Sleep problems are a hallmark of modern American life—perhaps never more so than recently. In 2016, the Centers for Disease Control and Prevention found that a third of Americans were getting too little sleep at night. But then came the stressors of the pandemic, job losses, disrupted schedules, and closed schools, which kept record numbers of Americans up at night or unable to wake up in the morning.
As many as 2 in 3 Americans reported getting either too much or little sleep, in a survey from the American Psychological Association during the pandemic’s second year. And though some parts of life are now returning to normal, the insomnia of the past two years may be stubbornly hanging on: Many people continue having more trouble falling asleep or staying asleep, or have seen unusual shifts in their sleep schedules.
All of this is taking a toll. “These different types of sleep changes seem to be closely related to [problems with] mental health,” says Karianne Dion, a graduate student in clinical psychology at the University of Ottawa. Research she co-authored, published in the Journal of Sleep Research in 2021, found “worse symptoms of stress, anxiety, and depression” among those who are sleeping less or going to bed later and waking up later than before.
Researchers have long known that anxiety and depression can lead to sleeplessness, while sleeping poorly can increase the likelihood of anxiety and depression. But a good night’s rest is also critical for a strong immune system, as well as for health overall. Insufficient sleep over time is associated with a greater risk of diabetes, high blood pressure, and heart disease, according to the CDC. It can lead to memory and cognitive issues as well.
So how can we get the sleep we need? It’s not easy to just flip a switch and start sleeping soundly again—if you ever did in the first place. Here’s how to solve seven common problems that can interfere with your rest and your health.
Problem: You often wake up in the middle of the night or early in the morning and then can’t get back to sleep.
Solution: If light coming into your bedroom is the issue, light-blocking products like blackout curtains or a sleep mask may do the trick. You might also want to cut back on—or cut out—caffeine (which can keep you perky long after you’ve consumed it) and alcohol (which can interfere with deep sleep).
Many people, however, sleep lightly because of “hypervigilance,” says Rafael Pelayo, MD, clinical professor at Stanford University’s division of sleep medicine and author of “How to Sleep: The New Science-Based Solutions for Sleeping Through the Night” (Artisan, 2020). In this context, hypervigilance refers to focusing too much on what might disrupt your slumber—before you doze off and even while you’re sleeping. This leads to an acute awareness of your environment and, paradoxically, can make it harder to sleep.
The best way to address this is a form of cognitive behavioral therapy (CBT) known as CBT-I—the “I” stands for insomnia, for which it’s often the go-to treatment. CBT-I offers techniques that can help you identify and modify thinking patterns and habits that keep you from sleeping. For example, people who spend 9 hours in bed at night but only 6 hours sleeping might be instructed to lessen their in-bed time by 2½ hours for a week. If that cuts down on unwanted wake-ups, they may slowly add back in-bed hours.
Though you can ask a sleep doctor about CBT-I, you can learn to do it on your own, too, Pelayo says. Consider using an app, like CBT-i Coach, which Stanford University developed in collaboration with the federal government. (The app’s makers say it’s not a replacement for therapy.) You can also teach yourself strategies to employ when you can’t fall back asleep, such as taking some slow, deep breaths, aiming for about six breaths per minute.
Problem: Nature always calls in the middle of the night—often multiple times.
Solution: “Waking up once during the night to use the bathroom is completely normal,” says Abigail Maller, MD, an assistant clinical professor of pulmonary, critical care, and sleep medicine at UCLA.
But if you find that you awaken two or more times each night for restroom visits, try reducing the salt in your diet, Maller says, because excess sodium—which your kidneys will try to flush out—can contribute. You may also want to avoid fluids in the 2 hours before bed, while making sure you hydrate well earlier in the day.
If these steps have little effect, consult your doctor. The awakenings “may be a symptom of an underlying issue” such as a sleep disorder or diabetes, Maller says. The good news is that treating the root medical problem may reduce your middle-of-the-night bathroom trips as well.
Problem: When you get into bed, your mind races, and it takes you too long to fall asleep.
Solution: Lying in bed with your bedroom dark, quiet, and at a comfortable temperature, try a short relaxation exercise—like tensing and then relaxing groups of muscles, starting at your feet and finishing with your neck and face. This may reduce physical tension in the body and help short-circuit thoughts that can interfere with sleep, according to the National Institutes of Health.
If you’ve been in bed for a while and still can’t nod off, go to another room and do a calming activity, rather than lying there watching the minutes tick by. Wait until you feel sleepy again before returning to your bedroom.
Longer-term, have a plan for heading off nighttime fretting: Before getting under the covers, make a habit of writing down the next day’s tasks, rather than holding it all in your head. One small 2018 study found that people who spent 5 minutes creating a to-do list before bed fell asleep faster than a control group.
It’s also helpful to establish a consistent bedtime and wake time, so your body gets used to falling asleep when you need it to. And avoid all screens for at least a half-hour before bed. In the few hours before you turn away from your TV and phone, consider shielding your eyes from their glow by using blue-light-blocking glasses or an app like f.lux or Night Shift. Blue light suppresses your body’s production of melatonin, a hormone that helps signal to your brain that it’s time to sleep.
Problem: You get at least 7 hours of sleep (go, you!) but still wake up exhausted.
