Tips to get a better night's sleep

This article provides seven tips on how to get a better night's sleep, and discusses the importance of getting a good night's sleep.

"Extreme sleep deprivation may affect brain health in later life."

"Sleep may aid chronic pain sufferers."

"Sleep apnea linked with blood sugar levels"

Dr. Paul Walting, a sleep specialist in the Department of Neurology at Baystate Medical Center, acknowledged the media attention “a good night’s sleep” is getting today.

“We are learning more and more, especially with increased research being published, that lack of sleep appears to be associated with a variety of medical problems from cardiovascular disease to Alzheimer’s. We also know that lack of sleep is associated with an increase in accidents and injuries, and for kids it can affect their school performance,” Walting said. “There are so many reasons to be sleep deprived today from overwork to staying up late and watching television or surfing the Internet on your computer, to medical reasons such as a sleep disorder.”

The body requires a good night’s sleep to gain energy for the day, which is essential for cognition, mood and overall health, he added.

According to the National Sleep Foundation, newborns should be getting 12-18 hours of sleep, infants 3-11 months need 14-15 hours, toddlers 1-3 years should get 12-14 hours, preschoolers 3-5 years need 11-13 hours, school-age children 5-10 years require 10-11 hours, teens 10-17 need 8.5-9.25 hours, while adults can survive with 7-9 hours of good ZZZs.

Baystate Medical Center’s Neurodiagnostics and Sleep Center and the
American Academy of Sleep Medicine offer the following additional tips on how to get a good night’s sleep:

• Avoid nicotine, alcohol, food or drinks that contain caffeine, and any medicine that has a stimulant prior to bedtime.


• Follow a consistent bedtime routine.


• Establish a relaxing setting at bedtime.


• Avoid any rigorous exercise within two hours of your bedtime.


• Make your bedroom quiet, dark and a little bit cool.


• Don’t watch the clock at night, but use an alarm to help wake you up.


• Get up at the same time every morning.

Some people with sleep deprivation are not actually suffering from a sleep disorder that Walting and other physicians in Baystate’s Sleep Clinic treat, such as sleep apnea, insomnia or narcolepsy. Instead, it may just be a matter of prioritizing sleep over other activities.

For those with a significant sleep disorder, like Teresita Alicea, a former criminal defense attorney in Springfield, there is treatment.

“I was falling asleep in front of some of my guests that I had over for dinner or even in the afternoon,” said Alicea.

After constantly being exhausted, Alicea had enough and in 2009, after retiring from work, she decided to have a sleep study at Baystate Medical Center. The diagnosis was sleep apnea.

“After they did the testing, they found out my breathing stopped 102 times per hour,” said Alicea. Since getting her BiPAP breathing machine and face mask, she now stops breathing just 0.7x per hour.

“I’m like a new person. I can sit through a concert, I can read a book, I don’t fall asleep in conversation anymore,” she said.

One of the most common sleep disorders, sleep apnea affects more than 18 million Americans, with the most common treatment being CPAP and BiPAP machines, which some patients cannot tolerate.

Now, there is good news for those who find the machines troublesome. The FDA in May approved a pacemaker-like device that can be implanted into the chest region which zaps airways open with an electrical current. The new device, to be available on the market later this year, is for those with moderate to severe obstructive sleep apnea. The new device is not for everyone, and patients should consult with their physician about its safety and viability for them.

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Sleep necessary for mental health and well-being

This article discusses how crucial good sleep is for a person's mental health and well-being, and the consequences of not having good quality sleep.

Having a good quality and restorative sleep is essential for one to be able to function well throughout the day. Failure to do so will lead to numerous impacts to health, both long- and short-term.

According to the Sleep Disorder Society Malaysia (SDSM) president Dr Muhammad Muhsin Ahmad Zahari, some of the short-term negative impacts include short attention span, memory recall and learning; while its long-term effects have long been associated with hypertension, ischaemic heart disease, stroke, obesity, diabetes, weakened immune system, and cancer.

