We want it. We need it. We gotta have it – tonight. Give it to us – long, full and deep. Is a good night’s sleep too much to ask? Apparently. For many women, it’s become a distant dream. We miss out so often on both quality and quantity that sleep experts call women the most sleep-deprived creatures on Earth.
If you’re feeling exhausted right now, then you know exactly what I mean. You routinely drag yourself through the day, thinking that maybe tonight will be the night when you’ll finally be able to catch up. You find yourself longing for eight beautiful, restful unbroken hours of sleep. But it probably won’t happen.
The latest figures show that during the workweek, the average woman gets a mere six hours and 41 minutes of sleep. Do you make up for it on weekends? Hardly. On Friday or Saturday night, you average only seven hours and 16 minutes. This means that every week you’re short of the recommended sleep totals by eight hours, the equivalent of one frill night. “Sleep deprivation is a major problem, but we’re only at the very beginning stages of public awareness,” says Dr. Rachel Morehouse, director of the sleep clinic and lab at the Atlantic Health Sciences Corp. in Saint John, N.B. “Women are particularly affected because of the ‘double shift.”‘
If you’re not putting in overtime at work, you’re doing it at home, helping with homework, putting in one more load of laundry, trying to roll out pie dough at midnight for tomorrow’s school bake sale. Even if you do manage to get to bed early one night, either you’re so keyed up after a hectic day that it takes you forever to fall asleep or you wake up in the middle of the night fretting and can’t get back to sleep. A 2000 poll by the US. National Sleep Foundation says more than 60 per cent of women report symptoms of insomnia for a few nights a month or more in the past year.
There’s always something or someone keeping you awake: a crying child, a snoring partner, a teenager coming home late, an elderly parent getting up in the night or your own worries and anxieties. The very fact that you’re a woman puts you at a disadvantage, since fluctuating hormones, from puberty to menopause, serve to disrupt your sleep.
Some women have been so sleep-deprived for so long that it seems almost normal to need caffeine breaks throughout the day, to nod off on a bus or in front of the TV, to fall asleep within two minutes of collapsing into bed. These are classic symptoms of sleep deprivation. The effects of such ongoing fatigue go far beyond grumping at loved ones and yawning through meetings. There’s growing evidence that a long-term sleep debt can result in low-grade depression, which is not severe enough to interfere with your daily existence but it can certainly drain your zest for life.
Chronic sleep loss can also hasten some aspects of aging. Not only can being tired make you look older, but it can also prematurely lower your pain threshold, raise levels of the stress hormone cortisol and reduce your body’s ability to secrete insulin.
Sleep experts say the average amount of sleep we need is eight hours a night, although they acknowledge that a few people require 10 while others can get by with six. Most women’s magic number is between seven and nine. How much do you need? Whatever it takes to let you wake up rested, refreshed and able to feel alert throughout the day without a nap.
If you’re not getting yours, is the culprit insomnia? Shift work? Hormones? A snoring partner? All you have to do now is find your nagging sleep problem and then read about the accompanying practical solutions for getting a good night’s sleep. After all, you deserve it.
Mapping the land of nod
Think of sleep as a long slow elevator ride that starts in the penthouse, glides down to the bottom floor, where we sleep deeply, comes halfway up, where we take a little side trip to have a few dreams, then rises again. Each night we take that elevator ride several times, every 70 to 90 minutes, as we cycle through the four ever-deeper stages of non-dreaming sleep, then shift into rapid-eye movement (REM) sleep, the dreaming stage. The periods of very deep, restorative Stage 4 sleep are longer in the first third of the night, while REM sleep periods are at their longest in the last third. Scientists are still unravelling the mystery of exactly why we need to sleep, but it’s believed that non-REM sleep helps repair cells, rest the body and mind and boost the immune system, while REM sleep helps store memories and consolidate learning. Problems can occur before or during any of the stages of sleep. More breathing problems occur around the lighter stages, including Stage 1, Stage 2 and REM. Unusual behaviours s uch as sleepwalking tend to occur in Stages 3 and 4.
From time to time, everyone can have difficulty falling asleep or staying asleep, but if it persists for two weeks or more, it merits attention. While insomnia can affect people of all ages, it is most common among those under the age of 30. “There are a lot of new stressors in that age group — starting careers, relationships, new lifestyles, going out into the world,” says Dr. Colin Shapiro, director of the Sleep and Alertness Clinic at Toronto Western Hospital.
