If you’re among those who think being a little sleepy won’t kill you, consider a study published in the Journal of the American Geriatrics Society in 2000: Among older people, particularly older women, daytime sleepiness was associated with an increased risk of death from any cause—greater than death from illness, cardiovascular disease, heart attack and congestive heart failure.
Rather than getting the eight hours of sleep a night that most of us need, Americans on average sleep 6.8 hours on weekdays and 7.4 hours on weekends, according to the National Sleep Foundation’s (NSF’s) 2005 Sleep in America poll. Lack of sleep is so rampant that renowned sleep researcher William C. Dement, M.D., calls it a hidden epidemic and says the United States is a “sleep-sick nation.” The 2005 poll also found that 75 percent of adults frequently exhibit signs of a sleep problem, such as taking more than 30 minutes to fall asleep, excessive daytime sleepiness or having trouble staying asleep.
Compared with the same poll in 1998, skimping on sleep has become more common. Many respondents admitted that sleepiness impaired driving skills and work performance and caused them to stay home from work and other events. Fatigue also put a wet blanket on sex drive. However, the majority of those surveyed either ignored or downplayed these symptoms.
“People who are chronically sleep deprived can be completely unaware of the root cause of their overwhelming fatigue,” says Dement, a professor in the Department of Psychiatry at Stanford University and author of The Promise of Sleep (Dell, 2000). This chronic mismanagement of a vital bodily function leads to accidents, illness and premature death. Sleep loss can impair reaction times on par with alcoholic intoxication (at a blood alcohol concentration of 0.08 percent, illegal for driving a motor vehicle). According to the National Highway Traffic Safety Administration, “Drowsy driving causes more than 100,000 crashes a year, resulting in 40,000 injuries and 1,550 deaths.” Dement says, “Drowsiness is a red alert to get off the road.” He adds that sleep deprivation was a factor in the Exxon Valdez running aground in 1989, spilling 11 million gallons of crude oil.
A night or two of poor sleep will impair concentration and memory, interfere with work and suck the air out of your social life. Mood begins to erode. First come crabbiness, peevishness and difficulty coping with everyday hassles, then a mounting vulnerability to depression. Fending off infections becomes more difficult. Worse, chronic sleep deprivation worsens diabetes and heart disease.
If you’re tired most days, you might have an underlying problem that disturbs your sleep, such as stress-induced insomnia, sleep apnea or restless legs syndrome, among other problems. See your doctor to rule out an underlying condition. For most people, daytime fatigue usually derives from burning the midnight oil. Because most doctors don’t think to ask about a patient’s sleep habits, it’s up to you to consider sleep as important as diet and exercise in maintaining your health.
Insomnia: A Common Concern
Some of us are tired because we don’t leave enough time for shut-eye. One in four, however, have insomnia, defined as difficulty either falling or staying asleep. Nearly one in 10 have difficulty sleeping most nights.
Insomnia is a symptom, not a disease. Factors that increase the odds of poor sleep include shift work, jet travel, stress, anxiety, pain, menopausal hot flashes, an uncomfortable sleep environment, consuming caffeine late in the day or excessive alcohol at night, and taking medications, such as decongestants, cortisone-type drugs, antidepressants, and drugs to lower blood pressure and relieve asthma.
Stress tops the list. Insomnia caused by a temporary upheaval (new job, romantic breakup, illness) often resolves once you’ve recovered from that setback. A greater threat is the chronic low-grade stress overscheduled Americans endure. We work too hard, go to bed too late, toss and turn, and rise too early.
Robert Sapolsky, Ph.D., a Stanford University professor and author of Why Zebras Don’t Get Ulcers (Owl Books, 2004), explains that not only does stress thwart sleep, but insufficient sleep itself acts as a stressor—it activates the stress response. The stress response elevates two adrenal gland hormones: epinephrine and cortisol. Heart rate, blood pressure, respiratory rate and many mental activities speed up. Other visceral activities (gastrointestinal and reproductive) slow down.
In one of life’s many ironic twists, the hormonal changes caused by a sleepless night have a nerve-jangling effect, making it difficult to sleep the next night, which activates the stress response, which raises epinephrine and cortisol … it’s a vicious, unhealthy cycle. Chronic stress can lead to immune dysfunction, weight gain, diabetes, osteoporosis, memory problems and mood disorders. Sapolsky acknowledges that chronic activation of the stress response may contribute to the maladies associated with inadequate sleep.
Getting the Hang of Sleep
While some people reach immediately for prescription or over-the-counter sleep aids, medications aren’t the only—and probably not the healthiest—way to treat insomnia. For some people, nondrug treatments can work as well or better. Although such methods take longer to work, the benefits tend to be enduring.
“Know thyself,” Dement likes to tell haggard people. In other words, figure out how you’re sabotaging your sleep. A standard approach is to improve “sleep hygiene,” learn relaxation skills and adopt positive strategies for late-night sleeplessness. Good sleep hygiene means you allow for a good eight hours of slumber each night, maintain regular sleep and wake times, create a cozy, quiet and dark sleeping environment, and avoid afternoon and evening use of stimulants, such as caffeine, and excessive alcohol at night.
