Does the question "How'd you sleep?" make you want to scream? Those of us plagued by middle-of-the-night waking often feel like punching people who don't know what it's like to stare at the ceiling in the wee hours. Here are the five most common types of middle-of-the-night sleep problems, and what to do about them.
Problem #1: You're awake for no reason, with your mind spinning.
Middle-of-the-night worrying is probably the number-one type of sleeplessness faced by people of all ages. And boy, is it frustrating. You know you need to relax and get back to sleep, but anxious thoughts and to-do list items keep popping into your head.
What to do
1. Preserve the darkness. 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 inside.
2. Move the clock out of reach. Constantly checking the clock and calculating how long you've been awake only feeds your anxiety: "Oh no, now I'm only going to get five hours of sleep." Set the alarm, then move the clock where you can't see or check it.
3. Write it down, then let it go. On your bedside table, keep a notebook and pen devoted solely to nighttime "worry lists." Using a dim night-light, write down each thought that's bothering you. Then, after you write it down, make a conscious effort to cross it off the list in your mind. In the morning, transfer the action items to your to-do list. Over time, you'll develop faith in yourself that writing down your worries equates with getting them done.
4. Breathe and ease. In his book The Worry Solution, anxiety specialist Martin Rossman recommends a three-step approach to sleeplessness that really works. First, do "belly breathing," which means breathing deeply enough that your diaphragm rises and falls. Next, isolate each part of your body, from your feet up to your neck, by tensing and relaxing it. Finally, imagine yourself in a favorite place, such as lying in the sun on the beach. Use all of your senses; imagine that you're hearing the waves and smelling the salt air. If it doesn't work the first time, do all three steps again in the same order.
What to Do When Bathroom Trips Interrupt Your Sleep
Problem #2: You wake up to use the bathroom and can't get back to sleep.
Whether it's once a night or over and over, popping awake to use the bathroom disrupts your sleep cycle and cuts into your restful REM sleep. The best solution for this problem, officially called "nocturia," is prevention. If you don't wake up in the first place, you won't lose those precious zzz's.
What to do
1. Drink liquids by day but not at night. If you stay well hydrated during the day, you can get away with not drinking in the evening. Experts in nocturia recommend cutting out all liquids after 8 p.m., and by 7 p.m. if you're an early-to-bed type. Most types of tea -- black, green, or white -- are diuretics, so no tea after late afternoon. Herb teas are usually fine until 8 p.m., but check the ingredient list for dandelion, which is also a diuretic. And resist that after-dinner glass of wine; alcohol has a twofold effect on sleep, making you have to go and stimulating your central nervous system.
2. Talk to your doctor about bladder problems. If you suffer from overactive bladder, the sudden need to go is going to jar you awake. Ask your doctor about bladder retraining, physical therapy to strengthen pelvic floor muscles, and other treatments.
3. Guys, seek help for prostate problems. When the prostate is enlarged, it blocks the flow of urine, resulting in the need to go, often in small amounts. This condition, also called benign prostatic hyperplasia, is worth seeking help for.
4. Watch out for hidden liquids. Don't eat foods with high liquid content, such as soup or fruit, for three hours before bed. If you're having soup for dinner, make it an early meal.
5. Ask the doc about a prescription. If nighttime urination is your only problem and lifestyle strategies don't work, a prescription antidiuretic called desmopressin might be the solution. A recent study by the American Urological Association found that the drug doubled the amount of sleep time between bathroom trips.
Problem #3: Pain wakes you up.
Chronic pain of all kinds is one of the most common sleep disrupters; between 60 and 90 percent of people who suffer from some type of chronic pain sleep poorly, studies show. Mild pain can have as profound an effect on sleep as extreme pain -- yet many people don't take pain's effect on sleep seriously.
What to do
1. Manage pain proactively. Chronic pain and lack of sleep can quickly become a vicious cycle, each worsening the other. Even more problematic, once pain is strong enough to wake you up, it's harder to treat. Pain management experts stress the importance of treating pain just as it starts or taking preventive pain control medications. Migraine sufferers can benefit from preventive medications such as beta-blockers; arthritis and fibromyalgia sufferers can get long-term relief from the tricyclic antidepressant nortriptyline, which is prescribed off-label to block pain signals.
