Sleep Differences Between Men and Women

Sleep is a universal biological need, but men and women don’t experience it in exactly the same way. Research has consistently shown that there are measurable differences in sleep duration, quality, architecture, and susceptibility to sleep disorders between the sexes. These differences arise from a combination of hormonal fluctuations, brain structure, circadian rhythm variations, and social influences.

Understanding how sleep varies between men and women is essential for clinicians aiming to provide personalized, effective care—and for anyone looking to optimize their own sleep health.

1. Sleep Duration and Quality

Women tend to sleep longer and may sleep better than men—at least in terms of total sleep time. On average, women sleep 11 to 13 minutes more per night than men.

However, this advantage is somewhat deceptive. Despite sleeping more, women are also more likely to report insomnia symptoms, night-time awakenings, and non-restorative sleep. These disruptions are often linked to hormonal changes across the menstrual cycle, pregnancy, and menopause, all of which can interfere with deep, uninterrupted sleep.

Men, by contrast, generally experience more consolidated sleep, particularly during early adulthood. Women typically have a higher proportion of slow-wave sleep, the most restorative phase of sleep. Men also tend to experience a more rapid decline in deep sleep with age than women do.

2. Hormonal Influence on Sleep

Hormonal fluctuations play a significant role in shaping how men and women sleep. Women experience regular changes in estrogen and progesterone throughout the menstrual cycle, which can influence body temperature, mood, and sleep regulation.

• In the luteal phase (post-ovulation), elevated progesterone can increase core body temperature, contributing to night sweats and sleep fragmentation.

• Estrogen can improve REM sleep but may also increase emotional sensitivity and susceptibility to sleep disturbances.

• Many women report poor sleep quality in the days before menstruation, often experiencing trouble falling asleep and vivid, intense dreams.

During pregnancy, especially in the third trimester, women frequently experience disrupted sleep due to hormonal shifts, physical discomfort, frequent urination, and fetal movement. Later in life, perimenopause and menopause bring declining estrogen levels, often leading to hot flashes, insomnia, and increased risk for sleep apnea.

Men, on the other hand, have relatively stable levels of testosterone until middle age. Testosterone supports deep sleep, and its gradual decline with age is associated with poorer sleep quality and a higher incidence of sleep-disordered breathing, particularly obstructive sleep apnea (OSA).

3. Circadian Rhythm Differences

Men and women also differ slightly in their circadian rhythms—the internal clock that regulates sleep-wake cycles. Research suggests that women tend to have a shorter circadian cycle and naturally lean toward an earlier chronotype, meaning they prefer going to bed and waking up earlier.

This can make women more susceptible to social jet lag, especially when work or social obligations require later sleep and wake times. Men, by contrast, are more likely to have an evening chronotype, preferring to stay up late and sleep in when possible.

These biological tendencies can influence sleep satisfaction, productivity, and vulnerability to shift work-related fatigue.

4. Prevalence of Sleep Disorders

Sleep disorders are not distributed equally between men and women.

• Insomnia is significantly more common in women, who are nearly twice as likely as men to experience difficulty falling or staying asleep. Hormonal shifts across the menstrual cycle, pregnancy, and menopause are major contributing factors.

• Obstructive Sleep Apnea (OSA) is more prevalent in men, especially in midlife and older age. Testosterone and upper airway anatomy may increase risk. However, OSA in women is often underdiagnosed, partly because women are more likely to report symptoms like fatigue and insomnia rather than classic signs such as snoring or gasping.

• Restless Legs Syndrome (RLS) also affects women more frequently than men, particularly during pregnancy and in older age.

• Narcolepsy appears to occur at similar rates in both men and women, though some studies suggest slightly earlier onset in men.

5. Mental Health and Sleep

Mental health significantly influences sleep, and here again, there are differences. Women are more prone to anxiety and depression, both of which are strongly associated with insomnia and sleep disturbances. These conditions may increase emotional arousal at night and make it more difficult to fall and stay asleep.

Men, on the other hand, tend to have higher rates of sleep-disordered breathing, which can lead to fragmented sleep, daytime fatigue, and increased cardiovascular risk. These disorders are often linked to higher body mass index (BMI), neck circumference, and testosterone levels.

The bidirectional relationship between mental health and sleep underscores the importance of addressing both in clinical settings.

6. Social and Environmental Influences

Beyond biology, social roles and environmental pressures also affect how men and women sleep. Women are more likely to serve as primary caregivers, particularly during childbearing and child-rearing years. This role often leads to sleep interruptions, emotional stress, and chronic sleep deprivation.

Additionally, workplace responsibilities, unequal domestic labor, and safety concerns can contribute to ongoing sleep challenges for women. Men, while generally experiencing fewer sleep disruptions due to caregiving, may face other stressors—such as long work hours or shift work—that negatively impact sleep.

Conclusion

The differences in sleep between men and women are not merely anecdotal—they are well-supported by decades of scientific research. From hormonal changes and brain activity to sleep disorders and social roles, multiple factors shape how men and women sleep, rest, and recover.

Understanding these differences allows clinicians to tailor sleep interventions more effectively, and it empowers individuals to make informed decisions about improving their own sleep health.

In short, better sleep starts with better awareness—and acknowledging that men and women may need different approaches to achieve it.

This article was created using OpenAI’s ChatGPT on September 19, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

How Menopause Impacts Sleep: What You Need to Know

Sleep is essential to overall health, but for many women, it becomes increasingly elusive during midlife. One of the most common and disruptive changes women experience during the menopausal transition is poor sleep. In fact, studies suggest that up to 60% of women report sleep disturbances during perimenopause and menopause.

Understanding how menopause impacts sleep can help women manage symptoms more effectively and seek the right support. This article explores the connection between menopause and sleep, the biological changes behind it, and strategies for better rest.

What Is Menopause?

Menopause marks the end of a woman’s reproductive years, defined clinically as 12 consecutive months without a menstrual period. It typically occurs between the ages of 45 and 55. The transition leading up to it—perimenopause—can last several years and is characterized by fluctuating hormone levels, irregular periods, and a variety of physical and emotional symptoms.

This hormonal upheaval can significantly impact sleep quality and patterns, sometimes even in women who previously had no sleep issues.

Common Sleep Issues During Menopause

Menopause can affect sleep in several ways. The most commonly reported sleep disturbances include:

• Difficulty falling asleep (sleep onset insomnia)

• Frequent awakenings during the night

• Early morning awakenings (waking too early and not being able to go back to sleep)

• Night sweats and hot flashes that interrupt sleep

• Restless legs or increased movement during sleep

• Non-restorative sleep (waking up feeling unrefreshed)

For many women, these sleep issues are not occasional—they can become chronic and severely affect daily functioning, mood, and quality of life.

The Role of Hormones in Sleep Disruption

The most significant hormonal changes during menopause involve a decline in estrogen and progesterone, two hormones that play important roles in regulating the sleep-wake cycle.

1. Estrogen

Estrogen helps regulate body temperature, mood, and serotonin—an important neurotransmitter involved in sleep regulation. As estrogen levels drop:

• Women are more prone to hot flashes and night sweats, which can cause sudden awakenings and difficulty returning to sleep.

• Lower estrogen levels may reduce REM sleep and make women more sensitive to environmental stimuli like noise or light.

• Declining estrogen is also associated with increased anxiety and mood disturbances, both of which can interfere with falling and staying asleep.

2. Progesterone

Progesterone has a calming, sleep-promoting effect. It acts as a natural sedative and supports deep, restorative sleep. As levels fall during menopause, women may notice:

• More restlessness or fragmented sleep

• Increased risk of obstructive sleep apnea (progesterone helps keep the airway muscles toned, and its loss can contribute to airway collapsibility)

Sleep Apnea and Menopause

Sleep apnea—particularly obstructive sleep apnea (OSA)—becomes more common after menopause. While OSA is traditionally more prevalent in men, postmenopausal women are at significantly higher risk due to hormonal changes and age-related weight gain, especially around the neck and abdomen.

Unfortunately, sleep apnea in women is often underdiagnosed, as they may present with symptoms like insomnia, fatigue, and mood changes rather than the typical snoring and gasping for air.

Mental Health and Menopause-Related Sleep Issues

The menopausal transition is also associated with increased rates of anxiety and depression, both of which can exacerbate sleep problems. Worry about aging, body image, changes in relationships, or caregiving responsibilities can fuel rumination at bedtime and increase sleep latency (the time it takes to fall asleep).