Dr Muhammad Muhsin added that sleep disorder can also increase the risk of accidents.

"People who suffer from insomnia are seven times more likely to become involved in an accident which then resulted in death or serious injury," he said at the launch of the `World Sleep Day Celebration and Sleep 2014 Conference' at Cititel Hotel, here, today.

He revealed that sleep disorder actually constitute a global epidemic that threatens health and quality of life for up to 45% of the world's population, thus it is essential for everyone to have a better understanding of sleep conditions.

"Sleep is a basic human need and it is crucial not only to our health and well-being, it also plays an important role in the metabolic regulation in children," said Dr Muhammad adding that SDSM is working closely with the relevant authorities, associations and organisations in improving the quality of service of sleep medicine.

"With regards to the quality service in sleep medicine, facilities such as sleep laboratory are vital. As our population grows, there is definitely a need to increase the number of sleep laboratory in public hospitals to cater to the need of the people." he added.

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Smoking leads to sleeping issues

Research suggest that smoking can negatively influence sleep and result in sleeping issues and disturbances.

Smoking may interfere with a good night's sleep, a new study suggests.

Despite being well established as the leading cause of preventable death and a wide range of health problems, smoking's effects on sleep are little understood.

In an effort to fill this gap in knowledge, researchers from the University of Florida and Research Triangle Park examined the relationship between sleep difficulty and smoking status among a nationally representative sample.

Twelve percent of current smokers, they found, reported trouble falling asleep, while 10 percent complained of waking too early. An additional 11 percent, moreover, said they often woke during the night.

Insufficient sleep is associated with a wide range of health problems, including depression, diabetes and high blood sugar. As a result, the researchers hypothesize that smokers may be putting themselves at risk for much more than the commonly recognized health problems associated with smoking, such as cancer and cardiovascular disease.

In an effort to decrease smoking rates across the United States, government health officials launched an anti-smoking campaign last year using funding provided by the Affordable Care Act's Prevention and Public Health Fund. Called "Tips From Former Smokers," the campaign was designed to depict in graphic detail the effects of smoking.

According to a study released by the Centers for Disease Control (CDC), the campaign prompted more than 1.6 million Americans to try to quit, of which 200,000 succeeded. 

All told, the results far exceeded the campaign's original goals of 500,000 quit attempts and 50,000 successful quits.

"This is exciting news," CDC Director Dr. Tom Frieden said in a statement. "Quitting can be hard, and I congratulate and celebrate with former smokers -- this is the most important step you can take to a longer, healthier life."

According to the CDC, more than 1,200 people living in the United States die every day due to the effects of smoking.

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Negative effects of sleep deprivation

This article discusses how important sleep is for people, and how detrimental sleep deprivation can be.

There's a tendency to see sleep as a giant time suck - some unfortunate biological need to be kept at bay until someone's finished their English paper or beaten a tricky level on Candy Crush Saga.

Robert Wittig sees it differently.

"The only time you cannot possibly waste is when you're sleeping," said Wittig, medical director at the Aspirus Keweenaw Sleep Disorder Center in Laurium.

Perceiving those work, school or social demands as more important than a restful night is the leading cause of sleep deprivation, Wittig said.

A good night's sleep has been redefined downward over the past century as advances in technology and luminosity have extended shopping and recreation to a 24/7 distraction. The average person got nine hours of sleep a night in 1900; now, it's under seven.

"You can see that as a great improvement in human efficiency, or you can see it as a looming disaster," Wittig said. "Personally, as a child of the 60s, I think it might explain the loss of creativity in popular music."

But there's more to fear from drowsiness than Karmin. About two-thirds of single-vehicle accidents on the road are due to falling asleep, Wittig said.

"It probably wasn't a problem when people had horses, because you could fall asleep and the horse would still get you there," he said. "You're going down a highway in a car that's supposed to be comfortable, and a car that's supposed to be quiet and luxurious, you're more likely to fall asleep."

