FALLS CHURCH, Va. — Ideally, doctors say, adults should get between seven and eight hours of sleep each night.
But, according to one national survey, about one in three American adults say they sleep far less than that most nights.
For some people, the daily grind of work and family responsibilities simply doesn’t leave enough time in the day for a full night’s sleep.
But for many others, the lack of sleep stems from a lifestyle or medical problem that might require healthier daily habits or long-term treatment from a health care provider.
Long-term sleeping problems can affect your mental health, relationships, quality of life, and performance at work.
“If you’re experiencing persistent problems with poor sleep, or if sleep difficulties are affecting your quality of life, you should seek professional assistance,” urged U.S. Public Health Service Capt. (Dr.) Anne Dobmeyer, a sleep expert who is currently the DHA’s section chief for Primary Care Behavioral Health Science, Development, and Education.
Sleeping problems are often cited among the top reasons why service members go to a local military hospital or clinic, according to data published by the Armed Forces Health Surveillance Branch.
Sleeping is healthy
Getting enough sleep is not a luxury. “It is something people need for good health,” according to the Centers for Disease Control and Prevention.
Yet a third of American adults report usually getting less than the recommended amount of sleep, says the CDC. The ideal amount varies for individuals, but it usually ranges between seven to eight hours a night for adults.
Not sleeping properly is linked with many chronic diseases and conditions, including Type 2 diabetes, heart disease, obesity, and depression. It can also increase risk for injury – such as motor vehicle crashes.
Treating sleep problems
A variety of factors can contribute to insomnia, including bad sleep habits, depression, anxiety, illness, discomfort (like being too hot or cold); or irregular work schedules such as during military deployments. Fortunately, there are ways to diagnose and treat insomnia.
Behavioral health consultants in primary care clinics across the Military Health System provide behaviorally based treatment for insomnia. Called Brief Behavioral Treatment for Insomnia, or BBTI, it involves changing sleep-related behaviors during the day to promote restful and lasting sleep at night.
“We can improve our nighttime sleep by changing some of our waking behaviors,” Dobmeyer said.
BBTI generally requires about five bi-weekly sessions of 20-30 minutes.
“The appointments in BBTI typically include monitoring sleep patterns, making changes to evening and bedtime routines, and altering the sleep schedule (bedtimes and waking times) to promote better sleep,” she said.
The treatment teaches patients to adopt certain behaviors that lead to better sleep and adjust other behaviors that may contribute to poor sleep. The aim is to develop an individualized prescription for sleep and wake time and to alter it as needed over time, said Dobmeyer.
Even people without a clinical diagnosis of insomnia may benefit from improving sleep-related behaviors. She recommends these eight tips below for better sleep:
• Have a consistent routine before bedtime to help you wind down and relax.
• Avoid napping during the day.
• Avoid exercise before bedtime; exercising in the late afternoon or early evening is better.
• Avoid heavy meals, alcohol, caffeine and tobacco close to bedtime
• Reserve the bed primarily for sleep. Avoid watching television, reading, working or gaming in bed. Over time, doing these activities in bed trains the body and mind that the bed is a place for wakefulness, not sleepiness.
• Avoid using screens that emit blue light, like cell phones or iPads, within two to three hours of bedtime. Blue light suppresses the brain’s production of melatonin, making it more difficult to fall asleep.
• Go to bed and rise at the same time or close to it every day. Keeping a consistent wake time is particularly important.
• Don’t stay in bed if you have trouble sleeping. Instead, get out of bed and do a relaxing activity until you feel sleepy. Then, return to bed.
Understandably, active-duty service members who are deployed may not have the space or time to adopt completely healthy sleep behaviors. In that case, Dobmeyer recommends adopting as many of these recommended behaviors as possible and to speak with their primary care manager if sleep problems persist.
Dobmeyer cautions against relying heavily on sleep medication.
“Although sleep medications can be helpful in certain circumstances for short periods of time, many sleep medications have side effects and are not intended for long-term use,” she said.
Often, the medications’ benefit only lasts as long as the patient continues to take them. So, people find that sleep problems come back when they try to decrease or stop the medication, she said.
With behavioral treatment, such as BBTI, individuals can instead learn to rely on themselves to make the necessary lifestyle changes to benefit their sleep. Just like an individual might alter their lifestyle to begin an exercise regimen to achieve an athletic goal, they can learn to alter their lifestyle to retrain their bodies to achieve restful sleep.
For people who don’t get sufficient improvement from BBTI at the primary care level, MHS patients can go see a specialist at a behavioral health clinic for a more intensive treatment called Cognitive Behavioral Treatment for Insomnia, known as CBT-i.
CBT-i includes the components of BBTI plus additional training in relaxation skills and in cognitive approaches to enhance sleep, such as decreasing worry or negative thoughts that interfere with sleep. Dobmeyer said this includes “teaching patients to recognize thought patterns that negatively affect their sleep.”
CBT-i treatment typically ranges from eight to 12 appointments lasting 45-50 minutes in a specialty behavioral health office.
There are other treatment options for physiological sleep disorders, such as sleep apnea, in which breathing repeatedly stops and starts. (These will be covered in more detail in later articles.)
For more information, check out DHA’s podcast, A Better Night’s Sleep, or talk to your primary health provider.