You’re in bed tossing and turning. The minutes tick by and you can’t seem to relax. Or maybe you fall asleep, only to awaken a few hours later. The next day, you’re tired, again.
According to the federal Centers for Disease Control and Prevention, which calls insufficient rest a public health epidemic, approximately 70 million Americans experience sleep problems. About a third of working adults, 41 million people in all, get less than six hours of sleep a night.
Unfortunately, getting a good night's sleep becomes trickier with age. "As we get older, our sleep gets a little bit lighter,” says clinical psychologist Michael Breus, author of The Sleep Doctor’s Diet Plan: Losing Weight Through Better Sleep (Rodale, 2011).
"You might get the same amount of sleep," he says, but its intensity in stages three and four, more commonly known as our periods of "deep sleep," tends to decline, becoming less physically and mentally restorative. As our sleep patterns shift away from deeper states, we sleep lighter and are more likely to wake up in the middle of the night.
Common middle-age health issues can also contribute to the problem. “Disorders such as sleep apnea and leg movements increase with age, and are found in a majority of adults over age 70," says Dr. Donna Arand, clinical director of the Kettering Sleep Disorders Center in Dayton, Ohio. "Sleep may also be affected by medications or medical conditions, especially those associated with pain."
For women experiencing menopause, she adds, "hormonal changes, including hot flashes, can disrupt sleep, while decreased estrogen and progesterone levels in post-menopausal women can cause insomnia."
Stress can have a detrimental effect on our sleep, too. Caregiving, divorce, unemployment, the death of loved ones and the financial pressures of preparing for retirement can all undermine our best nighttime intentions.
Most adults need about seven hours of sleep daily, Arand says, but only 20 percent of us actually get it. Yet the more we learn about the links between sleep and health, the more we realize how crucial it is to improve our rest. "At one point, sleep was viewed as what happens between 10 p.m. and 6 a.m.," says Dr. Douglas Kirsch, a clinical instructor at Harvard Medical School and the regional medical director of the SleepHealth Centers in Boston. But given the discoveries made in the past decade, he says, "Now we’re interested in how it affects your health.”
6 Health Risks of Poor Sleep
Cognitive decline. Simply put, people who don’t get enough sleep (or sleep too much) are at greater risk of cognitive decline. Four separate studies presented at the recent Alzheimer’s Association International Conference found the likelihood of developing symptoms is linked to common sleep disorders like deprivation, too much or too little rest, sleep-disordered breathing (apnea) and daytime sleepiness.
(MORE: Learn How to Enjoy Better Sleep)
Weight gain and diabetes. When you don’t get enough sleep, you’re at greater risk for gaining weight and, potentially, contracting Type 2 diabetes. This is due in part to the poor food choices we tend to make on low sleep, Breus says, but also because of hormonal changes. Research published earlier this month in The Annals of Internal Medicine found striking differences in the way our fat cells respond to insulin depending on how much we've slept. The study of lean, healthy young adults found that after just four nights with four-and-a-half hours of sleep, fat cells responded to insulin as if they were 10 to 20 years older. The cells' increased resistance to insulin limited their ability to store lipids, which instead can leach out and enter the bloodstream, a common a precursor to Type 2 diabetes. "I was very surprised" by the results, said University of Chicago associate professor of medicine Matthew Brady, who led the study.
Mood disorders. We're all grumpier when we don’t get enough sleep. According to a recent University of Michigan study, even earning an additional $60,000 more each year has less impact on happiness than averaging one additional hour of sleep each night. Scientists have long known that poor sleep puts people at greater risk for depression and that adults who already suffer from depression are much more likely to have trouble sleeping. Insomniacs are about 10 times more likely than others to be depressed and nearly 20 times more likely to have anxiety. Similarly, people with depression are five times more likely to have obstructive sleep apnea than others. The good news: Treatment of apnea has been found to reduce symptoms of depression.
Heart disease. Sleeping too little, or too much, raises your risk for heart attack, stroke and congestive heart failure, according to research presented at an American College of Cardiology conference this past spring. The new study of more than 3,000 adults age 45 or over — the first "nationally representative sample to find an association between sleep duration and heart health" — found that people who sleep less than six hours a night were twice as likely to have a stroke or heart attack and 1.6 times more likely to have congestive heart failure. Those who sleep more than eight hours a night are also at risk. The study found they're twice as likely to have angina (chest pain) and also have an increased risk of developing coronary artery disease.
“We now have an indication that sleep can impact heart health — and it should be a priority,” Chicago Medical School professor Rohit Arora, who led the study, said in a statement. “Based on these findings, it seems getting six to eight hours of sleep every day probably confers the least risk for cardiovascular disease over the long term.”
Car accidents. Insufficient sleep can slow your reaction time and impair your judgment behind the wheel. According to the National Sleep Foundation, 60 percent of Americans have driven while feeling sleepy and 37 percent admit that they've actually fallen asleep at the wheel. Most troubling, the foundation reports, is research that finds many drivers cannot tell when sleepiness is about to overcome them.
More pain. If you suffer from arthritis, fibromyalgia or back pain, you already know that less sleep equals more pain. It's not that the conditions get worse, though; it's that you're less able to cope with them: "The pain itself might not be different," Breus says, "but your perception of it is worse."
The Path to Better Sleep
The first step in improving your sleep is to make it a priority, something that doesn’t come easily to fiftysomething adults used to burning the candle at both ends. “Sleep is important, but we tend to value lots of things more,” Kirsch says. “On the other hand, if we slept more, we’d do better at the things we value." Following are six expert tips for sleeping better:
- Stay on schedule. “The best way to improve sleep is to develop and maintain regular sleep and wake times on a daily basis,” Arand says, adding that those habits should apply on weekends as well.
- Have a bedtime routine. Like children, adults need a nightly routine. Whether it's reading, listening to music or taking a bath, establish a pattern that works for you as you wind down every night.
- Exercise regularly. Being physically active helps improve sleep, especially when the exercise takes place in the morning or afternoon.
- Limit alcohol and caffeine intake. Both can keep you awake or disturb your sleep. To avoid their impact, finish your last glass of wine at least three hours before bed and stop consuming caffeine by 2 pm.
- Keep your bedroom cool, dark and quiet. A slightly cool temperature, around 68 degrees Fahrenheit, is most conducive for sleeping, says Arand, who, like most sleep experts, strongly advises against keeping TVs, computers and tablets by your bedside. All tend to prevent you from winding down successfully when it's time for sleep.
- Have the right nighttime gear. Replace old, uncomfortable mattresses, make sure your pillows are comfortable and consider room-darkening shades if exterior lights or sunrise are disruptive. "Sleep is a performance activity," Breus says. "If you have the right equipment you’ll be better off."