Mailbag FAQ – Questions About Sleep

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Q. When I wake up in the morning, my t-shirt/sheet/pillowcase is wet from my own sweat. Is it normal to sweat during sleep?

A. Yes, it means your bedroom is warm or you have a lot of coverings on the bed. You probably sweat more in the summer than in the winter. You can reduce or eliminate obvious sweating by reducing the air temperature or sleeping with less bed covering or clothing. The body’s thermoregulation system during sleep is an interesting topic. The body maintains a tight temperature range through a combination of movement (shivering if necessary) and sweating. Internal temperature doesn’t change much, but it does slowly fall during NREM sleep and rise during REM sleep. If your body is too warm you will sweat to get that lower temp during NREM, but by the time you wake up your body temperature will increase (you have higher temperature in both REM and waking). That’s why you might sweat during the night but not be actively sweating when you wake up.

Q. Sometimes I become wide awake in the middle of the night. There is no point lying in bed while I am so wide awake, so I get up and do housework. Is this a good idea or should I just tough it out and try to go back to sleep?

A. Sleep experts have started to change their tune in recent years. A period of waking in the middle of the night is now considered ok, and normal for some sleepers. Repeated periods of waking and sleeping are no good, but a single waking period that divides the night into two sleep periods is called a biphasic sleep pattern, and there is evidence many people slept this way before the industrial revolution gave us clocks and electric lighting. The question is: does this fit with your schedule? Can you modify your schedule to have this hour or so in the middle of the night and still get your sleep in? If you have this hour or so (which is how most people experience it), get out of bed and do something that doesn’t involve exercise. Housework might be ok, as long as it is light. Reading or working on the computer might be better. (Be aware that some people find the light from the computer screen makes it tough to get back to sleep.)

Q. I have too much pain to sleep through the night.

A. Consult a doctor. There are plenty of over-the-counter pain medications that responsible adults can use (follow the directions, especially on dosing.) Some commercially available medications combine an analgesic for pain with an antihistamine to promote sleep. The popular Tylenol Pm is like this. Don’t take these combination medicines unless you need each medicine by itself. If you need a pain reliever AND a sleep aid, fine. But if you need only one of those, there are drugstore products that have only one or the other active ingredients. More severe pain can be addressed by prescription medication. The opioid class of drugs relieve pain and famously cause sleep. They can be addictive, though, and millions of people have gotten into trouble taking them. Be careful and make sure your doctor knows what you are doing and all other medicines you are taking. Milder pain in muscles can sometimes be treated by cold packs. This has the added benefit that a cold pack may help you get to sleep faster, especially in the summer.

Q. Does daytime exercise make it harder or easier to get to sleep at night?

A. Both. Exercise is conducive to good overall health – which helps with nighttime sleep onset – and pushes the body to enforce circadian cycles. The problem with exercise too close to bedtime is that the body may be overwired by the time you are trying to get to sleep. Some people can’t come down fast enough to get to sleep. This is more a problem in the middle-aged and older crowd than for young people and there is considerable variation from person to person. But if you are having trouble getting to sleep, one thing to consider is that you are exercising too late in the evening. Give yourself some time to relax before bed.

Q. My husband/wife/someone in the house snores really loudly. I’m worried about apnea. How can we determine for sure?

A. The definitive diagnosis can be made through the results of a polysomnogram, and this unfortunately is expensive as it involves for an overnight stay at a sleep center. Check with your health insurance about whether they will pay for this type of study. If they will, it is only with authorization and referral from a doctor.

Q. Will certain foods make me dream?

A. No. There is a lot of folk psychology and myths surrounding dreams. Dreams might strike us as weird and ethereal, but they are a normal output of a brain. Some psychoactive drugs might promote dream activity, and some foods contain caffeine and other substances might, in a small way, increase dream intensity. But we stress “might”. We are unaware of any science showing drugs increase dreaming. When people say they are having a lot of dreams recently, what is happening is that they are rapidly transitioning from REM sleep to waking, so they are more likely to remember the dreams. They aren’t having more dreams; they are remembering them better. We are not aware that any food makes you emerge more quickly from REM.