Insomnia itself can worsen mental health symptoms, creating a vicious cycle that’s difficult to break without targeted intervention.

Restless Legs Syndrome (RLS) and Menopause

Some women also experience an increase in restless legs syndrome during menopause. RLS is characterized by an uncontrollable urge to move the legs, especially at night, and is linked to low iron and dopamine dysregulation, both of which can be affected by hormonal shifts.

This condition can lead to delayed sleep onset, frequent awakenings, and poor sleep quality overall.

Strategies for Improving Sleep During Menopause

Although menopausal sleep disruption is common, it’s not inevitable—and there are many effective strategies women can use to improve sleep:

1. Sleep Hygiene

• Maintain a consistent sleep schedule.

• Avoid screens and bright lights before bed.

• Keep the bedroom cool, dark, and quiet.

• Limit caffeine and alcohol intake, especially in the evening.

2. Hormone Therapy (HRT)

Hormone replacement therapy can relieve hot flashes and night sweats and may improve sleep for some women. However, HRT isn’t right for everyone and should be discussed with a healthcare provider to weigh risks and benefits.

3. Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is a highly effective, non-pharmacological treatment for chronic insomnia and has been shown to be beneficial for women going through menopause.

4. Mindfulness and Stress Management

Techniques such as yoga, deep breathing, progressive muscle relaxation, and meditation can reduce nighttime anxiety and promote better sleep.

5. Addressing Underlying Conditions

Women experiencing significant sleep disturbances should be evaluated for sleep apnea, RLS, or other medical conditions. Treating these disorders can result in significant improvement in sleep quality.

When to Seek Help

If sleep problems persist for more than a few weeks and begin to interfere with daily life, it’s important to consult a healthcare provider or sleep specialist. Many women assume that poor sleep is simply part of menopause, but it doesn’t have to be endured without support.

Final Thoughts

Menopause brings with it a host of changes—some expected, some disruptive. Sleep difficulties are among the most common complaints during this transition, but they are not something women have to accept as the new normal. With a combination of lifestyle changes, medical support, and targeted therapies, most women can significantly improve their sleep and overall quality of life during and after menopause.

This article was created using OpenAI’s ChatGPT on September 19, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

How Aging Affects Men’s Sleep: What Changes and What to Expect

Sleep plays a critical role in health at every stage of life, but as men age, changes in sleep patterns, quality, and duration become increasingly common. These changes are part of the natural aging process, influenced by shifts in hormones, circadian rhythms, lifestyle, and health status. While not all sleep disturbances are inevitable, understanding how aging affects sleep can help men navigate these changes and take steps to improve rest and overall well-being.

1. Sleep Architecture Changes with Age

One of the most noticeable changes in sleep as men age is in sleep architecture—the structure and stages of sleep throughout the night.

• Less Deep Sleep: Young men typically get a healthy amount of slow-wave sleep (also known as deep sleep), which is the most restorative phase. As men age, the amount of deep sleep declines significantly. By the time they reach their 60s or 70s, some men may have little to no slow-wave sleep.

• More Light Sleep: Aging men spend more time in lighter stages of sleep (N1 and N2), which are more easily disrupted by noise, movement, or internal discomforts such as the need to urinate.

• Reduced REM Sleep: There may also be a modest decline in REM (rapid eye movement) sleep, the stage associated with dreaming, memory consolidation, and emotional processing.

As a result, older men often report feeling less refreshed after a full night’s sleep—even if the total duration hasn’t changed significantly.

2. Shorter Sleep Duration and More Nighttime Awakenings

While the commonly recommended 7–8 hours of sleep still applies to men 65 years old and older, many aging men find it harder to sleep that long.

• Frequent Awakenings: It becomes more common to wake up multiple times per night, sometimes without any clear cause. These awakenings may last longer or be harder to recover from.

• Difficulty Falling Back Asleep: Waking in the early morning hours and being unable to return to sleep—known as sleep maintenance insomnia—is particularly common in older adults.

• Earlier Sleep and Wake Times: Older men often experience a shift in their circadian rhythm that causes them to become sleepy earlier in the evening and wake earlier in the morning. This phenomenon, known as advanced sleep phase syndrome, may feel frustrating if social or family schedules don’t align with it.

3. Hormonal Changes Affect Sleep Quality

Testosterone levels decline gradually with age, and this drop in testosterone has been linked to:

• Lighter sleep and more nighttime awakenings

• Reduced slow-wave (deep) sleep

• Increased risk for sleep disorders, including sleep apnea

Low testosterone may also contribute to daytime fatigue, mood changes, and reduced physical energy—all of which can further impact sleep quality and consistency.

While testosterone replacement therapy (TRT) may improve some symptoms in certain cases, it is not generally recommended as a treatment for sleep issues alone due to potential risks and side effects.

4. Increased Risk of Sleep Disorders

Several sleep disorders become more common as men age, and they often go underdiagnosed.

a. Obstructive Sleep Apnea (OSA)

• OSA is a condition where breathing repeatedly stops and starts during sleep due to airway blockage.

• Aging men, especially those who are overweight or have larger neck circumferences, are at higher risk.

• Symptoms include snoring, gasping for air, dry mouth, teeth grinding (bruxism), frequent urination at night (nocturia), nocturnal heartburn, palpitations, morning headaches, unrefreshing sleep, excessive daytime sleepiness/fatigue, and cognitive or mood complaints.

• Untreated sleep apnea increases the risk of high blood pressure (hypertension), diabetes, atrial fibrillation, heart disease, stroke, and cognitive decline (dementia).

b. Insomnia

• Insomnia can affect both falling asleep and staying asleep.

• It may be caused or worsened by medical conditions, medications, or psychological stressors.

• Chronic insomnia affects up to 30% of older adults, and men are less likely than women to seek treatment.

c. Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD)

• These conditions involve involuntary leg movements or sensations that interfere with sleep.

• They are more common in older adults and can lead to fragmented, poor-quality sleep.

5. Medical Conditions and Medications

As men age, they are more likely to have chronic health conditions that interfere with sleep, such as:

• Prostate enlargement (BPH), which leads to frequent nighttime urination (nocturia)

• Arthritis, causing pain that disrupts sleep

• Diabetes, which can cause night sweats or neuropathy

• Heart disease or lung conditions, which may lead to breathing issues during sleep

Additionally, medications taken for these conditions may have side effects that interfere with sleep. For example:

• Beta-blockers (for blood pressure) may cause insomnia or nightmares.

• Decongestants, steroids, or certain antidepressants can also disrupt sleep patterns.

6. Mental Health and Sleep

Aging can bring emotional challenges—such as retirement adjustment, loss of loved ones, or loneliness—which may contribute to anxiety or depression. These conditions are strongly linked with sleep disturbances, including early-morning waking or trouble falling asleep.

Unfortunately, older men are often less likely to discuss mental health concerns with healthcare providers, which can delay diagnosis and treatment of both emotional distress and the sleep problems it causes.

7. What Older Men Can Do to Improve Sleep

While age-related changes in sleep are natural, many sleep issues are treatable or manageable. Practical strategies include:

• Maintain a consistent sleep schedule, even on weekends.

• Avoid caffeine and alcohol late in the day.

• Limit screen time in the hour before bed.

• Keep the bedroom cool, quiet, and dark.

• Get morning sunlight exposure, which helps regulate circadian rhythms.

• Stay physically active, but avoid vigorous exercise close to bedtime.

• Treat underlying health conditions that may disrupt sleep.

If sleep problems persist, men should not hesitate to talk to a healthcare provider or a sleep specialist. Simple interventions—like adjusting medication timing, using a CPAP machine for sleep apnea, or trying cognitive behavioral therapy for insomnia (CBT-I)—can lead to significant improvements in sleep and overall quality of life.

Final Thoughts

Sleep changes are a normal part of aging, but they don’t have to mean sleepless nights. By understanding the factors that affect sleep in older men—from hormone levels and medical conditions to lifestyle habits—it's possible to take proactive steps toward better rest. And with good sleep comes improved memory, mood, energy, and long-term health.

This article was created using OpenAI’s ChatGPT on September 19, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

30 Days to Better Sleep: Day 30 — See a Sleep Doctor

At the conclusion of 30 days spent in an effort to sleep better, you may find yourself continuing to struggle. Through no fault of your own, restorative rest may still elude you. You may still struggle to sleep at night or wake feeling unrefreshed. What should you do now to improve your sleep? When should you see a sleep doctor?

