Get A Better Nights Sleep - Boosting Your Natural Energy: Chronic Fatigue

Content provided by the Faculty of the Harvard Medical School

Get a better night's sleep

If you suffer from a disorder such as sleep apnea, you'll need to see a doctor who specializes in sleep disorders. But most people with sleep problems such as insomnia don't need to visit a sleep laboratory or specialized center. They can usually help themselves by changing their habits. Occasionally, medications can also be helpful.

Avoid smoking

Smoking harms your health in many ways, but particularly relevant in this context is its ability to siphon off your energy by causing insomnia. Smoking can ruin your sleep with a kind of one-two punch. As a central nervous system stimulant, the nicotine in tobacco speeds the heart rate, raises blood pressure, and stimulates brain-wave activity associated with wakefulness, making it harder to fall asleep. What's more, once you do fall asleep, its addictive power can kick in and awaken you with cravings. The cravings are actually withdrawal symptoms, which can occur within a few hours of your last cigarette.

People who quit smoking fall asleep more quickly and wake up less often during the night. Although at first many former smokers experience sleep disturbance and daytime fatigue, they often report improvements in their sleep even during the initial withdrawal period.

Exercise to improve sleep

Exercise is the only proven way to increase the amount of time you spend in deep sleep, the type of sleep that restores your energy. The more deep sleep you get, the less likely you are to awaken in the middle of the night, and the more rested you'll feel the next day. In particular, aerobic exercise, which increases your heart rate, makes it easier to get to sleep. Doctors don't know how regular exercise leads to more hours of deep sleep, but it does. However, for a few hours after vigorous exercise, a person feels stimulated. So, if you have sleep problems, it's wisest to avoid vigorous exercise two to three hours before you go to bed.

Restrict your sleep

If you think you may be sleep-deprived, try getting less sleep. That's right: Get less sleep, at least for a few days. This advice may sound odd, but the goal is to determine how much sleep you actually need and to reduce the time you spend in bed not sleeping. This process makes it easier to fall asleep and promotes more restful sleep in the long run. Here's how to do it:

• Avoid napping during the day.

• The first night, go to bed later than normal and get just four hours of sleep.

• If you feel that you slept well during that four-hour period, add another 15–30 minutes of sleep the next night.

• As long as you're sleeping soundly the entire time you're in bed, slowly keep adding sleep on successive nights.

You can thus extend the time you spend in bed until you're getting a full night's sleep, ideally at least seven hours. Once you've done so, try to establish regular times for going to bed and getting up, seven days a week. Even though your schedule may be very different on the weekends, try not to vary your routine. If you get back to a solid seven hours of sleep on weeknights, you probably won't have as much need to "sleep in" on the weekends.

Recondition your sleep environment

People who have difficulty sleeping often come to associate their bedrooms with the frustration and anxiety of trying and failing to get to sleep. These associations create anxiety, worsening the insomnia. Reconditioning is a behavioral technique for breaking such negative associations. Here's what to do:

• Use the bed only for sleeping or sex. Watch TV or read reports for work in a different room.

• Go to bed only when sleepy. If you're unable to sleep, get up and go to another room. Stay up until you're sleepy again, then go back to bed.

• If you don't fall asleep quickly, repeat the process. In other words, don't lie in bed tossing and turning and worrying about not sleeping. If you're not likely to fall asleep, get up.

• Go to bed and get up at the same time every day. This way, you set your biological clock to sleep and wake on a regular schedule.

Relax to sleep

Many people have trouble getting to sleep because their minds are racing or they are worrying about something. Some report that their bodies are wound up with tension. Fortunately, there are ways to relax your mind and muscles, allowing you to slip into sleep. Try the following steps:

Get comfortable. Lie down, with your back in a comfortable position. Use a pillow if you like, or place one under your knees to help your back relax. Rest your arms, palms up, slightly apart from your body. Feel your shoulders relax.

