Getting a good night’s rest is important for many reasons. Allowing our bodies and minds to “reset” is critical for brain function, mood stabilization, and cellular repair.
Unfortunately, not everyone gets the rest they need. Whether it’s a new baby or puppy, racing thoughts late at night, or simply too many “to do’s” on our lists, more Americans are finding that getting the recommended 7 to 9 hours of sleep is nothing more than a dream.
Although it’s normal to experience an occasional night of tossing and turning, chronic restlessness can have a major impact on your quality of life, causing daytime sleepiness, irritability, weight gain, and even lower your immunity, making you more vulnerable to viruses.
There are several factors that contribute to nighttime restlessness.
Restless Legs Syndrome
Restless legs syndrome (RLS) is a persistent need to move your legs due to cramping or unpleasant tingling, burning, or creeping sensations which can often be relieved by moving around or getting out of bed. Doctors don’t know what causes RLS, but they suspect it may be hereditary. Women are more likely to suffer from RLS and the onset usually occurs after age 45. There is no specific test for RLS, but your health care provider can diagnose the condition based on your description of your symptoms.
In addition to a persistent need to move your legs, patients with RLS commonly describe symptoms that are triggered by rest, relaxation, or sleep and become worse at night. Symptoms are usually absent or improved by morning. Because there is no cure for RLS, treatment typically focuses on management and minimizing symptoms.
Your provider may prescribe medication to help control symptoms, but you may need to try various types before finding what works best for you. Lifestyle changes, such as limiting caffeine, tobacco, and alcohol, may be helpful in controlling RLS. Adding regular exercise and relaxation techniques, such as warm baths or massage, can get your body more ready for sleep.
If your RLS symptoms get worse, keep track of them and mention them to your health care provider, along with any medications you’re taking and lifestyle changes you’ve made. Your provider may refer you to a board-certified sleep medicine physician to help diagnose and determine your plan of care.
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Remember how you feel following a Thanksgiving dinner? All you want to do is lie on the couch and not move, because you are tired from too much food.
Yet by becoming a couch-potato you’re actually slowing the digestive process and the body can’t function the way it’s designed. It takes 20 minutes for the brain to signal you’re full. When you overeat and consume too many calories by eating too much too fast, your organs have to work harder.
To break down the nutrients in food, the stomach produces enzymes and hormones. When you overeat, however, acids back up into the esophagus and can cause heartburn. The burping, burning, and bulging stomach can leave you feeling sluggish, but unable to relax. The moral of the story is that it’s never beneficial to the body to eat too much too close to bedtime.
Caffeine affects the cardiovascular system through heart rate and blood pressure. It’s important to note, too, that caffeine can have a “half-life” of 4 to 6 hours. That means the stimulant still remains in your body for hours after drinking it. Drinking several caffeinated beverages in rapid succession may not allow your body to clear the caffeine as quickly as a single caffeinated beverage.
And don’t think it’s just those high-octane cups of Joe or fancy lattes that harbor caffeine. Teas, chocolate, soda pop, and popular energy drinks all have their own levels of caffeine, which means they can be as disruptive as coffee when you’re ready to wind down.
When you drink something with caffeine, your blood vessels constrict and expand, while stomach acid and urine output increase. Frequent urination is another reason people wake in the middle of the night because caffeine is a diuretic, which makes the kidneys produce more urine.
Alcoholic beverages also inhibit an uninterrupted night’s sleep because they interfere with the body’s circadian rhythms. This natural, internal process regulates the sleep-wake cycle and repeats roughly every 24 hours.
Alcohol affects rapid eye movement (REM) sleep—an important phase of the sleep cycle because it stimulates the areas of the brain that are essential in learning and making or retaining memories.
Alcohol can make you sleep in the first 4 hours, but as it starts withdrawing it causes more REM, more awakenings, more arousals, more snoring, and more periods of sleep apnea—a stoppage in breathing during the night. That is the one reason why people often wake up early after drinking and can’t go back to sleep, especially as they get older. The more you drink, the more disruptions you can expect during the night.
Alcohol also raises your internal body temperature and may cause night sweats. It also is known to suppress breathing and may trigger sleep apnea.
