If you’re reading this article, it’s because you’re having a hard time sleeping. Rest assured (pun intended!), you’re not alone. Roughly 60 million Americans (and many of my clients) regularly struggle with sleep (1).
I’m not a doctor. However, I, too, have struggled with sleep. In my lifetime, I’ve had trouble getting to sleep in the first place, staying asleep, and even getting good quality sleep. In fact, because of my own challenges sleeping and seeking answers for myself, I became somewhat of a layperson-expert on sleep. I created this resource to help my clients and readers who find sleep challenging.
Why Sleep Is Important
Sleep is restorative. It’s great for your body! Sleep can help you move faster and improve hand-eye coordination (2), and improve overall physical performance (3). Good sleep also helps reduce risk of Type 2 Diabetes (4, 5), stroke, and cardiovascular disease (6).
Sleep is good for your brain. It’s beneficial for cognitive processes, productivity, and general performance (7). When you get better sleep, you’re likely to make fewer mistakes (8) But when you don’t get enough sleep, the cognitive and motor impairments you’ll experience are similar to alcohol intoxication (9). Sleep can help your memory (10, 11) and problem-solving (12).
A good night’s sleep can help you lose weight, too (and a bad night’s sleep can help you gain weight). Research from all over the world shows that short sleep duration leads to increased risk of obesity (13, 14). Sleep may be a significant regulator of body weight and metabolism (15). Good sleepers even tend to eat fewer calories (16).
Finally, poor sleep is strongly linked to depression (17). In fact, 90% of people with depression complain about their sleep quality (18), and lack of sleep is even associated with an increase in risk of death by suicide (19).
So…sleep is pretty important.
Common Reasons Why We Struggle with Sleep
There are many reasons why sleep is a challenge, ranging from health challenges to environmental and lifestyle choices. Many factors impact our circadian rhythms, the 24-hour regulatory cycle that tells our bodies when to go to sleep, wake up, and eat (20).
Sleep and Medical Conditions & Medications
Heartburn, gastroesophageal reflux disease (GERD), diabetes, heart failure, musculoskeletal disorders (like arthritis), fibromyalgia, kidney disease, nocturia, thyroid disease, breathing problems, mental disorders, and neurological disorders can all lead to sleep disruption.
Additionally, if you’re taking medication to help with high blood pressure, alcohol withdrawal, smoking cessation, asthma, cough, cold, allergy, and flu, headaches, ADHD, or hypothyroidism, it’s possible that your medication may be impacting your sleep. Some medications can create insomnia, nighttime awakenings, nightmares, disrupted REM sleep, increased nighttime urination, muscle cramps, difficulty falling asleep, and fragmented sleep (21).
Sleep and Anxiety & Depression
Anxiety, panic attacks, and depression can all cause sleep disruption, and may create difficulty falling asleep, trouble staying asleep, and feeling rested after sleep (21). Many of my clients are “expert ruminators,” and that means you’re staying awake at night, cycling through repetitive, anxious, worry-filled thoughts. If that sounds familiar, then a) remember the many times I’ve mentioned that rumination isn’t a productive exercise, and b) your rumination may be impacting your sleep cycle.
Sleep and Stress
Stress and stressful events can lead to sleep disorders (22). In fact, stress is linked to shorter and lesser sleep than normal. There are many reasons why stress may be linked to poor sleep. First, stress leads to increased levels of cortisol in the blood – a hormone that the brain uses to signal the body that it is in distress. Second, stress tends to create a state of “hypervigilance” in the brain, overwhelming the sleep response (23). Third, stress tends to lead to rumination (see above).
Sleep and Aging & Hormones
Nearly half of women in perimenopause and menopause report trouble with sleep. Peri-menopause and menopause can cause significant sleep disturbances, either due to hot flashes and night sweats (24), an increased need to urinate during the night, stress, or changes in levels of estrogen and progesterone (25). As well, when one partner is experiencing sleep disruption, the other partner will likely also experience a sleep disruption, because you’re moving around, getting out of bed, and generally disturbing one another.
Men tend to become more responsive to the stress hormone, corticoliberin, as they age, which may lead to sleep disturbances (26).
Additionally, as we age, we produce less of the hormone that promotes sleep, melatonin, thereby affecting our circadian rhythms (27). Sleep apnea and movement disorders like periodic limb movement disorder and restless leg syndrome also are more prevalent in older adults, and all of these conditions can significantly impact sleep quality and quantity (28).
Sleep and Diet & Alcohol
Your diet can impact sleep as well. Some studies have shown that short sleepers eat more fat and snacks than longer sleepers (29). Low intake of vegetables and high intake of processed sugars (and general overall eating habits) have been associated with poor sleep quality (30).
Caffeine can obviously interfere with your sleep, spicy and acidic foods (and caffeine and alcohol as well) can lead to heartburn and GERD/acid reflux, which are exacerbated by lying down, and this can lead to sleep disturbance, too (31).
Around 20% of Americans drink alcohol to help them sleep, and indeed, alcohol does help you fall asleep. Unfortunately, alcohol ingestion before bedtime also leads to significant interruptions of circadian rhythms (blocking REM sleep and leading to poor sleep quality) and can result in waking up in the middle of the night. Alcohol also aggravates GERD/acid reflux, can contribute to breathing problems, increased nighttime urination (32).