Although many health practitioners discourage vigorous exercise just before bed, regular daily exercise can make your nights more restful, according to a 1997 Journal of the American Medical Association study. One study from the Journal of the American Geriatrics Society found that tai chi helped older people who had trouble sleeping. Yoga has helped people with chronic insomnia.
The hardest part of falling asleep can be turning off your busy mind. At first, you can’t sleep because you’re thinking about unfinished tasks from the day, regrettable bits of dialogue and tomorrow’s Sisyphusian to-do list. Then you glance nervously at the clock. How did it get to be 1 a.m.? You do the math; no way will you get enough sleep. Maybe you won’t sleep at all. You picture yourself stumbling through the next day, heavy-lidded and dim-witted. Stress hormones rise. Your nerve cells begin to twitch, mutter to themselves, grow five-o’clock shadows.
To avoid this scenario, Dement urges people to shun late-night activities that disturb peace of mind, such as doing homework, paying bills, watching the news and checking e-mail. The worst scenario is doing these things in bed—a place you want to associate only with sleep. If something’s on your mind, write it down, then tell yourself to forget about it overnight.
Whenever you can, occupy your last hours with relaxing activities, such as reading for pleasure. Make bedtime a sensuous ritual. Light a candle, turn out the electric lights, put on soothing music, and step into a warm bath or a hot foot soak. Try adding 10 to 15 drops of calming essential oils to the tub. (See “Soothe Yourself with Aromatherapy” on Page 44.) Focus on the sensation of water lapping your skin, the plant fragrances, the music, the candle’s flickering glow. Pat dry with a towel, and massage oil (apricot, grape seed or almond) into your skin. Cover the clock (and other light sources) and don’t look at it till morning. Lie in a comfortable position and notice your breathing slow down. To unclench your jaw, try parting your lips slightly.
You also can try progressive muscle relaxation, an effective technique used in many nondrug studies on insomniacs. Lie on your back. Starting with your feet, contract the muscles (really clench them), then relax. Appreciate what relaxation feels like. Next, move up to your calves, thighs, buttocks and so on, right to your face. Another method is to lie still with eyes closed and focus on your breathing, saying to yourself “in” as you inhale and “out” as you exhale. Dement’s own technique is to set the radio on the sleep function (so that it turns itself off in 30 minutes) and let the background chatter distract him from his own thoughts.
If you’re still wide-eyed after a half hour in bed, get up and do something relaxing, such as reading, listening to soothing music (which has proven sleep benefits), gently stretching or massaging yourself with your aromatherapy oil. Do not reach for the liquor cabinet, as alcohol disrupts sleep patterns. Emily Matuszewicz, a chiropractor and the director of Metropolis Center for Holistic Health in Denver, suggests getting out of bed and doing a calming yoga pose. Her favorite is lying on her back with her buttocks against the wall and her legs straight up the wall.
Herbs to Help You Get Your ZZZs
A number of herbs have sedative properties but do not interfere with daytime function—their sedating properties are mild (see exceptions below). Lesley Tierra, an acupuncturist and herbalist in Santa Cruz, California, recommends that people with persistent insomnia take herbs that support the nervous system three times daily, in addition to a dose at bedtime. In general, a dose is a cup of tea, 1/2 to 1 teaspoon of tincture or one to two capsules. Check product labels for more details.
Nerve tonics with subtly sedating effects include chamomile (Matricaria recutita), lavender (Lavandula angustifolia), skullcap (Scutellaria lateriflora), vervain (Verbena officinalis), wood betony (Stachys betonica) and lemon balm (Melissa officinalis). Lemon balm gets my award for the tastiest of the sedative herbs. Its minty, lemony taste makes it a fine addition to any brew.
Some herbs are nerve tonics yet have no sedating effects. One example is oats (Avena sativa). Eat oatmeal for breakfast and add oatstraw or oat tops to your tea. Herbalist Rosemary Gladstar writes in Rosemary Gladstar’s Family Herbal (Storey Books, 2001) that oat tops are rich in minerals and “one of the highest terrestrial sources of magnesium.” (Magnesium is thought to help regulate the internal clock.)
Hawthorn (Crataegus spp.) is subtly calming, gentle and suitable for long-term use. It also benefits the cardiovascular system. You can take it in the form of jams and syrups, or as a tea, tincture or capsule. Another herb that supports cardiac function is motherwort (Leonurus cardiaca). Many herbalists favor it for menopausal women awakened by heart palpitations.
If anxiety or mild to moderate depression underlies your sleeplessness, St. John’s wort (Hypericum perforatum) might be the herb for you. (For any serious psychological disturbance, make an appointment with a mental health professional. And be aware that St. John’s wort speeds the liver’s metabolism of many drugs, thereby lowering their blood levels, and thus, their effectiveness.)
According to herbalist David Hoffmann, author of Medical Herbalism (Element, 1996) and other books, the most effective sleep inducers are California poppy (Eschscholzia californica), hops (Humulus lupulus), passionflower (Passiflora incarnata) and valerian (Valeriana officinalis). He finds them particularly useful when pain interferes with sleep. I don’t recommend using these four herbs during the daytime.
