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Decoding Digestive Issues



Decoding Digestive Issues

Similar symptoms can make it tough to tell what’s wrong.

Gut disorders can be confounding. Are you sprinting to the bathroom because of something you ate, or is stress upsetting your stomach? Was that pain in your abdomen a gas bubble, or could you have an ulcer?

The first thing to keep in mind is that many digestive issues share the same initial symptoms. When there’s a problem in your gut, you’re likely to have one or more of the following:

  • Excessive gas
  • Bloating
  • Constipation
  • Diarrhea
  • Nausea and vomiting
  • Belly pain
  • Incontinence
  • Bleeding
  • Trouble swallowing

The second thing to know is that your experience of these symptoms may be unique. Research has found that a surprising number of factors impact how vulnerable you are to digestive issues and how intensely you’re affected by them.

You may be more or less susceptible to — and impacted by — gut dysfunction, depending on your:

  • Genetics
  • Personality traits
  • Mental health
  • Cultural background
  • Ability to manage stress
  • Other health conditions

When talking to medical professionals about digestive issues, report your symptoms with confidence. If your concerns are dismissed or you’re treated as if you’re “overreacting,” you may benefit from seeing a gastroenterologist (GI), who will better understand the complexity of these conditions.

The Nitty Gritty Details

To help get an accurate diagnosis, be clear about the shape, consistency, and color of your stool, as well as how frequently you go. If you’re reluctant to paint a detailed picture of your poop, consider giving its consistency a number, based on the Bristol Stool Scale:

Bristol Stool Scale

Type 1: Separate hard lumps, like nuts (hard to pass)

Type 2: Sausage-shaped, but lumpy

Type 3: Like a sausage, but with cracks on its surface

Type 4: Like a sausage or snake — smooth and soft

Type 5: Soft blobs with clear-cut edges (passed easily)

Type 6: Fluffy pieces with ragged edges, a mushy stool

Type 7: Watery, not solid pieces — entirely liquid

Check for unusual coloring (that isn’t related to colorful foods like beets or blueberries), and report that, too.

  • Stool that’s very light brown or gray may indicate a blockage between the liver and gut.
  • Stool that’s black or red may contain blood.

Changes in color and consistency may or may not signal a problem, but clue in your doctor to help them make an informed assessment.

Treating Tummy Troubles

Helpful tips for common digestive issues.

The digestive issues highlighted below happen so often that they can seem like no big deal. And if tummy troubles are short-lived and due to an obvious cause (diarrhea after eating bad seafood or constipation after a long day of travel), they may easily resolve with rest and plenty of water.
But if these conditions persist, are unexplained, or accompany worrisome symptoms like abdominal pain or bloody stool, it’s best to see your primary care provider (PCP) as soon as possible, since they can sometimes be linked to a more serious condition.


What it is: Bowel movements are difficult and infrequent — one common criteria is fewer than 3 bowel movements per week.

Possible causes: Too little fiber (from vegetables, fruits, or whole grains) and/or water, certain medications, traveling, or other shifts in routine. In rare cases, a serious bowel blockage may be to blame.

Treatment options: Some of the safest treatments are bulk-forming laxatives (for example, Citrucel™ and Metamucil™) and osmotic laxatives (for example GlycoLax™ and MiraLax™), which draw water into stool and help it move through the digestive tract. (People with kidney problems should avoid osmotic laxatives that contain magnesium and phosphate.)

Prevention tips:

  • Drink plenty of water.
  • Eat naturally high-fiber produce and whole grains.
  • Engage in light activity after meals.
  • Go to the bathroom when you need to instead of “holding it.”
  • Make a daily trip the bathroom 15-45 minutes after breakfast.
  • Prop your feet up on a stepstool and lean forward on the toilet for easier elimination.


What it is: Having 3 or more loose, watery bowel movements in a day.

Possible causes: Viral or bacterial infections, food allergies and intolerances, artificial sweeteners, caffeine, certain medications.

Treatment: Drink water and broth to replace lost fluids and sodium. Over-the-counter anti-diarrheal medications can provide some relief. That said, they should be avoided if you have a fever or bloody diarrhea.