Q. I want to remember my dreams. Is there something I can do to make that happen?

A. The most memorably, narratively coherent dreams happen during stage R or REM sleep. If a sleeper is awoken suddenly from REM, he or she is conscious of a recent dream about 80% of the time. If you can rig a system whereby you wake abruptly during REM, you can get your wish. However, most people don’t have a home EEG system to determine when household members are in REM. You can set an alarm clock to wake you when you think there is a high probability of REM (REM occurs most often late in the sleep cycle, so you could set the alarm for early morning, maybe a half hour before you usually awaken). This might work for one or two days, but then your body will adjust and you will awaken at that time on your own. Sometimes you rapidly go from REM to waking without being awoken by external stimuli, and that is conducive to remembering your dreams.

Q. Is there a difference between being brain-tired (for example if I learned a lot during the day) and body tired (from physical activity)? Does that affect my sleep needs and patterns?

A. Yes. Most everyone has had days that tire them physically but not mentally and vice versa. Exposure to a lot of mental stimulation or learning can increase your sleep propensity. Being muscle tired might contribute to sleepiness, but most of us know from experience this is a different feeling than mental sleepiness. We define sleepiness and drowsiness as the same thing in day-to-day language, but some sleep scientists make a distinction. Sleepiness is the propensity to get to sleep; it’s a physiological state. Drowsiness is a feeling of not being alert without necessarily the need to sleep. The word fatigue may refer to muscle tiredness and mental status of low motivation and energy. Lack of sleep can cause fatigue, but so can other things.

Q. What can I do to sleep less?

A. Unless you have hypersomnia, you probably don’t want to sleep less. You need to appreciate sleep more and don’t come here asking how to sleep less. However, there are ways to spend less time in bed. One metric to consider is sleep efficiency, the ratio of time spent sleeping to time spent in bed. For teenagers this number is typically high; for adults it tends to decline with age. Lying awake in bed doesn’t do you much good, so you want to reduce this middle-of-the-night awake time while maintaining your total sleep time. The best technique is sleep restriction therapy. Set a firm wake-up time in the morning and slowly advance your bedtime. You might feel sleepy during the day, but if you can handle this sleepiness in the short run, your brain may adjust to the shorter time and bed and increase sleep efficiency for you. Drugs can get you through sleep maintenance insomnia and increase sleep efficiency, but they will overall tend to get you to sleep more. Stay away from hypnotics or sedatives if you want to sleep less. Stimulant drugs can shorten sleep time, but be careful with them and use only with a doctor’s permission and supervision. (Stimulants are prescribed to people with hypersomnia.)

Q. I have a hard time getting going in the morning, and always have more energy at night. Does that mean I should shift my sleeping time?

A. If you can shift your sleeping time, try that. Many people have work or social obligations that force them to be awake and/or at certain places at certain times, so shifting their sleep time is difficult. But if your schedule permits, try making the shift. It might work, although there are no guarantees.

Q. Sometimes I go the whole night with hardly any sleep at all. I’m in that in-between state between sleep and waking. It’s miserable. Should I take a sleeping pill?

A. You probably are sleeping more than you realize during the night. Repeated tests of people with your complaint have found the insomniacs vastly underestimate the amount of sleep they are actually getting. We agree it can be miserable, though. One question for possible treatment is: do you feel sleepy during the day on a regular basis? If not, apply sleep restriction therapy and spend less time in bed in an attempt to squeeze those nighttime awakenings out. If you are sleepy during the day and the patterns persists, you probably qualify for a diagnosis of sleep maintenance insomnia. See our page on quick fixes for insomnia for what to do next.

