Don’t jolt yourself awake in the morning and stop taking naps, study says

According to the US National Sleep Foundation, “Approximately 40 million Americans experience insomnia every year and more than 57 percent of older adults experience a decline in quality of life and overall health due to insomnia.” 

Even though insomnia is not a rare disorder, it may wreak havoc with your quality of life if it goes on for too long: “Repeated occurrences can take a toll on your energy level, mood, productivity, and cognitive skills.”

A recent study notes that most patients with sleep problems try to treat themselves with “maladaptive” coping strategies. These strategies may include taking sleep aids, drinking coffee, and taking daytime naps, which may result in worse sleep quality.

"Patients will use caffeine and nicotine and nap to combat daytime somnolence and not even realise that these precipitate and perpetuate the insomnia even more," comments Rhonda Winegar, PhD, DNP (Doctor of Nursing Practice), author of the exploratory study. "Making small modifications to daily routines can help much more than prescribing hypnotics that have side effects and run the risk of dependency."

The paper, called Maladaptive coping mechanisms of sleep, was published in the journal The Nurse Practitioner. It overlaps with the National Sleep Foundation’s Sleep Awareness Week 2022, which falls on March 13 to 19 this year.

A vicious cycle

The pilot study featured 137 patients who visited a sleep clinic from 2017 to 2019, presenting with problems such as obstructive sleep apnea or insomnia.

"Having worked in a sleep practice for several years I noticed many of my patients had issues with insomnia based on their habits," Winegar says.

Winegar presented the patients with questionnaires which allowed her to interpret rates of certain types of maladaptive coping strategies and how they influenced the results of sleep laboratory testing (polysomnography), which presents specialists with “detailed information on sleep architecture.”

As with previous insomnia studies, most of the patients had been practising one or more counterproductive strategies to address their sleep problems:

Caffeine. Winegar notes that about two thirds of the patients taking part in the study reported using caffeine. Even though caffeine is used to perk up, feel more energetic and get rid of sleepiness during the day, when consumed in large amounts or late during the day, it can cause sleep problems.

Sleep aids. Almost half the patients (47 percent) were on prescription sleep medications, while another 19 percent used over-the-counter (OTC) sleep aids. Winegar notes that more than 40 percent of patients said they were using herbal products, which meant they were “self-medicating” for their inability to sleep.

Napping. More than one fourth of patients, according to the study, said they took naps during the day to make up for lack of sleep at night, which only made them more awake in the evening and unable to sleep when they go to bed.

The study notes that these “maladaptive” coping strategies affected sleep quality in numerous ways. Subjects who did not use sleep aids got into the critical rapid eye movement (REM) phase of sleep faster than those taking prescription sleep medications: 131 minutes as opposed to 167 minutes.

Subjects who were on prescription sleep medications also had fewer REM cycles than those on over-the-counter sleep aids or no sleep aids.

The study did indicate that sleep medications prescribed by a health provider had some beneficial effects, such as taking a shorter time to fall asleep (sleep latency) and higher sleep efficiency. Average sleep time for patients on OTC sleep aids was 349 minutes, while this time was 332 minutes for subjects on prescription sleep medications and 292 minutes for those who were not taking anything to help them fall asleep.

Subjects who didn’t take sleep aids also woke up more frequently during the night, which, the study suggests, may be an indicator of “more fragmented, less restful” sleep.

The study also revealed that subjects who used caffeine had longer times to REM sleep – except for those who had more than two servings of caffeine per day. As for subjects who took regular naps during the day were less sleepy but at night they suffered from longer sleep latency times (compared to those who didn’t take naps).

Insomnia is a “very common problem” that has major economic and social costs, as well as negative health effects. When people try to receive help for their sleep problems, they often consult a primary care provider, such as a family physician or a nurse practitioner.

"Learning about good sleep hygiene and making some slight changes to their routines – going to bed at the same time, turning off the television and lights when in bed – can help patients to sleep better without the use of sleep aids," Winegar advises.

Winegar recommends that individuals with insomnia or other sleep problems reprogram their lives and create new habits to “prioritise sleep.” "Always plan for eight-hours of sleep nightly," she notes. "Do not nap.  Keep the same sleep hygiene routine and sleep schedule on all days."