See your PCP if diarrhea lasts longer than 2 days and/or stool contains blood or pus, you have a fever, severe abdominal pain, or signs of dehydration — dark-colored urine, dry skin, fatigue, dizziness.

Prevention tips:

  • Take care to eat food that’s safely prepared and stored.
  • Limit drinks and foods that contain caffeine or artificial sweeteners.
  • Ask your PCP or pharmacist if medications you use may cause diarrhea.
  • Take antibiotics only when necessary and prescribed by your PCP.
  • Drink filtered or bottled water when traveling abroad.

Acid Reflux & GERD

What it is: Acidic stomach contents back up into your esophagus. This can cause a burning feeling in your throat, chest, or upper abdomen (aka “heartburn”). If this happens more than twice a week or if you’ve been taking over-the-counter antacids for two weeks or more with no relief, you may have gastroesophageal reflux disease (GERD), and you should see your PCP.

Possible causes: Medication side effects, smoking, and/or excess pressure on the abdomen from being overweight can cause the sphincter (muscular opening) between the stomach and esophagus to weaken or relax.

Treatment: Occasional acid reflux can be treated with over-the-counter antacids and medications that inhibit stomach acid production. If you have GERD, your PCP can help you choose the best treatment based on suspected causes.

Prevention Tips:

  • Eat moderately-sized meals.
  • Avoid foods and drinks that make symptoms worse.
  • Avoid lying on your back after eating.
  • Elevate the head of your bed.
  • Avoid smoking.


What it is: Veins that line the lower rectum or anal opening become swollen.

Possible causes: Straining during bowel movements, chronic diarrhea, being overweight, standing or sitting for long periods.

Treatment options: You may be able to relieve swelling and discomfort with ice packs or by sitting in a warm bath. Over-the-counter hemorrhoid creams and suppositories can also help. In some cases, hemorrhoids may have to be removed.

Prevention tips: The steps to prevent constipation and diarrhea (see above) will also help prevent hemorrhoids.



Digestive Disorders

These more serious conditions belong on your radar.

Sometimes digestive symptoms like diarrhea, constipation, or acid reflux are related to more complex conditions, like the ones below. If you suspect you might have any of these issues, schedule a visit with your primary care provider (PCP), and ask if you could benefit from seeing a gastroenterologist.

Irritable Bowel Syndrome (IBS)

IBS is a testament to the intricate connections between the digestive and nervous systems. If you have this condition, the muscles of your colon will contract more often than normal, often in relation to stress. This can lead to overly frequent bowel movements or equally disruptive “false alarms,” and it can also be associated with painful cramps and bloating.

IBS can be challenging to manage but often improves through changes to your diet (for example, eating frequent small meals and avoiding foods that worsen IBS) and by taking steps to reduce and cope with stress. Your PCP or specialist may also recommend medication.

Celiac Disease

If you have celiac disease, your immune system reacts to gluten (found naturally in wheat, rye, and barley) by attacking the lining of your small intestine, which can inhibit nutrient absorption.

You may not have any symptoms, but if you do they can include diarrhea, constipation, fatigue, or abdominal pain and bloating. If untreated, lack of nutrition absorption can contribute to osteoporosis, anemia, and cancer. Celiac disease can sometimes appear as a severe skin rash called dermatitis herpetiformis.

Switching to a gluten-free diet — though by no means easy — will prevent the immune reaction.

Diverticular Disease

When the lining of the large intestine becomes weak (which can happen naturally as you age), the pressure of hard stools may cause small areas to bulge out to form pockets or “diverticula.”

At least half of all people have diverticula by the time they reach 80 years old. Diverticular disease is diagnosed when diverticula become associated with abdominal pain, bloating, fever, or diarrhea, usually due to inflammation or infection.

You may be prescribed antibiotics to fight infection as well as dietary changes (increased fiber and water) to help prevent constipation. In some cases, sections of the large intestine may need to be removed.

Colorectal Cancer

Tissue growths or “polyps” that grow in the lining of the colon or rectum can sometimes become cancerous. If you’re over 50, ask your PCP if you’re due for a colonoscopy (an internal screening to detect polyps).

Polyps found during screening can be easily removed before they can become cancerous. If a polyp does become cancerous, treatment depends on the extent to which cancer has spread.