People operating on fewer hours of sleep will also have less initiative and be less efficient, he said.

When people come into the clinic, the first thing Wittig does is take the patient's case history. This can include what drugs they're taking, how often they have substances like alcohol or caffeine and their usual sleep environment.

Wittig once treated a woman from Detroit with terrible insomnia. She was admitted to the sleep center, where she had an uneventful, restful night. They were puzzled until she remarked on how warm it was. As it turns out, her house had no heat.

"That's why you literally have to spend an hour asking these questions, because something simple and obvious can end up being the problem," Wittig said.

About two-thirds of the people who come to the center wind up going through a sleep study. The three main measurements used are electromyography (muscle response), electroencephalography (electrical activity in the brain) and eye movement.

"With those three things, you can tell if a person's awake, asleep, what stage of sleep they're in," Wittig said.

Other tools can include an electrocardiogram, strain gauges on the chest, electrodes to measure restless legs and an oximeter to measure the oxygen saturation of hemoglobin in the blood.

But about a third of patients don't need a sleep study to find the remedy, said Wittig. He cautioned against overtreating patients when simpler solutions exist, using the example of a man who only snores when he drinks.

"As a male, half snore by the age of 50," he said. "It doesn't mean we all need sleep studies."

Some remedies are surgical.sSleep apnea, which causes snoring can be caused by obesity, or by large tonsils or a jaw defect; surgery can be used to open up the throat. Another route is continuous positive airway pressure, in which a machine blows air into a tube connecting to a mask that goes over the nose and mouth.

"Literally, that can be an overnight miracle for someone who got into a problem over years and didn't realize," Wittig said. "Overnight, they're a new person, and they think you're wonderful."

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What may be keeping you up at night?

This article discusses the common issues that keep people from getting a good night's sleep, such as insomnia, sleep apnea, narcolepsy, restless leg syndrome, and periodic limb disorder.

The illusive good night’s sleep. According to the National Center for Sleep Disorders Research at the National Institutes of Health, it’s a national problem. Between stress, problems with your sleeping environment and any number of disorders, 30 to 40 percent of the U.S. adult population reports experiencing symptoms of insomnia each year.

We talked to Marcy Guido-Posey, registered polysomnographic technologist and registered sleep technologist who is a coordinator at Holy Spirit Sleep Centers, and Beverly Azemar, certified nurse practitioner at Penn State Hershey Sleep Research and Treatment Center in Hummelstown, to get the skinny on what’s keeping you from a blissful eight hours.

Insomnia

“Insomnia is defined as the inability to fall asleep, stay asleep or both,” Guido-Posey said. It can lead to impaired daytime functioning.

“When people have trouble sleeping it’s insomnia, which is a symptom and not a disease,” Azemar said. Insomnia symptoms fall into three categories:

• Transient: lasting less than one week

• Short-term: lasting one to three weeks

• Chronic: lasting one month or longer

Sleep apnea

“Sleep apnea is a decrease or total cessation of airflow during sleep,” Guido-Posey said. “Often you will hear loud, rhythmic snoring, followed by a period of silence that ends with a loud snort or gasp as breathing resumes, then stops again. This pattern repeats itself over and over.”

According to the American Sleep Apnea Association, sleep apnea occurs most frequently in men, particularly African Americans and Hispanics. It affects more than 18 million Americans. The three types of sleep apnea are:

• Obstructive sleep apnea: caused by a blockage in the airways

• Central sleep apnea: “That is when the airway is not blocked, but the brain fails to signal the respiratory muscles to breathe,” Azemar said.

• Mixed: a combination of obstructive and central sleep apnea

Narcolepsy

Narcolepsy is the chronic neurological disorder often depicted in movies by characters falling asleep suddenly during daily activities, which isn’t far from the truth. Excessive daytime sleepiness is the main symptom of narcolepsy and happens because the brain isn’t able to regulate the body’s sleep-wake cycle.