Relax. Take several slow, deep breaths through your nose, and feel yourself relax. Exhale with a long sigh to release tension.

Focus internally. Begin to focus on your feet and ankles. Are they painful or tense? Tighten the muscles briefly to feel the sensation. Let your feet sink into the floor or bed. Feel them getting heavy and becoming totally relaxed. Let them drop from your consciousness.

Mentally scan your body. Slowly move through the different parts of your body: the calves, thighs, lower back, hips and pelvic area, middle back, abdomen, upper back, shoulders, arms and hands, neck, jaw, tongue, forehead, and scalp. Feel your body relax and your lungs gently expand and contract. Relax any spots that are still tense. Breathe softly.

Let distracting thoughts pass. If thoughts or worries distract you, don't struggle to eliminate them. Instead, focus on your breathing, and let the unwanted thoughts leave your mind. Tell yourself that you can pay attention to them some other time.

Medications for sleep

When behavioral techniques don't cure your insomnia, talk with your doctor about sleep-promoting medications. Although such medications can be helpful in the short term to break a pattern of insomnia, when used long-term, they may actually worsen your fatigue by leaving you groggy during the day.

Prescription sleep medications should be used cautiously because they can cause tolerance (the need for progressively larger doses over time to get the same effect). Over-the-counter sleep aids (which typically contain antihistamines) are often ineffective and, in some people, cause irritability, but when used occasionally they may work well for some individuals.

Melatonin. One over-the-counter supplement that many take as a sleep aid is a synthetic form of the hormone melatonin. Each day, the body releases melatonin in response to darkness, causing drowsiness. In the mid-1980s, researchers began investigating whether oral doses of natural melatonin might help people reset their biological clocks, which would particularly benefit travelers, shift workers, and people with insomnia. But the results have been mixed, and the FDA hasn't approved it as a treatment for insomnia. Melatonin supplements are not regulated by the FDA for purity and effectiveness.

Benzodiazepines. These are prescription medications frequently used as sleeping pills. They include temazepam (Restoril), diazepam (Valium), and triazolam (Halcion). These medications work by enhancing the activity of the inhibitory neuro­transmitter GABA, which calms brain activity. The various benzodiazepines differ in how quickly they start working and how long they remain active. While effective at helping people fall asleep and stay asleep, benzodiazepines have several limitations. They can lead to drowsiness and sedation the next day. And people who use them may develop a tolerance for them, so that after a few weeks, the drug won't promote sleep and might even contribute to rebound insomnia, in which discontinuation of the drug results in worse insomnia than before the drug was started. Finally, if taken regularly, these medications should be discontinued only under a doctor's supervision because withdrawal can lead to muscle tension, restlessness, irritability, or — in rare cases — convulsions.

Imidazopyridines. This class of drugs, which first became available by prescription in the early 1990s, specifically enhances the sleep-inducing activity of the neurotransmitter GABA. One such drug, zolpidem (Ambien), begins to work after about 30 minutes, and its effect lasts about five hours. In 1999, zaleplon (Sonata), a shorter-acting imidazopyridine, became available. The newest drug in this class, eszopiclone (Lunesta), is approved for use in all types of insomnia. It has been shown to be safe and effective even when used for six months. The most common side effects of the imidazopyridines are headache, dizziness, nausea, and grogginess.

Antidepressants. When depression interferes with sleep, an antidepressant may improve both sleep and mood. If depression is not the problem, older anti­depressant medications known as tricyclics are sometimes used because these drugs reduce the length of time it takes to fall asleep, and they improve the continuity of sleep. At the low doses used to treat sleep disturbance, tricyclic antidepressants seem to be less habit-forming than benzodiazepines and, therefore, less likely to contribute to rebound insomnia. Tricyclic drugs should be used with caution in people over age 60 and in people with known heart disease. Another commonly prescribed antidepressant is trazodone (Desyrel). This medication increases levels of the neurotransmitter serotonin, which is involved in sleep regulation as well as mood.

Last updated:	January 23, 2007