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January 19, 2009

Better in Bed: Do You Need a Sleep Makeover?

3 sleep-deprived readers check in with Rubin Naiman, Ph.D., the snooze expert.

woman sleeping on a pillow

Photo Credit: Lise Gagn/iStock Images

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"I depend on Rockstar"
KIM DELATORRE, 34, stay-at-home mom with two kids, ages 1 and 2; married; Kalama, WA

Kim's Sleep Situation: "My kids are night owls, and my husband works from 2 p.m. to 2:30 a.m. I usually get to bed around midnight, but I breast-feed my daughter three times a night and also wake up when my husband comes home, so I rarely get consecutive hours of sleep — it's usually about six broken-up hours. I hate coffee but depend on Rockstar energy drinks. I usually drink about half a can a day."
The Doc's Diagnosis: "Rockstar has at least 160 milligrams of caffeine, so Kim probably has some caffeine in her body 24 hours a day. She has 'mixed insomnia,' which is difficulty falling asleep and staying asleep."

Better Sleep Rx: "Implement a firm sleep-wake schedule and an earlier bedtime for Kim and her kids."

"Give up the Rockstar. To get her caffeine fix, she should try a cup of green tea. An 8-ounce cup packs only about 25 milligrams of caffeine. This will help her fall back into a deep sleep quickly after waking up during the night."

"Invest in light boxes for dark winter months. The best thing for daytime energy is light."

The Two-Week Follow-Up: Kim has cut back on the Rockstar. When she doesn't drink it, she falls asleep faster after getting up to breast-feed. She's also putting the kids to bed an hour earlier and uses the extra time to wind down.

Is caffeine cramping your sleep style? Addicts, limit your intake to 300 milligrams a day, ideally before 2 p.m. Here, a guide to what has the most kick:
Starbucks grande drip coffee (16 oz.): 330 mg.
Espresso (1 oz.): 90 mg.
Diet Coke (12-oz. can): 46.5 mg.
Snapple Lemon Iced Tea (16-oz. bottle): 42 mg.
Dark semisweet chocolate (1 oz.): 20 mg.
Excedrin Extra Strength (2 tablets): 130 mg.
Midol Menstrual Complete (1 tablet): 60 mg.

"I work the night shift"
COURTNEY EPPS, 24, surgical nurse, works 7 p.m. to 7 a.m. three days a week; single; New York City

Courtney's Sleep Situation: "I've been working in a fast-paced unit on the night shift for the last year. I'm on the list to switch to days, but I'll have to wait at least three months. As soon as I get home from work, I typically go to sleep until 6 p.m. At that point, I try to interact with friends, but then I find myself struggling to get through my night shifts. I work in the dark because I'm trying to get the patients to go to sleep, so my body never registers my awake hours as my 'daytime.' When I'm working, it's almost like I'm on a high, but once I leave, the exhaustion hits me all at once."

The Doc's Diagnosis: "It's virtually impossible to get healthy sleep with this kind of work pattern. We call it 'shift-work syndrome.' There's a clock inside the brain that creates a 24-hour circadian rhythm. If that clock isn't synchronized with the clock that you live your life by, it creates a dissonance. People who do this for years can end up with pretty serious illnesses — depression, gastrointestinal disorders, and cancer."

Better Sleep Rx: "Wear wraparound sunglasses on the way home to communicate to your system that it's nighttime."

"Buy a good-quality sleep mask with circular raised pillows around the eyes. When a mask presses against the eyes, it can interfere with REM sleep."

"I don't typically recommend medication, but since there's no room for mistakes in Courtney's job, she could consider the prescription stimulant Provigil. It gives a steady source of energy for eight hours without the jittery side effects of caffeine."

The Two-Week Follow-Up: Wearing sunglasses home from work in the morning has helped Courtney fall asleep faster once she gets there. After considering Provigil, she ultimately decided to pass, but she does intend to purchase a new sleep mask.

"I can't sleep through the night"
AMANDA ZISKIN, 34, personal assistant; single; Brooklyn

Amanda's Sleep Situation: My work sometimes has me out late during the week, so I typically get to bed between midnight and 2 a.m., then wake up between 8 and 10 a.m. Since it takes me nearly two hours to fall asleep, I keep my laptop and iPhone in bed with me and have the TV on. Lately, I've been waking up around 3:45 a.m. and can't get back to sleep until 6. I'm very energetic during the day, so it doesn't take a toll on me, but I do sometimes rely on Nyquil, Tylenol PM, Simply Sleep, or Ambien to fall asleep faster. I alternate because one never works for me consistently."

The Doc's Diagnosis: "Amanda isn't getting enough good-quality sleep. Her high energy level during the day helps her compensate, and she could probably go on like this for another 10 to 15 years — but I wouldn't recommend it. At night, it takes her longer to come down off that high — she essentially runs out of fuel and crashes. Amanda needs to learn how to slow down before she gets in bed."

Better Sleep Rx: "Start slowing down an hour before bedtime — process the day by writing in a journal for 15 minutes and dim the lights. If Amanda must use her laptop or watch TV, she should wear blue-blocker glasses to block out the blue component of light that disrupts melatonin production."

"Up sleep efficiency — the percentage of time you're in bed actually sleeping. A normal sleep efficiency is 90 to 95 percent. If Amanda is doing other things, she may begin to negatively associate wakefulness with the bed."

"Steer clear of over-the-counter 'PM' products, like Tylenol PM — they contain diphenhydramine [Benadryl], which remains active in the body well into the next morning and can negatively impact cognition and perception. The only thing I'd recommend is melatonin.

The Two-Week Follow-Up: By no longer watching TV in bed and simply dimming the lights before bedtime, Amanda is finally sleeping through the night. She's also swapped OTC meds for Simply Sleep melatonin and has found it effective in helping her fall asleep faster. —Jihan Thompson

Snooze through sleep-disturbing PMS with tips from Michael Breus, Ph.D., founder of Sound Sleep Solutions:

Flush your system by drinking at least half of your body weight — in ounces — of water a day. So if you weigh 130 pounds, that means 65 ounces of water, approximately eight glasses. Ask your doctor about increasing calcium, magnesium, and vitamin B complex intake before and during your period. Use a nonsteroidal anti-inflammatory to ease tension and cramps: ibuprofen (Advil), naproxen sodium (Aleve), or aspirin.

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