It is estimated that up to 200,000 Americans suffer from narcolepsy. It affects men and women equally. While there is no cure, treatment can involve stimulants, antidepressants and other types of prescription medication. Symptoms include:

• Cataplexy: a sudden loss of muscle control

• Sleep paralysis: the brief inability to talk or move while falling asleep or when waking up

• Hypnagogic hallucinations: scary dreams when falling asleep

• Automatic behavior: performing routine tasks without awareness, or even memory, of performing them

Restless Legs Syndrome

Willis-Ekbom disease, or restless legs syndrome, is a neurological disorder. Its hallmark is a tingling sensation in the legs or arms that results in an irresistible urge to move. The sensation varies from person to person with patients describing a creeping, crawling, or electric feeling, according to the National Sleep Foundation.

RLS is estimated to affect 7 to 10 percent of Americans. Treatments include dopaminergic agents or anticonvulsants combined with behavioral techniques.

Periodic Limb Movement Disorder

PLMD is basically RLS while you’re asleep, explained Guido-Posey. The disorder is characterized by repetitive movements such as twitching or jerking every 20 to 40 seconds. Like sleep apnea, it is often recognized first by bed partners.

PLMD isn’t considered to be a serious medical condition, but it can be a contributing factor in insomnia. The NSF recommends seeking treatment for PLMD when it’s accompanied by RLS and/or daytime sleepiness.

Symptom management with medication

Insomnia sufferers do have over-the-counter and prescription medication options to consider that may help them get a better night’s sleep. OTC drugs such as Benadryl and Tylenol PM can help with occasional sleeplessness, but the Mayo Clinic warns that they aren’t intended for long-term use.

Another issue with OTC sleep aids is the day-after hangover. “Many over-the-counter aids are antihistamines and they can also cause residual daytime drowsiness the next day,” Azemar said. She also warns that while they are fairly safe to use because they are over-the-counter, they can be abused.

Doctors can prescribe medication for their sleep-lacking patients. Common prescription brands of sleeping pills include the sedatives Ambien and Lunesta. These drugs work by relaxing patients and helping them fall asleep and stay asleep.

“When patients are prescribed a sleep aid, they are usually used for 1-2 weeks, but then again some patients need them longer. They just need to be followed and monitored to make sure they are effective and they’re getting the appropriate results,” Azemar said. Some prescription sleep aids help you fall asleep while others can be taken in the middle of the night to help you get back to sleep.

Patients are cautioned that use of prescription sleep aids can come with risks. Side effects can include dizziness, prolonged daytime sleepiness and weight gain. Use can also lead to an increased risk in nighttime falls in older adults.

Sleep hygiene

One of the most important factors in a good night’s sleep is your hygiene. Sleep hygiene is the collection of practices necessary to developing a healthy sleep schedule.

Factors in sleep hygiene include:

• Creating a sleep-promoting environment

• Maintaining a regular sleep schedule

• Sticking to healthy eating habits

• Lowering your stress level

If you are maintaining healthy sleep hygiene and still experiencing insomnia or symptoms of a sleep disorder, talk to your doctor about scheduling a sleep study and treatment options.

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The Importance of Slumber from the NIH

This article from the National Institutes of Health discusses the importance and benefits from getting a good night's sleep.

We have so many demands on our time—jobs, family, errands—not to mention finding some time to relax. To fit everything in, we often sacrifice sleep. But sleep affects both mental and physical health. It’s vital to your well-being.

Of course, sleep helps you feel rested each day. But while you’re sleeping, your brain and body don’t just shut down. Internal organs and processes are hard at work throughout the night. 

“Sleep services all aspects of our body in one way or another: molecular, energy balance, as well as intellectual function, alertness and mood,” says Dr. Merrill Mitler, a sleep expert and neuroscientist at NIH.

When you’re tired, you can’t function at your best. Sleep helps you think more clearly, have quicker reflexes and focus better. “The fact is, when we look at well-rested people, they’re operating at a different level than people trying to get by on 1 or 2 hours less nightly sleep,” says Mitler.          