Inflammatory Bowel Disease (IBD)

IBD includes Crohn’s disease (extensive inflammation of the digestive tract), ulcerative colitis (inflammation of the large intestine), esophagitis (inflammation of the esophagus), and other digestive conditions characterized mainly by inflammation.

With IBD, you may have symptoms including diarrhea, fever, fatigue, abdominal pain and cramping, bloody stool, reduced appetite, and unintended weight loss. These symptoms often come and go as inflammation fluctuates, making IBD an especially frustrating condition to manage and live with. The causes of IBD are still unknown, but they are thought to be immune-related.

Treatment is highly individualized, depending on the level of inflammation and where it occurs, but often involves lifestyle changes (diet and exercise) plus medication to reduce inflammation, suppress auto-immune response, or fight infection. Surgery is sometimes recommended.

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Early Birds and Night Owls



Time to learn about your body clock!

Whether you joke about being a morning person — or how you’re definitely not a morning person — there’s truth to these labels. Everyone grooves to their own natural rhythm. Scientists refer to individual differences in sleep-wake patterns as “morning-eveningness.”

In this lesson, we’ll talk about “morning people” vs. “evening people” and explain how staying in sync with your body’s natural rhythm can help you sleep better. (Not to mention, give you more energy when you’re awake.)

What Makes Your Body Clock Tick

Your body has an internal timing device that is made up of special molecules in your tissues and organs that interact with every cell in your body. This system is controlled by 20,000 nerve cells in your brain that receive direct input from your eyes. That explains why you feel most alert when you’re exposed to bright light, and you’re naturally tired when it gets dark.
Your body clock is responsible for producing “circadian rhythms” — physical, mental, and behavioral changes that follow a 24-hour cycle.

These rhythms affect:

  • Hormones
  • Eating habits
  • Digestion
  • Body temperature
  • Sleep

Some long-term health issues have also been linked to abnormal circadian rhythms. Among them: type 2 diabetes, obesity, depression, bipolar disorder, and seasonal affective disorder.

Circadian rhythms happen naturally, but they can also be influenced by things outside your body. Light has the most significant impact. Not sticking to a regular sleep schedule can throw off your body’s natural rhythms, as well.



Your body tells you when it needs to rest.. Are you listening?

While all humans — not to mention animals, plants, and even bacteria! — depend on an internal timing device, we don’t march to the same beat.

If your body clock runs faster than a 24-hour cycle, you’re a:

Morning Type

Also known as: An early bird or morning lark

Sleeping habits: You prefer to go to bed early and wake up early.

Eating habits: You’re more likely to eat breakfast and keep meal times consistent every day, even over the weekend.

Energy levels: The best time for you to be productive is in the morning, when your energy hits a high around 8 a.m.

If your body clock runs slower than a 24-hour cycle, you’re an:

Evening Type

Also known as: A night owl

Sleeping habits: You prefer to go to bed late and wake up late.

Eating habits: You’re more likely to skip breakfast.

Energy levels: The best time for you to be productive is towards the end of the day. Many evening types find that their energy rises around 7pm.

If your clock runs close to a 24-hour cycle, you’re an:

Intermediate Type

Also known as: Morning-evening person

Sleeping habits: You have qualities of both morning and evening types. About 60% of people fall into this category.

Eating habits: Your eating patterns are solidly sandwiched between those of morning and evening types. For instance, you’re likely to skip breakfast more than early birds, but not as often as night owls.

Energy levels: You’ll likely experience your biggest energy dip between 1-3 pm.
You largely inherited your morning-eveningness, but it could shift with age. During puberty, most teens become night owls. As adults approach older age, it’s common to shift to early bird status. (Although if you’re a hardcore night owl, that transition can take longer.)

Timing is Everything

Set your body clock up for success.

One type of “morning-eveningness” isn’t better than another, but you do pay a price for upsetting your natural rhythms. Jet lag’s the most obvious example. When you physically pass through different time zones, it takes a few days for your body clock to readjust. Until that happens, you’ll be tired and hungry at times that feel “off” to you — and cranky to boot.

When you don’t stick to a regular sleep schedule — for instance, maybe you get up early for work during the week, then sleep in on weekends — your body clock also gets out of sync. You’ll experience a similar phenomenon known as “social jetlag” until you find your rhythm again.