Melanie Barfitt, 27, a busy Toronto-area kitchen designer, has suffered years of insomnia, taking about three hours to fall asleep, then dragging herself out of bed in the morning. “I’m a real worrier and if I’ve had a night where I’ve hardly slept at all, I get stressed out that I won’t sleep the next night either,” she says. Consequently, Barfitt loses sleep over losing sleep. Sleep experts say that while stress is usually the initial cause of insomnia, our own bad habits and performance anxiety perpetuate it. A 1999 study from Laval University in Quebec found that insomniacs who received nothing but counselling had better long-term results than those who received sleeping pills. The counselling included reassurance that insomnia was not necessarily a catastrophe and tips on keeping a regular sleep schedule.
Your best defence is healthy sleep habits, which the experts call good sleep hygiene.
* Adopt the relaxing bath-story-song routine of childhood. Going from a warm (not hot) bath to a cool room causes you to release body heat, a key step in inducing sleep. A little reading (not work-related) and some quiet music can distract you from the stresses of the day.
* Try to get up about the same time every day, no matter when you fell asleep the previous night. This anchors your sleep schedule. If you must nap, keep it to under 20 minutes and at least eight hours before bedtime.
* Get into bright light, either natural or artificial, for several hours during the day but preferably in the morning, to reset your awake-sleep cycle.
* You need a cool room but warm feet to fall asleep. If your partner won’t let you toast your toes on his calves, use a hot water bottle (remove it before you fall asleep or you’ll swelter) or wear socks.
* Realize that while alcohol may help you fall asleep, it worsens middle-of-the-night wakefulness.
* Avoid smoking, especially at night. Nicotine is a stimulant.
* Don’t go to bed hungry or overly full. Have a light snack an hour beforehand, preferably containing cheese, milk, banana, turkey or tuna. These contain the amino acid tryptophan, which helps facilitate the sleep process. Avoid sugary snacks, which may cause your blood sugar to plummet later and wake you up.
* Watch your coffee intake. Caffeine from coffee (and, to a lesser extent, from tea, cola and chocolate) can affect you for up to 12 hours.
* Exercise regularly, but not within three hours of bedtime.
* Realize that sex is an exception to the above exercise rule. Dr. Shapiro says, “Unless you’re a sexual athlete, sex is a relatively minor workout whose satisfying effect may facilitate the sleep process.” If, like some women, you lie awake after sex, try to schedule it anytime but bedtime.
* If you wake up fretting about something, write it down so that it’s off your mind and then tell yourself to deal with it in the morning.
* Turn your clock so you can’t see the time if you wake up in the middle of the night. The mental math that you do to determine how tired you’ll be tomorrow, coupled with your frustration, will only keep you wide awake.
* Keep your bedroom just for sleep and sex — no TV, computer or office paperwork.
* Join a self-help group and try suggestions from other sufferers. (Barfitt has recently been sleeping better thanks to acupuncture treatments.)
Sleep Thief bathroom visits
If nighttime urination is a problem, ask yourself if you’re waking up because you need to pee or you’re getting up to pee because you’re already awake.
* If you really do have a twitchy bladder, don’t drink liquids in the evening and ask your doctor about medications that may help. Some can work on brain chemicals to help control overly frequent signals from the bladder.
* Retrain your bladder. If getting up has simply become a habit, tell yourself that you can hold it till morning. Amazingly, this can work.
Sleep Thief shift work
About 20 per cent of adults in Canada work shifts. Wendy Malachowski is one of them. As an emergency room nurse in a large Toronto hospital, she works 12-hour shifts, such as 11:30 a.m. to 11:30 p.m. (Her husband, a police officer, also works shifts.) By the time she makes the long commute home to Newmarket, Ont., checks her daughters’ homework, makes their lunches, grabs something to eat, cleans up the kitchen, has a shower and sits down to unwind in front of the TV, it’s 2 a.m. And she’ll be up again at 6:30 to get her girls off to school. “I drink three mugs of coffee before I get out the door in the morning,” says Malachowski, 46. Rotating shifts, from afternoons to days to the occasional overnight, leave her chronically tired.
Humans weren’t designed to work very long shifts, night shifts or rotating shifts, says Dr. Morehouse. “We’re daytime mammals and we thrive best with a regular daytime routine.” Women shift workers have an especially hard time, since they often curtail their own sleep for family and household responsibilities. Women on shifts may experience unwanted weight gain, digestive problems, menstrual irregularities and fertility problems. The graveyard shift may also increase the risk of heart disease. Nerve activity around the heart is naturally lower at night whether you’re awake or not, and trying to work may put the heart under added stress.