There are many things that you can do to improve your sleep. As observed over the past month, you can sleep better by keeping a regular sleep schedule. You can improve your sleep environment by removing electronics, pets, and even the alarm clock. You can meet your sleep needs, pay off your sleep debt, and sleep at the right time for you. By recognizing sleepiness, you can create a relaxing buffer zone and go to bed only when sleepy. You can sleep better by cutting out caffeine, alcohol, and nicotine. You can exercise at the right time, avoid peeing frequently during sleep, and eliminate heartburn at night. By eliminating stress and addressing mood problems, you can limit wakefulness in bed and sleep more. Exposure to morning sunlight and prioritizing sleep can also be helpful. If after all these changes, and more, you continue to have difficulty sleeping, you may need additional professional assistance.

Persistent difficulty falling or staying asleep or sleep that is not refreshing should be evaluated by a physician. If you are too sleepy during the day, struggling with frequent naps and compromised function, you may need help. Problems that last more than a month should be further assessed. Although you might start by speaking with your primary care doctor, you may benefit from speaking with a specialist. Who should you see to discuss your problem?

Seek out a board-certified sleep specialist who is a medical doctor who has completed fellowship training in sleep medicine. A sleep medicine fellowship is 1 to 2 years of additional training after a primary residency has been completed. These doctors may have previously been trained in pulmonary medicine, neurology, or psychiatry. They then take a board examination that certifies their expertise in the discipline. The clinic or lab that you visit should be further certified by the American Academy of Sleep Medicine (AASM), a marker of the quality of care you should expect. Many professionals may express an interest or promote an expertise in sleep medicine, but you deserve to see someone who has the training and credentials necessary to help you. Not all "sleep experts" are created equal.

After speaking with a verified sleep specialist, it may be recommended that further testing be conducted. Most often, an overnight sleep study called a polysomnogram may be performed to identify a sleep disorder such as sleep apnea. Additional tests may be used to diagnose restless legs syndrome, narcolepsy, and other sleep disorders. There are many effective treatment options available once the condition has been properly identified.

You do not need to suffer from difficulty sleeping. There are sleeping pills as well as behavioral treatments, including: sleep restriction, stimulus control, and cognitive therapy. For these latter options, it can be helpful to work with someone who has training in these therapies, such as a certified psychologist. Surgical options and medical devices such as light boxes or CPAP may also have a role. A well-trained specialist will assess your individual needs and provide guidance for what therapy best suits your situation.

If after making a good-faith effort to improve your sleep, you still find yourself falling short, don't give up. Targeted advice and adjunctive treatments may be just what you need. Seek out some professional assistance and you will be able to finally sleep better, a goal that is most worthy of your efforts.

30 Days to Better Sleep: Day 29 — Make Sleep a Priority

As the "30 Days to Better Sleep" blog series draws to a close, there are only a few finishing touches necessary to ensure a good night's sleep. One of the most important is completely within your control: it is the decision to make sleep a priority.

Sleep concludes our day. It is, quite literally, the last thing we get to, but it is a finish line that we tend to postpone when necessity or preference dictates. Work, family obligations, and hobbies may intrude on the amount of sleep that we obtain. A late night with friends, a few hours surfing the internet or watching a movie, a project for work; there are endless distractions and diversions that can intrude on our time for sleep.

The first task is to consider how much sleep you need and when you should be sleeping. Once these determinations are made, you can recognize an appropriate bedtime and wake time. It can be helpful to draw a line in the sand to conclude your day, a previously described artificial closure. From this point, a period of relaxation called a buffer zone before bedtime should be observed. Then, when it is time to go to bed, the transition to sleep will be eased with a decreased likelihood of suffering from insomnia.

The challenge presents in how to preserve your sleep period. How can you protect it from the innumerable intrusions? Enroll your family and friends in these efforts. By including your bed partner in these priorities, he or she can contribute to your adherence. Be kind but firm with others who may present opportunities for distraction. If you find consistent conflicts, you may decide to slightly shift your sleep schedule to accommodate these needs on a permanent basis.

Do your best to keep your sleep schedule consistent through the week and weekend. Avoid sleeping in or staying out too late on a handful of days. Instead, go to bed and wake up at the same time each day. You will be rewarded with a consistent ability to sleep well at night, wake feeling refreshed, and be rested during the rest of the day.

Sleep may seem like the least interesting part of your day. It may be viewed as an inconvenience, a waste of time, a hassle. Neglecting your sleep needs can lead to the ill effects of sleep deprivation. These can undermine your ability to function during the day, causing poor concentration or attention, loss of short-term memory, or a disagreeable mood. If you gain more of this compromised wakefulness at the expense of some shut-eye, what good is this?

Instead, now that you have made many changes and improved your ability to sleep, respect your newfound gains. Set aside the time you need to sleep, just like you make a priority to eat or exercise. It is as just an important part of your life. Give it the respect that it deserves. You will be glad that you did.

30 Days to Better Sleep: Day 28 — Consider If You Are Too Sleepy

In the grand scheme of improving your sleep, it is important to assess the gains and recognize if you are simply too sleepy during the day. The irony is that the sleepier you are, the less you might recognize the degree of impairment in yourself. What are the causes of persistent excessive daytime sleepiness? How might being too sleepy affect your daytime function in regards to memory, focus, and mood? Take a moment and consider whether you may still be too sleepy and why.

Remember the difference between sleepiness and fatigue. Sleepiness or drowsiness is a strong compulsion to fall asleep. When it occurs during the day, it is marked by the ability to take naps. It may contribute to accidents if coupled with driving. It may lead to cognitive performance issues, including poor concentration, attention, and short-term memory. It may contribute to mood complaints, including depression and irritability. Perhaps it is easy to recognize when you feel sleepy, but how do you know when you are too sleepy?

There are a few measures used to assess excessive daytime sleepiness. The most common is the Epworth sleepiness scale. It assesses your ability to fall asleep in passive situations. Scores higher than 10 are consider to be pathological and should prompt an evaluation for sleep disorders. You may be too sleepy if you take daily, especially prolonged naps. If you fall asleep in less than 5 minutes at night, you may also be too sleepy. In addition, there are other objective tests available to assess the degree of sleepiness, including multiple sleep latency testing (MSLT) and maintenance of wakefulness testing (MWT).

What causes excessive sleepiness? The most common reason for people to feel sleepy during the day is inadequate total sleep time. Sleep deprivation leads to an increasing desire to sleep, especially in the afternoon when the waking effects of the circadian rhythm naturally dip. It's a simple relationship: if you don't sleep enough at night, you will be too sleepy during the day.

Sleep that is of poor quality will also contribute to daytime sleepiness. This may be caused by conditions such as sleep apnea or insomnia, in which sleep overnight becomes greatly fragmented or disrupted. In addition, there are conditions that cause rapid transitions between sleep and wakefulness, leading to profound sleepiness in the day, such as may be seen as part of narcolepsy.

Sleep deprivation or sleep that is of poor quality can lead to great impairment. There may be physical signs and symptoms, including hallucinations and even death. One of the key tasks of sleep is to clear away a neurotransmitter in the brain called adenosine. This chemical contributes to the feeling of sleepiness, and if it is not removed, our thinking becomes muddled. We may not even recognize the degree to which we are actually impaired. Therefore, it is important to get the perspective of other observers in our lives, including our family, friends, and coworkers. Get a candid assessment of your performance and mood, and if there is room for improvement, consider what role your sleep may have in the situation.

Excessive daytime sleepiness does not have to be a familiar part of our day. It may suggest that our sleep at night is in need of our attention. With a little collaborative information in hand, you can discuss your situation with your doctor and pursue appropriate testing, including an overnight sleep study. Start by considering if you are too sleepy, and if you are, reach out and get the help that you need to wake feeling rested and function at your best throughout the day.

30 Days to Better Sleep: Day 27 — Get Rid of the Alarm Clock

For as long as you can remember, it has been the first thing you look at in the morning: the alarm clock. It is a symbol of obligation, intrusion of responsibility, and a marker of the modern working life. One of the highlights of retirement may be finally getting rid of it. What if you could hit the snooze for good? How is an alarm clock affecting your ability to sleep and wake feeling rested? Consider whether it may be time to get rid of the alarm clock.

