Can’t sleep? You’re not alone.

If you have trouble going to sleep or you wake up in the middle of the night and can’t get back to sleep, you’re in good company.

Insomnia and sleep problems are very common.

But, the good news is that most people can overcome challenges, improve their sleep and feel much more rested and healthy.

Sleep help from an expert

Dr. Katherine Green talks about sleeping better during her appearance on the new evre women's health podcast. Photo courtesy of Dr. Katherine Green.
Dr. Katherine Green is a pro at providing sleep help. Here, she shares her tips for improving sleep. Photo courtesy of Dr. Katherine Green.

We consulted with Dr. Katherine Green to answer your top questions on how you can sleep better. She’s the medical director of the Sleep Center at UCHealth Sleep Medicine Clinic on the Anschutz Medical Campus and also is an assistant professor at the University of Colorado School of Medicine.

Green is one of very few ear, nose and throat specialists — or otolaryngologists — in the country who also has formal fellowship training in both sleep medicine and sleep surgery. She was the first surgeon in Denver to offer Inspire therapy — an alternative to using traditional CPAP (continuous positive airway pressure) machines for obstructive sleep apnea.

Green is passionate about treating sleep disorders and educating patients about the role that sleep plays as a foundation for wellness, quality of life and good health. Tune in to the evrē podcast to hear Green share her top sleep tips in Episode 1, “Sleep Well.”

What are the top 5 simple tips to help you sleep better?

  1. Establish a routine and stay consistent. In general, go to sleep and wake up every day at about the same time, even on weekends.
  2. Exercise regularly.
  3. Watch your caffeine intake and avoid caffeine after noon.
  4. Unplug from your devices at least 30-minutes to an hour before bedtime. Blue light from devices stimulates us to stay awake.
  5. Get outside and expose yourself to sunlight every day. You’ll sleep better if you have a healthy internal body clock. Exposing yourself to sunlight helps prepare your brain for sleep at the appropriate time.

Why is a good night’s sleep so important? 

“There’s growing evidence showing that both sleep quality and quantity have far-reaching effects on everything from driving safety, to daytime energy levels, to focus, attention, job performance and even things like mood,” Green said. “People who don’t get enough sleep can be more irritable and more prone to depression and anxiety.”

Is it true that lack of sleep can cause serious health problems including obesity, strokes, heart disease and heart attacks?

Yes, studies show that insufficient sleep can affect systems throughout the body, Green said.

“Poor sleep affects systems that regulate your metabolism. It can cause increased predisposition to things like obesity and diabetes and even long-term cardiovascular health effects, like an increased risk of hypertension, strokes and heart attacks,” Green said. “It can also cause long-term memory impairment or early cognitive decline.”

What should I do if I’m wide awake in the middle of the night?

Green advises people to avoid bad habits.

  • Avoid reaching for your phone, turning on the TV or working on your laptop.
  • Don’t get up and eat, exercise, clean or do an activity that stimulates you to be more awake.

If you’re awake in bed for 20 minutes or more, here’s what you can do:

  • Avoid tossing and turning because you’ll just get more frustrated. “Get out of bed and do something calming, not stimulating, like reading, coloring, doing a Sudoku or an easy crossword puzzle,” Green said.
  • “Mindfulness apps and breathing techniques can also be very helpful, along with things like white noise or calming music.”

What is blue light? How does it disrupt sleep?

Electronic devices like phones, laptops and TVs emit what’s known as “blue light.” This type of light wakes us up. So, while it’s fine during the day, exposure to blue light before bed or during the night tells our brains to wake up.

“It really disrupts the circadian rhythms and will interfere with the melatonin production that helps you stay asleep,” Green said.

What are some of the common causes of insomnia? How do I know if have insomnia?

Insomnia is one of the most complex health issues and that’s what makes it so difficult to treat, Green said.

“Stress and anxiety are very big drivers of insomnia. Situational stress and personal stress – whether that’s short-term stress with an illness, or a sick family member, or a big job project coming up – certainly can impact your ability to fall asleep and the quality of sleep that you get.

“All ​of us have had a bad night of sleep or two. That’s to be expected,” Green said.

If sleep problems persist over time, then a person is dealing with insomnia.

​“Your circadian rhythm, the thing that drives those sleep and wake cycles, is really dependent on external and environmental cues. When those mechanisms get out of whack, that’s really when we see chronic insomnia start to snowball,” Green said.

How can I sleep better?

To get a good night’s sleep, start by focusing on your sleep environment, Green said.

Here are her basic rules of thumb for creating an environment that promotes sleep:

  • Make sure your bedroom is cool and dark. That lowers your body temperature at night so you can sleep better.
  • Save your bed for sleep and sexual activity. “Getting into your bed at night should be the cue that tells your brain that it is time to fall asleep. This is called a sleep association, like when kids have a specific stuffed animal or blanket that they sleep with,” Green said. “When you do other things in bed like watching TV or lying awake, you lose that association and it makes it harder to fall asleep in the future.”
  • Reduce alcohol and caffeine consumption. Ideally, you should avoid caffeine after 2 to 3 p.m. and avoid consuming alcoholic drinks two to three hours before bedtime.