2. Don't take naps. People in pain often get into a problematic pattern of not sleeping well at night and then taking long naps during the day because they're tired. But you need sufficient "sleep debt" to trigger sleepiness and relaxation when it's time to go to bed. Experts suggest avoiding naps altogether or, if that's not possible, limiting them to less than 30 minutes and taking them before 3 p.m.
3. Distract with reading. Many people find that reading works to soothe them back to sleep by taking their mind off the pain. However, reading can also backfire if you get caught up in your book and read too long, use an overly bright light (tricking your brain into thinking you should be awake), or read something too exciting or disturbing. Instead, choose a book that's easy to read in small installments and isn't a page-turner, and keep it handy for those times when you find it hard to fall back to sleep. Some people find books of quotations, poetry, or simple meditations useful for this purpose.
Distractions and digestion
Problem #4: Your environment won't let you sleep.
Light, sound, temperature changes, and vibrations all have the effect of putting your body on alert. Recent sleep studies have shown that even when subjects don't fully awaken from exposure to stimuli, they experience "microarousals" that disrupt sleep.
What to do
1. Block street noise with white noise. Planes, trains, and automobiles all can disrupt your sleep. If the rumble of streetcars, the whine of leaf blowers, or the snoring of your dog is a problem, try soothing your ears with white noise. Some people prefer wave machines or CDs of nature sounds, while others find that oscillating fans work just as well. And of course, you can always wear earplugs.
2. Make darkness your friend. Check your bedroom for any light source that could be disturbing your sleep. Use blackout curtains or shades to block streetlights, or use a double layer with shades underneath and curtains on top. (There's a reason hotels do this.) Put tape over the small lights from smoke detectors and appliances and charge laptops, phones, cameras, and other devices in another room. Use an alarm clock without a lighted dial, or cover it with a scarf. Instead of nightlights, keep a mini flashlight next to your bed and use it when you have to get up.
3. Keep your cool. Heaters that turn on and off during the night are a major sleep disruptor, and an overly warm room isn't conducive to deep sleep. Oddly, though, many people need to feel warm to fall asleep. So what to do? Turn the heat down, but use an extra comforter or blanket that you can toss off as you warm up.
4. Check the house for creaks. If a door routinely wakes you when it opens, oil the hinges. If the floor above your room creaks, put down a rug. You may feel a little silly making a big deal about house noise, but it beats wearing earplugs all the time -- or yelling at family members.
Problem #5: Your digestive system won't let you sleep.
A growling stomach can wake you -- and your partner -- and heartburn or gas can leave you lying awake in misery. Then there's gastroesophageal reflux disease (GERD), which can disrupt your sleep without your realizing it. (You might wake with a sour taste in your mouth but not know what woke you.)
What to do
1. Eat smaller, more frequent meals. This is a general remedy for heartburn, but it works wonders for most digestive issues that disrupt sleep. If your schedule allows it, eat a substantial snack in the late afternoon and then a smallish early dinner. (And no midnight snack.) It's also best not to eat for two to three hours before bedtime.
2. Eat stomach-soothing foods. Reserve burritos and your favorite spicy chip dip for lunchtime, and let evenings be spicy-food-free. Anything with chili in it is likely to give you heartburn, as is anything acidic, such as tomato soup. Also avoid fatty foods, which put pressure on the valve at the lower end of the esophagus. Instead eat lots of vegetables and high-fiber grains to keep digestion moving efficiently.
3. Strengthen your digestion. Probiotics can help with stomach upset by encouraging the growth of healthy bacteria in the intestines. Digestive enzymes are valuable for those with chronic stomach upset, which is often caused by irritation of the stomach lining. For heartburn and GERD, take calcium after meals; recent studies show it strengthens the valve between the esophagus and the stomach.
4. Sleep on your side, with a body pillow. Lying on your back is a recipe for digestive upset. If you're not a natural side-sleeper, a body pillow can help you get more comfortable. If you suspect GERD, try sleeping on the left side, which recent studies show eases pressure on the esophagus.
5. Keep antacids handy. Although you don't want to be popping digestive aids regularly, sleep is important. Keep antacids in your bedside drawer for occasional attacks of heartburn and an anti-gas medication handy for painful gas and cramping.