Valerian is the best-researched hypnotic—or sleep inducing—herb. More than 20 clinical trials show the root extracts hasten sleep onset and improve sleep quality, without side effects. Most studies used valerian alone, but a few also found benefits for valerian plus hops, lemon balm or kava (Piper methysticum). Valerian also has compared favorably with the prescription drug Serax (oxazepam).
Valerian is the best- researched sleep herb.
A 2006 review of 16 studies, published in The American Journal of Medicine, reported that valerian significantly improved sleep and didn’t cause a morning hangover. However, the authors criticized the methods of many studies, including the use of small numbers of volunteers.
Don’t expect valerian to work instantly. When chronic insomniacs took a single 600-mg dose one hour before bedtime, valerian did not significantly affect objective or subjective measurements of sleep. Fourteen consecutive nights of treatment did improve sleep efficiency, though, according to a 2000 study published in Pharmacopsychiatry. The take-home message: This herb seems better suited to long-term maintenance of sleep.
Valerian’s notoriously musty taste drives most people to down liquid extracts or capsules rather than teas (the herb’s scent has been compared to dirty socks). Thirty minutes to an hour before bedtime, take 1/2 to 1 teaspoon of tincture or 300 to 500 mg of a concentrated extract containing no less than 0.5 percent volatile oils. Warning: Herbalists note that some people are stimulated, rather than relaxed, by valerian.
California poppy has a long tradition as an analgesic and sedative. Laboratory studies show it reduces anxiety and induces sleep. One study found that a French product called Sympathyl, which contains California poppy, hawthorn and magnesium, was safe and more effective than a placebo in treating mild to moderate anxiety disorders.
Hops, a critical ingredient in beer, is mildly sedating. The fluffy strobiles can be put into sleep pillows, along with fragrant lavender. Gladstar, who finds hops’ bitter taste difficult to disguise, takes the herb as a tincture, often in combination with valerian. Keep the bottle at your bedside. That way, if you awaken in the middle of the night, you can take a couple droppersful.
Sharon Tessier, who teaches aromatherapy and other holistic health classes at Metropolitan State College of Denver, says her favorite remedy for a hectic day is a cup of chamomile tea and a warm bath. “If time does not permit a full body bath, I use a shoulder pillow filled with flaxseeds, heat it in the microwave for two minutes, put it around my neck, and make peace with my day while I drink my tea.”
Soothe Yourself with Aromatherapy
In addition to drinking chamomile tea, Tessier counters insomnia with plant essential oils. Good candidates include chamomile (Roman and German), bergamot, clary sage, frankincense, lavender, neroli, sweet marjoram, rose and ylang ylang. Neroli tops her list. “Blended with lavender and bergamot,” Tessier says, “neroli will surely soothe the disconnected body, mind, emotion and spirit.”
Lavender essential oil also has a good track record of alleviating insomnia, a tradition verified by scientific research. A 2006 Korean study of college women found that aromatherapy with essential oil of lavender helped relieve insomnia. Another study found that smelling lavender essential oil helped seniors maintain sleep as they withdrew from benzodiazepines (a group of drugs that includes Serax, Restoril, Valium and Halcion).
If you have time for a warm bath at night, Tessier recommends you add 10 to15 drops of essential oil (half that amount for elderly people and young children) and soak for at least 15 minutes. Inhale the wonderful aromas. Those volatile oils absorb across your respiratory linings as well as across your skin. Note: Tessier cautions that these potent plant medicines not be taken internally and be kept out of children’s reach.
Ashley Dew has personal experience with using massage for insomnia. When stress-induced insomnia shadowed Dew’s college life, her mother gave her a gift certificate for a massage. That night, Dew slept like the proverbial baby. She left Savannah, Georgia, for the Boulder College of Massage Therapy. A side benefit of being a student afforded her twice weekly massages, which cured her insomnia and anxiety. Now a certified massage therapist at Metropolis Center for Holistic Health in Denver, Dew gets one or two massages a month to stay healthy.
If you can’t afford regular massages, consider swapping with a friend. And you always can massage yourself. Focus on your hands, feet, temples, jaw, shoulders, neck and other reachable tight muscles. The ideal is to have a massage right before bedtime—a treat a generous loved one might provide.
Consider making a nighttime massage oil spiked with the aforementioned calming essential oils. Tessier recommends 15 drops of essential oil per one fluid ounce of carrier oil or 2 to 3 drops per teaspoon of carrier. Halve the dilution for elderly people. For small children, use one-third the amount of the adult formula.
Sleep: A Precious Elixir
Guard your sleep. Think of it as a precious elixir for health and longevity. Try to eradicate any underlying sleep thieves. Consider the long menu of possible remedies. Clean up your behaviors, try herbs and, if needed, try a medication. Do whatever works. Now, get some sleep! •
Linda B. White, M.D., is the coauthor of The Herbal Drugstore (Rodale, 2000). She teaches botanical medicine and other health classes at Metropolitan State College of Denver. She plans to take her own advice about sleep seriously.