When it comes to diet, the bottom line is that you’re in control of preventing certain sleep disturbances. You can improve your sleep by keeping evening snacks and meal portions small and by consuming healthier options instead of simple or refined sugar, carbs, and fat-laden foods. Peanut butter on toast, yogurt and fruit, or string cheese and whole grain crackers will make you feel satisfied but not stuffed. Finally, curb or eliminate alcohol and caffeine in the hours before bed so you have time to properly digest.
Obstructive Sleep Apnea
Obstructive sleep apnea is a common yet serious condition that causes breathing to repeatedly stop and start during sleep. Nearly 30 million U.S. adults suffer from it.
When the muscles of the upper airway relax during sleep (and become even more slack if you’re sleeping on your back), the passage is narrowed and can become blocked. This limits the amount of oxygen to the lungs and usually results in snoring, snorting, coughing, or choking noises as the body tries to breathe. At times, this may occur hundreds of times during the night, waking you – and your partner – from slumber.
The long-term lack of oxygen, if left undiagnosed and untreated, can do much more than cause you to feel grumpy and groggy the next day. It also can bring with it heart disease, stroke, high blood pressure, prediabetes or diabetes, and depression. If your provider suspects you have sleep apnea, they may refer you to specialist for a sleep study.
During a sleep study, breathing and other vital signs are monitored to find the origin of the problem. Sleep apnea often can be successfully treated by losing weight, changing your diet, and getting more exercise. However, if these lifestyle changes do not work, a continuous positive airway pressure (CPAP) device or another oral appliance may be recommended to ensure open airways during sleep. Sometimes, surgery may be necessary.
Poor Sleep Hygiene
Just as it’s important to brush your teeth and wash your face before bed, following a bedtime routine for sleep helps prepare your body for rest. Having good “sleep hygiene” means creating habits that ensure a regular bedtime and an environment conducive to a good night’s rest without any interruptions. Consider your senses in preparing for bed – specifically sight, sound, and touch.
The good news is that most problems with sleep hygiene can be easily corrected. A cool, dark, quiet room is optimal for a comfortable night’s sleep. Limit the use and presence of electronic devices in the bedroom. Without the beeps, blips, buzzes, and bright lights of a TV, iPad, or smartphone, you won’t be stimulating your senses and you’ll allow the body systems to begin winding down, which can take 4 to 5 hours before you fall asleep. All electronics should be off at least one hour before the lights go out. If that’s too quiet, try some white noise in the form of a machine or an oscillating fan that can lull you to sleep if you need it.
The body’s core temperature also drops in preparation for sleep. Conversely, the body temperature rises toward sunrise to stimulate wakefulness. If you’ve ever awoken in the middle of the night in a sweat kicking off covers, you don’t need a scientific study to confirm that cooler is better. Still, experts agree that a bedroom temperature between 60- and 67-degrees Fahrenheit is best for sleeping.
And while most people like to sleep in on the weekends or their days off, sleep specialists advise staying within a one-hour timeframe from your usual bed and wake times to keep your body’s internal clock consistent. Too much sleep can be as detrimental as too little, so avoid lingering in bed on the weekends and keep a regular sleep schedule.
When it comes to your overall health, proper nutrition, regular exercise, and exposure to natural light during the day also are helpful in making sure you feel refreshed, rested, and ready to both start and end your day on a positive note.
From pregnancy to menopause, women’s hormones play a significant role in sleep quality.
Hot flashes, night sweats, frequent urination, and general discomfort can be attributed to the drop or increase in hormone levels, depending on what is causing them. These disturbances often occur in the first half of the night as women are trying to fall sleep. While both pregnancy and nearing the end of your menstrual cycle are temporary conditions, they can seem like a lifetime when you’re suffering for months or years during the experiences. These hormonal changes, of course, make women more vulnerable to restless sleep.
Declining estrogen levels before menopause may be treated with hormone supplements, although not every woman is a candidate for hormone therapy. Guided imagery, such as mediation, and other sleep hygiene changes can help women find a peaceful night’s rest.
