up the soft palate; coblation, which uses radiofrequency to shrink nasal tissues; and even use of a carbon dioxide laser to shrink the tonsils.
Upper Airway Resistance Syndrome (UARS)
Sort of a milder cousin of sleep apnea, UARS occurs when some type of resistance slows or blocks air in the nasal passages. The most common causes are mild nasal congestion or a tongue position during sleep that blocks breathing. Because the resistance makes it harder work simply to breathe, your body is half-waking up over and over again during the night, so you don't feel refreshed in the morning.
If you have a narrow face, small jaw, thin neck, or you wore braces as a child for overcrowded teeth, you're more likely to have UARS. If you've found over the years that you simply can't sleep on your back without waking up, it's likely that the reason is UARS.
What to do: Many people benefit from breathing strips, such as Breathe Right strips, or the nasal dilator Nozovent. Other self-care steps to try include irrigating the nasal passages with a saline nasal spray and taking a nonsedating allergy medication such as Claritin if you suspect congestion from allergies.
Ask your doctor for a referral to an ear, nose, and throat (ENT) specialist, who can evaluate whether you're a candidate for Continuous Positive Airway Pressure (CPAP), a specially designed nasal mask that prevents your nasal passages from collapsing and delivers air directly into your airway. If tongue position during sleep is causing your UARS, the doctor may recommend a dental device that pushes the jaw and tongue forward and prevents the tongue from blocking the opening to the throat.
Restless Leg Syndrome
A nocturnal movement disorder, restless leg syndrome can feel like itchiness, tingling, or prickling that makes you feel like you have to move your legs. Your legs may also move without your control while you sleep. You may or may not be aware of waking during the night, but restless leg syndrome causes sleep problems by preventing deep, restful sleep.
What to do: Ask your doctor if your restless leg syndrome might be caused by another health condition or by a medication you're taking. Diabetes, arthritis, peripheral neuropathy, anemia, vitamin B deficiency, thyroid disease, and kidney problems can all contribute to restless leg syndrome. Medications that can cause restless leg syndrome as a side effect include antidepressants, antihistamines, and lithium. Treating the underlying condition or changing medications may banish the symptoms. Restless leg syndrome has been linked to deficiencies in iron and B vitamins, particularly folate, so talk to your doctor about boosting your intake of these nutrients.
Treatment for restless leg syndrome usually involves taking one of several drugs developed for Parkinson's , such as pramipexole, ropinirole, L-dopa/carbidopa, bromocriptine, and pergolide, all of which have been shown to reduce or eliminate the muscle jerks. Some doctors prescribe Clonazepam, a benzodiazepine, to help people sleep more deeply.
Periodic Limb Movement Disorder (PLMD)
As suggested by its name, PLMD is an involuntary movement disorder. (An older name, nocturnal myoclonus , is rarely used anymore.) People with this problem experience sudden, involuntary leg movements during the night, such as kicking or jerking. The difference between this and restless leg syndrome is that, unless the kicking wakes you up, you don't know you're doing it. You don't experience the tingling and discomfort that leads you to consciously move your legs, as with restless leg syndrome. At least 80 percent of people with restless leg syndrome have PLMD, but the reverse isn't true.
What to do: See a doctor, who will likely first check you for underlying conditions related to PLMD. Diabetes, thyroid disorders, anemia, and a number of other conditions can cause PLMD. If you do have another condition, the doctor will treat it and see if the PLMD goes away. The next step is to control the involuntary movements with medication. Drugs that suppress muscle contractions work well for preventing PLMD. The doctor may also prescribe medication to help you sleep more deeply, with the idea of preventing the involuntary movements from keeping you in light sleep.
A catch-all term for the inability to fall or stay asleep, sleeplessness is -- as sufferers know -- a very serious problem. It's sleeplessness whenever something, whether it's physical pain, anxiety, or an underlying condition, prevents you from falling asleep within a reasonable amount of time or staying asleep long enough to achieve a good night's sleep.
What to do: Talk to experts about sleeplessness, and you'll be told to practice good "sleep hygiene." What this means is that you need to take your lack of sleep seriously and look at your sleep habits and physical surroundings to see what might be preventing you from sleeping well. Start with your evening habits: What do you do in the hours before bed? Eliminate late-night eating, drinking, and computer use and your chances of falling asleep quickly and sleeping soundly are much greater. Use the last hour before bed to do things that relax you, like taking a warm bath, meditating, or reading.
Next take a look at your bedroom. Is it completely dark? If not, find the light sources and eliminate them. This might mean taking big steps, like hanging light-blocking shades, or small steps, like putting duct tape over the tiny lights in smoke alarms.
Now consider noise. If a ticking clock disturbs you, buy one that doesn't tick, or use your phone. Turn clock radios and MP3 players to the wall and cover lighted screens. Lay in supplies of earplugs, eye masks, and anything else that helps screen out light as well as sound. Some people find a fan or white-noise machine is soothing and blocks out street noise. If you don't like wearing earplugs or an eye mask when you fall asleep, keep them on your bedside table in case you wake up later. Many people find they're more sensitive to light and sound in the middle of the night.
Experts also recommend using your bedroom only for sleeping and sex. If you've got papers strewn around or you bring your laptop to bed, you bring that stress with you when you go to sleep.