Rest-Assured

Ask any new mother or harried executive: Lack of sleep can be torture. The more sleep a person loses, the more he or she worries about not being able to sleep, being tired in the morning, and not being able to produce at the office, on the golf course or in the classroom. Those dark, solitary hours spent tossing and turning in bed are often our peak anxiety times, when we worry about money, our health, a wayward child, an ailing parent, or, if you’re like me, melting glacial ice and starving polar bear cubs.

Dr. Martin Cohn, medical director of the Naples-based Sleep Disorders Center of Southwest Florida, says that when a person has a sudden problem with sleeping as a result of a difficult situation—say, worrying over a big presentation at work—it will usually improve after a few days. For times like these, short-term use of an over-the-counter sleep aid will probably do the trick. But Cohn adds that OTC sleep aids are antihistamines, so drowsiness is actually a side effect, and one that might result in a hangover feeling the next morning.

When the sleeping problem persists, the symptoms get harder to treat. It’s at this point that a patient truly has insomnia, which Cohn describes as "trouble sleeping to the point that it affects how you feel during the day." There is a range of treatment options, from limiting caffeine and alcohol intake to prescription sleep aids such as the much-advertised Ambien, Lunesta and Rozerem.

An alternative treatment is cognitive behavioral therapy (CBT), which, despite conjuring up visions of Woody Allen-esque confessions on a therapist’s couch, actually involves retraining the body to sleep on a normal schedule. During CBT, the patient will stay in bed—either awake or asleep—only five hours per night. The result is that by the third day of difficult sleep and an early wake-up time, the patient will crash. According to Cohn, the exercise "gives patients the confidence that if they’re tired enough, they can get a full-night’s sleep."

When prescription drugs and schedule and diet adjustments don’t work, your physician is likely to refer you to a sleep specialist like Cohn, or to a hospital-based sleep center, such as the Sleep Disorders Center at Southwest Florida Regional Medical Center in Fort Myers. Jim Hill, a technician and supervisor at the center, rattles through a battery of tests that might be conducted at a sleep clinic, and the resulting diagnoses.

An esophageal-reflux test may detect obstructive sleep apnea, while multiple latency sleep tests look for signs of narcolepsy. More traditional sleep studies will monitor patient airflow through the nose and mouth, the onset of deep REM sleep, and look for limb movement disorder or other muscle activity that is fragmenting the patient’s sleep.

Hill, who has worked at the Sleep Disorders Center for 25 years, has seen every disorder in the book. During REM Behavioral Disorder, the patient will act out his or her dream. "This ranges from arm movements in bed to people actually jumping out of bed and running into the wall," Hill says. A patient with Sleep Eating Disorder "may eat some very strange things while asleep." And someone with Sleep Sexual Disorder? "Well," says Hill circumspectly, "there are varying degrees of behavior with that."

Proponents of nontraditional medicine look to natural remedies for problem sleepers. Darlene Carswell practices acupuncture, Shiatsu massage and Chinese medicine from her Fort Myers-based practice. She touts the many benefits of acupuncture, including its effectiveness on insomnia. Moreover, Carswell stresses, alternative medicine treats the whole person, not just the symptoms of insomnia. Balancing the qi (pronounced "chee" and meaning spiritual energy) through massage, acupuncture, biofeedback and other therapies leads to better sleep and better overall health.

As the amount of stress-related disorders she treats has shot up in the last 15 years, Carswell’s message is "balance, balance, balance." This means shutting off the cell phone and turning off the TV, spending more quality time with family, and releasing energy through deep, calm breathing techniques. "People need to take responsibility for their health and their illness instead of looking for a quick fix," Carswell says. "You may have to change your diet, go for a walk, do some yoga and breathe. These are real, natural, sensible things to do."

8 Steps to Sweet Dreams

1. Keep a regular schedule.
Our body and brain don’t distinguish between weekends and workdays, so a regular waking time and bedtime are important every day of the week. Resist the urge to sleep in on your day off.

2. Relax before bedtime.
The hour or so before bedtime is not the time to pay bills, watch a suspenseful movie or call up that ex you’re still angry with. Experts recommend a hot bath, relaxing reading or soothing music to ease the transition from waking to sleeping time.

3. Have good props.
A good mattress and pillow set the stage for a good night’s sleep. Though preferences for mattress firmness and pillow fluffiness vary with the individual, your mattress should be free of lumps, bumps and dips, and pillows should be comfortable and allergen-free.

4. Set limits in the sack.
There are only two things your bed should be used for, and reading isn’t one of them. Remove the TV, the laptop, stack of books and magazines from your bedroom, and use your bed only for sleeping and love-making.

5. Don’t pig out before turning in.
Have your last meal of the day two to three hours before bedtime. While a glass of milk or some tea might help you relax, avoid heavy fluid consumption, big meals and spicy foods in the hours prior to sleeping.

6. Exercise, but earlier in the day.
While physicians are all but unanimous on the benefits of exercise, working out too late in the day can keep you awake. Late afternoon is fine, but avoid exercising at least three hours before bedtime.

7. Hold the caffeine.
Your last dose of coffee, tea or chocolate should come at least six to eight hours before bedtime, or longer if you’re particularly sensitive to caffeine.

8. Nix the nightcap.
That lovely glass of pinot noir is more likely to wake you up in the middle of the night than it is to relax you. Sure, you can always drink enough to pass out cold, but most of us know first-hand the drawbacks to that method of sleep-inducement.

For more information on a healthy night’s sleep, visit www.sleepfoundation.org.