“Loss of sleep impairs your higher levels of reasoning, problem-solving and attention to detail,” Mitler explains. Tired people tend to be less productive at work. They’re at a much higher risk for traffic accidents. Lack of sleep also influences your mood, which can affect how you interact with others. A sleep deficit over time can even put you at greater risk for developing depression.

But sleep isn’t just essential for the brain. “Sleep affects almost every tissue in our bodies,” says Dr. Michael Twery, a sleep expert at NIH. “It affects growth and stress hormones, our immune system, appetite, breathing, blood pressure and cardiovascular health.”

Research shows that lack of sleep increases the risk for obesity, heart disease and infections. Throughout the night, your heart rate, breathing rate and blood pressure rise and fall, a process that may be important for cardiovascular health. Your body releases hormones during sleep that help repair cells and control the body’s use of energy. These hormone changes can affect your body weight. 

“Ongoing research shows a lack of sleep can produce diabetic-like conditions in otherwise healthy people,” says Mitler. 

Recent studies also reveal that sleep can affect the efficiency of vaccinations. Twery described research showing that well-rested people who received the flu vaccine developed stronger protection against the illness. 

A good night’s sleep consists of 4 to 5 sleep cycles. Each cycle includes periods of deep sleep and rapid eye movement (REM) sleep, when we dream. “As the night goes on, the portion of that cycle that is in REM sleep increases. It turns out that this pattern of cycling and progression is critical to the biology of sleep,” Twery says.

Although personal needs vary, on average, adults need 7 to 8 hours of sleep per night. Babies typically sleep about 16 hours a day. Young children need at least 10 hours of sleep, while teenagers need at least 9 hours. To attain the maximum restorative benefits of sleep, getting a full night of quality sleep is important, says Twery.  

Sleep can be disrupted by many things. Stimulants such as caffeine or certain medications can keep you up. Distractions such as electronics—especially the light from TVs, cell phones, tablets and e-readers—can prevent you from falling asleep.

As people get older, they may not get enough sleep because of illness, medications or sleep disorders. By some estimates, about 70 million Americans of all ages suffer from chronic sleep problems. The 2 most common sleep disorders are insomnia and sleep apnea.

People with insomnia have trouble falling or staying asleep. Anxiety about falling asleep often makes the condition worse. Most of us have occasional insomnia. But chronic insomnia—lasting at least 3 nights per week for more than a month—can trigger serious daytime problems such as exhaustion, irritability and difficulty concentrating.

Common therapies include relaxation and deep-breathing techniques. Sometimes medicine is prescribed. But consult a doctor before trying even over-the-counter sleep pills, as they may leave you feeling unrefreshed in the morning. 

People with sleep apnea have a loud, uneven snore (although not everyone who snores has apnea). Breathing repeatedly stops or becomes shallow. If you have apnea, you’re not getting enough oxygen, and your brain disturbs your sleep to open your windpipe. 

Apnea is dangerous. “There’s little air exchange for 10 seconds or more at a time,” explains Dr. Phyllis Zee, a sleep apnea expert at Northwestern University. “The oxygen goes down and the body’s fight or flight response is activated. Blood pressure spikes, your heart rate fluctuates and the brain wakes you up partially to start your breathing again. This creates stress.” 

Apnea can leave you feeling tired and moody. You may have trouble thinking clearly. “Also, apnea affects the vessels that lead to the brain so there is a higher risk of stroke associated with it,” Zee adds.

If you have mild sleep apnea, you might try sleeping on your side, exercising or losing weight to reduce symptoms. A CPAP machine, which pumps air into your throat to keep your airway open, can also help. Another treatment is a bite plate that moves the lower jaw forward. In some cases, however, people with sleep apnea need surgery. 

“If you snore chronically and wake up choking or gasping for air, and feel that you’re sleepy during the day, tell your doctor and get evaluated,” Zee advises.

