The 9 Habits of Highly Successful Sleepers

If you have trouble falling asleep, or staying asleep, you've got plenty of bleary-eyed company. Here, the best--and most up-to-date--advice on getting a good night's rest.

Marquez isn't alone. More than 60 million Americans--slightly more women than men--struggle with insomnia. Proof of its prevalence lines the shelves of drugstores, where bleary-eyed Americans spend an estimated $325 million each year on potions promising improved sleep. Add to that the $50 million spent annually on melatonin--the latest rage-- and you begin to see the magnitude of the problem. The good news: Scientists are beginning to understand the causes of insomnia and can now offer advice on remedies that really work.

Too Stressed to Sleep
Insomnia doesn't strike the same way each time. There's the fleeting type, which lasts only a few nights, and usually is brought on by stress, travel, a minor illness, or medications containing caffeine or other stimulants (see "Drugs That Disrupt Rest," page 88). Hormonal fluctuations can also cause transient insomnia. (In fact, they may explain why more women experience trouble sleeping.) One study found that premenstrual syndrome (PMS) sufferers spend only 5 percent of their slumber in deep, restorative sleep, as compared to the 15 to 20 percent logged by women without the condition.

Short-term insomnia lasts slightly longer--anywhere from more than a few consecutive nights to three weeks, or as long as the cause persists. It's typically the result of ongoing stress at work or home, pain from an injury, or the hormonal upheavals of menopause or pregnancy. Decreased estrogen levels cause 75 percent of menopausal women to awaken repeatedly with hot flashes and night sweats. Pregnant women are known to be light sleepers because of discomfort and an increased need to urinate during the night.

Transient and short-term insomnia aren't serious, but experts say it's important to nip the problem in the bud, because sleeplessness can be a self-perpetuating condition. It may even lead to chronic insomnia.

More than half of those with ongoing troubles have a physical ailment, such as heartburn; fibromyalgia, a type of chronic pain; sleep apnea, a condition that causes repeated interruptions in breathing during sleep; or periodic muscle contractions that cause the legs to jerk. But pyschological problems like anxiety or depression may also be responsible. For reasons doctors still don't understand, depression seems to make it difficult for people under 40 to fall asleep. In older adults, however, it manifests itself with middle-of-the-night or early-morning awakenings.

When to Get Help
Insomnia that lasts longer than three weeks warrants a visit to your doctor; he or she can help with minor bouts as well. Vet the majority of sufferers never seek attention. The reason is clear Most of us view sleep as expendable--even indulgent. Dark undereye circles are the merit badges of our hard-driving culture. These days, well-rested people are considered lazy and slothful.

But that attitude couldn't be more off-base. "Sleep is believed to be an active state, during which your body takes care of itself in a number of ways," says James Walsh, Ph.D., executive director and senior scientist at Unity Sleep Medicine and Research Center in St. Louis. "It's essential for physical and mental restoration."

Studies show that if you sleep just two hours less than usual on a single night, your judgment can suffer the next day. That's minor if all you're doing is picking out matching socks, but it's critical when you get behind the wheel of a car. Statistics show that drowsy drivers are responsible for as many as 300,000 car accidents per year (at least 10 percent of the total), 10,000 of which are fatal.

Too little sleep for just a few nights can make you cranky, unable to concentrate, and slow to react, and may even make you more susceptible to illness, because your immune system is rejuvenated during sleep. Furthermore, missing out on dream time may leave you less able to cope emotionally with daily problems.

How much sleep do you need? On average, most people require between seven and nine hours. Two people in ten can get by on six hours or less, and one in ten needs nine or more hours. If you doze off during ER, fall asleep within five minutes of hitting the pillow, and feel comatose when your alarm goes off, you're dangerously low on sleep.

Here, the best advice for developing healthy snoozing habits:

1 Adopt sleep-promoting behavior:

Get,up at the same time each morning and go to bed at the same time each night. Sleeping in on Sunday can leave you wide-awake Sunday night--and sluggish Monday morning.

Don't drink coffee or other caffeinated beverages after noon.

Don't smoke; nicotine is a stimulant.

Get regular exercise, which has been shown to cut in half the amount of time it takes insomniacs to fall asleep. Reserve vigorous exercise for the afternoon--between 2:00 P.M. and 5 00 P.M. is best--but not within four hours of bedtime. It's okay to take a leisurely walk after dinner, though

Don't eat a large meal within three hours of bedtime. But don't go to bed hungry, either; it can interfere with sleep. If you want a late-night snack, try some warm milk or a banana. Avoid fatty and spicy foods that can cause gas and indigestion.

Use your bed only for sex and sleep. "If you watch TV, eat, or work in bed, you run the risk of associating it with waking activities instead of sleep," says Paul Fredrickson, M.D., codirector of the Sleep Disorders Center at the Mayo Clinic in Jacksonville, FL.

If you're tired, take a short nap in the early afternoon, but not after 2:00 P.M. Don't doze any longer than 30 minutes.

