Basic Facts About Sleep

Most adults need 7-8 hours of sleep each night. Not everyone gets the sleep they need.

Once in a while, you may have trouble sleeping due to:

• Stress
• Health problems and medicines
• Long work hours/ shift work
• Light or noise
• Drinking alcohol or eating too close to bedtime

If you have trouble falling asleep or staying asleep most nights, you may have a sleep problem called insomnia.

Some people have more serious sleep problems. Talk to your doctor if you:

• Fall asleep during the day
• Snore or make choking sounds in your sleep
• Have odd feelings in your legs or feel like you need to move your legs

Medicines to Help You Sleep

There are medicines that may help you fall asleep or stay asleep. You need a doctor’s prescription for some sleep drugs. You can get other over-the-counter (OTC) medicines without a prescription.

Prescription

Prescription sleep medicines work well for many people, but they can cause serious side effects.

• Talk to your doctor about all the risks and benefits of using prescription sleep medicines.
• Sleep drugs taken for insomnia can affect your driving the morning after use.
• Sleep drugs can cause rare side effects like:
  • Severe allergic reactions
  • Severe face swelling
  • Behaviors like making phone calls, eating, having sex or driving while you are not fully awake

Over-the-Counter (OTC)

OTC sleep drugs have side effects too. Read the "Drug Facts Label" to learn more about the side effects of your OTC sleep medicine.

Tips for Better Sleep

Making some changes to your night time habits may help you get the sleep you need.

• Go to bed and get up at the same times each day.
• Sleep in a dark, quiet room.
• Avoid caffeine and nicotine.
• Don’t drink alcohol before bedtime.
• Do something to help you relax before bedtime.
• Don’t exercise before bedtime.
• Don’t take a nap after 3 p.m.
• Don’t eat a large meal before you go to sleep.

Talk to your healthcare provider if you have trouble sleeping almost every night for more than 2 weeks.

Light therapy

Light therapy involves sitting in front of a light box, which produces bright light similar to sunlight. Light visors and light glasses may also be effective. Light therapy may help adjust the amount of melatonin your body needs to make to reset your sleep-wake cycle.

• To move your sleep and wake times earlier, use the light box when you wake up in the morning. This may also help reduce daytime sleepiness. This method may be used to help treat delayed sleep-wake phase disorder, irregular sleep-wake rhythm disorder, and jet lag disorder when you travel east.
• To move your sleep and wake times later, use the light box late in the afternoon or early in the evening. This method may be used to help treat advanced sleep-wake phase disorder, shift work disorder, and jet lag disorder when you travel west.

Side effects of light therapy may include agitation, eye strain, headaches, migraines, and nausea. Ask your healthcare provider before using light therapy if you have an eye condition or use medicines that make you sensitive to light.

Orofacial therapy

Exercises for your mouth and facial muscles, also called orofacial therapy, may help treat sleep apnea in children and adults. This therapy helps improve the position of your tongue and strengthens the muscles that control your lips, tongue, upper airway, and face.

Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I is a 6- to 8-week treatment plan to help you learn how to fall asleep faster and stay asleep longer. This is usually recommended as the first treatment option for long-term insomnia and can be very effective. CBT-I can be done by a healthcare provider, nurse, or therapist; you can do it in person, by telephone, or online. It involves the following parts:

• Cognitive therapy helps you feel less nervous about not being able to sleep.
• Relaxation or meditation therapy teaches you how to relax and fall asleep faster.
• Sleep education helps you learn good sleep habits.
• Sleep restriction therapy gives you a specific amount of time to spend in bed, even if you are not able to sleep during this time. With time, this helps you sleep better when you go to bed. Your sleep time can be increased when you start to sleep better.
• Stimulus control therapy helps you have a regular sleep-wake cycle so you can link being in bed with being asleep. This involves going to bed only when you are sleepy, getting out of bed if you cannot sleep, and using your bed only for sleep and sexual activity.

