If you struggle with sleep — falling asleep, staying asleep, feeling refreshed when you awaken — you’re like an estimated 1 in 3 American adults who don’t get enough. As many as 84 million U.S. adults don’t sleep well and up to 70 million have sleep disorders. Their sleep problems may also plague those around them.
Americans rack up $90 billion a year in related health care costs, per a Journal of Clinical Sleep Medicine study. And in 2022, Gallup found the economy suffered to the annual tune of $44.6 billion for sleep-related lost productivity.
No one’s really guessing how much money we spend on products to boost our odds of getting Zzzzs.
Sleep is crucial and Deseret News never tires of writing about it, but this timing is not coincidental. March is National Sleep Month and daylight saving time starts March 10. Views on whether that’s good or bad vary. The American Academy of Sleep Medicine takes a strong position against changing the clocks, which most states do, noting natural circadian rhythms are more aligned with standard time and earlier darkness.
Experts say improving sleep helps virtually every aspect of life.
“Sleep is a main pillar of health — a necessary behavior for life itself,” said Kelly Baron, a licensed clinical psychologist and director of the Behavioral Sleep Medicine program at University of Utah Health. “If you’re not sleeping, it affects things downstream. Mental well-being and sleep really should be considered with diet and physical activity as main wellness behaviors.”
“One common thread is people think sleep is optional, rather than an essential component of health. That is manifested most frequently by people not giving themselves enough time to sleep,” said Dr. Vishesh Kapur, spokesperson for the sleep academy and professor of medicine at the University of Washington.
Damage is significant. Last year, researchers found young people with better sleep habits are “incrementally less likely to die early.” The Harvard-led team said about 1 in 12 deaths — regardless of cause — might be sleep-related. Researchers found sleeping seven to eight hours and not struggling with sleep more than twice a week, not needing medicine to sleep and feeling rested on rising could add nearly five years to a man’s life expectancy and half that to a woman’s.
We often fall short. Gallup said the U.S. adult averages 6.8 hours and, for many, it’s far less.
Bottom line, per a 2021 Journal of Clinical Sleep Medicine study: Sleep needs include quality, quantity, appropriate timing, regularity and managing sleep disorders.
While you were sleeping
“Sleep is often underestimated in its importance and undervalued in our fast-paced society. One common misconception is that sleep is simply a time of rest or inactivity,” said Jacob Smith, a certified sleep therapist at Orderyoursupplies.com in Miami, Florida. “In reality, sleep is a complex and active process that plays a crucial role in overall health and well-being.”
It is in sleep that memory consolidates, learning cements and cognitive function boosts, he said. “Lack of sufficient sleep can impair these cognitive functions and lead to memory problems, difficulty concentrating and decreased productivity.”
Harvard and the National Institutes of Health are among those hailing sleep for vital functions, including restoration, cognition, emotion processing, growth and development in youths, injury repair, immune function, metabolism (inadequate sleep is tied to unwanted weight gain via dysregulated hunger and appetite hormones), heart health and more. Too little sleep leads to lower productivity and more errors and accidents, including vehicle crashes.
The human body and brain work hard as sleep cycles through five stages several times nightly. Per the Sleep Foundation, most time is spent in non-REM sleep, including deep and light stages. In light sleep, body temperature drops and muscles relax; heart and breathing slow. Those are slowest during deep sleep, a stage that’s longer in the first half of the night. Kapur said it’s believed toxins are flushed in deep sleep.
The REM (rapid eye movement) stage starts about 90 minutes into sleep and heart and respiration speed up. Most dreams happen then, but muscles are temporarily paralyzed so a dream that you can fly doesn’t send you to the roof. In REM, the brain makes sense of emotions, processes what you learned that day and decides what to file in memory. What the brain deems unimportant — often including dreams — is tossed.
Cascading woes
Missing a few hours of sleep here and there won’t be devastating, Baron and Kapur agree. Degree of loss depends on how long and how much you short your sleep.
Brief sleep deprivation means you won’t feel well the next day or perform optimally. You may be irritable, lack motivation and think more slowly.
“The short-term loss is really enjoyment of life when people aren’t sleeping. They don’t feel as good during the day,” Baron said.
Chronic sleep deprivation raises risk of more serious problems: diabetes, obesity, high blood pressure, cardiovascular disease, more stress or depression, cognitive deficit, lower sex drive, poor immune response and possible early death. Disrupted sleep may predict Alzheimer’s disease, though not for everyone with insomnia.