Sleep and Screen Time & Technology
Did you ever notice that during the time when you’re supposed to be sleeping, night time, it’s usually dark outside? That’s because exposure to light or to darkness is a major factor in regulating your circadian rhythms (33).
Technology is an increasing concern with sleep, as we are more and more tied to our phones and computers. It’s very common for people to spend evenings watching TV, working on a computer, or looking at their phones. Unfortunately, the blue light emitted by TVs, computers, and mobile devices like phones and tablets has been shown to suppress production of melatonin, making it harder to fall and stay asleep (34).
These devices also keep your brain alert. If you’re watching a dynamic, thrilling movie or TV show, for example, your brain is on high alert as the action unfolds. Social media and email keep your brain engaged, tricking it into thinking it needs to stay awake (34). Finally, if you keep text and email notifications and calendar reminders on during the night, these beeps and rings will undoubtedly disturb your sleep.
Strategies for Improving Your Sleep
Obviously, there are many reasons why you may struggle with sleep, but don’t give up hope! There are lots of ways to improve your sleep situation.
Please check with your doctor before trying any of these suggestions.
Visit Your Doctor to Get Help Sleeping
First, visit your doctor and see if s/he has any recommendations for you. This should be your first stop anyway, to see if any of the suggestions below are a good idea for you. Remember, I’m not a doctor, so you should definitely make sure you check with your doctor before taking my advice (or any advice from the internet and/or Dr. Google).
Sleeping pills may be an option, however some have side effects like daytime sleepiness, confusion, memory disturbances, hallucinations, headaches, dizziness, and some can be habit-forming (35).
You may want to consider acupuncture as an alternative, as a recent controlled clinical trial in China showed that acupuncture was a more effective treatment for insomnia than some popular sleeping pills, and acupuncture has no side effects at all (36) (unless you hate needles, I guess, though the needles used are really fine).
For women in menopause, hormone replacement therapy may be an option that helps with many menopausal symptoms, including the hot flashes and night sweats that cause sleep disruption, but also general sleep quality as well. HRT is controversial, and seems to have both risks and benefits that you should discuss with your doctor (37). Women may also find a system like the BedJet to be of great assistance in regulating body temperature at night.
Sleep and Melatonin
Melatonin is a natural hormone that plays a role in sleep. Production of melatonin in the brain increases during the evening and decreases in the morning. Studies suggest that it’s helpful with some sleep disorders, and seems to help with insomnia and onset of sleep, particularly extended-release melatonin (38). Side effects of melatonin are uncommon (39).
Sleep and Meditation & Progressive Body Scan
One of the easiest ways to help with problems falling asleep is with meditation, which has been shown in clinical trials to be significantly effective in helping with insomnia, depression, and anxiety (40, 41). Mindfulness meditation in particular appears to be a solid option when it comes to sleep (42, 43), but progressive body scan is also effective (44).
There are several apps to help with this, but my favorite is the Calm App because it offers both guided and quiet meditations, as well as progressive body scans and “Sleep Stories,” which offer a relaxing distraction from the “noise” in your head.
Sleep and Exercise
Yoga, Tai Chi, and Qi Gong are all considered to be useful and effective strategies to help with sleep (45). You may want to avoid vigorous exercise before sleep, if you find that exercise makes you more alert, however, it’s not necessarily counterproductive to exercise before bed (46).
Sleep and Dietary Adjustments
Generally, to improve sleep, you’ll want to eat more vegetables and limit your intake of processed sugars and carbohydrates (50). Fish consumption seems to have a positive impact on sleep in general (51), and interestingly, kiwifruit may improve sleep onset, duration, and efficiency in adults with self-reported sleep disturbances (52). Additionally, a tart cherry juice has modest beneficial effects on sleep in older adults with insomnia, with effect sizes equal to or exceeding that of valerian (a common herbal remedy for insomnia) and melatonin (53, 54).
Avoid caffeine for four to six hours before bedtime (wean yourself slowly, otherwise you can expect headaches). You’ll find caffeine in coffee, tea, soda, chocolate, and some over-the-counter medications (58).
You may also want to consider avoiding nicotine, as it is a stimulant. Try avoiding it at least 30-45 minutes before bed (59).
As discussed earlier, alcohol can make you drowsy, but in fact, it can severely impact your sleep cycle, block REM sleep, and interfere with ability to get restful sleep. Avoid alcohol for two to three hours before bed (60).
Finally, you may also consider avoiding consuming beverages after 8 PM, so that you reduce the times needed to get up during the night (61).
Sleep and Blue Screen Filters
Our screens (TV, smartphones, tablets, etc.) tend to mimic sunlight, decrease melatonin production, and stimulate your brain (62, 63). Remember, the research indicates that blue light exposure at night may be linked to cancer, diabetes, obesity, and heart disease (64, 65). And a single hour of blue light exposure can suppress melatonin up to 71% (66).