Medicines to help you fall asleep

If you are having trouble falling asleep or staying asleep, and improving your sleep habits and other therapies have not helped, your healthcare provider may talk to you about medicines to help you sleep. Many of these medicines have side effects and should not be taken long term.

PRESCRIPTION MEDICINES

Some prescription medicines used to treat other health conditions can also increase your risk of developing sleep conditions.

• Benzodiazepine receptor agonists are medicines such as zolpidem, zaleplon, and eszopiclone. Side effects may include anxiety. Rare side effects may include having a severe allergic reaction or doing activities while asleep such as walking, eating, or driving.
• Melatonin receptor agonists are medicines such as ramelteon. Side effects can include dizziness and fatigue. Some people experience the rare side effects of doing activities while they are asleep, like walking, eating, or driving; or they may have a severe allergic reaction.
• Orexin receptor antagonists such as suvorexant are not recommended for people who have narcolepsy. Rare side effects may include doing activities while asleep such as walking, eating, or driving; or not being able to move or speak for several minutes while going to sleep or waking up.
• Benzodiazepines may be prescribed for insomnia if other treatments and medicines have not worked. Talk to your healthcare provider about the side effects of these medicines, which can include dizziness, confusion, and muscle weakness. Benzodiazepines can also interact dangerously with other medicines. They can be habit-forming and should be taken for only a few weeks.

OFF-LABEL MEDICINES

In some cases, healthcare providers may prescribe medicines that are commonly used for other health conditions but are not approved by the U.S. Food and Drug Administration (FDA) to treat insomnia. Some of these medicines include antidepressants, antipsychotics, and anticonvulsants.

OVER-THE-COUNTER (OTC) MEDICINES AND SUPPLEMENTS

Tell your healthcare provider about any OTC products that you are taking.

• OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your provider before taking them, as antihistamines can be unsafe for some people.
• Melatonin supplements are lab-made versions of the sleep hormone melatonin. Many people take melatonin supplements to improve their sleep. These supplements are not regulated by the U.S. Food and Drug Administration like medicines. Because of this, the dose and purity of these supplements can vary between brands. Talk with your provider about how to find safe, effective melatonin supplements, and also about possible side effects or medicine interactions, especially if you are pregnant or trying to become pregnant. Side effects of melatonin may include excess sleepiness, headaches, high blood pressure, low blood pressure, stomach upsets, and worsening symptoms of depression.
• Dietary supplements may help you sleep, but they can also have health risks. Talk to your healthcare provider before using dietary supplements.

The U.S. Food and Drug Administration (FDA) regulates dietary supplements under a different set of regulations than those covering "conventional" foods and medicines. The FDA does not currently review dietary supplement products for safety and effectiveness before they are marketed.

Medicines to help you stay awake

Some people with sleep conditions, like narcolepsy, need to take medicine to help them stay awake during the day. Sometimes, people can use caffeine to help promote wakefulness, but other times, prescription medicine is required.

• Stimulants, or wakefulness-promoting agents, can help with daytime alertness. The effects of these medicines may last only for a short time, and you may still experience some sleepiness.
• Depressants, such as sodium oxybate, treat daytime sleepiness and cataplexy, the sudden loss of voluntary muscle control. Side effects can include bedwetting, headache, and dizziness.

Continuous positive airway pressure (CPAP)

CPAP is a device that uses mild air pressure to keep your airways open while you sleep. A CPAP machine includes a mask that fits over your nose or your nose and mouth with straps that position the mask. It also includes a tube that connects the mask to the machine’s motor and a motor that blows air into the tube.

For the treatment to work, you should use your CPAP machine every time you sleep, including during naps. You should also take your CPAP machine with you when you travel. It will take some time and patience to get used to your CPAP machine.