It’s important to talk to your provider to determine if your menstrual cycle or the absence of it is at the root of your insomnia or nighttime waking. There are many factors and conditions that could cause night sweats or irritability. For example, low estrogen levels causing sleep disorders in women who have recently given birth are also associated with depression.
Interestingly, some birth control pills may cause sleep disturbances. Women still getting their periods may also experience related issues, such as cramping, nausea, or heavy bleeding that can interfere with rest. A heating pad, warm shower, over-the-counter medication, chamomile tea, and yoga stretching can soothe these monthly discomforts. As always, talk to your provider about your symptoms, severity, and frequency to get a proper diagnosis.
Everybody experiences stress thanks to hectic work schedules, family obligations, health situations, major lifestyle changes, and even celebratory moments that require time and effort to plan and attend. Stress is a part of life and while acute stress can motivate and help us focus on a task, chronic stress has serious ramifications and restless sleep is one of the first signs of a problem.
Taking care of yourself is a significant step toward reducing stress, as well as admitting you may need a little help. Sometimes we associate asking for help as a form of weakness when in fact it’s an act of empowerment. Nobody can do it all every day and other people have certain resources, skills, and time that can complement your own strengths. Delegating tasks at home and at work can help lighten your load and get your tasks completed.
For more serious stressors, such as a death, major diagnosis, job loss, or financial crisis, seeking professional help in the form of a counselor, financial advisor, or spiritual/religious guide is encouraged. The anxiety and emotional toll of these scenarios can create chronic stress in the body that is counterproductive to the rest the body needs to heal or repair itself.
Chronic stress also threatens heart health and can lead to a heart attack, abnormal heart rhythms, and even stroke. It also can lead to weight gain if you eat or drink to deal with emotions or find comfort in your favorite foods.
When it comes to sleep, make the commitment to get 7 to 9 hours each night. Making this healthy lifestyle choice a ritual and seeking extra help for what’s weighing on your mind will help you get the rest your body needs.
From shift work to late-night exercising to binge-watching Netflix, lifestyle choices can negatively affect your sleep. When your routines are off or nonexistent, the body’s internal clock or circadian rhythms take a major hit.
If your job has you working overnight, sleep hygiene is even more critical because you’ll be sleeping during nontraditional sleep hours. Maintaining a routine, setting up a comfortable sleep environment, and limiting caffeine and alcohol before bed all can help get your sleep on track despite working in the dark.
It’s also important to recognize that while you may leave work with a long to-do list, sleep is imperative for your overall well-being and ability to stay alert and do your job again the next day. So don’t compromise proper rest by trying to do too much when you should be sleeping.
It’s proven that regular physical activity help lower blood pressure and cholesterol, and reduces the risk of chronic illness and disease. Regular exercise helps burn not only calories but also negative energy. We know that exercise improves mood, appearance, and sleep quality, yet exactly what time of day you should exercise remains a personal choice.
Research has shown that the early bird doesn’t always get the worm or the benefits of morning exercise; rather, it says, the act of establishing the exercise habit and respecting your body is what yields long-term success. Experts also say it’s about intensity coupled with timing.
In other words, whatever your chosen physical activity, if it’s within an hour of bedtime choose wisely. A brisk walk or yoga before bedtime may help you sleep better than an energetic spin class or a run. A tired body, after all, is already prepped for sleep. Follow your chosen activity with a warm cup of decaf tea, a bath, meditation, or another form of relaxation before turning in.
Incorporating exercise into your lifestyle is important for your general health, period. So if nighttime is the only time you can squeeze in your workout, experts say the benefits far outweigh any disadvantages.
Follow-Up With Your Provider
If you experience one or several of these sleep disorders, talk to your primary care provider. You also may be referred to our sleep center for further evaluation.
About Sleep Medicine
Millions of Americans struggle with disorders that prevent them from getting a good night’s sleep. Better sleep can lead to better overall health, and the UPMC Sleep Medicine Center is here to help. We diagnose and treat numerous sleep conditions or disorders. We also provide help to people suffering from lack of sleep because of other health problems. We recognize a lack of sleep can cause problems during other times of the day, including alertness, memory, and health immunity. We hold sleep studies and lead clinical trials, all in the name of helping you sleep. Find a provider near you.