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Shorting Sleep

By Dan Gordon '85

Published Jul 1, 2018 8:00 AM

A UCLA neurologist offers tips for those of us who spend too much time awake.


Illustration by David Pohl.

So much to do, so little time. If you often find yourself muttering some variation of this gripe — and, more to the point, losing sleep because of it — Alon Avidan ’88 would like a word with you. A neurologist who directs the UCLA Sleep Disorders Center, Avidan spends a good deal of his time counseling people who complain that they’re exhausted during the day because they don’t sleep long enough or well enough at night. Often, he says, that’s at least partly because they think of a good night’s sleep as a luxury, rather than an essential part of their health and wellness.

“People push themselves to do so much, and by the time they go to bed they haven’t allowed enough hours for proper sleep,” Avidan laments. Even when hitting the pillow at a reasonable hour, many find themselves too worked up to go to sleep. “They lie in bed thinking about what happened during the day, or planning what they need to do tomorrow,” he says. At what price? Everyone knows the rejuvenating sense that comes from restful slumber, but, Avidan notes, many don’t appreciate the potential risks of too many restless nights — from memory and cognitive difficulties to depression, cardiovascular problems and diabetes.

Certain medical conditions can disrupt what Avidan refers to as the sleep architecture. One is obstructive sleep apnea, a serious disorder in which a blocked airway restricts the flow of oxygen to the lungs, interfering with deep sleep. (See “The Science of Sleep,” page 20.) But the most common sleep complaint is insomnia, which afflicts about one-third of the U.S. adult population at some point, and 10 percent often enough to significantly impair their daytime functioning. Severe cases require intensive treatment with strategies such as cognitive behavioral therapy, but for most, Avidan says, adopting commonsense sleep hygiene practices can make all the difference. He offers some tips, starting with letting go of any notion that a good night’s sleep is a luxury. “People need to think of sleep as one of their bodily needs, like breathing and eating,” he says.

Timing Is Everything
Anyone who has traveled internationally knows the malaise associated with jet lag — that discombobulating sense that what looks like morning feels like evening, and vice versa. But even at home, an irregular sleep schedule can throw the brain’s circadian rhythm out of sync, Avidan says. He advises sticking to a regular schedule, with consistent bedtimes and wake-up times, even on weekends, as well as set times for meals and exercise. Maximizing light exposure early in the day and avoiding bright light in the last couple of hours before going to sleep will also help to keep the circadian rhythm aligned.

Plan the Day with the Night in Mind
Actions taken during the day can affect the drive to sleep at night, for better or worse. Naps are fine, but, Avidan cautions, they shouldn’t exceed 20 minutes or occur later than around 3 p.m. Regular exercise contributes to sounder sleep, but it is best confined to the early part of the day; too close to bedtime, it raises alertness — not conducive to slumber. Avidan also advises avoiding coffee and other caffeine products in the afternoon and evening.

Control Substances
Caffeine isn’t the only substance that can disrupt the sleep architecture. Certain medications, such as antidepressants, can also contribute to wakefulness at night or sleepiness in the day; Avidan suggests consulting a physician when starting a new drug to learn its potential sleep impact. And while alcohol might help you doze, it’s likely to produce fragmented sleep, especially in the first half of the night.

The Bed is for Sleep
One of the foundations of good sleep architecture is to associate the bedroom with sleep, but that connection can become frayed when we spend too much awake time in bed. “People will get under the covers and start reading on their iPads, replacing sleepiness with wakefulness,” Avidan says. It’s good to do your reading, eating and television viewing outside the bedroom. During bouts of insomnia, get out of bed, he advises, and engage in a quiet, soothing activity until you get sleepy.

Take Time to Wind Down
The prelude to sleep is important. “Too many people sit in bed responding to work emails until the last minute, or doing the New York Times crossword puzzle, and they’re just making the brain more active,” Avidan says. Plus, the artificial blue light emitting from electronic devices delays the production of sleep-inducing melatonin. On the flip side, a hot shower or bath a few hours prior to bedtime will not only contribute to relaxation, but it will also lower the core body temperature and increase the release of melatonin. Choose dim over bright light and relaxing over mind-arousing activities. If you tend to lie awake stressing over all you have to do the next day, keep a notepad by your bed and make a list to empty the brain of these preoccupations.

Protect the Environment
Creating the right sleep environment is paramount. “You want to make sure the room is dark, quiet and a bit cooler than average — around 68-69 degrees is more sleep-promoting than warmer temperatures,” Avidan says. Assign noisy pets to another room for the night, and while you may not want to do the same for a noisy bedfellow, earplugs and white-noise machines can do the trick. Make sure you have a comfortable mattress and pillow.

Do Yourself a Solid
Once you’re set up for a good night’s sleep, take precautions to minimize awakenings during the night. Avoid heavy meals just before going to bed and, in particular, fatty foods that could contribute to heartburn or reflux. But don’t go to bed hungry. Avidan suggests a banana, yogurt or nuts as a before-bed snack if you need it, but steer clear of chocolate and other sugary foods. And remember that too much fluid intake in the evening can compel you to get up to visit the restroom more frequently.

Finally, keep digital clocks out of view. “If you wake up in the middle of the night and the time is flashing at you, it can be stimulating and make it more difficult to go back to sleep,” Avidan says. “And if you’re having trouble falling asleep, seeing the time is just going to make you more stressed.” As long as your alarm is set, don’t worry about the time. Focus on the task at hand: getting enough sleep.