In the overnight hours, Floridians are waking up, tossing and turning, and desperately trying to get back to sleep.
Those old tricks of counting sheep or counting backward from 100 don’t seem to work anymore in an era where overstimulation from devices makes it challenging to slow the brain or shut it off.
Sleeplessness and its profound impact on health have led to an industry of medical and behavioral health specialists in the state who offer interventions. From sleep labs to sleep coaching to implanted devices, Florida experts are working to help people get the rest they desperately seek.
“Sleep issues have become incredibly common,” said Dr. Sarah Silverman, an Orlando sleep therapist and insomnia expert. “There is a lot of sleep support, and it doesn’t get talked about enough.”
Silverman is a licensed psychologist who addresses the issues that wake people up. She teaches how to improve sleep naturally without medication. She uses a method called Cognitive Behavior Therapy for insomnia (CBT-i), which considers habits and behaviors that interfere with quality sleep.
The worst thing someone can do, she said, is lie in bed stressing over not getting back to sleep.
“If you’re wide awake, get out of bed and move to another room and do something calming. Stay out of bed until you feel sleepy again,” she said. “Over time, this re-trains your brain to only associate bed as a place for sleep, not a place to be awake and stressed, so it breaks the negative associations.”
According to the CDC, 38.8% of adults in Florida are getting less than the recommended seven hours of sleep a night. Many turn to over-the-counter sleep aids, supplements like melatonin, and even CBT gummies. However, all have side effects, including drowsiness the next day and headaches. And some studies have found that high doses of melatonin can lead to short-term memory loss, especially in healthy young people.
PRIME expo
Health reporter Cindy Goodman will be moderating a panel discussion on improving your sleep, on Sunday Nov. 2 at the South Florida Sun Sentinel PRIME Expo in Boca Raton. Entry is free to all who register. Sign up by Saturday Nov. 1 at primeexposf.com/#pbs (Don’t forget to switch your clocks for Daylight Saving Time before you head to the Expo.)
Finding solutions
Finding solutions are increasingly important as people age, with the restorative processes from sleep tied closely to cognitive function and memory. However, chasing a good night’s sleep gets more challenging as you age. Research shows older adults spend less time in deep sleep and more time in lighter stages, which increases their likelihood of waking.
Christine Spadola has conducted extensive research on sleep issues in Florida and said that when adults do awaken, they sometimes begin to process unresolved stress from the day. “Strategies for that might be to start a wind-down routine and journal to get your thoughts out of your head before you go to sleep,” she said.
Spadola was an assistant professor in the Phyllis and Harvey Sandler School of Social Work at Florida Atlantic University in 2019 when she studied whether drinking alcohol or caffeine near bedtime or using nicotine products interfered with sleep. She found that those who consumed alcohol or caffeine within four hours of going to bed had worse sleep continuity. Even if you can fall asleep after drinking a cup of coffee or having cocktails, they will diminish the quality of your sleep.
“Alcohol is used as the most common over-the-counter sleep aid,” Spadola told the South Florida Sun Sentinel. “It will help you get to sleep faster, but it wakes you up in the second half of the night. I recommend that if you’re concerned about sleep, you have drinks at brunch.”
Aim for quality sleep
Also noteworthy, she said, “Sleep quality counts more than duration.” People differ in how much sleep they need, her research shows.
“Eight hours is average, but it’s more about how you feel,” she said. “Some people need only six hours, which may be why they toss and turn for two hours.”
Spadola has left FAU and is now part of the sleep health project at the University of Texas-Arlington. Ebow T. Nketsiah, assistant professor at FAU’s Phyllis & Harvey Sandler School of Social Work, now incorporates sleep health into his work in South Florida. He emphasizes how sleep and brain health are intertwined. Exercising, he said, is important for both.
“For people who want to sleep better at night, the key is to be active during the day,” he said.
Nketsiah also advises paying attention to your sleep schedule.
“That’s key, getting up at the same time each day, going to bed about the same time each day, and even maintaining that consistency through the weekends,” he said.
It may be a medical condition
For some Floridians, though, poor sleep is a medical issue caused by conditions such as sleep apnea, prostate issues, hormone fluctuations or other sleep disorders. New devices, procedures and even medications are available, with more on the horizon.
At Delray Medical Center, you can receive a sleep study, or polysomnogram, which records brain waves to monitor sleep stages and diagnose sleep disturbances. At-home sleep studies range from $300 to $600, and in-lab studies can cost as much as $3,000.
Sandy Fairlie, the sleep lab coordinator at Delray Medical Center, says patients often are shocked by the results of their sleep test.
“You could wake up a hundred times during the night and not have a clue,” she said. “Sometimes you’ll wake up from snoring or another event and you’re not quite sure why you woke up and you’re like, ‘Well, I think I have to go to the bathroom.’ And you’ll get up to go to the bathroom, where maybe if they didn’t have sleep apnea, they might have been able to sleep the whole night through.”
Fairlie said the sleep test generates a report. “We will download the data, we will get it ready for the doctor and the doctor will interpret it and can refer you to a pulmonologist or a sleep specialist who can discuss with you what’s going on and offer certain solutions,” she said.
Dr. Lee Mandel, director of the Florida Sinus & Snoring Specialists, specializes in minimally invasive sinonasal, sleep and snoring surgeries. While new devices aimed at sleep apnea are rolling out, some work and others don’t, he said. The most successful, he said, is an implant that keeps your airway open while you sleep, so you can breathe regularly. However, Mandel says the success depends on who performs the implant procedure.
“Someone might have the skills to put the implant in, but if you don’t understand sleep, it’s not going to work properly,” he said. “When you’re doing a permanent implant for someone, it should be the last thing that you’re recommending to them. The CPAP is still considered the gold standard.”
In other advancements, the CPAP (continuous positive airway pressure) machines have become smaller, and clinical trials for a new obstructive sleep apnea drug are showing potential. There is also an oral appliance made by a sleep dentist that allows the tongue to fall forward instead of backward during sleep to help with snoring.
South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.