To keep your body clock running like, well, clockwork:

Be consistent about your sleep. Try to go to bed and wake up at the same time (or roughly within an hour) every day. Sleeping until noon on weekends may feel great, but it can disrupt your body clock for the rest of the week.

Go outside in the a.m. Morning sunshine helps your brain understand that it’s time to be awake and alert. Even opening your curtains can make a difference.

Limit screen time before bed. Artificial light from your devices can confuse your body into thinking it’s time to stay awake. Power down at least an hour before bed.

Look for ways to sync your schedule. If you’re a night owl, it might be tough to push back the start of your work day, but can you avoid scheduling anything before work? Can you exercise on your lunch break? Or schedule doctor appointments in the late afternoon? If you’re a morning person, see if you can limit late nights, when your energy naturally flags.

You can’t completely change your morning-eveningness, but a few strategies can help you adapt. Just go slowly! You’ll find it easiest to shift your schedule just 15 minutes at a time.

If you’re a night owl and want to be more of an early bird:

  • Dim all the lights in your house an hour before bed to prepare your brain for sleep.
  • As soon as you wake, expose yourself to as much light as you can. Natural outdoor light is best, but in a pinch, turn on lots of indoor lights.
  • If you’re an early bird and want to be more of a night owl:
  • Try to eat your meals a little later. This will gently shift your day.
  • If you can, try to exercise in the evening.


Who Should Join the Dream Team

…and who shouldn’t?

While we all enjoy a good nap, especially when a hammock’s involved, it will do you the most good if one of the following is true:

  • You’re sleep-deprived. When you don’t get enough rest, your body releases norepinephrine, the hormone involved with your body’s “fight or flight” response. As a result, your heart rate, blood glucose (BG), and blood pressure all rise. A short nap has the power to reverse these effects.
  • You know you’re about to be sleep-deprived. Taking a nap before your body runs low on sleep could help you stay more alert. If you’re napping because you know you’ll be working throughout the night, you may need as long as a 2-3 hour nap to reap these benefits.
  • You’re sick. When you feel under the weather, your body needs extra rest to help heal.

It’s a balance. Sometimes naps can create problems. Keep in mind:

  • Naps may make your insomnia worse. Sleep too much or too long during the day and you may find it harder to sleep well at night. This is especially true if you take very long naps or tend to rest in the late afternoon.
  • Long naps may hurt your health over the long term. Daytime snoozes lasting longer than 40 minutes have been shown to raise your cholesterol, blood pressure, and even your BG, all of which increase your risk of heart disease.

The “Right” Way to Nap

There’s more to a daytime snooze than pulling a hat over your eyes.

To reap the most benefits from your nap — and wake refreshed, not cranky — follow these steps.

Find a “cave.” Your perfect napping spot should be cave-like — cool, dark, and quiet. This environment’s ideal for sleep, so you’ll be able to drift off quickly.

Nap for less time than you’d like. Between 10-30 minutes of sleep time is often the best length for a nap. Rest any longer and you’ll enter a deeper stage of sleep that’s harder to wake from. As a result, you’ll feel groggy and disoriented, a state that experts call “sleep inertia,” or a “nap hangover.”

Aim for an afternoon naptime. For many people, 2-3pm is the perfect window to snooze: You’ve just had lunch, and your blood glucose and energy levels are in a natural slump. Try to nap earlier and you may not be tired enough. Wait until later and your nap could interfere with bedtime. If 2-3pm just doesn’t work with your schedule but you really need to close your eyes, nap when you can…but keep it short. (See above.)

Save longer naps for when you really need them. If you’re desperate for more daytime ZZZZs, set a timer for 90 minutes. That extended period will give your body enough time to go into, then emerge out of, deep R.E.M. sleep, so you wake feeling refreshed. But think of this longer nap as an emergency short-term solution — not something you should make a habit.

Give yourself time to wake up. Your brain needs a few minutes to transition back to the waking world, especially if you’ll be doing something that requires you to think fast on your feet. When you plan out your nap, factor in this extra time.

Emergency Nap Hacks

Need to nap but aren’t at home? Here’s how to make the most of it.