Oral devices

Oral devices are devices that you wear in your mouth while you sleep. These are often custom-made by a dentist or orthodontist (a dentist who specializes in correcting teeth or jaw problems) to fit your mouth or jaw. Oral devices hold your jaw or tongue in a position that helps keep your airway open. You may need an oral device if you have mild sleep apnea or if your apnea happens only when you are lying on your back. If you have sleep apnea, your doctor may prescribe an oral device if you do not want to use CPAP or cannot tolerate CPAP.

There are two types of oral devices that work differently to open the upper airway while you sleep. Some hybrid devices have features of both types.

• Mandibular advancement devices cover the upper and lower teeth and hold the jaw in a position that prevents it from blocking the upper airway.
• Tongue retaining devices are mouthpieces that hold the tongue in a forward position to prevent it from blocking the upper airway.

A new type of oral device was recently approved by the FDA for use while awake. The device delivers electrical muscle stimulation through a removable mouthpiece that sits around the tongue. You wear the mouthpiece once a day for 20 minutes at a time, for 6 weeks. The device stimulates the tongue muscle while awake to help prevent the tongue from collapsing backward and obstructing the airway during sleep.

Your dentist or orthodontist will make sure your device is comfortable and teach you how to use it to get the best results.

For the treatment of sleep apnea, if a CPAP or other oral devices do not work, you may need surgery.

• Adenotonsillectomy surgery removes the tonsils and adenoids.
• Surgery to place an implant may help monitor your breathing patterns and control certain muscles that open your airways during sleep. Other types of implants, called nerve stimulators, can help control your tongue muscles while you sleep. This helps prevent your tongue from blocking your airway.
• Surgery to remove some soft tissue from your mouth and throat can make your upper airway bigger.
• A maxillary or jaw advancement surgery moves your upper jaw (maxilla) and lower jaw (mandible) forward. This helps make your upper airway bigger.

You can take steps to improve your sleep habits. First, make sure that you give yourself enough time to sleep. With enough sleep each night, you may find that you're happier and more productive during the day.

Sleep is often the first thing that busy people squeeze out of their schedules. Making time to sleep will help you protect your health and well-being now and in the future.

To improve your sleep habits, it also may help to:

• Go to bed and wake up at the same time every day. For children, have a set bedtime and a bedtime routine. Don't use the child's bedroom for timeouts or punishment.
• Try to keep the same sleep schedule on weeknights and weekends. Limit the difference to no more than about an hour. Staying up late and sleeping in late on weekends can disrupt your body clock's sleep-wake rhythm.
• Use the hour before bed for quiet time. Avoid intense exercise and bright artificial light, such as from a TV or computer screen. The light may signal the brain that it's time to be awake.
• Avoid heavy or large meals within a few hours of bedtime. (Having a light snack is okay.) Also, avoid alcoholic drinks before bed.
• Avoid nicotine (for example, cigarettes) and caffeine (including caffeinated soda, coffee, tea, and chocolate). Nicotine and caffeine are stimulants, and both substances can interfere with sleep. The effects of caffeine can last up to 8 hours. So, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night.
• Spend time outside every day (when possible) and be physically active.
• Keep your bedroom quiet, cool, and dark (a dim night light is fine, if needed).
• Take a hot bath or use relaxation techniques before bed.

Napping during the day may boost your alertness and performance. However, if you have trouble falling asleep at night, limit naps or take them earlier in the afternoon. Adults should nap for no more than 20 minutes.

Napping in preschool-age children is normal and promotes healthy growth and development.

Strategies for shift workers

Some people have schedules that conflict with their internal body clocks. For example, shift workers may have trouble getting enough sleep. This can affect how they feel mentally and physically.

If you're a shift worker, you may find it helpful to:

• Take naps and raise the amount of time available for sleep
• Keep the lights bright at work
• Limit shift changes so your body clock can adjust
• Limit caffeine use to the first part of your shift
• Remove sound and light distractions in your bedroom during daytime sleep (for example, use light-blocking curtains)

If you're still not able to fall asleep during the day or have problems adapting to a shift-work schedule, talk with your doctor about other options to help you sleep.