It's no secret that a good night's sleep plays a vital role in mental and physical health and well-being. The way you feel during your waking hours depends greatly on how you are sleeping, say sleep experts.

A pattern of getting inadequate or unsatisfying sleep over time can raise the risk for chronic health problems and can affect how well we think, react, work, learn and get along with others.

According to the National Heart, Lung and Blood Institute, an estimated 50 to 70 million Americans have sleep disorders, and one in three adults does not regularly get the recommended amount of uninterrupted sleep needed to protect their health.

Many factors play a role in preparing the body to fall asleep and wake up, according to the National Institutes of Health. Our internal "body clock" manages the sleep and waking cycles and runs on a 24-hour repeating rhythm, called the circadian rhythm. This rhythm is controlled both by the amount of a sleep-inducing compound called adenosine in our system and cues in our environment, such as light and darkness. This is why sleep experts suggest keeping your bedroom dark during your preferred sleeping hours.

Sleep is also controlled by two main hormones, melatonin and cortisol, which our bodies release in a daily rhythm that is controlled by the body clock.

Exposure to bright artificial light — such as from television, computer and phone screens — late in the evening can disrupt this process, making it hard to fall asleep, explained Sanjay Patel, director of the UPMC Comprehensive Sleep Disorders Clinical Program and a professor of medicine and epidemiology at the University of Pittsburgh.

Keeping our body clock and hormone levels more-or-less regulated are the best ways to consistently achieve good sleep, Patel said. He encouraged people with sleeping struggles to focus more on behavioral changes than seeking quick fixes, such as with over-the-counter sleep supplements like melatonin or by upping alcohol intake to feel drowsy.

Patel said there's not much clinical evidence that melatonin supplements work very well, and that "a lot of the clinical trials of melatonin haven't shown consistent evidence that it helps with insomnia."

He did point out that the supplement isn't particularly harmful either, except when "people start increasing and increasing the dose. And in particular, we worry about the high doses that a lot of children are being given by their parents, where it really can cause problems," he said. Taking any more than three to five milligrams doesn't increase the sedative effects, "and yet, we see people showing up to clinic all the time taking 20 milligrams."

Sleeping potions

Many have suggested that warm milk, chamomile tea or tart cherry juice can induce a somniferous effect. While Patel said there's no evidence they work, he did point out that they're preferable to a nightcap.

"Alcohol is really bad for your sleep long term, for a number of reasons," Patel said. First, alcohol can relax the throat muscles and can make sleep apnea and snoring worse for sufferers. Secondly, the body metabolizes alcohol rather quickly so its sedation effects do not last throughout the night.

"So while it may put you to sleep, what happens is, three or four hours later, the alcohol has been metabolized, and now you will wake up from not having alcohol in your system," he said.

Evening libations can also increase acid reflux and long-term drinking can cause "changes in your brain chemistry and is a big cause of insomnia," he said. Heavy drinkers who suffer from insomnia will often increase their intake of alcohol in an effort to fall asleep, thus creating a dangerous cycle that could lead to alcohol use disorder.

Cannabis is not much better, Patel said.

While a handful of pot users — specifically those who use it to treat anxiety — may see some sleep benefits, for the most part cannabis often does not help chronic insomnia and likely will make it worse.

"They actually see a lot of people whose sleep gets better when they stop using (cannabis)," Patel said.

Instead of turning to sleep aids — natural or otherwise — Patel said developing a bedtime routine that promotes relaxation and unwinding is a much better route to a good night's rest.

Whether it's taking hot bath, reading a book, meditating or even tuning into the nightly news, the brain will associate an oft-repeated bedtime ritual with the relaxation required to fall asleep, he explained.

You can watch television, but stay off social media, he said. "The algorithms on social media are designed to keep us engaged and end up contributing to people not closing their eyes until much later than they planned."

Other common reasons that sleep can be unsatisfying or elusive are stress, worry and the simple fact that many people don't give themselves enough time for rest.

"We see all the time that people plan to go to bed at a certain time, but then once they get into bed, they do other things and keep their mind active," such as responding to emails, paying bills or scrolling on social platforms.

Aging influence

The rhythm and timing of the body clock changes with age, Patel said.

People need more sleep early in life when they're growing and developing. For example, newborns may sleep more than 16 hours a day, and preschool-age children need to take naps.

In the teen years, the internal clock shifts so that they fall asleep later in the night, but then want to sleep in late. This is troublesome for teens because "they need to be up for school at 6:30 a.m. and so that's causing lots of problems," Patel said.

Some school districts in the region, including Pittsburgh Public in 2023, have shifted to later start times with this in mind.

For adults, sleep during middle age can be tricky with young children in the home who disrupt parents' sleeping patterns. This is also a time of life when stress and worry are heightened, he said.

Older adults tend to go to bed earlier and wake up earlier, but they've got their own unique challenges, Patel said.

"A lot of physical problems mean that people are often waking up more in the night as they age. They have to get up to go to the bathroom. They have chronic aches and pains that are waking them up. They're often taking medications that ... have side effects that affect your sleep," he said.

Ask for help

A bad night's rest crosses over into being a chronic condition when it really starts to impact how you function during the day, Patel said. That's when it might be time to talk to your doctor about what's going on.

A sleep specialist can help patients find remedies for everything from stress and acid reflux to sleep apnea.

"In general, if things are going on for more than three months, then we think of it as a chronic problem that's unlikely to get better by itself," Patel said.

The NIH also recommends several ways to achieve a better night's rest:

* Go to bed and wake up at the same time every day.

* Try to keep the same sleep schedule on weeknights and weekends.

* Use the hour before bed for quiet time, avoiding intense exercise and bright artificial light.

* Avoid heavy meals and alcohol within a few hours of bedtime.

* Avoid stimulants nicotine and caffeine.

* Spend time outside every day and be physically active.

* Keep your bedroom quiet, cool and dark.

* Take a hot bath or use relaxation techniques before bed.

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