What does it mean to use an alarm clock? At its foundation, the implication is that you need to wake up at a certain time, probably before you would naturally wake on your own, and that you wouldn't without a prompting. If you trusted that you would wake up with time to spare, you wouldn't set an alarm. Instead, if left to its own devices your body is likely to keep sleeping, making you late for work or other obligations. Therefore, by waking with an alarm, you are shortening your total sleep time.

The consequence of waking with an alarm is sleep deprivation. If you had your fill of sleep, you would be waking before your alarm even goes off. Instead, you are trying to continue sleeping when the alarm prompts you to arise with a buzz, blare, or musical interlude. How much longer would you have slept? You might get a glimpse of the answer by how many times you hit the snooze button. Better still would be the days that you turn it off completely or don't turn it on to begin with, such as a weekend on which you can sleep in. Initially, this extra sleep will pay off the accumulated sleep debt, and then you will approach your average sleep needs.

If you determine that you need 8 hours of sleep each night, why not allow yourself this time in bed? It is a matter of simple math to figure out when you should go to bed and when you will naturally wake up on your own. If you wish to wake at 6 AM, then a bedtime at 10 PM would let you to get enough sleep without fear of oversleeping. This assumes, of course, that you will spend most of this block of time sleeping. If you suffer from insomnia or a circadian rhythm disorders, especially delayed sleep phase syndrome, you might need to correct this problem first before setting the alarm clock aside.

If you are interested in eliminating the alarm clock, it is also imperative to keep a regular sleep schedule. Go to bed and get up at the same time every day, including weekends. Your body will reward this regular pattern of sleep by waking you up at the right time. Prior to unplugging the alarm clock and trusting your ability to wake on time on your own, you should probably ease yourself into the new arrangement. Keep a very regular schedule for several weeks, getting a sufficient amount of sleep, and then set the alarm clock to a later time, a point at which you absolutely must get up -- or be late. You might also let your employer know that you are making this transition, in case you need a little extra forgiveness for tardiness.

With a little planning and persistence, you can obtain the sleep that you need and get rid of the alarm clock for good. What could be better than that?

30 Days to Better Sleep: Day 26 — Expose Yourself to Morning Sunlight

What is the first thing you do when you wake up in the morning? Chances are that it doesn't involve getting prolonged direct exposure to sunlight. How might this undermine your ability to sleep? Learn how exposure to morning sunlight may help you to sleep better, especially if you have a circadian rhythm disorder.

Light is the principal control of our day-night cycle, influencing everything from body temperature to metabolism to sleep. Without it, our bodies will run on a pattern determined by our genetics (called tau). This may not be quite 24 hours in length, and the daily discrepancy can add up. We also have natural tendencies that determine when we most want to sleep, with about 10 percent of people being night owls.

When the timing of sleep runs counter to our social obligations, it can be problematic. Falling asleep and waking too late may represent delayed sleep phase syndrome. On the other hand, falling asleep and waking too early may characterize advanced sleep phase syndrome. Each of these conditions may be helped by properly timed exposure to light and melatonin.

Light can also be helpful in people who suffer from difficulty sleeping as part of insomnia. It can help to regularize the patterns of sleep and wakefulness. How and when should you expose yourself to light?

There is a growing market for artificial light boxes. Many of these provide an intensity of light of about 10,000 lux or less. For comparison, the sun's light intensity is 100,000 lux. Light boxes can cost up to several hundred dollars, but sunlight is free. Therefore, it is recommended that people head outdoors.

For most people, exposure to sunlight should occur in the morning upon awakening, typically within the first hour after crawling out of bed. It is best to spend 30 to 45 minutes getting direct sunlight exposure into the eyes. Do not wear a sun visor or sunglasses. Sunlight filtered through a window pane may not have the same effect. If you are concerned about the effects on your skin, you can wear sunscreen. The sunlight is somewhat less intense in the morning, and it has little risk of adverse effects.

It is best to get the sun exposure while going for a walk. Alternatively, you can sit on the patio while reading the morning newspaper or having breakfast, as long as the light is hitting your eyes directly. What if the day is overcast with clouds? Even when filtered through clouds or rain, the sunlight will continue to have its effect. Keeping a regular schedule with a consistent wake time coupled with exposure to sunlight as part of a morning walk is an extremely helpful combination.

If you are struggling to sleep well at night, especially with insomnia or a circadian rhythm disorder, begin to regularly expose yourself to morning sunlight. You will find that your sleep and daytime function improve significantly.

30 Days to Better Sleep: Day 25 — Focus on Weight Loss

Your ability to sleep well at night may be profoundly affected by being overweight or obese. The extra weight may contribute to various sleep disorders, including obstructive sleep apnea, obesity hypoventilation syndrome, and restless legs syndrome. There is a complex interplay between sleep and metabolism, and sleep deprivation may contribute to weight gain. What is the best way to lose weight? Focus on weight loss, including diet and exercise, and you may find that you are able to sleep better.

The greatest concern related to being overweight or obese is the effect that this can have on breathing during sleep. The most commonly associated condition is obstructive sleep apnea. Sleep apnea is the collapse of the upper airway during sleep. This may occur scores or even hundreds of times during a night. It disrupts the flow of air into the lungs, leading to drops in the blood's oxygen levels. When the brain recognizes this, an awakening is triggered, disrupting sleep. Therefore, sleep becomes fragmented and is not fully refreshing. In the setting of obesity, increased levels of carbon dioxide during sleep may lead to the diagnosis of obesity hypoventilation syndrome.

How does excessive weight cause sleep apnea? There is increased fat (or adipose) tissue throughout the body. This may increase the size of a belly or bum, but it also lines the airway with padding. In combination with a large stomach that pushes upward when lying on the back, the pressure can more easily collapse the airway. This may manifest with snoring or pauses in breathing that characterize sleep apnea.

Interestingly, people who are overweight or obese also are at increased risk of restless legs syndrome. This is characterized by an uncomfortable feeling in the legs at night when lying down that is relieved by movement. It can be very aggravating and may lead to difficulty falling asleep, a symptom of insomnia.

If you don't sleep enough at night, you may have another reason to get sufficient rest: Sleep deprivation contributes to weight gain. This may be dependent on numerous factors. A lack of sleep may disrupt or change normal metabolism. Resulting excessive daytime sleepiness may affect food choices and lead to increased caloric intake, including caffeine-containing products. There may also be less motivation or energy to exercise.

If you are overweight or obese based on your body mass index (BMI), there are a handful of recommendations that can be helpful for weight loss. By incorporating these changes, you will be able to shed the extra pounds and maintain a healthy weight. In order to lose weight, consider these guidelines:

• Measure and record weight at the same time every day.

• Eliminate empty calories including junk food such as soda pop, candy, and fast food.

• Try to eat more fruits, vegetables, and whole grains.

• Cut portion sizes by putting food back after fixing a plate.

• Get 30-60 minutes of exercise daily, including low-impact activities such as walking or swimming.

By measuring and recording your weight each day, preferably in the morning in the nude before getting ready, you will have a daily reminder of how the weight loss process is going. You will need a scale at home to accomplish this. It can be helpful to record these daily weights in a log. You can then track your progress, comparing your weight to benchmarks weeks or months before. If you have a bad day, failing to exercise or making the wrong food choices, you will have immediate feedback on the consequences.

Calories can be hidden in foods. It is shocking when you really pay attention to food labels. Stop drinking juices and soda pop. Try drinking more water. Cut out manufactured foods that are high in sugar. Avoid fast food, much of which has high caloric, fat, and salt content. Incorporating healthier foods that are filling and more nutritious can make a huge difference.

Too often our eyes are bigger than our stomachs. If this persists, our stomachs will soon catch up, however. When we are at our most hungry, it is easy to serve large portions and fill our plates with tempting fare. Once we start eating, it takes time for the signal from a full stomach to reach our brain, letting us know that we are satisfied and should stop eating. In the meanwhile, we can clean our plates and consume more calories that we may not need. By fixing a plate and then putting part of the portions immediately back, we can avoid eating too much.

Finally, there is a critical role for staying active and engaging in exercise. No matter our personal physical limitations, it is possible to exercise. This may be as simple as stretching or walking. Another low-impact activity is swimming. In the setting of other health problems, you should discuss your exercise regimen with your physician before increasing your activity. The more active you can be, the better you will sleep at night as well.

Weight loss can be a battle, but it is a struggle that can be overcome. Simple steps such as those outlined above can make a big difference. Not only will you feel better during the day, but you will also sleep better at night.