If you can't sleep after spending 15 to 20 minutes in bed, or if you wake up in the middle of the night and can't doze off again, consider getting up and going into another room. Do something dull, such as light housework, or read with a dim light. But don't watch television: The bright light has an arousing effect. Go back to bed only when you're sleepy.

2 Set aside "worry time." Dedicate a half hour or so of your evening to think through anything that's making you anxious. On index cards, write down each worry. Then, try to think of solutions. You may not come up with quick answers, but experts say that working on problems while you're awake can prevent them from bugging you while you're trying to sleep.
3 Practice relaxation techniques. Meditation, deep breathing, or progressive muscle relaxation, in which you tense and relax muscle groups, can be beneficial if your insomnia is caused by stress, chronic pain, or PMS. "Any technique that decreases mental and physical arousal helps facilitate sleep," says Dr. Fredrickson.
4 Use OTC medications sparingly. Most drugs touted as sleep aids contain antihistamines, which make you drowsy. "They're okay to use if you've had several bad nights and you're starting to get worried about it," says Walsh. But don't take them the night before an important presentation (or anything else that requires mental sharpness) because they can leave you feeling groggy. And avoid using them for longer than two or three nights in a row because you'll need ever-higher doses to benefit.
5 Skip melatonin. There's no convincing evidence that this popular hormone, which regulates the body's sleep/wake cycles and is sold as a dietary supplement, helps the majority of troubled sleepers. "One study found that melatonin worked for elderly people who no longer secreted much of the hormone, but for those still secreting it, the supplements had no effect," says Walsh. One exception: There is evidence that melatonin may ward off jet lag (see "How to Beat Jet Lag"). Keep in mind, however, that melatonin is not approved by the Food and Drug Administration, so you can't be sure of the quality or potency of the product you're buying.
6 Restrict your sleep. If you have chronic insomnia, try limiting the time you spend in bed to the number of hours you're typically able to sleep. (Note: If that amount is less than five hours, don't do this exercise.) After several nights; you'll be tired and ready to spend more time under the covers. Allow yourself only an extra 15 minutes in bed per night until you're spending at least 90 percent of your time asleep.
7 Take presciption sleeping pills as recommended. "Short-acting" sleeping pills, like Halcion (triazolam), Restoril (temazepam), and Ambien (zolpidem tartrate) are best for people who have trouble falling asleep. They help a sufferer doze off but leave the body quickly, which minimizes morning-after haziness. Long-acting Dalmane (flurazepam) is only for people who have trouble staying asleep--and for those suffering from chronic pain. But because it stays in your body longer, it will make you feel foggy the next day.
No one should take prescription sleeping pills for more than three weeks, because they can exacerbate insomnia, as well as lead to dependence, daytime sleepiness, and coordination problems.

8 Try other prescription medications. Only about half the drugs prescribed as sleep aids are actual sleeping pills. More and more doctors are treating sleep problems with antidepressants, antianxiety medications, and antihistamines, although none of these have been studied as insomnia treatments.

Still, low doses of antidepressants like Prozac (fluoxetine) and Zoloft (sertraline) can be effective. They're especially helpful when the underlying cause of insomnia is depression or anxiety.

9 Consider estrogen replacement therapy. This can help relieve the hot flashes that tend to disrupt sleep during menopause.

How to Beat Jet Lag
Travel can wreak havoc on your sleep--especially when you cross several time zones. But there are ways to ease the transition:

If it's possible to do so, put your body on vacation two to three days before you leave home. Gradually move the times you eat and sleep so they coincide with the time zone of your destination. Do the same thing on your way home.

Drink plenty of nonalcoholic beverages during your flight. A well-hydrated body adjusts to time changes faster.

When you reach your destination, immediately abide by your hosts' clocks. Eat when the locals eat, sleep when they sleep.

Use daylight to help you adjust to the new time zone. If you're traveling east, you'll want to sleep later than the locals. Don't. Force yourself to get up and go outside in the morning light, which will help your body reset its clock to the local time. Likewise, if you're heading west, you'll want to go to bed earlier than your hosts, so exposure to late afternoon light will "remind" your body that it's still daytime.

Take small doses of melatonin, a hormone that regulates the body's sleep/wake cycles. If you're traveling east, take one-half milligram (mg) of melatonin at 3:00 P.M. on the day of departure to trick your brain into thinking dusk is coming earlier. Take another dose at 3:00 P.M. (home time) the next day. If you're going west, take one-half mg melatonin when you wake up on the day of departure to prolong dawn. Then, take three mg at bedtime to stay asleep as long as the locals do.

G.G

Drugs That Disrupt Rest

To find out if medication might be causing your insomnia, check the label for amphetamines and caffeine, and read the package insert to see if it mentions potential sleep disturbances. Some of the most common culprits:

Painkillers

Decongestants

Diuretics

Asthma drugs containing ephedrine, aminophylline, or norepinephrine

Steroids such as cortisone

Prescription and over-the-counter diet pills

High blood-pressure medications called beta blockers.