Some people claim they don’t need much sleep. Is it true that some people can get by with as little as four hours of sleep a night?

No. Adults need about seven hours of sleep a night, Green said.

In the past, some CEOs and famous people bragged that they were “Type-A” and didn’t need much sleep.

“That used to be a badge of honor 20 or 30 years ago,” Green said.

But, we now know that everyone needs good sleep to function well and to stay healthy.

“Study after study has shown that in order to be our best selves, in order to function at your top performance level, the vast majority of adults really need a seven-hour night of sleep,” Green said. “What we see is that these health effects, these performance effects really start to creep in if you’re getting fewer than seven hours of sleep a night.”

Is there such a thing as getting too much sleep?

Yes, it’s possible for some people to sleep for too many hours.

“If you are requiring more than eight to nine hours of sleep at night, that may be a sign of some underlying sleep problem,” Green said. “If you have sleep apnea and you are never rested by the sleep that you are getting, then you can sleep for 10 or 11 hours, but you’re not getting the quality of sleep that you need.”

Why is there a link between poor sleep and weight gain? How does that work? Does better sleep mean I will no longer be overweight or obese?

The relationship between poor sleep and weight gain is complex, Green said.

“It’s probably not one thing that ties those two things together. What we know is that your metabolism, just like your sleep cycle and so many other things in the body are on a 24-hour circadian rhythm. So, just like you have sleep and wakefulness hormones that fluctuate throughout the day, your metabolism does the same things.

“When you have disrupted sleep, inefficient sleep, what we see is that all of those hormones that regulate your metabolism can also start to get out of whack.

“So, what we’ve seen is that when you have insufficient sleep, or if you have underlying sleep issues such as sleep apnea, we know that there’s an increased resistance to weight loss efforts,” Green said.

In other words, people who are not well rested have a tougher time losing weight. In part that may be related to feeling exhausted, having lower energy levels and being less active.

“You are less likely to be doing something metabolically active and more likely to be sedentary and potentially snacking or eating,” Green said.

Conversely, when people sleep better, they should be able to lose weight more easily. But, it won’t be automatic. Unfortunately, the pounds won’t just melt off. Losing weight still requires people to cut calories and increase physical activity.

Do men or women deal with more sleep problems?

Sleep apnea is more common among men. But, insomnia is more common among women. That may be in part, because women are more in tune with their sleep schedules or their loss of sleep. And, of course, new mothers commonly have to cope with dramatic sleep loss as they tend to infants.

“Women and men definitely have different sleep issues. Sleep apnea tends to be more common in men than in women in middle age, although very interestingly, once women reach perimenopause, the incidence of sleep apnea is actually just as common as in men,”

How does high-quality sleep affect memory?

“There are many processes that only happen in our body during sleep. Memory, specifically memory consolidation, is one of the biggest things that we see,” Green said. “There’s this consolidation during sleep, from short-term storage to long-term storage.”

So, if you have a big test or a big work presentation, prepare well in advance, then prioritize getting enough sleep. You will remember the concepts much better after getting adequate, high-quality sleep.

“The amount and quality of sleep that teenagers get has a direct relationship on school performance and emotion. We see that same process in adults, and there are processes that actually just don’t happen when you’re awake. They are part of your brain’s architecture when you’re sleeping,” Green said.

How much has the COVID-19 pandemic affected sleep problems and insomnia?

“Sleep problems have gone through the roof in the last year,” Green said. “I think some of it is really new and some of it is that there are things that have been brought to life, probably long-standing issues that have come more to the surface.

But, Green has also seen a spike in sleep problems among family and friends.

“Increased stress and anxiety impact the likelihood that you will develop insomnia and some of these insomnia behaviors,” Green said. “There’s no question that the day-to-day worrying and struggling and isolation have increased our stress level significantly and certainly play a role in insomnia and sleep quality.”

The pandemic has also undercut many of our routines. And, changes in routine can impact quantity and quality of sleep.

“The transition to working from home has upset the daily routine for many people. You don’t have the morning commute or the afternoon commute to disconnect work life from home life. So, all of a sudden, you’re answering emails a little bit later into the day,” Green said.

“Or, you’re not going outside to go for a morning walk because all you have to do is go down from your bedroom to your dining room to start your day. So, you’re not getting as much natural sunlight in the morning or starting your day by going to the gym and being active.

“When circadian rhythms are lost and when they’re not as regular, I think that is one of the biggest driving factors for a disruption of sleep,” she said.

How can I sleep better now that that COVID-19 pandemic may be easing?

​Be intentional about your routines.

Plan for exercise and sleep every day. Limit your work hours. Don’t work around the clock. And never work from your bed (or your bedroom if you can avoid it).

“Be more intentional,” Green said. “Establishing a regular routine around sleep is important. That has to do with not only that time before you fall asleep, but also that time after you wake up. Trying to go to bed and wake up at the same time every day, it sounds really simple but it does require some intentionality. It means that sleep can’t be the last thing on your schedule that you do once everything else on your to-do list is done.​”

Is good sleep related to more productivity?