30 Days to Better Sleep: Day 24 — Quiet Your Restless Legs

Resting at night depends on getting to sleep easily and staying asleep. Aside from insomnia, one of the sleep disorders that can make it difficult to fall asleep is restless legs syndrome (RLS). What is this condition and what are the major causes of RLS? Frequent bouts of restlessness in your legs may require treatment, so what are the options? Learning if you have RLS and finding an effective therapy will certainly help you to sleep better.

Restless legs syndrome, or RLS, is a commonly experienced but infrequently discussed condition. It may affect up to 20% of adults. It typically involves an uncomfortable or disagreeable feeling in the legs that occurs at night while sitting or lying, with an urge to move that is relieved by movement. The feeling may be described as a restlessness, an electrical sensation, like bugs are crawling under the skin, or even as a deep ache. It often affects the legs, but may affect the arms or any part of the body. Though it frequently occurs at night or in the evening, it may occur during the day, especially during prolonged sitting like on a flight or long car ride. As the name "restless legs syndrome" does not always characterize the symptoms completely, it has been more recently referred to as Willis-Ekbom disease, acknowledging the original doctors who described it.

No matter what you call it, RLS can really impact your ability to sleep. If you feel like bugs are crawling under your skin, and you have to constantly shift your legs so that you do not have the sensation, you can imagine that this might make it tough to relax and sleep. Many people who suffer from the condition have to get up and walk around to make the symptoms subside. This will delay sleep onset, and may contribute to feelings of insomnia. In order to understand how to relieve this, it is important to consider the major causes.

Restless legs syndrome may be primary or idiopathic. This means that it is not due to another known medical cause or that the underlying cause is simply unknown. For the vast majority of people, this is the best description of why RLS is occurring. There are, however, some recognized causes of RLS that can be reversed. The known causes of RLS include:

• Iron Deficiency

• End-stage Kidney Disease

• Diabetes

• Multiple Sclerosis

• Parkinson's Disease

• Pregnancy

• Rheumatic Disease

• Varicose Veins

Aside from these major causes, there are other conditions that seem to be associated with RLS. Obesity is by far the most common. Others include hypothyroidism, high blood pressure, and heart disease. Problems with the nervous system can contribute such as peripheral neuropathy, lumbosacral radiculopathy, or spinal stenosis. Diet can also contribute, including vitamin deficiencies, excessive caffeine intake, and low blood sugar (typically among diabetics on medications).

How do you know if you have RLS? The diagnosis is based only on symptoms. There is no testing required. Movement of the legs during sleep can be captured with a sleep study. These periodic limb movements of sleep (PLMS) are often associated with RLS. These are not, however, diagnostic of RLS. Restless legs syndrome is about the sensation, not the movement. Someone can have PLMS without having any symptoms of RLS, and thus would not be diagnosed with RLS. This is because PLMS may result from other conditions as well, including sleep apnea. If you do not have symptoms of RLS, even with PLMS on a sleep study, you do not need evaluation or treatment of RLS. It is sufficient for a sleep doctor to determine if you have RLS based solely on a proper history.

Once it is determined that you have RLS, it is often useful to check an iron level in the blood called ferritin. If this is low, oral iron supplementation may be recommended. If there is another contributing cause, this should be treated as appropriate. Residual symptoms can be treated with multiple effective medications.

If you have restless or uncomfortable feelings that disrupt your ability to fall asleep at night, you should see a sleep specialist. After a careful interview, you can discuss whether treatments for RLS may help quiet your restless legs and help you to sleep better.

30 Days to Better Sleep: Day 23 — Snoring and Sleepiness Equals Sleep Apnea

In reviewing the articles in this blog series, you may have become convinced that the only thing that affects sleep is not sleeping as part of insomnia. However, there are many other sleep disorders that can contribute to difficulty sleeping and waking refreshed. One of the major contributors to excessive sleepiness during the day is trouble breathing at night, best characterized by sleep apnea.

Sleep apnea occurs when the upper airway collapses during sleep. Tissues in the airway, from the nose past the soft palate to the base of the tongue, may obstruct the flow of air. When this occurs, this obstruction may be partial (hypopnea) or complete (apnea). It may be worsened by lying on one's back or during REM sleep when the body's muscles are actively paralyzed, including the muscles lining the airway. This soft, flexible tube is thus able to collapse and disrupt breathing. These events may occur as few as 5 times per hour or as many as hundred of times per night.

It may not matter much that the tissues at the back of the nose and mouth collapse during sleep. It wouldn't, that is, if our brain didn't recognize the problem. These disruptions to breathing trigger a panicked response from the brain. A burst of cortisol races through the body, while blood oxygen levels drop heart rate spikes, and sleep is briefly disrupted to restore breathing. This brief arousal is transient, lasting only seconds, but it shifts the brain from deeper stages of sleep to lighter ones, and often fully to wakefulness. Sleep becomes fragmented and the restorative properties diminish.

As a result, people with sleep apnea do not feel refreshed when they wake in the morning. Quite the contrary, they may even feel worse after sleeping. Whatever good is to come from sleep is lost. Upon awakening, there may be morning headaches and a strong desire to return to bed (sleep inertia). Later in the day, someone with sleep apnea is plagued by excessive daytime sleepiness; a "mental fog" with poor concentration, attention, and short-term memory; and mood issues including depression and irritability. There are serious health consequences to this fragmented sleep, including hypertension, diabetes, high cholesterol, memory loss, stroke, heart attack, and sudden death. This is a serious business, but it doesn't have to be.

How do you know if you have sleep apnea? People who snore at night have an airway that is narrow with the turbulent airflow causing a vibration that is heard as snoring. When this air stops flowing, apnea occurs. A careful observer may note pauses in breathing, lasting more than 10 seconds, followed by a sudden snort or gasp and return to snoring. When experienced, someone with apnea may wake up gasping or choking. (Incidentally, children should never snore and they often have undiagnosed or misdiagnosed sleep apnea with hyperactivity, attention problems, and growth restriction.) In adults, this condition can run in families due to upper airway anatomy and facial structure. It is worsened by weight gain, alcohol use, and smoking. In women, menopause may signal a time when sleep apnea worsens or first becomes evident. In anyone who is predisposed, aging and the associated loss of muscle tone can also exacerbate the condition.

Fortunately, there are effective treatment options for sleep apnea, including the preferred therapy called continuous positive airway pressure (CPAP). It works by maintaining the airway open with a constant flow of air. Though there can be initial hurdles, once these are overcome, CPAP can make a world of difference. There are no major side effects, and it can leave you sleeping and functioning a lot better.

If you snore at night and suffer from excessive daytime sleepiness (with a score higher than 10 on the Epworth sleepiness scale), you should seek evaluation for possible sleep apnea. If you have witnessed pauses in your breathing and are too sleepy, you almost certainly have sleep apnea. Treatment can be highly effective, so do yourself a favor and get checked out by a sleep doctor. Curing your sleep apnea is most certainly a major way to sleep better.

30 Days to Better Sleep: Day 22 — Address Underlying Mood Disorders Including Anxiety and Depression

Sleep walks hand in hand with mood. Anyone who has tried to go to bed upset knows that time is spent tossing and turning instead of sleeping. It is good advice to not go to bed angry, but what about other negative feelings? Mood problems such as anxiety and depression can severely affect sleep. Consider how addressing these psychiatric conditions may help you to sleep better.

In order to sleep, we have to ensure that certain conditions are meant. It is a rich tapestry with the integration of distinctive elements. Some of these are physical; we have to have been awake long enough to feel sleepy, for instance. Some of these are behavioral; we have to go to a place where we will be comfortable to sleep, typically our bedroom. Other conditions imperative to sleep depend on our thoughts or moods, sometimes referred to as the cognitive element of sleep. Interplay exists between all of these factors, and mood is particularly powerful.

If we are in a state of stress, we are unlikely to fall asleep easily. This is protective. If we have witnessed something that we find emotionally distressing, the resulting anxiety provokes us to stay awake to ensure our personal safety. Once the anxiety fades without further being incited, our state of arousal remits and we can rest. Psychiatric problems that lead to persistent disturbances in our moods, such as anxiety or depressive disorders, can also lead to chronic difficulties sleeping. In fact, these disorders can change the very structure of sleep.