Invest in a neck pillow. Deep sleep requires all your muscles to relax — including the ones in your neck. That’s impossible if you’re rigidly sitting straight up, so invest in a U-shaped or inflatable neck pillow.

Block out light and noise. Reduce as much sensory input as you can: Turn off the lights, put on an eye mask, or just cover your eyes with a t-shirt. Use ear plugs to block out noise, or play white noise from your phone.

Choose a window seat. If you’re in an airplane, train, bus, or car, choose a seat that allows you to lean or rest your head against a wall.
Make the most of a flat surface. Can’t recline? This works in a pinch: Lean forward, cross your arms over a flat surface (like an airplane tray table or your desk), and rest your head on top of your arms.

Lose the “nap guilt.” It can be tough to make time in your day to sleep, especially if you’re used to packing (or overpacking) your schedule. Think of a short nap as an opportunity for your body and brain to recharge, kind of like plugging in a laptop when the battery’s low. Then lie back, relax, and enjoy those precious minutes of extra shut-eye.

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The Great Snack Debate



To snack or not to snack? Here’s how to decide.

Snacks have a bad reputation as sources of excess calories, but that doesn’t have to be the case. In fact, regular snacks may be a key way for you to manage hunger and get extra nutrition. Research shows that people who snack on fruit and nuts tend to have a higher-quality diet, and that snacking on veggies is associated with a lower body mass index (BMI).
Figuring out if your current snacking habits are working for you depends on when you’re snacking, which snack foods you’re choosing, and how your snacks impact your appetite at mealtimes.

You may want to add a snack if…

You’re overly hungry at mealtimes
You could benefit from added nutrition (e.g. more fiber from veggies and fruit or more calcium from dairy) but it’s challenging to fit it into your meals

You may want to eliminate a snack if…

You’re not hungry at mealtimes
You eat to distract yourself (from stress, boredom, or other uncomfortable emotions)
You eat because you’re tired or low on energy

You may want to change up your snack choices if…

You still feel hungry after snacking
You snack on “trouble foods” that are easy to overeat
You snack on high-sodium foods
This week, we’ll help you evaluate your snacking habits so you can decide what, if anything, you want to change. Plus, we’ll serve up some fresh snack options in case your current standbys are getting stale.


Track Your Snacks

Shed some light on between-meal munching.

Snacks can be challenging to track, especially if you’re quickly eating whatever’s available when hunger or a craving strikes. To gain insight into your habits, consider tracking all your snacks for a week, or at least a few days. As you enter snacks into your Omada Food Tracker, add details that help you identify patterns.
Details to include in your tracker:
Approx. serving size(s) of your snack
Time and place you ate it
How hungry you were
What you were doing and/or how you were feeling
The more information you add, the more useful tracking will be. Your entries might read something like “Handful of grapes, 1 cheese stick (11am, at work, mildly hungry, stressed)” or “2 cookies, medium black iced coffee (3pm, coffee shop, not hungry, low energy).”

As you track, keep an eye out for these and other patterns:

Snacking on high-sodium foods. Store-bought snacks tend to be sky-high in sodium. Switching to homemade and whole-food snacks (see the next page for ideas) may be a great way for you to reduce your sodium intake.

Portion-free snacking. Not sure how much you ate because you were snacking straight out of a box or bag? Make it a goal to roughly measure out a single portion (and put the rest away) before you start snacking.

Snacking at certain times/places. Knowing when you typically snack empowers you to plan ahead and ensure you have nutritious options available.

Snacking before physical activity. It’s common to think you need extra snacks when you exercise, but unless you’re exercising at moderate or high-intensity for 30 minutes or more, that may not be true. Tune into your hunger level — your body will let you know if you need a snack.

Snacking late at night. If you have a balanced dinner within 3-4 hours of bedtime, night snacking is probably more a matter of habit (or an attempt to satisfy a craving) than a response to hunger. Choose low-calorie snacks — air-popped popcorn, cut veggies with dip, roasted chickpeas, or veggie chips (see recipes on the next page).

Snacking instead of eating meals. If you’re snacking through meal times, that’s a habit worth changing. Snacks aren’t likely to provide balanced nutrition that keeps you at your best. It may also be a sign that self-care — which includes eating well — is too low on your list of priorities.

