Not sleeping well? Here's what to do

This is National Sleep Awareness Week, so it's a good time to review healthy sleep habits. I see a lot of adults and teens in my clinic who are chronically tired and have trouble sleeping — both falling asleep and staying asleep.

How much is enough?

According to the National Sleep Foundation's research, here's the amount of sleep we need each night:

• Newborn (0-3 months): 14 to 7 hours
• Infant (3-12 months): 12 to 5 hours
• Toddler (1-2 years): 11 to 14 hours
• Preschool (3-5 years): 10 to 13 hours
• School age (6-13 years): 9 to 11 hours
• Teenager (14-17 years): 8 to 0 hours
• Adult (18-64 years): 7 to 9 hours
• Older adult (over 65 years): 7 to 8 hours

One of the main problems caused by too little sleep is daytime sleepiness. A fascinating series of studies involving children showed that insufficient sleep and daytime sleepiness can hurt a child’s academic achievement. Most of the children went to bed at 9-9:30 p.m. and almost all got up at 7 a.m., causing a daily sleep deficit of 30 minutes to an hour for many children. While that may seem like a small amount, it adds up.

Later school start times can help

One bit of good news from the studies describes how delaying school start times even by just a half-hour can significantly increase sleep time at night and reduce daytime sleepiness. As part of the study, six primary schools in Shanghai delayed school openings from 7:30 a.m. to 8 or 8:30 a.m. This gave the children almost an hour of extra sleep. More importantly, the later start times reduced complaints of daytime sleepiness.

This fits with studies in other parts of the world and supports the growing movement, led by pediatricians, to delay school start times. Just doing this could result in better sleep and improved test scores for all students!

Besides lower academic performance, poor sleep also leads to an increased risk of being overweight or obese. This is true for children as well as adults. A 2007 analysis of 36 studies around the world showed a strong association between short sleep times and weight gain in children, which continues into adulthood.

For adults, poor sleep can contribute to problems with high blood pressure, depression, diabetes and obesity. It can also cause dangers such as falling asleep while driving and errors at work. (People in medical school and internships, along with night-shift workers, are notoriously affected by this.)

My tips for sleeping well

Get all screens out of the bedroom. Technology is changing so quickly that it's difficult for research to keep up. But it's clear that many people have more trouble sleeping when they use their iPads and cellphones at bedtime. This is partly because the backlight from these devices alters our sleep hormones. These devices also distract us with text messages even after we turn out the lights. I think a great general rule, for adults and kids, is no screen time two hours before bed. That includes TV. And definitely keep all screens out of your bedroom while you sleep.

Exercise often — but early. Exercise has been shown to improve sleep habits, but only if done at least four hours before bedtime. Otherwise, you still may have too much metabolic energy, which can make it hard to fall asleep. This is also a good tip for kids who have sports practices late into the night.

Avoid alcohol and smoking before sleeping. Alcohol is a major cause of insomnia for many. Drinking will certainly make you sleepy, but your body will rebound and wake you up in the middle of the night. It’s best to have only a drink or two, and at least two hours before bedtime. Smoking causes the same problems. That initial relaxation quickly wears off and the nicotine stays in your system for hours.

Avoid caffeine after lunch. As we get older, we can’t handle the triple-shot cappuccinos that we drank in college, and it’s very common to sleep poorly when we’ve consumed anything that contains caffeine after lunch. So if you’re not sleeping well, definitely take a look at your caffeine habits. Any tea, sodas or coffee after lunch may be keeping you awake. If you must have your afternoon coffee, at least try to switch to decaf.

Don’t stay in bed if you can’t sleep. If you can’t fall asleep after 20 minutes in bed, you should get up and try to relax in another room. Staying longer in bed generally makes you more anxious, and that makes it even harder to fall asleep.

Take a nap. Napping, even if only for 20 to 30 minutes, has been shown to greatly benefit short-term memory and concentration. As I get older, I definitely lag more in the afternoon and a 15-minute power nap at lunch really helps me get through a busy clinic afternoon (as does a lighter lunch).

What about natural medicines and non-prescription pills to help you sleep? Many people use over-the-counter pills such as Tylenol PM. They do work well in the short term for many people. But I strongly advise against taking them regularly, as the Tylenol component of the medicine is unnecessary and can cause liver problems if taken habitually. 

If you must use medicine, please only buy one that has the active ingredient diphenhydramine (Benadryl). As for natural medicines, melatonin works for some types of insomnia but it’s rarely very effective. Other options include an herbal capsule with valerian and other compounds such as passionflower, hops or lemon balm.

For more tips to keep your family healthy, you can read my wellness blog, MyFamily Health Guide. You can also check out my Facebook page for more wellness news. 

If you or someone in your family has trouble sleeping, talk to a pediatrician or your primary care provider. Call 1-800-793-3474 to make an appointment with a Swedish provider. We also offer Sleep Medicine services for children and adults.