Sleep deprivation: A public health epidemic
If you’ve mastered the art of falling asleep but tend to wake up in the middle of the night, you’re not alone. According to the Centers for Disease Control and Prevention, an estimated 50 to 70 million adults report waking or sleeping disorders.
Too little sleep can set you up for depression, diabetes, high blood pressure, heart attacks, stroke, and car accidents, says Meeta Singh, MD, medical director of the Henry Ford Sleep Lab in Columbus, Michigan.
You’ll likely feel lousy the next day, too. A 2017 study in The Journal of Pain found that just two nights of fragmented sleep was enough to make women super sensitive to pain. And a 2015 study in Perspectives on Psychological Science tied lack of sleep with bad moods, feelings of distress, poor work performance, and less engagement at work.
To prevent fragmented sleep, first determine what’s causing it. We’ve asked experts to explain possible triggers and how to sleep through the night.
Why sleep is important
As adults, we keep hearing that we need seven to nine hours of sleep a night—uninterrupted sleep at that.
Sleep is when “the brain starts to organize the millions of thoughts we have every day, the sensory input, the feelings, the emotions. The brain shuts off from rest of the world and does internal maintenance,” explains Randall Wright, MD, director of the Houston Methodist Brain Wellness Center at The Woodlands. “Anything that disrupts that process can manifest as problems down the line. There are real-time consequences.”
Causes of fragmented sleep
Waking mid-slumber doesn’t always mean you have a problem. “Occasionally, waking in the middle of the night is not necessarily an issue,” says Dr. Singh. “However, if a person frequently wakes up at night, they should try to address this.”
Getting to the root of the problem is the key to fixing it. And it’s extra important if you have trouble drifting off again.
Any number of things may be waking you: a full bladder, pain, anxiety, your partner’s snoring, or a nightcap before you hit the sack.
Then there’s age. Older adults spend less time in deep sleep and more in light sleep, which means they’re more easily wakened. And older adults may be more likely to deal with sleep disruptions like a full bladder. “As we get older, more people have an issue with nocturia, or having to urinate frequently in the middle of the night,” says Lauren Broch, a psychologist with Northwell Health Sleep Disorder Center in Great Neck, New York.
You can’t change your age, but you can adjust many lifestyle factors to get a better night’s sleep.
Tips for sleeping through the night
Consider your sleep environment
Take a look around your bedroom. Do you sleep in a hot room illuminated by a 24-7 street light and filled with the sound of rushing traffic? If so, it would be surprising if you didn’t wake up. Other things likely to keep you up at night: lumpy pillows, a bad mattress, and uncomfortable bedclothes.
“Make sure you are sleeping in an environment that is comfortable and conducive to sleep,” says Broch. Ideally, your bedroom will be dark and quiet, with a comfortable temperature (usually on the cooler side). If you can’t do anything about noise, try an app for white or gray noise to drown out the sounds, she suggests.
Limit bedroom activities
Your bedroom isn’t an all-purpose area for watching TV or hanging out. Let your body know that sleep happens in the bedroom by limiting the other activities you do there. “Make your bedroom a sleep sanctuary,” says Dr. Singh. “Reserve it for sleep, intimacy, and restful activities such as meditation and reading for pleasure.”
Watch how you spend pre-sleep hours
What you do before bed can affect how well you sleep. Drinking, exercising, and eating right before you hit the sheets can mess with your sleep. Large, rich, or spicy meals in particular can trigger acid reflux, making it harder to sleep. Try to abstain from all three for about four hours before retiring.
Caffeine is also a no-no before bed since it can keep you awake. Skip the alcohol, too. “Alcohol can make you sleepy when you first drink it, but three to four hours later, it becomes a stimulant,” says Dr. Wright.
It goes without saying that you shouldn’t smoke before bed (or anytime). Exercising is great, but don’t work out right before bedtime.
Turn off your computer
Dimming lights in your bedroom before sleep is a good start, but it’s not enough. You need to put the computer and any other electronic equipment to bed as well. In fact, they should go to bed earlier than you: about two hours.
“The brain is the only organ that really takes its cues from the external environment and reacts to that,” explains Dr. Wright. It is sensitive to light. Phone, tablet, and laptop screens emit all blue light, which sends a signal to the brain that it’s time to wake up. It throws off your circadian rhythm.
Some devices allow you to adjust or block the blue light or try filters for your devices that block the blue light. Or read a print book or magainze instead.
If you’re bothered by light you can’t control (say, a street lamp), consider blackout curtains.
Check your schedule
“Keeping regular sleep and wake hours is essential,” says Broch. “If someone sleeps another three hours on the weekend, that will contribute to problem sleeping during the week, especially at the beginning of the week.”
As much as you may hate the idea, go to bed and wake up at the same time every day of the week. And factor in some time to unwind before you hit the sack.
Napping can also interfere with continuous sleep. It’s best to avoid naps, especially in the afternoon or later.
This is where physical activity earlier in the day comes in handy. Study after study has shown that exercise not only reduces stress but also helps you sleep well. Adults should get at least 150 to 300 minutes of moderate-intensity aerobic activity every week, according to the Office of Disease Prevention and Health Promotion.
A 2018 study in Sleep Research Reviews has shown that resistance exercise specifically can ease anxiety and depression and benefit sleep.
Other ways to relax include meditation, yoga, and progressive muscle relaxation. If you’re still having trouble, consider cognitive behavioral therapy for insomnia (CBT-i). “It’s reteaching people how to fall and stay asleep,” says Dr. Singh.
Review your medications and underlying health conditions
Antihistamines, beta-blockers, alpha-blockers, and antidepressants all can interfere with good sleep, especially if you take them close to bedtime, says Dr. Singh. If you think one of your meds is to blame for your fragmented sleep, you may need to make an adjustment. Remember to always check with your doctor before discontinuing any medications.
Certain medical conditions also affect sleep: nocturia, sleep apnea, pain and movement disorders such as restless leg syndrome, periodic limb movement disorder (PLMD), and rapid eye movement (REM) sleep behavior disorder. If you have any of these conditions—or think you might—see a health care professional.
What to do if you wake up during the night
Even without an identifiable reason, waking up during the night happens. One of the worst things you can do is stay in bed, watch the clock, and worry about not getting to sleep again. Instead, after about 20 minutes, get out of bed and find ways to wind down without turning on a device or working.
“Go somewhere nice and dimly lit, and then you can take out your book, preferably not your iPad, and read something boring, then return to the bedroom only when you feel sleepy again,” says Dr. Wright. “If you stay in the bedroom, you develop anxiety and the bedroom becomes a source of stress.”
And don’t sleep in the following today. Instead, try to stick to your normal schedule.
When to talk to your doctor
“I tell people that there are four main reasons why you should talk to your doctor and get a referral to see [a sleep specialist],” says Dr. Singh. The first is if you snore or gasp for air while you sleep. This could be a sign of sleep apnea, which, left untreated, can raise your risk for hypertension, heart attack, and stroke.
You may want to see a specialist if you continually have a hard time falling or staying asleep, you feel tired during the day (another possible sign of sleep apnea), or if you can’t perform your daily activities because you’re so tired.
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