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Sleep Well!



Sleep impacts nearly every aspect of your health and wellbeing.

How have you been sleeping? If your answer is “not great,” we want to help you get your rest. Like eating nutritious food and staying active, sleeping an average of 7 to 8 hours each night can be game-changing for your physical and mental health.
Each night while you sleep, complex processes in your brain and body improve your ability to:
⦁ Regulate blood pressure
⦁ Heal and repair your heart and blood vessels
⦁ Regulate hunger
⦁ Repair muscle tissue
⦁ Fight off infection
⦁ Pay attention
⦁ Make decisions
⦁ Be creative
⦁ Solve problems
⦁ Control your emotions
⦁ Cope with change
Sleeping fewer than 7 hours a night for even a couple of days will impair your functioning. Not getting enough sleep for weeks, months, or even years? That takes a serious toll.
Individuals who regularly sleep fewer than 7 hours a night are more likely to report having:
⦁ Diabetes
⦁ Heart attack
⦁ Coronary heart disease
⦁ Stroke
⦁ Asthma
⦁ Chronic Obstructive Pulmonary Disease (COPD)
⦁ Cancer
⦁ Arthritis
⦁ Depression
⦁ Chronic kidney disease
If you’re struggling from lack of sleep, you’re in a big club. According to the latest national data from the CDC, on average, 35% of Americans sleep less than 7 hours per night. That means more than 1 out of 3 people are chronically sleep-deficient.
One strategy you may already be working on is getting regular exercise. A National Sleep Foundation poll of 1,000 people found that those who engage in any level of activity during the day reported sleeping better than those who didn’t exercise at all. Further research shows that exercise helps people fall asleep faster and stay asleep longer.
Aside from physical activity, let’s explore other changes — big and small — that will help you rest well.


Stay Aware of Sleep Apnea

Be on alert for this common disorder, so you can address it quickly.

Have you heard of obstructive sleep apnea (OSA)? It’s an extremely common sleep disorder that often goes unnoticed. Half of all people with hypertension are estimated to have the disorder.
Sleep apnea is an interruption in breathing during sleep that can last 10 to 120 seconds and may occur up to 30 times or more each hour. OSA is caused by a blockage of the airway, typically when soft tissue in the back of the throat collapses and closes. That blockage prevents you from breathing. As oxygen levels drop, your lungs automatically trigger a big intake of air. To someone else in the room, this can sound like choking or coughing.
When your body is repeatedly deprived of oxygen, it triggers a stress response that drives up your blood pressure and blood sugar, increasing your risk of type 2 diabetes, and making it harder to manage hypertension. Day to day, sleep apnea disrupts and prevents restorative sleep, leaving you tired and groggy.
What causes OSA? In adults, a common cause is being overweight or obese, as increased fat deposits in the neck can block the upper airway. Drinking alcohol and smoking are also contributing risk factors.
Below are symptoms that may indicate you have OSA:

When You’re Awake When You’re Asleep
You feel tired, despite getting to bed at a decent hour Snoring loudly
Not being able to concentrate Tossing and turning
Being forgetful Coughing or choking
Having a morning headache Getting up to urinate frequently
Having a sore throat in the morning Sweating heavily

If you have any of these symptoms, talk to your primary care provider. There are many effective treatments for OSA, including weight loss, reducing nasal congestion, and using devices that keep the airway open.


Common Sleep Disruptors

Not sure why you can’t fall or stay asleep? Here are some likely causes.

Sometimes, there’s a major obstacle standing between you and a good night’s sleep — such as caring for small children, chronic pain or discomfort, or a job that requires you to work at night. Dealing with one of these? Reach out to your coach, who can guide you toward positive steps.
Otherwise, if you struggle to fall or stay asleep, it’s likely that one or more of the factors below are infringing on your shuteye. Read up on the factors that may be impacting you and what you can do about them, starting tonight.
Which sleep disruptors might be affecting you? Which could you potentially change?