People with depression often suffer from early-morning awakenings. Rather than waking with an alarm clock, people with depression may wake several hours before intending to. Depressed people also have a quicker onset of rapid eye movement (REM) sleep during the night.

In contrast, anxiety problems such as generalized anxiety disorder are commonly associated with insomnia that may impact the entire night. It takes longer to fall asleep. There is more wakefulness after sleep onset, with nighttime awakenings followed by prolonged periods awake. The total amount of sleep is reduced. In addition, people with anxiety may also experience early-morning awakenings, similar to what occurs in depression.

There appears to be a clear relationship between mood and sleep problems. Not only do mood problems often result in sleep disorders like insomnia, but people with insomnia are more likely to develop anxiety or depression. The combination increases the risk of suicide. People with sleep apnea often have depression as well.

These facts should lead us to a comprehensive conclusion: in order to sleep better at night, it may be necessary to address any coexistent mood disorders. When symptoms of anxiety or depression are present, these must be improved in order to fix the difficulty sleeping. By tackling each factor that contributes, it will be possible to improve your sleep so that you can face your day fully rested and feeling your best.

30 Days to Better Sleep: Day 21 — Restrict Your Time in Bed, Consolidate Your Sleep

Our beds can be a place of almost heavenly repose, where we retire at the end of a full day and restore our bodies and minds with sleep. This may not always be the case, however. When the bed becomes a place of turmoil and struggle, the night filled with wakeful anguish, it is not what it could be. If you struggle with insomnia, limiting the amount of time spent in bed may actually help you to sleep better.

Insomnia is characterized by difficulty falling or staying asleep. People with it will often spends hours lying awake in bed at night. Although some light sleep may occur, the desire for sound sleep is diminished by this extended time in bed. It is not uncommon for insomniacs to go to bed early or sleep in as they attempt to maximize the amount of sleep that they get. Unfortunately, this works against the natural systems that contribute to the ability to sleep.

There are two processes that work in combination to promote sleep. The first is the natural timing of sleep called the circadian rhythm. If you try to sleep at the wrong time, as may occur after jet lag, your struggle will increase. The other contribution is homeostatic sleep drive. This is the desire for sleep that builds the longer a person stays awake. This occurs due to the build up of a chemical within the brain called adenosine. By spending more time in bed, especially in light sleep, the sleep drive is diminished.

In order to consolidate your sleep, you should track your sleep patterns with a sleep log. Over 1 to 2 weeks of time, track your typical bedtime, wake time, and the number of hours spent sleeping. Then, to the best you can estimate, calculate your total sleep time. Let's take an example. If you crawl into bed at 10 PM, spend 1 hour falling asleep, spend 2 hours awake in the night, and get up at 6 AM, you would estimate that you got 5 hours of sleep. It is recommended that the nightly total sleep time be averaged over at least 1 week. This way you may have good nights and bad nights without skewing your average too significantly.

Once you have calculated the average amount of sleep that you are getting, you should arrange your bedtime and wake time to reflect these needs. Most people with insomnia will calculate that they are getting between 5 and 7 hours of sleep. There are certainly some who will estimate even less (or none). You should pick your average, but not less than 5 hours. Then consider what your preferred wake time is. If you want to get up at 6 AM and you estimate you are getting 5 hours of sleep based on your numbers, then you do some simple arithmetic. Subtract 5 hours from 6 AM and you have your new bedtime: 1 AM. The suggestion that this be taken as the new bedtime inevitably meets with stern resistance.

Why would sleep experts encourage you to spend even less time in bed when you are struggling to get enough sleep? If your sleep is fragmented, punctuated by awakenings and prolonged periods spent awake, how can you expect to sleep enough to function with less time in bed? Fortunately, you are not the first person to suffer from insomnia and experience and research demonstrates that sleep restriction is a highly effective treatment. In seeking out expertise in this matter, you have reached a point where your insomnia has negatively affected your life. It is time to take the action needed to set things right.

Restricting the time you spend in bed will consolidate the amount of sleep that you get. By staying up late, you will build up a stronger sleep drive. Therefore, when you crawl into bed, you will be even sleepier. So sleepy, in fact, that you will fall asleep more quickly. In addition, this desire for sleep will keep you asleep during the time that you are in bed. You will then wake up at your desired wake time. You must keep your commitment to the wake time. Set an alarm clock, two if you must, or have someone else wake you. If you have a rough night or two, ride it out: it will get better.

When you start to get reconnected with the feeling of sleepiness (and not fatigue), you may start to add additional time to your total sleep time by going to bed earlier. Do this slowly. You didn't develop insomnia overnight, so don't expect it to be fixed in a few nights. It is probably best to add back 15 minutes every 3 days. Do this until you reach your desired total sleep time. If you calculate your sleep needs, you may stop adding time at 7 or maybe 8 hours. Therefore, if you start at 5 hours, you will have moved your bedtime back sufficiently in about 3 weeks. The best part is that this effective treatment has none of the side effects common to sleeping pills!

If you suffer from insomnia, you can effectively set things right by restricting the time you spend awake in bed. You can consolidate your sleep with a tailored sleep or "time in bed" prescription based on your recent sleep needs. By slowly adding time in bed, you will find that you fall and stay asleep much easier. If you need additional guidance in this process, you can find a cognitive behavioral therapist for insomnia who can ease you through the changes. No matter how you go about it, you will be grateful that you took the initiative to sleep better.

30 Days to Better Sleep: Day 20 — Don’t Take Naps

What's the harm in taking a nap? If you have difficulty sleeping at night, you may do well to cut out napping during the day. How do you know if your nap is harming your ability to sleep?

There are plenty of people who can get by taking a nap during the day with no ill effects on that night's sleep. Unfortunately, there are others who will struggle falling asleep as a result. The ability to sleep is dependent on two factors: homeostatic sleep drive and circadian rhythm. Sleep drive builds throughout the day: the longer you stay awake, the stronger the desire to sleep. It is similar to hunger and the desire to eat: the longer you go without eating, the hungrier you become. If sleep overnight is a feast, naps during the day are snacks. By eating a snack, you will be less hungry for the feast. By taking a nap, there is a weaker desire and ability to fall asleep and stay asleep overnight.

Many people with insomnia will be unable to sleep during the day, including during naps. These individuals are "tired but wired," with complaints of fatigue, exhaustion, and diminished energy, but a notable inability to sleep during the day if given the opportunity. An insomniac will lie down to rest and spend the time awake. If sleep is obtained, even briefly, it can be very disruptive to sleep at night. There are others who will find it easy to fall asleep during the day, with little impact on the ability to sleep at night.

If you are getting an inadequate total number of hours of sleep at night, failing to meet your sleep needs, the difference may be partially made up with naps. As an example, if you need 7 hours of sleep and only get 6 hours, an hour long nap during the day may effectively make up the difference. When sleep is of poor quality due to sleep apnea, naps may also be a common occurrence. In addition, naps can be an important coping mechanism in conditions such as narcolepsy. Naps can also be very helpful to prevent or provide relief from drowsy driving.

There are societies in the world where naps are integrated into the daily schedule. This "siesta" time takes advantage of the natural lull in wakefulness that occurs in the early to mid-afternoon, just after lunch. Is it better to avoid naps altogether?

If you are struggling to sleep at night, especially if you have difficulty falling asleep, you should cut out naps during the day. This will increase your drive to sleep and make it easier to fall and stay asleep. If you have an underlying sleep disorder, or suspect you might, naps may occur commonly and may suggest a need for evaluation. Naps can be a wonderful, refreshing opportunity to take a break in the day, incorporated into lifestyles and societies around the world. However, for those who fight with insomnia and have difficulty sleeping at night, it may be time to discover a simple way to sleep better: don't take naps.

30 Days to Better Sleep: Day 19 — Instead of Trying to Sleep, Change the Focus to Rest

Have you ever really tried to fall asleep? The more effort that is attempted, the harder it is to doze off. Why is it hard to fall asleep when it becomes the focus of our attention? Consider what to do when you have difficulty falling asleep and why it can be helpful to change the focus to rest.

Insomnia is commonly characterized by difficulty falling or staying asleep. Whether this occurs at the start of the night, or after an overnight awakening, difficulty falling asleep may be worsened by an active mind. It can be helpful to change the focus: rather than striving and struggling to sleep, the focus should shift to obtaining rest.

