Cut Down On Caffeine - General Ways To Improve Sleep: Sleep Disorders

Content provided by the Faculty of the Harvard Medical School

Cut down on caffeine

Cut down on caffeine

Caffeine drinkers may find it difficult to fall asleep. Once they drift off, their sleep is shorter and lighter. For some people, a single cup of coffee in the morning means a sleepless night. That's because caffeine is an adenosine blocker, impeding the very neurotransmitter that promotes sleep. Caffeine can also interrupt sleep by increasing the need to urinate during the night.

People who suffer from insomnia should avoid caffeine as much as possible, since its effects can endure for many hours. Because caffeine withdrawal can cause headache, irritability, and extreme fatigue, some people find it easier to cut back gradually than to go cold turkey. Those who can't or don't want to give up caffeine should avoid it after 2 p.m., or noon if they are especially caffeine-sensitive.

Stop smoking or chewing tobacco

Nicotine is a central nervous system stimulant that can cause insomnia. This potent drug makes it harder to fall asleep because it speeds your heart rate, raises blood pressure, and stimulates fast brain wave activity that indicates wakefulness. In people addicted to nicotine, a few hours without it is enough to induce withdrawal symptoms; the craving can even wake a smoker at night. People who kick the habit fall asleep more quickly and wake less often during the night. Sleep disturbance and daytime fatigue may occur during the initial withdrawal from nicotine, but even during this period, many former users report improvements in sleep. Quitting also offers many other health benefits, including a lower risk for cancer, heart disease, and stroke. But those who continue to use tobacco should avoid smoking or chewing it for at least one to two hours before bedtime.

Use alcohol cautiously

Alcohol depresses the nervous system, so a nightcap can help some people fall asleep. However, the quality of this sleep is abnormal. Alcohol suppresses REM sleep, and when it's metabolized a few hours later, the soporific effects are gone. Drinkers have frequent awakenings and sometimes frightening dreams. Alcohol is blamed for 10% of chronic insomnia cases.

Some people fail to get even the short-term benefit from a nightcap because alcohol raises their epinephrine levels and makes falling asleep difficult. Also, because alcohol relaxes throat muscles and interferes with brain control mechanisms, it can worsen snoring and other nocturnal breathing problems, sometimes to a dangerous extent.

Besides contributing to middle-of-the-night wakefulness, alcohol can cause dangerous drowsiness during the day or evening. Drinking during one of the body's intrinsic sleepy times — midafternoon or at night — will induce more sleepiness than imbibing at other times of day. Even one drink can make a sleep-deprived person drowsy. In an automobile, the combined effect of alcohol and sleepiness can be deadly, with the two factors significantly increasing a person's chances of having an accident.

Avoid a sedentary life

Aerobic exercise like walking, running, or swimming promotes restfulness by decreasing the time it takes to fall asleep, reducing the frequency of awakenings, and increasing the amount of deep sleep. According to a Duke University study, physically fit older men fell asleep in less than half the time it took for sedentary men, and they woke up less often during the night.

Exercise is the only known way for healthy adults to boost the amount of deep sleep they get. Researchers from the University of Washington found that older men and women who reported sleeping normally could still increase the amount of time they spent in deep sleep if they engaged in aerobic activity. Exercising five or six hours before bedtime will encourage drowsiness when it's time to go to sleep, but strenuous activity within two hours of bedtime can keep you awake. If you can't exercise several hours before bedtime, exercising earlier in the day can also help you sleep better.

Improve your sleep surroundings

Like Pavlov's dogs, humans learn to respond to environmental cues. Removing the television, telephone, and office equipment from the bedroom is a good way to reinforce that this room is meant for sleeping.

An ideal environment is quiet, dark, and relatively cool, with a comfortable bed and a minimal amount of clutter from daytime responsibilities. Reminders or discussions of stressful issues should be banished to another room.

Maintain a regular schedule

A regular sleep schedule keeps the circadian sleep/ wake cycle (see "Circadian rhythm: Understanding your internal clock") synchronized. People with the most regular sleep habits report the fewest problems with insomnia and the least feelings of depression. Experts advise getting up at about the same time every day, even after a late-night party or fitful sleep. Napping during the day can also make it harder to get to sleep at night.

Keep a sleep diary

Keeping a sleep diary may help you uncover some clues about what's disturbing your sleep. If possible, you should do this for a month, but even a week's worth of entries can be beneficial.

Use strategic naps

If your goal is to sleep longer at night, napping is a bad idea. Because your daily sleep requirement remains constant, naps take away from evening sleep.

But if your goal is to improve your alertness during the day, a scheduled nap may be just the thing. If an insomniac is anxious about getting enough sleep, then a scheduled nap may improve the quality of nighttime sleep by reducing anxiety (although it'll reduce the time spent asleep at night).

If possible, napping should take place shortly after lunch. People who snooze later in the afternoon fall into a deeper sleep, which causes greater disruption at night. An ideal nap lasts no longer than an hour, and even a 15- to 20-minute nap has significant alertness benefits. Naps that produce lingering grogginess should be shortened or eliminated.

Last updated:	January 23, 2007