Using digital devices before bed

Watching TV or using your phone at night can feel like a harmless, entertaining habit, but it may be keeping you awake. Using devices distracts you from sleep, and light emitted by digital screens may suppress melatonin, the hormone that regulates your sleep cycle.
To sleep better, consider shutting down your phone, your laptop, your tablet, and your TV an hour before bedtime — polls show that people who use devices 60 minutes before bed have the hardest time falling asleep. Make sure everything is in do-not-disturb mode so you won’t be woken up by pings, chimes, and suddenly bright screens.

Drinking alcohol at night

Drinking before bed may help you doze off faster but can lead to low quality sleep later in the night, and cause you to wake up more often. The neurochemical effects of alcohol prevent your brain from transitioning into the deeper, more restorative stages of sleep.
And because alcohol relaxes the muscles of your throat, drinking also makes you more prone to snoring and sleep apnea (more on that topic on the next page). Lastly, you’re more likely to wake up because you need to use the bathroom.
If you currently drink at night and wake up tired, aim to have your last drink at least 2-3 hours before bed

Eating foods that trigger acid reflux

If you struggle to fall asleep because of a burning sensation in your chest or wake up coughing or choking with a sour taste in your mouth, it could be due to acid reflux (aka gastroesophageal reflux). Acid reflux is a digestive issue that occurs when stomach acids flow backwards into the esophagus. It’s one of the leading causes of disturbed sleep among people ages 45 to 64.
The main causes of acid reflux include increased pressure on your abdomen due to excess weight, certain medications (talk to your primary care provider about whether something you’re taking could be contributing to acid reflux), and smoking or inhaling secondhand smoke.
If you experience acid reflux, you may be able to control it by:
⦁ Avoiding greasy and/or spicy foods, as well as alcohol, coffee, peppermint, and tomatoes/tomato products
⦁ Eating smaller meals
⦁ Finish eating 2 – 3 hours before bedtime
⦁ Staying upright 3 hours after a meal
⦁ Wearing clothes that are loose around the waist
⦁ Raising the head of your bed by 6-8 inches (by putting blocks under the bedposts)
⦁ Losing weight
⦁ Quitting smoking/avoiding secondhand smoke
⦁ Taking over-the-counter medication to reduce stomach acid

Consuming caffeine late in the day

You know caffeine makes you more alert and less sleepy but you may not realize that the chemical stays in your system for up to 6-8 hours after you consume it. That means having a cup of coffee or a caffeinated soda later in the day could be keeping you awake at night.
Note that different people can be more or less sensitive to caffeine (and caffeine sensitivity can increase as you get older). So if you struggle to fall asleep and can’t pinpoint a reason, it’s worth reducing or cutting out caffeine to see if it helps.

Taking certain medications

Many medications can disrupt sleep, including several used to treat hypertension. If you’re not resting well at night, ask your primary care provider if anything you’re taking (whether prescription or over-the-counter meds) could be keeping you up or interfering with your normal sleep cycles.
Even if you think a medication is making it harder for you to sleep, do not alter or skip doses without talking to your primary care provider.

Being stressed, anxious, or depressed

If you have chronic stress, anxiety, or depression, you may find it more difficult to fall asleep. Even when you do drift off, you may sleep lightly, missing out on the benefits of more restorative phases of sleep. (If you’re on antidepressants and aren’t sleeping well, talk to your primary care provider about whether the medication could be affecting your sleep.)
A relaxing bedtime ritual may help you counteract stress before bed. See the next page for more info.

Smoking before bed

There are many health-related reasons to quit smoking. Add getting a better night’s rest to that list. Nicotine is a stimulant, so smoking within one or two hours of bedtime is likely to keep you up.
Nicotine has also been shown to disrupt normal sleep and contribute to sleep apnea (see the next page), leading to chronic sleep deprivation. Heavy smok

A bright, noisy, or overly warm bedroom

To facilitate sleep, your bedroom should be like a cave — dark, cool, and quiet. Next time you turn off the lights in your bedroom, consider how dark it really is. Many electronics have small, bright lights that you can’t turn off. Consider covering them with thick, black paper or electrical tape.
If you live in a noisy building or neighborhood, get a good set of earplugs or use a white noise machine, fan, air-purifier, or soft, instrumental music to drown out other sounds.
To allow your body temperature to drop at night (a natural sleep precursor), keep the thermostat at a comfortable temperature, and wear light, breathable pajamas.


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