​Absolutely, Green said.

“Really high-performing people know that the best way to have a very productive day is to figure out how to get that seven hours of sleep at night so you’ll wake up ready to hit the ground running,” Green said.

Does regular exercise help people sleep better?

Yes, there’s a direct correlation between regular exercise and better sleep, Green said.

“People who exercise regularly have significantly lower rates of insomnia,” she said.

How does alcohol affect sleep?

“Alcohol is nothing but bad news for sleep quality,” Green said.

“Drinking alcohol before bed makes you groggy. Alcohol is pretty good at knocking us out,” Green said.

But, alcohol has a very negative impact on the quality of sleep we get.

“It changes what we call your sleep architecture, how much light sleep or deep sleep you get,” Green said.

“Alcohol is really good at knocking you out. You feel like you get a hard two or three hours of sleep. But then, what we see is that in the second half of the night, after about two or three hours, sleep is very, very fragmented and you have a lot of awake time.”

If I have insomnia should I avoid drinking alcohol?

If you are prone to insomnia, avoid drinking at all or skip alcoholic beverages about three hours before bedtime.

“So, have drinks before dinner or with dinner and skip the after-dinner drinks because it really does have a negative impact on the sleep following it,” Green said.

How does exposure to the morning sun help me sleep better at night?

“Morning light exposure is one of the things that really drive the wake-promoting hormones in our body. So, that’s something that can help your body be awake during the day and readier to fall asleep at night,” Green said.

If you have trouble feeling awake in the morning, try to get out for a morning walk or run, Green said.

“Part of that is also just if you’re getting natural sun, it also means you’re getting outside and you’re getting some fresh air. So, there’s probably some other benefits to that as well. But UV light has been shown to be very beneficial,” Green said.

How do hormones affect sleep?

There are two hormones that are the main drivers of our cycles. They are

melatonin and adenosine.

“They control your brain’s drowsiness, your brain’s tendency to fall asleep. Melatonin is the main driver of your ability to fall asleep and stay asleep. So, melatonin is a hormone that your body doesn’t really produce at all during the day. Your brain starts to produce melatonin a few hours before bed and it increases to peak a few hours after bedtime,” Green said.

“Then melatonin production dissipates throughout those morning hours so that by morning, your melatonin levels are very low and that’s one of the things that causes you to be ready to wake up,” Green said.

“Adenosine is the opposite of melatonin. It naturally rises throughout the day as you burn energy and burn calories. The more adenosine you have in your system, the drowsier you are,” Green said.

If I’m having trouble sleeping, should I take melatonin?

“In general, melatonin is a very safe supplement, although our data on supplements is often limited since they are not regulated in the same way that other medications. There are very few large studies on long-term side effects or risks,” Green said.

“But it’s really the same type of substance that your body is naturally producing. For some people, melatonin can really help with sleep onset.”

What is sleep apnea? I hear it’s common, but many people don’t know they have it.

Sleep apnea occurs when a person’s airway closes and they frequently stop breathing during sleep. It’s normal for people to temporarily stop breathing fewer than five times each hour. People who stop breathing more frequently have sleep apnea.

The condition is quite common and 80% of people who have sleep apnea don’t realize they have it.

A simple at-home test can detect sleep apnea. Green encourages anyone with concerns to get tested.

“If you are doing all the right things and you don’t feel refreshed by the sleep you are getting or if you are having trouble staying asleep, it’s time to talk to a sleep doctor,” Green said.

What if my partner snores a lot? Could they have sleep apnea?

Yes. Most people who snore have no idea. And snoring can be a sign of sleep apnea. Green encourages people to talk openly with their partners and seek help if necessary.

Do breathing exercises and relaxation techniques help with sleep problems?

Yes, relaxation techniques can be very helpful.

“Relaxation techniques can help people fall back to sleep more quickly,” Green said. “There’s a lot of good evidence to show that things like guided breathing, or mindfulness techniques, relaxation apps, are all very beneficial in terms of helping people fall asleep more easily and also go back to sleep more quickly if they are waking in the middle of the night.”

Are naps healthy?

Short naps of between 10 and 30 minutes can be great. But, Green advises people to avoid really long naps.

“Strategic napping is something that can be very helpful at improving your productivity and focus. There have been good studies showing that people have an increase in their mental acuity after taking a short nap,” Green said.

Napping for too long can leave people feeling groggy and can disrupt healthy sleep patterns.

How does menopause affect sleep?

Hormonal changes and hot flashes can disrupt sleep. There’s also a huge increase in sleep apnea among women around the time of menopause, Green said.

“Whereas middle-aged men are about four times as likely to have sleep apnea as women, after menopause, we see that that incidence is actually one-to-one,” Green said. “Some of insomnia that can come along with menopause may actually be a symptom of sleep apnea.”

Editor’s Note: During the pandemic, the Colorado Times Recorder will occasionally post articles from UCHealth Today, which is published by UCHeatlh, the hospital associated with the University of Colorado School of Medicine. Our goal is to provide as many people as possible with accurate information about the virus and related topics.