* Stay on the same shift as much as possible.
* If you must rotate, go with the clock: days to afternoons to nights.
* Since light helps to keep you awake, use very bright lights at night to mimic day.
* If you’re planning to sleep right after the graveyard shift, make extra efforts to get home safely, knowing you are tired.
* If you can’t fall asleep in the morning, wait until early afternoon, when there’s a natural energy dip.
Women of all ages have different sleep problems than men because we have different biology and sleep patterns. Women should have an advantage, since from adolescence onward, we experience more deep restorative sleep than the guys and have fewer sleep disorders. But there’s a trade-off: since hormonal fluctuations disrupt sleep, simply being female puts us at higher risk for some sleep problems such as insomnia. Puberty, PMS, painful periods, pregnancy, perimenopause, menopause — there’s always something.
Menstrual changes Many women notice sleep troubles a few days before and at the beginning of their periods. They blame bloating, breast tenderness or cramps, but the very withdrawal of estrogen and progesterone at that time can cause restlessness. Helen Driver, a sleep researcher at Queen’s University in Kingston, Ont., who has studied the relationship between hormones and sleep, recommends the following:
* Take a calcium-magnesium supplement in the evening (the effervescent kind is absorbed fastest), which promotes muscle relaxation.
* Increase your intake of soy products. Their weak plant estrogens may smooth out the wild estrogen fluctuations.
Nothing interrupts sleep like babies — even before they’re born. Insomnia can strike as early as the first trimester of pregnancy, when nausea, leg cramps, heartburn and worries can cause wakefulness. You’re also likely to pee more often at night, not from the baby’s pressure on the bladder — the baby isn’t big enough yet for that — but from the relaxing effect of high progesterone levels on bladder walls. By the third trimester, your sheer bulk makes it difficult to find a comfortable sleeping position.
* Try lying on your side with a pillow between your knees or forget the bed and sleep in a reclining chair.
* Have a cup of warm milk an hour or so before bed and ask your partner to give you a massage. Even so, it’s likely you’ll have some sleepless nights, especially as you near the end of your pregnancy. Think of it as nature’s way of preparing you for the major sleep loss to come after the baby arrives.
Are you ready for this? It’s estimated that you’ll lose about 700 hours of sleep during your baby’s first year. The sleep you do get will be fragmented, at least for the first few months.
* Grab sleep whenever you can. Nap when baby naps. Forget about housework.
* Ask your partner to take the baby for a long walk while you rest or soak in a hot tub.
By about three months of age, most babies no longer need a middle-of-the-night feeding and start becoming physiologically ready to sleep through. You can help this process. Your goal now is to improve your sleep as well as to help your child establish her own healthy sleep habits.
* Some families believe in sleeping with the baby so she is always in contact with a warm body. If she wakes up, a simple pat on the back might do the trick to get her back to sleep. That way, you won’t be shuttling back and forth to her crib and your bed. You may want to breastfeed, but it may not be necessary and may prolong the cycle of wakefulness.
* Other parents will bring their babies into bed with them if they wake up in the middle of the night. But if you find it disruptive sleeping with your baby, you may want to try a method popularized by U.S. pediatrician Dr. Richard Ferber in his book, How to Solve Your Child’s Sleep Problems (Simon & Shuster).
Here’s what he recommends:
* If your baby cries in the middle of the night and you’re sure she’s not in peril, go to her, stroke her gently, tell her quietly that it’s time to go back to sleep and leave her. Do not turn on the lights, which will wake her up even more.
* Repeat this process every five, then 10 and as many as 15 minutes until one of you (preferably, the baby) gives in. You can also use this technique with older children who have trouble sleeping because of a scary movie, a nightmare or school work anxiety.
* Within a week or so, your baby will be less likely to wake in the night. In fact, you may be amazed that she will sleep right through until morning. However, you may have to repeat the method when your baby gets a cold or around nine months or so. That’s when they start crawling in earnest and may get hungry at night again. The Ferber method remains controversial. Some parents can’t stand the thought of leaving their babies to “cry it out.” Others who have successfully “Ferberized” their babies swear by it.