Solution: Expert groups like the American Academy of Sleep Medicine recommend that most adults get 7 to 9 hours of sleep a night. So if you’re getting only 7 hours, start by upping that to 8 or even 9.
Next, figure out whether you’re sleepy or fatigued. Sleepiness means you feel drowsy and have a hard time staying awake, Maller says. Fatigue, in which you feel tired but don’t find staying awake difficult, is a symptom of many illnesses—including anemia, thyroid disease, and depression—that may not be directly related to sleep.
Discuss ongoing fatigue with your primary care provider, Maller and Pelayo say. And if you’re constantly sleepy, ask for a referral to a sleep specialist. It could be a sign of some form of sleep apnea, in which breathing stops and starts during sleep.
The doctor may also test you for other sleep disorders that leave you exhausted after a good night’s rest. (Read “When to See a Sleep Expert,” below.) In addition, bruxism (clenching or grinding your teeth during sleep) can get in the way of rest. Headaches and jaw pain in the morning are telltale signs. A dentist can check your teeth for wear and fit you with a mouthguard that may help.
Problem: You always fall asleep in the living room after dinner, wake up, and then can’t fall asleep again at bedtime.
Solution: Brief naps are not necessarily a problem, especially if you take them after lunch and before dinner. But nodding off on the couch in the evening and then feeling wide awake once you get into bed is “a typical pattern in chronic insomnia,” Pelayo says.
If you can’t resist the lure of a comfy couch, doing something active at that time, like taking a walk, may keep you from dozing off. But you may also need to reset your circadian rhythm. Here’s how: Get up at the same time each day, and make sure to get some sunlight each morning. If you can’t do this, you might want to ask your doctor about trying a light-therapy device.
Problem: Your partner’s loud snoring and tossing and turning keep you awake.
Solution: Allergies, congestion, or a deviated septum can cause snoring. But routine snoring can also be a sign of obstructive sleep apnea (OSA), in which a physical obstruction in the throat—often the tongue—interferes with breathing during sleep. This can have serious health consequences, like a higher risk of stroke. Symptoms can also include daytime sleepiness, high blood pressure, and night sweats.
Helping your partner get to the root of their snoring will enable you to sleep—and, Pelayo says, “you may save their life.” So urge them to see a doctor.
The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine, which sends a constant flow of air into your airway through a mask and tube attachment worn during sleep, and is often at least partially covered by insurance. These were once uniformly noisy and bulky, but many modern CPAPs are far sleeker, smaller, and quieter.
Once a CPAP user gets used to the device—and settles on a mask that fits properly, which can take a few tries—the snoring should completely stop. If not, adjustments to the device can help.
If your partner moves around a lot and it’s ruining your sleep, consider whether it’s time for a new mattress. In CR’s tests, mattresses are tested for “stabilization” or bounciness—a measure of the likelihood that movement on one side of the bed will disturb someone on the other side. Consider trying mattresses together in a store to see how they feel when you move around, says Chris Regan, who oversees CR’s mattress testing.
Problem: You work irregular hours, which makes it hard to sleep when you need to.
Solution: Sleep issues are common among overnight workers and those with inconsistent schedules—going in, say, at 10 a.m. one day and 7 a.m. the next.
If you need to sleep during the day so that you can work at night, keep your bedroom as dark as possible. Blackout curtains are a must. “Strategic napping”—timing naps for maximum benefit—can help, too, Maller says. For overnight workers, a nap right before a shift (or even during, if it’s permitted) may boost alertness and performance. Limit these naps to 60 minutes, to reduce the chance you’ll enter deep sleep. “Waking from deep sleep can be associated with grogginess and disorientation,” Maller says.
You may want to consult with a sleep specialist to figure out what nap-time would help you most, based on your schedule. And modafinil (Provigil), which might not be for everyone, is a prescription wake-promoting medication approved by the Food and Drug Administration for shift-work sleep disorder and some other issues.
When to See a Sleep Expert
If you have consistent sleep issues that interfere with your daily life, tell your doctor—who may refer you to a sleep specialist. If the doctor suspects issues like sleep-disordered breathing (such as obstructive sleep apnea), narcolepsy (daytime episodes of falling asleep suddenly), idiopathic hypersomnia (excessive daytime sleepiness), or periodic limb movement disorder (repetitive leg and foot movement during sleep), they are likely to advise an overnight sleep study for a definitive diagnosis.
These studies usually take place at specially designed sleep centers, where you’ll have your own room and bathroom. As you sleep, technicians will typically record your brain waves, heart rate, breathing, blood oxygen levels, snoring, eye and leg movements, and more. In the case of suspected narcolepsy or hypersomnia, you’ll also spend some daytime hours at the center, says Abigail Maller, MD, a sleep specialist at UCLA.
For sleep apnea, you may be able to do an at-home overnight study, with equipment lent to you. Note: This popular option is prone to false negatives and may require follow-ups.
Insurance for sleep studies can vary, so check first. And if you’re simply interested in learning more about how you sleep, consider a smartwatch—like the Apple Watch Series 7—or fitness tracker with sleep-tracking capabilities.
Editor’s Note: This article also appeared in the February 2022 issue of Consumer Reports magazine.
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