Having Trouble Sleeping?
Is there anything more frustrating than spending an entire night listening to the tick of the clock on your bedside table?
Restless nights can sap your vitality and zip. Without enough rest, you become more forgetful, have difficulty concentrating, become more accident prone, and often feel irritable. As we get older, the natural aging process, certain chronic conditions, and medicines can all erode your chances of a good night's rest.
What Happens During Sleep
"Sleep is a physiological necessity," says Margaret Moline, PhD, director of the Sleep-Wake Disorders Center at New York Presbyterian Hospital. "It's part of what the brain and body need to do. Getting enough sleep is a real quality-of-life issue."
"Sleep is not unconsciousness," Moline continues. "Sleep is a diminished sense of your surroundings." Each night, sleepers cycle through multiple stages of rapid eye movement (dreaming) sleep and non-rapid eye movement (slow-wave) sleep. During episodes of slow-wave rest, sleep deepens, and you are less likely to hear disruptions such as a dog barking or a partner getting up to use the bathroom.
Why Sleep Becomes Elusive
"With aging, there's less slow-wave, deeper sleep," Moline explains. "Therefore, older persons are more likely to be awakened by noises in the environment."
According to the National Sleep Foundation, a number of health problems can make sleeping difficult:
- Pain: People with arthritis may have difficulty falling asleep or staying asleep because of painful joints. If you suffer from arthritis, ask your doctor about treatment for the pain.
- Heartburn: Nighttime heartburn may casue symptoms of wheezing and chronic cough, with repeated awakenings and daytime sleepiness. Raising the head of the bed may alleviate symptoms, or medicine may be needed.
- Respiratory ailments: Asthma, chronic interstitial lung disease, and various neuromuscular diseases can cause awakening.
- Menopause: The hot flashes and breathing changes associated with menopause appear to disturb sleep. In one study, hot flashes were associated with arousals once every eight minutes on average.
- Medicine: Ask your doctor or pharmacist if your medicines can cause insomnia or drowsiness, and if changing the time the drug is taken could help overcome these problems. "Older people have to get up to use the bathroom," Moline says. "If it happens somewhat frequently, it interferes with sleep."
- Going to the bathroom: an enlarged prostate or other conditions cause an increased need to get up and go to the bathroom through the night. These multiple trips can disturb your sleep. If you are going to the bathroom multiple times per night, discuss this with your doctor.
- Chemical changes: Production of the hormone melatonin, which influences sleep and wakefulness, changes as we get older.
Sleep Disorders: A Whole Other Ball of Wax
Some of the most common sleep disorders include:
- Insomnia: Many adults will complain of difficulty falling or staying asleep or waking too early at some point in their lives.
- Sleep apnea: Noisy, irregular breathing can signal this treatable sleep disorder. In severe cases, the sleeper wakes several hundred times during the night due to a partial obstruction that temporarily blocks air flow. Untreated sleep apnea may lead to high blood pressure, heart disease, and an increased risk of diabetes.
Good Sleep Habits
Good sleep habits include:
- Go to bed at the same time each night.
- Reserve your bed for sleep and sex. Watch television or read in another room.
- Avoid ]]>caffeine]]>, ]]>alcohol]]>, and cigarettes, especially in the afternoon and evening.
- Do not lie in bed watching the clock. If you cannot fall asleep within half an hour, get up and listen to calming music or read.
- Exercise 20 to 30 minutes at least three days a week—but not too close to bedtime.
- Limit naps and do not nap longer than 30 minutes.
- Take a walk outside during the day.
- Sleep in a cool, quiet, dark room. Wear earplugs or eyeshades to block out light and sound.
- Sleep on comfortable bedding.
- Limit drinking liquids a few hours before bedtime.
- Do not go to bed hungry or overstuffed. Both may cause physical discomfort.
Sleep Medications and Herbal Remedies
"Sleeping pills are meant for short-term use," says Moline. "We look to improving sleep hygiene and see if the judicious use of sleep medications is warranted."
A study reported in the Journal of the American Medical Association found behavioral changes provided longer-lasting benefits in the treatment of insomnia than did sleep medicines. With a diary of your sleep and wake habits, your doctor may help determine the cause of and solution to your sleeplessness.
]]>Melatonin]]> supplements are not approved by the Food and Drug Administration (FDA) and lack sufficient evidence proving that they can aid sleep. However, research indicates that melatonin might be beneficial for patients with jet lag. ]]>Valerian]]>, an herb, has been used all over the world to induce sleep. There is mixed evidence to how effective it is though.Inform your doctor if you are taking any herbal supplements.
Remember that sleep is a necessity, not a commodity. It is as much a part of overall health as good nutrition and regular exercise. So do not settle for two to three hours per night. Crawl into a comfortable bed, don your earplugs, and turn off all the lights. And call your doctor if you need help.
American Academy of Sleep Medicine
Early to Rise: Research Offers Clues to Older People's Sleep Habits. National Institute on Aging
National Sleep Foundation
Sleep Information. National Heart, Lung, and Blood Institute
Better Sleep Council Canada
Canadain Sleep Society
Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation. Apr 2003;107(12):1671-8.
Brennan R, Jan JE, Lyons CJ. Light, dark, and melatonin: emerging evidence for the importance of melatonin in ocular physiology. Eye. Sep 22, 2006.
Insomnia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 2010. Accessed June 7, 2010.
Morin CM, Koetter U, Bastien C, Ware JC, Wooten V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep. Nov 1, 2005;28(11):1465-1471.
Tasali E, Mohkalesi B, VanCauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest. 2008;133(2):496-506.
Last reviewed June 2010 by ]]>Brian P. Randall, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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