New research shows that around age 40, the quality of women’s sleep declines precipitously. Vida Bond, 41, of Aurora, Ont., noticed it at age 38, when she suddenly went from being a good sleeper to a fitful one. Despite having excellent sleep habits and a healthy active lifestyle, she averages only six hours of sleep during her eight hours in bed. “I can get through my day, but I’m a little impatient and I can be lethargic,” Bond says.
It’s a common complaint among perimenopausal women, says Driver. She recommends “sleep restriction therapy” If, like Bond, you’re lying in bed for eight or nine hours but sleeping only six, then your sleep is inefficient.
* Increase your sleep efficiency by trying a few nights of going to bed at midnight and then getting up at six. (Plan a time when you don’t need to be very alert during the day.)
* If you wake up at night and become agitated from just lying there, get up and do a quiet activity such as reading, knitting or a jigsaw puzzle until you’re sleepy again. Don’t nap during the day because it will interfere with the new sleep schedule that you’re trying to establish.
* If this doesn’t work, talk to your doctor about natural progesterone cream, which you apply to your skin, or hormone replacement therapy. “We think HRT improves sleep in perimenopause but we caution that after menopause, while it helps with hot flashes, it won’t necessarily improve sleep,” Driver says.
Here are some remedies for those annoying night sweats that accompany the menopausal years, which can start as young as 40 and peak between ages 50 and 54.
* Eat soy products, which deliver some much-needed plant-like estrogens.
* Keep your bedroom cool.
* Use 100 per cent cotton sheets, cotton nightgowns (with a spare handy in case you soak through the one you’re wearing).
* Have separate duvets or covers for you and your partner.
You’ve elbowed him, prodded him, whispered in his ear, yelled and rolled him onto his side. Yet, his snoring still makes you feel as though you’re lying beside an airport runway. Well, take heart; there are people who feel your pain. More than one in five women share the problem. 1999 U.S. study by the Mayo Clinic found that people who sleep beside loud snorers lose about an hour of sleep a night. Snoring — especially irregular snoring punctuated by gasps and snorts — can signify obstructive sleep apnea, a common but potentially serious sleep disorder. Encourage your partner to see a doctor.
* Try using a “snore ball,” a tennis ball sewn into the pocket of a T-shirt. With the T-shirt worn back to front, the snorer is discouraged from rolling onto his back.
* Encourage your partner to lose a few pounds, which may lessen the snoring.
* Don’t use alcohol and sleeping pills, which just make the snoring worse.
* Talk to a doctor or dentist about the more than 50 different anti-snoring dental appliances, which are also helpful for people who grind their teeth.
* Wear earplugs.
* Sleep in separate bedrooms.
Early to bed, early to rise could refer to a wholesome lifestyle or it could signify a sleep disorder. Morning larks fall asleep before 8 p.m. and get up by 4 a.m. due to a genetically linked disturbance in circadian rhythms that runs in families. On the flip side are night owls, who sleep from about 2 a.m. till mid-morning.
Unless you’re a morning talk-show host or a bartender in an after-hours club, these disorders — called sleep phase advance or sleep phase delay syndrome — can make everyday life more difficult.
* If your odd hours are wreaking havoc on your work or family schedules, consult a sleep clinic, which can offer medication and therapy to modify the problem. C
When registered nurse Wendy Malachowski of Newmarket, Ont., heads home after a long shift in Toronto, she’s too exhausted to focus on her driving. “Some days, I’ll drift over and hit the gravel,” she says. After alcohol use, sleepy driving is probably the No. 1 cause of accidents, says Alistair MacLean, a psychology professor at Queen’s University in Kingston, Ont., who has studied the new research.
Many of us wouldn’t dream of driving after drinking. But MacLean says that if you’ve been up all day and evening and you’re driving at 2:30 a.m., you’re as impaired as if you’ve had two drinks. By 5 a.m., it’s as though you’ve reached the legal limit. You’re sleep-drunk. This condition may make you stressed, impatient and lead you to road rage. You may actually drive faster too. “Very sleepy drivers do riskier, more stimulating things to try to compensate for their sleepiness,” MacLean says.
If you’re sleepy, don’t drive. But if you must:
* Stop your car periodically and walk around it to increase alertness.
* Drink coffee, which may sharpen your focus for an hour or so.
* Have a short nap before you drive.
* Avoid the peak accident times of 3 p.m. to 4 p.m. and 2 a.m. to 6 a.m.
* For short-term pick-me-ups, open a window, crank up the radio and sing.