As AARP reported, “Insomnia and depression in particular are a two-way street. Insomnia is a symptom of depression, but multiple studies have also shown that insomnia can predict the onset of depression,” citing sleep expert Wendy Troxel of RAND Corporation and University of Pittsburgh.
AARP also cites the Sleep Foundation: 40% of people with insomnia may have a mental health disorder and 75% of people with depression have insomnia, which increases with age.
Sleep deprivation has clear warning signs, the foundation says:
- Dozing at work or while driving, reading or watching TV.
- Slow reaction times.
- Difficulty focusing, learning, problem-solving, remembering or making decisions.
- Making more mistakes.
- Behavior issues in children like impulsivity, anger or moodiness.
How much sleep do you need?
Baron has twins turning 13. Her son is a morning lark who doesn’t always go to sleep easily and sometimes wakes up too early. Her daughter is more of a night owl but an excellent sleeper.
“I think the average person who’s in tune with their body knows when they’re not getting enough sleep,” said Kapur. “But I think a lot of people are not very in tune and they can mask some effects by taking stimulants like caffeine during the day.”
Most adults need seven to nine hours of sleep a night; most experts call seven the minimum. Teens need eight to 10 hours, while older adults need seven to eight. Young school-age kids need nine to 12 hours, while toddlers need 10 to 13. Babies may sleep two-thirds of the time, while kids through age 2 should sleep 11 to 14 hours.
One of the best things people can do is learn how much sleep they specifically need, Kapur said, noting vacation is great for that. Go to bed at the same time and see when you wake up naturally, then do the math. “At the end of a couple of weeks, you will have a rough idea of how much sleep you actually need. Then allow yourself that much time in bed on a consistent schedule seven days a week.”
Getting seven hours for most people takes about eight hours in bed, Baron said, including time to fall asleep and perhaps waking mid-sleep to use the bathroom.
Only a “fairly uncommon individual” truly needs just six hours of sleep, said Kapur.
“Short sleep” — less than five hours nightly — is linked to later depression, per a 2023 genetic study by University College of London published in Translational Psychiatry.
Quality matters. Research in Neurology showed 30- and 40-somethings with lousy sleep are more apt to show memory problems a decade later. They tested poorly on cognitive measures in middle age compared to sound sleepers, researchers at University of California San Francisco found.
And the bad news keeps coming.
A Journal of the American Heart Association study linked inconsistent sleep hours and bedtime variation to atherosclerosis for those 45 and older, compared to consistent sleepers. When sleep duration varied two hours or more within a week, they were 1.4 times as likely to have calcified plaque in their arteries, the main cause of heart attacks and strokes.
It may be especially hard for teens and young adults to get needed sleep as they juggle work, school and extracurriculars, as well as a social life, Baron said.
Can you make up for inadequate sleep by binging? Maybe.
Paying your sleep debt
The single best thing for your health when it comes to sleep is consistency. Go to bed at the same time. More importantly, wake up at the same time. Daily.
Baron said for many of her patients that’s the only intervention needed.
Dr. Kevin Huffman, of Elyria, Ohio, is a board-certified bariatric physician and founder and CEO of AmbariNutrition. His patients often struggle with sleep. “I recommend a consistent sleep routine — a regimen that sets your body’s metabolism for sleep and for wakefulness at regular predetermined times. The body does indeed follow a rhythm of regularity, and respecting this fact can have a profoundly positive effect on sleep quality. Adopting fixed going-to-bed and waking-up times each day could help you to effectively cope with surprising wake-ups and generally boost that most important sleep factor: restorative sleep,” he said.
“It is a biological fact: Your body loves routine.”
In a recent study in Sleep, researchers from Australia, the U.S. and England found “sleep regularity” cut the risk of dying prematurely — from any cause — by 20% to 48% compared to people with the most irregular sleep patterns.
Sleep debt isn’t easy to repay.
Kapur said sleeping an extra couple of hours on the weekend might make up for a 20-minute daily shortfall during the week or for staying up a couple of hours to complete a project. But persistent sleep debt can’t be made up and may lead to chronic health problems.
“Sleep is a system of balance. If you oversleep too much, you under-sleep the next night,” said Baron, who noted research shows five days of insufficient sleep is not erased by two days of catch up. “Obviously, the best solution would be to have adequate time and opportunity for sleep during the week. Not everybody has that option.”
Many have challenging schedules, working at different times or overnight. Not everyone controls their schedule. “For those who do, trying to get on a consistent schedule is really the best thing and by not oversleeping as much, you’re giving yourself the opportunity to stay on that schedule,” she said.