We have a very peculiar ideal of sleep, and one that can be difficult to meet. Our expectation is that we will crawl into bed, fall asleep immediately, sleep soundly without awakening during the night, and immediately jump out of the bed in the morning feeling refreshed. Unfortunately, sleep is typically much more different than this, especially in the setting of insomnia.

It is normal to wake up in the night. If a loud noise didn't awaken us, we may find ourselves placed in harm's way. Though unconscious, we remain reactive to stimuli in our sleep environment. A mother quickly wakes to her crying infant, for example. In addition, we naturally wake during sleep, especially during transitions between sleep stages. As we get older, our ability to sleep uninterrupted during the night decreases. More time is spent in lighter stages of sleep and sleep may seem less refreshing.

Studies have shown that when someone is awakened from the lightest stage of sleep, called stage 1, 50% of people will say they were awake and 50% will say they were asleep. All of them are, in fact, asleep. This means that there can be a misperception about when sleep is occurring. Some people with insomnia will greatly underestimate the quantity of sleep obtained due to this misperception. If someone with insomnia has a sleep study, they may report that they didn't sleep a wink, but the objective data from the test may suggest otherwise. Therefore, light sleep in the night may occur and be perceived as wakefulness, and anxiety about not sleeping may not be fully justified.

The more our attention dwells on whether or not we are asleep, the less likely it is that we will be able to fall asleep. These thoughts are alerting. The constant checking of what state of consciousness we are in actually wakes us up. It leads to arousal and vigilance, two characteristics that undermine our ability to drift off to sleep. If we focus on sleeping, and put forth effort to do so, we will inevitably fail.

What if you set a different goal for the time spent in bed? Ideally, you would spend the night in the deepest, most refreshing stages of sleep. However, it is normal to spend time in lighter stages and even awake. This time is still restful to both the body and mind. It is also possible that time you believe to be spent awake is actually a light stage of sleep. The focus can then shift to obtaining rest, rather than striving to obtain sleep. You will never be able to force sleep to come, so give up the fight and let yourself rest. Quiet wakefulness can be a normal part of the night, and it does not need to be a source of aggravation. Learning to let go can be accomplished with a treatment called paradoxical intention.

If you find yourself struggling at night, trying with all your might to sleep, you should change your focus. By allowing your attention to shift elsewhere, you may find that you have a more enjoyable night and wake feeling more refreshed. Part of getting better sleep may be accepting rest as an acceptable alternative.

30 Days to Better Sleep: Day 18 — For a Racing Mind, Make a List

It can be hard to get to sleep when you have a lot of things on your mind. For people with insomnia, characterized by difficulty falling or staying asleep, this is a frequent occurrence. Difficulty sleeping may provoke anxiety, and one technique to ease a racing mind is to make a list.

Why does anxiety disrupt sleep? The time before falling asleep should be relaxing. If it becomes a source of anxiety or stress, it can be far more challenging to fall asleep. Anxiety, stress, worry, or tension will provoke alertness. In a state of anxiety, your mind is triggered to keep you safe. Part of this is maintaining vigilance to your environment and preventing inattentiveness or sleep. This has an evolutionary advantage: if you get drowsy with a lion on the prowl, you will soon become its dinner. Unfortunately, this works against us in modern life.

Many people with insomnia will complain that they try to fall asleep and cannot. It becomes a chore to relax and drift off to sleep. After crawling in bed, the mind of an insomniac may rev up. Scattered thoughts may come to mind, like a movie made up of rapidly changing but distinct images. The litany of worries and preoccupations that fill the day present themselves to be addressed. Anticipation for the next day's events may also become provocative. There may be associated feelings with these thoughts that themselves are disruptive and alerting.

Let's take an example. You are leaving on a European vacation early in the morning. You know that you need to get up at 4:30 AM to catch your flight, and you rushed readying things up to the point of crawling into bed. Now that you are settled under your covers, you are starting to review your preparations. "Did I pack the camera? I need to water the plants in the morning. The passport is in my bag. Do I have enough cash? I stopped the mail. Have I left enough time in the morning to make it to the airport? What is the weather going to be like? Where is my black coat? ... Why can't I get to sleep?" This may be an infrequent example, but the same can occur on a daily basis with different concerns coming to mind.

What is the best way to diffuse a racing mind? Although a simple solution, it actually can be very helpful to make a list. It is best to set aside some time in the afternoon or early evening, several hours from bedtime, to sit and write down the issues in your life that might lead to stress. These may include incomplete home or work tasks, family stress, health concerns, financial problems, and a variety of other stressors. Enumerate these concerns. By writing them down, you no longer have to devote mental energy to keeping track of them. As part of this, you may even write down action points, any ideas you have to reduce or eliminate the source of stress.

Why is making a list helpful? This process orders your thoughts. It helps you to recognize, organize, and articulate what is leading you to feel stressed. By supplementing this with an action plan, you will decrease your stress because you have identified ways to make this better. You no longer have to worry about remembering these things. If you can set aside time each day to review the list, you will have scheduled a time to address these concerns. Then, if the thoughts come to mind as you are trying to fall asleep, you simply tell yourself, "I have written this down on my list and I will address it tomorrow when I have my time to review it." You then disengage from the anxiety, not dwelling on the thought, and let it go.

When partnered with a relaxing period before bedtime, this list can be a powerful way to diffuse anxiety and turn off a racing mind. For those who struggle with insomnia, it may be just the thing to finally get to sleep.

30 Days to Better Sleep: Day 17 — Manage Your Stress with Relaxation Techniques

Stress can have a major impact on your ability to fall and stay asleep. Feelings of anxiety, worry, and tension can lead to insomnia. Sometimes the cause is obvious: a lost job or loved one, a big project at work, an examination, a divorce, a trauma, and so on. In other circumstances, the underlying trigger may be less evident. When stress undermines your ability to sleep, you may benefit from relaxation techniques. What is the best way to handle stress? Learn how to manage and relieve your stress with some specific recommendations to unwind.

In an anxious state, it can become impossible to sleep at night. There is an innate "fight or flight" response programmed into your nervous system. Therefore, when you are under conditions of perceived threat, you won't accidentally nod off and put yourself in harm's way. Although this protective mechanism has served humanity well when we lived in the wild, it can be disruptive in the modern world. The stressors of life may put us in a heightened state of arousal, leading to persistent difficulties sleeping at night.

People with insomnia seem to have a higher degree of arousal, which makes it easier to stay awake during the day but harder to sleep at night. When it is time to unwind and transition to sleep, insomniacs may find their minds racing and sleep difficult to obtain. It is important to preserve a buffer zone before going to sleep and wait until sleepiness comes before retiring to bed. As part of this transition period, there are a number of relaxation techniques that can prove to be helpful.

It should be acknowledged that the exact same activity may be relaxing to one person and stress-inducing to another. For example, reading is a pastime that many people find soothing before bed. However, someone who struggles with dyslexia may find reading to be very stressful. Therefore, it is best to individualize the relaxation techniques that you utilize. It can be helpful to brainstorm a list of activities that you find relaxing. To get you started, consider these possibilities:

• Take a warm bath or shower

• Listen to relaxing music

• Read a book or magazine

• Spend time praying or meditating

• Stretch from a lying position

• Breathe slowly in and out

• Write in a journal

• Practice yoga

• Knit, sew, or work on a craft project

• Relax your muscles

• Clean or organize your home

• Take a long walk

If tension and worry is taking a toll on your sleep, it can help to dial back the anxiety by engaging in targeted relaxation techniques. Reflect on what you personally find to be a source of relaxation. Even the act of generating a list of relaxing activities can put your mind at ease as you focus on things that make you calm and happy. By incorporating these pastimes into the hour before bed, you will more readily transition to sleep and sleep better through the night. For those with persistent anxiety, it can also be helpful to speak with a professional therapist to obtain stress relief recommendations.

30 Days to Better Sleep: Day 16 — Don’t Lie Awake in Bed at Night

This is it. In 30 days of lessons to improve your sleep, this is the one you print out and hang above your desk. This is the one you e-mail to your family and share among your social networks. This is the lesson that, once mastered, will guarantee you sleep better for the rest of your life. It is simple, common sense, and the heart of it all: Don't lie awake in bed at night.

Insomnia is difficulty falling or staying asleep or an adequate amount of sleep that is not refreshing, in the absence of another sleep disorder. It is characterized by feeling "tired but wired," a sense of fatigue or exhaustion with an inability to sleep, especially during daytime naps. It may run in families. It may be provoked by periods of stress, but it may simmer beneath the surface for years, waiting to raise its ugly head. Once begun, changes may occur that perpetuate the effects. No matter how it manifests, it nearly always includes lying awake in bed at night.