NIH is currently funding several studies to gain deeper insights into sleep apnea and other aspects of sleep. One 5-year study of 10,000 pregnant women is designed to gauge the effects of apnea on the mother’s and baby’s health. Zee says this study will shed more light on apnea and the importance of treatment.

Good sleep is critical to your health. To make each day a safe, productive one, take steps to make sure you regularly get a good night’s sleep. 

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Exercise helps you sleep and keeps away sleep apnea

A national poll from the National Sleep Foundation showed that getting exercise is a very important contributor to getting good sleep. Also, those who did not exercise were at the highest risk for sleep apnea.

Exercise can affect your sleep. The results of the National Sleep Foundation's 2013Sleep in America® poll show a compelling association between exercise and better sleep.

"Exercise is great for sleep. For the millions of people who want better sleep, exercise may help," says David Cloud, CEO of the National Sleep Foundation (NSF).

Exercisers say they sleep better

Self-described exercisers report better sleep than self-described non-exercisers even though they say they sleep the same amount each night (6 hours and 51 minutes, average on weeknights). Vigorous, moderate and light*exercisers are significantly more likely to say "I had a good night's sleep" every night or almost every night on work nights than non-exercisers (67%-56% vs. 39%). Also, more than three-fourths of exercisers (76%-83%) say their sleep quality was very good or fairly good in the past two weeks, compared to slightly more than one-half of non-exercisers (56%).

"If you are inactive, adding a 10 minute walk every day could improve your likelihood of a good night's sleep," says Max Hirshkowitz, PhD, poll task force chair. "Making this small change and gradually working your way up to more intense activities like running or swimming could help you sleep better."

"Our poll data certainly find strong relationships between good sleep and exercise," adds Hirshkowitz. "While cause and effect can be tricky, I don't think having good sleep necessarily compels us to exercise. I think it is much more likely that exercising improves sleep. And good sleep is fundamental for good health, productivity, and happiness."

Vigorous exercisers report the best sleep

Vigorous exercisers are almost twice as likely as non-exercisers to report "I had a good night's sleep" every night or almost every night during the week. They also are the least likely to report sleep problems. More than two-thirds of vigorous exercisers say they rarely or never (in the past 2 weeks) had symptoms commonly associated with insomnia, including waking up too early and not being able to get back to sleep (72%) and difficulty falling asleep (69%). In contrast, one-half (50%) of non-exercisers say they woke up during the night and nearly one-fourth (24%) had difficulty falling asleep every night or almost every night.

"Poor sleep might lead to negative health partly because it makes people less inclined to exercise," says Shawn Youngstedt, PhD, poll task force member. "More than one half (57%) of the total sample reported that their activity level will be less than usual after a night of poor sleep. Not exercising and not sleeping becomes a vicious cycle."

Non-exercisers are the sleepiest and have the highest risk for sleep apnea

Non-exercisers tend toward being more excessively sleepy than exercisers. Nearly one-fourth of non-exercisers (24%) qualify as "sleepy" using a standard excessive sleepiness clinical screening measure. This sleepiness level occurs about twice as often than for exercisers (12-15%). Also, about six in ten of non-exercisers (61%) say they rarely or never have a good night's sleep on work nights.

Sleepiness clearly interferes with many non-exercisers' safety and quality of life. One in seven non-exercisers (14%) report having trouble staying awake while driving, eating or engaging in social activity at least once a week in the past two weeks, almost three times the rate of those who exercise (4-6%).

"Sometimes we might feel tired, and that's normal," says Matthew Buman, PhD, poll task force member, "but if excessive sleepiness is your normal state, it warrants a conversation with your doctor. It could be a red flag that something is wrong with your health."

Indeed, non-exercisers have more symptoms of sleep apnea. Sleep apnea is a serious medical condition in which a person stops breathing during sleep. Its symptoms often include tiredness, snoring, and high blood pressure. It also increases the risk for heart disease and stroke. More than four in ten non-exercisers (44%) exhibit a moderate risk of sleep apnea, compared to between one in four and one in five of light exercisers (26%), moderate exercisers (22%) and vigorous exercisers (19%).

