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The best thing you can do for your health may also be the easiest
Want to look better, live longer and think more clearly? Spend more time asleep. It should be the easiest thing you can do for your health, but a third of Americans aren't getting enough rest, the CDC says. These strategies might help. - photo by Jennifer Graham
Want to look better, live longer and think more clearly?

Sleep more.

Scientists aren't exactly sure why humans need sleep, but they know most adults need seven to nine hours to function optimally. And a third of Americans aren't getting that, according to a new report from the Centers for Disease Control and Prevention.

Researchers surveyed more than 444,000 people from across the country on their sleep habits. One-third reported sleeping less than seven hours a night, a practice associated with higher incidence of obesity, high blood pressure, diabetes, heart disease, stroke and death.

The best sleepers were college-educated, married and employed, and lived in the Great Plains. The worst were divorced, widowed or separated, unemployed, and lived in Hawaii, the Southeast or along the Appalachian Mountains.

While Hawaii is an anomaly, the data from the Southeast and the Appalachian region confirm that poor sleep and poor health is often related, since those areas have among the highest rates of diabetes, heart disease and obesity in the nation.

This is the first time the CDC has been able to look at sleep habits over geographical regions, said Anne G. Wheaton, a co-author of the report and an epidemiologist at the CDC.

This presents a chicken-or-egg question: Does too little sleep cause poor health, or does poor health cause poor sleep? Both are true, Wheaton said, and the data will enable state health departments to develop programs to help people sleep better and longer.

RX for sleep

The CDC study may understate the number of Americans who get too little sleep or sleep poorly, according to Shawn Stevenson, author of the forthcoming book "Sleep Smarter" and host of a popular health podcast on iTunes.

Stevenson, a nutritionist and health coach, said his research suggests two-thirds of Americans have some sort of sleep issue. Four percent of Americans take prescription sleep medicine, and millions more use over-the-counter sleep aids, although they can be addictive and cause drowsiness the next day.(Many contain the antihistamine diphenhydramine; its side effects include upset stomach and constipation, and excitability in children.)

In one survey by Consumer Reports, 41 percent of people who used over-the-counter sleep aids used them for more than a year, and nearly half used them several times a week.

And use of both over-the-counter and prescription sleep medications is on the rise, as is its overuse. The number of people who sought medical attention from emergency rooms after taking zolpidem, the ingredient in Ambien and other prescription sleep aids, jumped 220 percent between 2005 and 2010, from 6,111 to 19,487 visits.

Wheaton acknowledged that the CDC did not investigate the quality of respondents' sleep, only the duration. And the researchers had no way of knowing whether people who reported adequate sleep had to use prescription pills like Lunesta or Ambien or over-the-counter sleep aids like ZzzQuil or Tylenol PM.

"The number of people using sleep aids has been increasing, and it is really disturbing that a lot of people go to those first before making lifestyle changes or trying to find out if they have a sleep disorder" that needs medical attention, Wheaton said.

Stevenson is an advocate of lifestyle changes to improve sleep, which he details in his forthcoming book. Among the most effective: exercising in the morning, turning off all electronics 90 minutes before bedtime, and using heavy curtains and shades to ensure that your bedroom is completely dark.

While getting enough exercise is frequently cited as a way to improve sleep, the time of day matters, Stevenson said. He cites a study at Appalachian State University that said people who exercise early in the day experience up to 75 percent deeper sleep than those who exercise midday or in the evening. This is because exercise stimulates the release of cortisol, the so-called stress hormone, which, in natural cycles, should be highest in the morning and drop throughout the day, while another hormone, melatonin, takes over.

But melatonin is suppressed by computer screens and smartphones, which is why Stevenson suggests people have a "screen curfew" 90 minutes before they go to bed, to allow their melatonin levels to surge. (When recommending this to groups, Stevenson said people are often perplexed about what they would do without their screen for an hour-and-a-half. He suggests they read a book, or "crazy as it sounds," talk to their spouses.)

As for your sleeping environment, Stevenson urges a total blackout. Any light in your bedroom can disrupt sleep, he said. In one study at Cornell University, researchers found that a light the size of a quarter positioned behind the sleeper's knee decreased melatonin. Light can suppress the hormone's levels more than 50 percent, he said.

Other research has shown that room temperature plays a significant role in the quality of sleep: the cooler the room, the better. A recent report in The Wall Street Journal recommended setting the thermostat between 60 and 67 degrees and said a hot bath before bed may help sleep by lowering the core body temperature, which appears conducive to restful sleep.

Coaches, bracelets and chocolate

The ever-helpful marketplace has been quick to capitalize on America's sleep deficit. Besides sleeping pills, there are sleep coaches to help insomniacs, sound machines, cooling pillows, melatonin-infused chocolate, and even bracelets that are said to improve sleep.

Retired Brig. Gen. Remo Butler, of Tampa, Florida, tried the sleep bracelet manufactured by Philip Stein (and endorsed by Oprah Winfrey) after a friend recommended it. Butler said he usually got enough sleep, but often it wasn't high quality until he started wearing the bracelet last summer.

I was waking up, and I was tired. I would be like, Wow, did I even go to sleep? he said.

After using the sleep bracelet, an alternative therapy that is supposed to work by attracting calming frequencies, Butler said his sleep is deeper, and his dreams are more frequent and vivid. (Remembered dreams occur most frequently in the stage of sleep called REM rapid-eye movement which is said to be the most restorative period of sleep.)

"I don't know how it works; it could be psychological for all I know, but it works," Butler said.

The power of suggestion may well play a role in improved sleep. In one 2013 study, participants slept better even after they were told they were being given a placebo.

Regardless of how you improve it, better and longer sleep has enormous health benefits. "More than diet, more than exercise, nothing is more impactful than sleep, and it affects everything from the way we look, to our energy levels to how our brains process information," Stevenson said. "Every night we skimp on sleep, bypass it for something else, we are aging ourselves."
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