What happens when an insomniac lies awake at night in bed? This is time that is not spent sleeping, which is a source of endless aggravation. Inevitably, sleep becomes a focus of attention and a source of tension. Questions flood a racing mind: "Why can't I sleep? What is wrong with me? Why can't I turn off my mind?" Anxiety inevitably builds as concerns turn to the effects on the next day. When sleep is pursued, it becomes a struggle. Sleep is evasive, fleeting in pursuit. You cannot strive to sleep. You have to give up the struggle.

If you cannot fall asleep within 15 to 20 minutes, you should leave your bed. Move to another place where you can recline and engage in relaxing activities while waiting for sleepiness to come. These activities should not be stimulating or rewarding. Avoid computers and television, and instead choose to read a boring book or an old magazine. You may choose to stretch or breathe slowly, allowing any tension to dissipate. Only when you feel drowsy or sleepy - your eyelids getting heavy, lingering in closure - only then do you return to bed. You must only go to your bed when you feel sleepy and periods of wakefulness must be truncated.

What happens if we stay in bed while awake? We learn to associate our beds with wakefulness and perhaps even tension or anxiety. Those with insomnia must break a negative association with the bed: "That is the awful place where I struggle to sleep." Pavlov was famous for his dogs. He would ring a bell while feeding them, the food initially prompting salivation. In time, a bell alone, without food, would lead to salivation. This is a conditioned response. Similarly, those with insomnia may develop a negative association with the bed. This must be extinguished and in its place it is necessary to re-establish the relationship of bed with sleep.

Many people with insomnia will try to get as much sleep as they can manage. If difficulty falling or staying asleep starts to erode away the total amount of sleep a person gets, it is natural to extend the opportunity to sleep. Why not go to bed early or sleep in to catch up? If you spend hours awake in the night, it makes sense to try to balance this out by spending more time in bed. Unfortunately, this is the opposite of what should be done. Going to bed early will lead to more time spent awake before falling asleep as you will diminish your desire for sleep and disrupt your circadian rhythm. By staying in bed longer into the morning, you will spend some of this time sleeping, which will make it harder to fall asleep the next night for the same reasons. Sleep consolidation works by harnessing your ability to sleep, and lying awake in bed at night undermines it.

For those with insomnia, the cure you seek is entirely within your grasp: Don't lie awake in bed at night. There can be hurdles to mastering this simple advice, however. It is sometimes necessary to incorporate additional lessons to facilitate the change, including the management of thoughts, behaviors, attitudes, and emotions linked to sleep. It can be especially helpful to have a guide in this journey, such as a sleep doctor or a trained cognitive behavioral therapist who specializes in insomnia. You have the ability to reclaim your sleep; we can help.

30 Days to Better Sleep: Day 15 — Avoid Heartburn at Night

There are few things as miserable as waking with the discomfort of heartburn. As you make progress in sleeping better, one of the key milestones is avoiding heartburn at night.

Heartburn goes by many names: reflux, gastro-esophageal reflux disease, GERD, water brash, acid indigestion, or pyrosis. It all amounts to the same thing, however. The esophagus is a muscular tube that extends from the mouth to the stomach. At the connection between the esophagus and the stomach is a muscular ring called the lower esophageal sphincter (LES). This cincture is meant to close and keep the contents of the stomach from regurgitating back into the esophagus or mouth. When the lower esophageal sphincter becomes weak, or the acidity of the stomach excessive, heartburn occurs.

People who suffer heartburn can list the inciting culprits: coffee, tomato products, citrus, chocolate, fatty foods, peppermint, and alcohol. A glass of orange juice, a spicy dinner, a few pints of beer; these are the stuff of a night of indigestion. Many of these foods actually cause the lower esophageal sphincter to relax and become leaky. How can this be avoided? The most obvious solution is to not eat or drink these particular foods. It may also be especially important to avoid late meals. These may not be the only necessary remedies, however.

Believe it or not, there are actually sleep disorders that can contribute to heartburn and reflux. The most common contributor is obstructive sleep apnea. It may seem bizarre that a breathing problem can contribute to a condition that affects the stomach and esophagus, but these pipes are closely related.

The esophagus lies directly behind the windpipe or trachea. Sleep apnea is characterized by a collapse of the airway during sleep. This occurs in the muscular portion that is able to collapse, most often at the back of the throat. The effort to breathe will persist through this obstruction, with the brain prompting the diaphragm and respiratory muscles to continue working. When the lungs expand against a closed airway, a negative pressure is created. This negative pressure within the thorax can suck the contents of the stomach into the esophagus, resulting in reflux.

Therefore, it is imperative to treat sleep apnea. If you experience heartburn at night, this is a necessary consideration. In the context of loud snoring, pauses in breathing during sleep, and excessive daytime sleepiness, it is virtually diagnostic of sleep apnea. Interestingly, untreated heartburn may lead to a side effect with the mainstay therapy for sleep apnea called continuous positive airway pressure (CPAP) treatment. Some people have aerophagia, or air swallowing, that leads to belching, flatulence, or bloating. Aerophagia seems to occur due to weakness in the lower esophageal sphincter, allowing air to get into the stomach during treatment. This may improve with the use of medications to treat GERD (such as proton pump inhibitors), over-the-counter gas relief such as simethicone or Gas-X, or by raising the head of the bed by 30 degrees.

If you find heartburn disrupting your sleep at night, you may start by making some simple dietary changes and avoid large meals too close to bedtime. In the setting of other symptoms suggestive of sleep apnea, you should speak with your doctor. It is possible to sleep well at night, and this certainly should include avoiding unnecessary heartburn.

30 Days to Better Sleep: Day 14 — Decrease the Frequency of Trips to the Bathroom to Pee

There is nothing worse than having to wake up in the middle of the night to go to the bathroom. Once you get to sleep, the last thing you need is a full bladder waking you up. For some people, these awakenings may even evolve into difficulty falling back asleep, a symptom of insomnia. How can you decrease the number of trips to the bathroom to urinate in the night? Fortunately, there are a few changes that you can make that will help you to stay asleep and, if you do awaken, fall back asleep more easily.

First, it is uncommon for younger people to get up in the night to pee. Children may have enuresis, or bedwetting, but this is typically outgrown. There are also a number of effective behavioral treatments and even medications that can help. If your child is waking during the night to pee, it could be a sign of another medical condition or even a sleep disorder such as sleep apnea.

Later in life, our ability to concentrate urine overnight declines. As a result, bladders fill more quickly and compel trips to the bathroom. In particular, men who are middle aged or older may develop urinary frequency as part of benign prostate enlargement. When urination occurs during the night it is called nocturia. Nocturia may also be part of medical problems such as diabetes, chronic kidney disease, or heart failure. It may also frequently occur as a side effect of taking diuretic blood pressure medications - sometimes called "water pills" - including furosemine or Lasix.

Aside from the role of aging, these medical conditions, and the side effects of medications, there are some causes of nighttime urination that can be controlled. Drinking an excessive amount of water before going to bed will increase the likelihood of nighttime awakenings to pee. This is especially true if these liquids are consumed in the 4 to 6 hours before bedtime. Caffeine, which works as a stimulant, is also a mild diuretic that can increase urination. By reducing fluid intake before bed, you may decrease the trips to the bathroom in the night.

Finally, it is important to treat sleep apnea as this can also lead to nocturia. There are two major reasons for this. Sleep apnea leads to the fragmentation of sleep. Deeper stages of sleep are disrupted by the breathing disruption and the affected person spends more time in light sleep. In these lighter stages, there is more awareness of how full the bladder is. In addition, research suggests that sleep apnea itself triggers the release of hormones that increase urination at night.

If you do wake during the night to pee, you should try to minimize the amount of light that you expose yourself to during the night. By using a small nightlight, you may make it easier to fall back asleep. You should also limit your activities; make a quick trip to the bathroom and return promptly to bed. Don't wander around the house, get a snack or drink, or get distracted by other tasks.

If you find yourself getting up during the night to pee, there are certain changes that you can make to decrease the frequency and degree of waking. If you have sleep apnea or a medical condition, speaking with your doctor may provide some relief. By decreasing the frequency of trips to the bathroom to pee, you can sleep better.