Ten years ago, I knew nothing about sleep. I thought it was something that took care of itself after I passed out. I start this story with my journey to sleep health, and then to assist you with dialing in your sleep, we delve into what doctors and scientists say about how to get seven hours of the best thing you can do for your mind and body.
For years I had been told that my snore was like a banjo solo. You knew the next note was coming but there was nothing you could do to stop it. It wasn’t a big deal outside of the stress on my marriage with Julie. She threatened to use duct tape. A taser. Finally, the note on her desk: “To stop the snoring, place pillow tightly over face. Hold until snoring stops. Burn this note.”
Julie insists she has gotten used to my snoring, but says lately the sound is more like convulsive explosions of someone desperate for air but unable to suck it in. My doctor makes me take a sleep test, and Julie had nailed it: I have severe obstructive sleep apnea. My soft palate closes over my windpipe, and I stop breathing. Given the mayhem that happens to your body when your oxygen level drops, I am grateful I didn’t stroke out.
My doctor persuades me to try a CPAP, which stands for Continuous Positive Airway Pressure. It pumps a low-pressure air stream through your nose into your lungs, and that keeps your throat open and keeps the soft palate from closing. Wearing it, I look like a character out of the Star Wars cantina scene.
Getting used to the CPAP was a steep learning curve. To a claustrophobe like me a chin strap can feel like a torture device that must be outlawed at the Geneva Convention, but on the first night, I got lucky. It worked. Next morning I walked with a spring in my step that I had not felt in 20 years.
The Journal of Sleep Medicine reports that one in four men have sleep apnea, and one in eight women. What about the rest? Does the non-apnea crowd need to be concerned about their sleep? Do younger people even need to care?
“There is no aspect of your wellness that can retreat at the sign of sleep deprivation and get away unscathed.” So says brain scientist Matthew Walker.
Every night we go on Mother Nature’s life support system, a restoration that gives us our best shot at immortality. Healing miracles happen when we sleep, and madness, memory-loss and malady when we don’t. Sleep allows cerebrospinal fluid to wash your nervous system clean of metabolic waste and plaque, while sleep deprivation can damage even your DNA.
Some people wear their sleep deprivation like a badge of honor. They will even say, “You can sleep when you’re dead.” But brain scientist Matthew Walker is professor of neuroscience and psychology at UC Berkeley and co-author of Sleep, Memory and Plasticity, suggests this is “mortally unwise.”
Walker lays it out: “The shorter your sleep, the shorter your life. Short sleep predicts all-cause mortality; it increases your risk of cancer and contributes to cognitive decline during aging. It will erode your DNA genetic code.”
Getting to Sleep and Staying That Way
Dr. Aaron Morse has spent more than 30 years helping people sleep. He works with Sleep Health MD, which has offices in Sunnyvale, Los Gatos, Santa Cruz and Watsonville. “I love what I do. I love seeing patients. It’s extremely gratifying because so many people get better.” He tells me that his Sleep Health MD office deals with people who have multiple sleep disorders; they could have insomnia or restless leg syndrome, or nightmares related to PTSD. Morse says that while sometimes medications are necessary, he really encourages behavioral treatment. He likes to treat underlying problems first, like depression or anxiety. “I had a patient with terrible PTSD. After her PTSD was treated, she got better, and her insomnia went away. We had her on medications, but it was treating the PTSD that helped her sleep.”
There are drugs that can be effective for an occasional sleepless night, but there are caveats. Dr. Morse says that most over-the-counter sleep aids contain antihistamines and tolerance can develop. The longer you take them, the less likely they are to make you sleepy. There is the hangover effect, and medicated sleeping is not as rejuvenating for your brain and body. Taking drugs to sleep beats the hell out of not sleeping at all, but continually taking drugs to sleep may not be your best longevity game.
Here are a few drugs you might want to check out as described by the Mayo Clinic:
Doxylamine (brand name Unisom) is a sedating antihistamine. When I cannot sleep and I must, one 25mg tab will put me out in 30 minutes. I will wake up groggy seven hours later. But when I’m on the road, 25mg of Unisom can give me seven hours of sleep so I can safely drive to the next town. Unisom works for me, I just don’t want to become dependent upon it.
Diphenhydramine (Benadryl) is a sedating antihistamine. Back when I toured and lived in comedy clubs and airports, I would use Benadryl to fall asleep on planes. I remember it leaving me less groggy than the Unisom I sometimes use now, but maybe I was just younger and friskier then. Experiment carefully and with your doctor’s advice, everybody is different.
