How to Get to Sleep, Stay Asleep, and Sleep Better

Millions of Americans don't get good sleep at night, but what they may not know is that sleep deprivation can lead to heart disease.

By Sara Broek and Linda Wasmer Andrews, Reviewed by Nancy Foldvary-Schaefer, D.O., 2008


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How to Get to Sleep
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    It's a vicious cycle: Studies link sleep problems to a host of cardiovascular risks and conditions, while heart disease -- in particular heart failure -- often interrupts sleep.

    "People come to the doctor and forget to talk about their sleep," says Dana Supe, M.D., a pulmonologist and director of the sleep diagnostics lab at Deborah Heart and Lung Center in Browns Mills, New Jersey. "Some don't even realize there is a problem, they've become so accustomed to sleeping poorly."

    Nancy Foldvary-Schaefer, D.O. and director of the Sleep Disorders Center at Cleveland Clinic, says that insufficient and disrupted sleep -- especially from sleep apnea, when breathing stops and starts repeatedly during sleep -- strains the heart over time and has been linked to:

    -- heart failure

    -- arrhythmias

    -- high blood pressure

    -- atherosclerosis

    -- heart attack

    -- stroke

    -- pulmonary hypertension (high blood pressure in the arteries to the lungs)

    Conversely, heart failure, angina (chest pain), and atrial fibrillation or palpitations (the sensation of a racing or pounding heart) can disturb sleep.

    Sleep problems also can lead to changes in metabolism that boost the odds of developing obesity and diabetes, two major risk factors for heart disease.

    But there is good news: Treating sleep problems may improve heart health, and vice versa.

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Get to Sleep Faster

    Add one or all of these relaxing behaviors to your wind-down routine to help you fall asleep with ease.

    -- Keep a worry journal. Before heading to bed, "write down all your worries," says sleep specialist Dana Supe, M.D. "Keep the journal in the kitchen or living room. Leave worries out of the bedroom -- literally."

    -- Set your alarm clock to tell you when to go to bed. "I suggest to my patients that they set their alarm for 45 minutes to one hour before they should be asleep," says Michael J. Breus, Ph.D., diplomat of the American Board of Sleep Medicine. This allows you to have a set bedtime routine.

    -- Turn off your phone. When it's turned off, the backlight won't bother you, and neither will your friends.

    -- Avoid late-night caffeine. If you're going to drink caffeine, it's best to taper off during the course of the day. "Drink the highest caffeinated beverages in the early parts of the day and then move to less caffeinated or decaf beverages by about 1 p.m.," Breus says.

    -- Only use your bed for sleep and sex. "You don't want to get the brain used to using the bed for other things because then the brain will think that it's acceptable to do other things during sleep time," says Nancy Foldvary-Schaefer, D.O., of Cleveland Clinic. "And they will be setting themselves up for a long-standing insomnia problem."

    -- Wear socks. The extra layer can help improve circulation throughout your legs, which can help you fall asleep faster.

    -- Take a warm bath. Your temperature naturally drops at night, so when you soak in a warm tub, your temperature rises. It's the rapid cool-down afterward that relaxes you.

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Stay Asleep All Night

    Stay asleep longer and have a better quality of sleep by doing the following:

    -- Get up. Nancy Foldvary-Schaefer, D.O. of the Cleveland Clinic suggests that if you go to bed and lie awake for more than 20 minutes, get up. Do something relatively mundane, and when you feel sleepy, try to go to bed again. Repeat this cycle until you fall asleep. You might not get the amount of sleep you were wanting, but you'll get a better quality of sleep.

    -- Keep a regular exercise program. "The data is quite clear that regular exercise not only helps people fall asleep easier, but also keeps them in deeper sleep," Micheal J. Breus, Ph.D., says.

    -- Kick furry friends out of bed. Pets are notorious for interrupting sleep. When they're on the bed, they take up the room you need and paw at you when they want you to wake up.

    -- Avoid alcohol before bed. "Alcohol is the most commonly used sedative-hypnotic, but while it allows you to crash faster, it causes markedly disrupted sleep as it is metabolized," Foldvary-Schaefer says.

    -- Keep your bedroom cool. Your body needs to drop two degrees to go from the first stage of sleep (getting ready to sleep) to the fifth stage of sleep (the REM cycle), says Alan Letton, chief science officer for Sealy mattress company. "Ensure that your mattress and pillow work with your body to do so, not make you warmer."

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Find the Right Mattress for You

    Another big part of getting to sleep -- and staying asleep for a healthy amount of time -- is finding the right mattress and pillow to support you throughout the night.

    The Right Mattress

    With help from Alan Letton, chief science officer of Sealy, we've picked out what you should look for in the perfect mattress.

    Side Sleepers: Choose a bed that will allow you to conform to your spine's neutral position -- the fetal position with your hips slightly tilted forward -- without "sagging" into the bed. Get enough cushion that you won't have space underneath you from your shoulder to your hips.

    Back Sleepers: Go for a bed that will conform to the small of your back but gives you the right support so the small of the back doesn't cave in. One way to test that is to lie on your back and have a friend try to put his or her hand under the small of your back. If they can, the mattress is not giving you the support you need.

    Stomach Sleepers: When lying in a bed best for you, there should be a slight curvature of the back at the shoulder blades.

    Letton says that the more time you spend testing your new mattress at the store, the better. Lie down for five minutes in your normal sleep position to test the pressure relief and support to combat tossing and turning. He also suggests rolling to your side and lying there for five minutes. (Many of us are unknowing side sleepers. We move to that position because it's the most neutral and comfortable position.)

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Find the Right Pillow for You

    Beth Mack, CMO of Hollander Home Fashions, the largest pillow manufacturer in the U.S., shares tips on what to look for when you're buying your next pillow.

    Side sleepers: Choose a firmer pillow with higher elevation; aim to fill the space between ear and shoulder, so your head and neck are aligned.

    Stomach sleepers: Go for a soft pillow with little elevation.

    Back sleepers: You need a moderately firm pillow that will support your neck and the natural curvature in your spine.

    When should you get a new pillow?

    Pillows should be replaced every one to two years. A pillow past its prime could contain a high level of dust mites, which can increase breathing disorders, asthma, or allergies.

    Symptoms of a bad pillow: Pillows that have reached the end of the road will often feel lumpy or flat and won't re-fluff very well.

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What to Do If You're Still Restless

    If changes in your bedtime routine aren't enough, it's time to ask your doctor for help with health issues that can interfere with sleep:

    Depression: Depression can lead to problems with sleeping too little or waking too often during the night. Such sleep problems, in turn, can contribute to a depressed mood and low energy during the day.

    Obesity: Being overweight is a strong risk factor for obstructive sleep apnea, in which the airway collapses or is blocked during sleep, leading to shallow breathing or pauses in breathing.

    Cigarette addiction: Nicotine is a stimulant, so smoking close to bedtime can make it harder to fall asleep. Smokers also may have more nightmares. Giving up cigarettes can increase sleep problems at first, but in the long run, it's good for your sleep and your health.

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Signs of a Sleep Disorder

    If you're still having trouble sleeping, it may mean you have a sleep disorder. Here are some signals to watch for:

    High blood pressure

    Check your blood pressure at home and tell your doctor if it's higher before you get out of bed in the morning than when you're at rest during the day.

    Irregular sleep patterns

    Track your sleep patterns by keeping a sleep diary for two weeks and recording how long it takes to fall asleep, how often you wake up, the total number of sleeping hours, and how awake you feel the next day.

    Snoring

    Tell your doctor if you know you snore loudly and frequently.

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