As for naps, experts say 20 minutes is optimal. More or less and you may feel more droopy.
Nighttime disruptions
Even great sleepers have occasional bad nights, Baron said. Sleep apnea is “incredibly common,” the incidence rising with age. “But it’s probably less common than somebody who’s not spending enough time in bed or who has insomnia symptoms.”
Her practice focuses on non-drug treatments.
The gold standard to beat insomnia may surprise you: behavioral treatments. They’re not used often enough, Baron said. “Many people don’t bring sleep up to doctors because they’re afraid they’ll be put on medications. Or they’re trying over-the-counter.”
Cognitive behavioral therapy for insomnia, CBTI, is the No. 1 treatment for poor sleep. Per AARP, “Recent studies find CBTI works for insomnia in cancer survivors, during menopause and in people with chronic arthritis pain — and can slash risk for insomnia-related depression by 51% in older adults, too.”
However, a scarcity of practitioners makes it hard to get an appointment. Baron said online treatments, self-help books and other aids also promote behavior change.
Many of her patients had never seen a psychologist. “They say, ‘It’s not a mental problem, it’s that I can’t sleep.’ It’s important to know the treatment for sleep is very behavioral and it’s relatively focused on getting sleep regulated on the right pattern. It’s different than psychotherapy.”
Depression, stress and sleep often overlap.
“The cognitive part of CBTI is your thoughts about sleep,” she said. “When people don’t sleep, it starts to snowball. They start to stress about the night’s sleep, which gets worse and worse.”
Ryan Wong, 34, of Cheyenne, Wyoming, a human resource manager for BarkLikeMeow.com, started finding sleep a chore 12 years ago during a stressful period in college. “My mind would race, anxieties would bubble up and frustration grew with each passing hour spent staring at the ceiling. Lack of sleep made me feel constantly exhausted, foggy-brained and irritable. Simple tasks felt like mountains to climb and my mood took a significant hit,” he said.
As relationships and productivity suffered, he withdrew. It took sleep hygiene practices, relaxation techniques, a sleep specialist and time to repair his sleep. He called CBTI especially helpful, tackling underlying anxieties and negative thoughts that fueled sleep problems. When sleep now eludes him occasionally, he said he copes.
Obstructive sleep apnea is especially common in middle-aged adults, sometimes linked to weight gain. The result, said Kapur, is not reaching deep sleep, instead awakening often, as well as impact from fluctuating oxygen levels and adrenaline as breathing pauses.
Separate beds
Sleep apnea can raise blood pressure and contribute to stroke, heart attack and cognitive decline. Folks may have more risk of vehicle crashes.
People with the condition may be in bed long enough for solid sleep, but not feel alert when awake, said Kapur. He said awareness varies. Some know they’re waking up a lot, while others just feel extremely tired constantly. He suspects many don’t even recognize it.
Recently, The New York Times reported that 1 in 5 U.S. couples sleep in separate bedrooms, about two-thirds of them nightly, per a survey by the International Housewares Association.
As Deseret News reported, a partner’s sleep can affect the other partner, from extreme snoring to different temperature needs. But sleeping separately may prevent discovering a partner has worrisome sleep.
Sleep can also be derailed by medication conditions, as Corinne Segura, 41, of British Columbia, knows. She has chronic fatigue that’s accompanied by trouble falling asleep, frequent wake-ups and not sleeping deeply sometimes. She’s tried many things and found meditation helps some.
Sami Mansfield, cancer exercise and lifestyle medicine consultant and founder of Cancer Wellness for Life, said poor sleep quality and quantity are among the most pervasive side effects of cancer. Patients have “significant physical and emotional side effects not only from the actual treatments but the impact of their diagnosis and everything that can come with it, from worrying about bills, fear of dying and how to continue being a great parent.”
Mansfield coaches patients to start the morning with a glass of water, a minute of movement and light, preferably natural, within five minutes of waking up. At night, she tells patients to try for sleep within the same hour, after an enjoyable winding-down period that does not include TV, social media or stimulating communication.
Middle age and menopause are major sleep disruptors, too, Baron said, noting it’s not all explained by hormonal changes. Middle age has social and other aspects that can be hard, including depression and caregiver roles. Plus, a lot is happening biologically and socially that impacts sleep. Throw in hot flashes and sleep may disappear.