Duloxetine may help insomnia by improving depression and anxiety.
Melatonin in moderate doses can be effective for sleep. It’s a hormone that helps control your natural sleep-wake cycle. Dr. Morse says, “Rather than having insomnia patients take a slug of melatonin before they go to sleep, we have them take a very low dose of melatonin five to seven hours before their normal sleep time, for a condition called delayed sleep phase syndrome. It won’t make young adults sleepy but helps align their circadian rhythm to reduce the time it takes to get to sleep.”
Trazodone is an anti-depressant that isn’t used much anymore for depression, but its major side effect is it makes you sleepy and is widely used for sleep. It may be better at making you sleep than treating your depression.
Valerian is sold as a dietary supplement and is promoted as a sleep aid for nervous tension and insomnia.
Some of my friends squirt a dropper of liquid CBD (60mg) under their tongue before bed. They buy it online from Charlotte’s Web.
Brain scientist Walker agrees with Dr. Morse and calls sleeping pills blunt instruments that do not produce naturalistic sleep. In patients with complex insomnia, sleep medications may be effective.
Walker offers two ways to improve our sleep, and number one for him is regularity.
“Go to bed at the same time, wake up at the same time, no matter whether it’s the weekday or the weekend. Regularity is king; it will anchor your sleep and improve the quantity and quality of your sleep.”
Walker’s second pillar of productive sleep is to keep it cool. He says your body needs to drop its core temperature two to three degrees to fall asleep and stay asleep. “You will find it easier to fall asleep in a room that is too cold rather than too hot. Aim for a bedroom temperature of around 65 degrees.”
Surviving the Sleep Tariff
The economy is stressing us out. Living through the self-anointed king’s reign of chaos is making us lose sleep, and it is no surprise that financial anxiety about stock volatility in 401(k)s is keeping us up nights. Financial psychologist Brad Klontz tells The New York Times, “We tend to anchor on whatever our highest balance was, so you may be focusing on how much money you’ve lost since then. If you look at your balance from a year ago, you’re probably still up.” Dr. Klontz says that it takes a good 30 minutes to an hour to calm down, so don’t look at your balances before bedtime. Just don’t.
When your finances feel out of your control, hiking is hard to beat for giving yourself a sense of mastery over your environment. Hippocrates, the father of medicine, said, “If you feel bad, take a walk. If you still feel bad, take another one.”
If you spend more time trying to get to sleep than sleeping, you are not alone. Both Dr. Morse and scientist Walker say that if you are staying in bed awake for too long, go to a different room and do something different. Only return to bed when you are sleepy. Walker points out that we’d never sit at the dinner table, waiting to get hungry. Why would we lie in bed, waiting to get sleepy?
Dr. Morse says there is a common form of insomnia called psychophysiological insomnia, where excessive worry about sleep itself leads to difficulty falling or staying asleep. “Somebody might have had a major stress in their life, financial problem, divorce, and it’s common to develop insomnia in association with that stress. People will lay there and struggle to get to sleep. The harder you try to get to sleep, the harder it is to get to sleep. The answer is to only go to bed when you’re sleepy. If you can’t sleep, get up.”
Sleep Divorce
New York Times reporter Catherine Pearson writes about partners sleeping apart, initially to get better sleep, but finding that it actually enhances their sex. The practice is at once taboo and common, but in an American Academy of Sleep Medicine survey, one-third of respondents sometimes sleep in another room to accommodate their partner. This may be seen as a sign that there is trouble in paradise, but more often people report that it helps reignite the spark. Ms. Frey said, “The moment we separated our bedrooms, it was fun! It was like, ‘Do you want to come over to my room tonight?’” For couples considering sleeping apart, it’s important to talk about how you will prioritize intimacy. Don’t spring this on your squeeze after a rough night; maybe bring it up over a glass of wine and smooth jazz.
Final solution to stop snoring: put bed frame on casters. Wait until husband is asleep. Push through the doorway and down the street. Look for tramp steamer.
There are creative ways to hack the bedroom. Dr. Phyllis Zee, a sleep medicine specialist with Northwestern Medicine, says earplugs, white noise or separate mattresses can help. As for me and my bride, wearing my CPAP has taken me from rattling the walls to being a silent sleeping partner. Julie and I have added a pug to our bed situation and it’s Pugsley who snores now. I wear earplugs; Julie listens to recordings of falling rain and the pug snores, refusing to use a CPAP.