"The poll data suggest that the risk of sleep apnea in exercisers is half that of non-exercisers," says Christopher Kline, PhD, poll task force member. "People with sleep apnea are often overweight. Exercise can be part of the treatment."

Less time sitting is associated with better sleep and health

Separate from exercise, spending less time sitting may improve sleep quality and health. Those who sit for less than eight hours per day sitting are significantly more likely to say they have "very good" sleep quality than those who sit for eight hours or more (22%-25% compared to 12%-15%). Furthermore, significantly more of those who spend less than 10 hours per day sitting mention excellent health, compared to those who spend 10 hours or more sitting (25-30% compared to 16%).

"This poll is the first to show that simply spending too much time sitting might negatively affect our sleep quality," says Prof. Marco Tulio de Mello, poll task force member. "In addition to exercise, standing at your desk, getting up for short breaks, and moving around as much as possible are important healthy behaviors to include in our lives."

Exercise at any time of day appears to be good for sleep

Those who report exercising close to bedtime and earlier in the day do not demonstrate a difference in self-reported sleep quality. In fact, for most people exercise at any time seems to be better for sleep than no exercise at all.

This finding contradicts long-standing "sleep hygiene" tips that advise everyone not to exercise close to bedtime. The National Sleep Foundation has amended its sleep recommendations for "normal" sleepers to encourage exercise without any caveat to time of day as long as it's not at the expense of sleep. (However, people with chronic insomnia should continue to restrict late evening and night exercise, if this is part of their treatment regimen.)

"Exercise is beneficial to sleep. It's time to revise global recommendations for improving sleep and put exercise -- any time -- at the top of our list for healthy sleep habits," says Dr. Barbara Phillips, poll task force member.

Healthy Sleep Advice

To improve your sleep, try the following sleep tips:

• Exercise regularly. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep.
• Create an environment that is conducive to sleep that is quiet, dark and cool with a comfortable mattress and pillows.
• Practice a relaxing bedtime ritual, like a warm bath or listening to calming music.
• Go to sleep and wake at the same time every day, and avoid spending more time in bed than needed.
• Use bright light to help manage your "body clock." Avoid bright light in the evening and expose yourself to sunlight in the morning.
• Use your bedroom only for sleep to strengthen the association between your bed and sleep. It may help to remove work materials, computers and televisions from your bedroom.
• Save your worries for the daytime. If concerns come to mind, write them in a "worry book" so you can address those issues the next day.
• If you can't sleep, go into another room and do something relaxing until you feel tired.
• If you are experiencing excessive daytime sleepiness, snoring, or "stop breathing" episodes in your sleep, contact your health care professional for a sleep apnea screening.

Poll Methodology and Definitions

The 2013 Sleep in America® annual poll was conducted for the National Sleep Foundation by WB&A Market Research, using a sample of 1,000 adults between the ages of 23 and 60. The number of completes needed for both age groups and regions was determined using the most current U.S. Census data from 2010.

The maximum sampling error of the data for the total sample is +/- 3.1 percentage points at the 95% confidence level. The sampling error will vary depending on the sample size and the percentages being examined in the sample.

* Using a self-reported measure of physical activity, for which respondents considered physical activity they did for at least 10 minutes in the past 7 days, participants were classified into four different activity levels: vigorous, moderate, light and no activity. In this self-report measure, vigorous was defined as activities which require hard physical effort such as: running, cycling, swimming or competitive sports. The next level, moderate, was defined as activities which require more effort than normal such as: yoga, tai chi and weight lifting. Light activity was defined as walking, while those who do not do any activity classified themselves into the no activity level. Segments are often referred to as vigorous exercisers, moderate exercisers, light exercisers and non-exercisers based on this measure of self-categorization.

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