One way to improve sleep is to expose yourself to more bright light during the day, boosting your ability to sleep at night, as well as improving your mood and alertness during the daylight hours. You probably also want to avoid looking at bright digital screens for two to three hours before bed (67).
You may want to consider a carotenoid supplement, which may help to strengthen the eye’s natural ability to block blue light, but as always, talk with your doctor before taking any supplements (68).
Much has been made of blue light filter apps that are intended to filter out the blue light emitted by our screens. However, recent research suggests that these apps don’t actually help alleviate the melatonin suppression problem (69), so you might think of blue light filtering glasses…except there’s uncertain science behind these as well (70).
The better and most reliable choice is to just decrease exposure throughout the day, and also try to remember to blink more frequently when you’re staring at your devices (71).
How much sleep do I need?
Generally, it’s good to get somewhere between five and eight hours of sleep at night. This timeframe is associated with lower mortality rates, meaning that those who sleep less than five hours a night or more than eight hours a night have much higher rates of mortality than those who keep their sleep within the five to eight hour window (72).
Despite earlier thinking that sleep isn’t a “bank” that you can replenish, current research indicates that it’s the average amount of sleep that you get that’s important – it seems like you can compensate for poor sleep during the week by catching up during the weekend (72).
While this research suggests that we can make up for lost sleep during the week, you’ll feel better overall if you set your biological clock by creating some regularity and routine (73). Going to bed at the same time at night and getting up at the same time in the morning every day will help create a routine, so that you no longer have to fight your brain and body as they act confused (and groggy) during the week.
Nighttime Sleep Routine
Consider a relaxing nighttime routine. Give yourself time to unwind. An hour before bedtime, don’t rush around – brush your teeth, wash your face with warm water, set the mood for relaxation (74). A warm shower or bath before bed raises your body temperature, so that as you cool down, your circadian rhythm is signaled to begin making you sleep (75).
Minimize excitement like thrilling TV shows, stressful emails, and try to restrict the time when you’re in bed to the time when you’re sleeping. Try to avoid watching TV, listening to the radio, eating, or reading in bed (76).
Sleep and Room Temperature
The temperature of your bedroom can have an impact on your sleep. If the room becomes uncomfortably hot or cold, you’re more likely to wake up or impact your REM sleep. However, what’s comfortable for one person isn’t always comfortable for another. General recommendations call for somewhere between 65 and 72 degrees Fahrenheit (77), but you may want to play around with temperature to find what’s best for you.
For women in perimenopause and menopause experiencing hot flashes and night sweats or couples who have different ideas about what’s comfortable, a device like the BedJet system may help ease temperature challenges.
Bedding, Mattresses, Sleep Position, and Pillows
If you have an uncomfortable mattress or pillow (or the wrong ones for how you sleep), you won’t sleep well. Choose a mattress based on how you sleep (stomach, side, back) as well as on the various pain points you personally experience (neck, back, and hips being the most common). Ignore marketing about “soft” or “medium firm” and find what works best for you. Test drive a mattress thoroughly before you buy it by lying on it in the position in which you actually sleep. Many manufacturers now offer in-home trials that give you the opportunity to thoroughly assess a mattress (78).
Back to temperature for a moment, bear in mind that memory foam may run hotter than other kinds of mattresses (79). Additionally, some linens are designed to help with temperature regulation and some are more effective than others.
Side sleeping is considered to be the healthiest sleep position (but not if you can’t sleep that way, obviously) (80).
As many as 20 million Americans are allergic to microscopic dust mites (83), and they’re particularly problematic for people with asthma (84) . Washing your pillows, sheets, and bed coverings regularly in hot water can help rid your linens of dust mites. As well, you can consider “allergy-proof” pillow and mattress covers to contain them (85).
Sleep and Darkness
You’ll want to dim the lights as you get ready for bed. Turn off bright lights, so that you ease into your nighttime routine and aid your brain’s production of melatonin. Hide digital clocks and glowing electronics, and if light from the street shines through, consider a sleep mask or blackout window shades (86).
- Sleep is critical for long-term health, longevity, productivity, sound decision-making, and mental health.
- Many of the reasons why we don’t sleep well are easily modified.
- Check with your doctor before trying any of the suggestions below.
- Begin preparing for sleep 4-6 hours ahead of time by stopping caffeine consumption.
- 2-3 hours before bed, turn off electronic devices (at least turn off all of the notifications and noises; you can set a “Do Not Disturb” feature so they come back on the next day, if you insist), or just stop looking at them.
- Stop consuming alcohol 2-3 hours before bed, nicotine 1 hour before bed, and try not to drink beverages after 8 PM.
- Relaxing exercise, dimming lights, or a warm shower/bath before bed will help get your brain and body oriented toward sleep.
- Consider improving your diet, and reducing overall fat and processed sugars. Added fish and some supplementation may help.
- Check your bed – would a new mattress, pillow, or linens help you sleep better?
- Check your bedroom – are there “light leaks” or extra glows from electronics that may be interfering with sleep? How’s the temperature of the bedroom?
- Talk with your doctor about melatonin supplementation. Extended-release melatonin is over-the-counter, but may interfere with some medications.
- As you fall asleep, consider meditation or progressive body scans.