Q. If I fall asleep watching television in the living room, does that count toward my total sleep for the night? I might be asleep for an hour on the couch before I get up and get into bed.

A. Yes, it “counts” toward your nightly sleep. Your brain gets some benefit from it, and if you are recording your sleep in a diary, you can include the time on the couch. It’s obviously not optimal because you awaken to move into the bedroom and your body’s skeletal muscles probably weren’t as relaxed on the couch as they are in a bed.

Q. I am so groggy in the morning. Is there any way to sleep so I can be perky and alert when I wake up?

A. Some people have sleep inertia bad while others pop right out of bed. To some extent this is constitutional and genetic. Some are morning larks and others are night owls. You can reduce the risk of morning grogginess by making sure you have good sleep hygiene and are getting enough sleep every night. Try an earlier bedtime and keep a sleep diary to see if that makes a difference. Medications that promote sleep will, if anything, make morning sleep inertia worse. That’s one reason to avoid them and the half-life of the medicine in the body is an important consideration in selecting a type of sleeping pill and dosage. It is also possible that a medication you take for another condition could cause morning grogginess. Coffee is the old stand-by for getting over grogginess, or exercise, but these are responses to try to mitigate the inertia. Addressing your sleep needs directly is the best hope for waking up with more energy, but even then you can’t necessarily guarantee success.

Q. My grandmother’s old home remedy (e.g. herbs, warm bath) works as well as any drug.

A. Great! If you can avoid using a drug, you should. Remember, however, that those home remedies (like drugs) work for some people and not for others. You have to be careful with herbs, too, to make sure you are not consuming a poisonous herb or too much of one that should be taken in only small amounts. Herbs can also have side effects and detrimental effects when taken with certain medications – even if those medications are not for sleep.

Q. I grind my teeth during sleep. Does this mean I am over-stressed?

A. It means you have a condition called bruxism. Stress could be a cause, although it is not always the only cause. There are ways to address bruxism. Ask your doctor or dentist.

Q. I heard having a cell phone near the bed can disrupt sleep because of the radio waves.

A. This is an urban myth. There is no evidence radio waves of the magnitude normally found in the home can affect sleep.

Q. I want to make more efficient use of my time. How can I take a nap at will?

A. It’s not always possible to coax a period of sleep in the middle of the day and you may have to practice this skill before you can do it whenever you want. A place conducive to napping (dark, quiet) may help.

Q. My husband sleeps much more since he retired. Is that normal?

A. Yes. Without the structure of a job many people find themselves sleeping more and taking daytime naps. This is not a sign of a sleep disorder, necessarily, or an indication that sleep debt is being repaid.

Q. How can I not sleep so much?

A. Try sleep restriction therapy to increase your sleep efficiency and spend less time in bed awake. Keep a sleep diary to find out what lifestyle choices might make you sleep more, e.g. timing and intensity of exercise, diet. Experiment and learn.

Q. What is the best alarm clock?

A. We are not aware that any formal study has been done about which method of awakening is best. From anecdotal reports, we have heard good things about systems that gradually increase light levels and temperature in the bedroom at the time of desired awakening.

Q. Should I use the snooze button?

A. People prone to sleep inertia are more likely to use the snooze button – it takes time for these people to wake up. Using the snooze button may be better than oversleeping if you have an appointment to get to, but in general it is probably better to try to avoid the snooze button and cultivate the habit of getting out of bed when you wake up. If the alarm is going off too early and not allowing you enough sleep, either go to bed earlier or set the alarm for later.

Q. I often nod off in a movie theater / at a lecture / in church. Is something wrong with me?

A. Falling asleep at inappropriate times can be a sign of Excessive Daytime Sleepiness, a hallmark of many sleep disorders including insomnia. Questions on the Epworth Sleepiness Scale and other subjective measures probe into whether falling asleep when not in bed is a problem.

Have questions for us? Shoot us a note and we’ll do our best the answer them and post to this page as quickly as possible!

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