Getting those Zzzzzs
Fan Chung, of Ontario, Canada, had long hours and endless worries as he was establishing his business, Top Choice Car Detailing. Lack of sleep made everything harder.
He tried to get ahead of it. “The turning point came when I integrated a routine that included winding down for an hour before sleep, avoiding screens and practicing mindfulness. This personal trial and error taught me the importance of a holistic approach to tackling sleep issues,” he said.
Ann Swanson’s sleep issues were actual nightmares, disrupting her life. Swanson, of Denver, Colorado, once snapped awake on a rooftop, screaming. “The only thing that’s worked for me is meditation,” said Swanson, author of “Meditation for the Real World.” “Meditation got to the root causes of the issue, which were anxiety and perfectionist tendencies. Not only do I now get the best sleep of my life, but I am more calm during the day. I meditate daily, but also have mini-meditations I practice when I am struggling to fall asleep or if I wake in the middle of the night.”
While nothing tops waking up at the same time to improve sleep, other strategies help. According to experts in this story:
- Ensure your sleep environment is comfortable, quiet and dark. Reserve it solely for sex and sleep.
- Avoid substances like caffeine and alcohol late in the day that may interfere with sleep.
- Light exposure is bad for sleep — even that tiny cell phone screen. Light keeps the heart rate up and reduces slow-wave and REM sleep, per PNAS.
- Besides blackout curtains and banishing screens, some recommend eye masks.
- Check room temperature. While the Sleep Foundation says the best temperature for most is about 65 degrees Fahrenheit, a study in Science of the Total Environment found, especially for those 65 and older, warmer temperatures are better: 68 to 77 degrees. Below or above that range, sleep quality declines. Infants thrive at 67 to 69 degrees.
- Have daily bedtime and awakening routines. Huffman suggests enjoyable activities before bed like reading, taking a bath or doing relaxation techniques. They seem “deceptively simple,” but offer “profound and lasting effect on nightly sleep quality.”
- Try yoga or meditate. Per Echo Wang, CEO and founder of Yoga Kawa, “Gentle poses before bedtime not only wind down your body, but also quiet your mind. Stretches release tension, deep breaths soothe anxieties and even simple meditation poses can lull you into a relaxed state. Yoga’s focus on mindfulness helps you stay present and drift off naturally.” Adds the certified yoga and meditation teacher, “It’s a relaxing routine you can do right at home. ... Consistency is key, so aim for a few minutes of yoga most nights before bed and sweet dreams will soon follow.”
- Check your mattress. Dr. Jordan Duncan, a chiropractor and owner of Silverdale Sport & Spine in Silverdale, Washington, said studies suggest a medium-firm mattress is best for those with sleep issues related to back pain.
The most unusual — and specific — solution Deseret News heard came from Tim Hopfinger Lee, owner of Tim’s Coffee in East Hampton, New York. He jokes he used to “live like a vampire, minus the cool powers,” but his insomnia was not funny. He started having trouble sleeping while earning a master’s degree years ago.
He tires briefly between 9 p.m. and 10 p.m., too early for bed. That passes quickly, leaving him wide awake. In bed around 11 p.m. or midnight, he tosses. Occasionally he feels sleepy at the right time and crashes. Momentarily.
“I’ve tried herbal tea, meditation and getting into my comfiest clothes, but nothing works,” he said. Tiny sounds crash like cymbals, so he uses apps to drown them. What really helps is audiobooks.
“They can’t be too gripping, though, or I’ll get hooked and stay up even later. My sweet spot is slightly-above-average fantasy novels by lesser-known authors.”
He’s proof, he added, that what works for one may not help another.
Experts told Deseret News sleep medications are not the best long-term solution, but may be appropriate for occasional use. Both Baron and Kapur said studies suggest melatonin supplements don’t help the average individual.
“There are relatively safe prescription sleeping pills that can be used in specific situations when more natural means aren’t effective,” said Kapur.
Prepping for daylight saving time
When clocks spring forward March 10, providing what is for many a coveted hour of later-day sunlight, the American Academy of Sleep Medicine says people should be careful, noting the time switch is associated with more risk of heart attacks, stroke and hospital admissions for atrial fibrillation. In the first few days, traffic accidents increase and the sleep academy notes more mood disturbances and suicide.
You can make the time change easier by getting at least seven hours of sleep for adults and eight for teens consistently. You can shift sleep time 15 or 20 minutes earlier each night for a few days leading to the change. Do the opposite when time “falls back” later.
While you’re at it, try getting a few extra Zzzzs Sunday night, so you’re ready for the week.