The New Normal
|How much sleep did you get last night? If you are like many individuals, you probably average six hours or less. Then there are those who actually fall asleep but can’t stay asleep. This group of individuals falls into the category called sleep deprived or an insomniac. |
Truth be told, insomnia is Not a Normal Part of Aging but in today’s fast paced society insomnia is a common complaint among all sectors of the population from young children and teenagers to the middle aged and the older adults. And it seems that the older adults in particular make the assumption that aging means no longer sleeping well.
Researchers on the other hand recognize that illness, inactivity, poor sleep habits, and the inappropriate use of alcohol, caffeine and tobacco—rather than age—are the major culprits associated with this escalating problem. Fortunately, proper medical care and changes in sleep habits can often promote a good night’s sleep, without the need for sleeping pills.
In the case of the older adult, a lack of exercise, an unstructured daily schedule, combined with fewer responsibilities may leave an older person at an increased risk for insomnia. Added to these risk factors are illnesses such as heart and lung diseases, depression, dementia, and chronic pain, which are common among older adults.
Why and How We Sleep
To understand the current treatments available for sleep disorders, it is helpful to know why and how we sleep. Like healthy nutrition and daily activity, sleep is important for maintaining and restoring physical and mental health, affecting both the body and mind.
SLEEP FACT: 17 hours of wakefulness is equivalent to having a blood alcohol level of 0.05 – enough to be considered legally drunk.
The authors of Sleep and Dreaming: Scientific Advances and Reconsiderations found that sleep and dreaming are necessary for recovery, learning, memory, and to regulate body functions such as blood pressure, blood sugar, and immune system.
And in the book The Secret World of Sleep the author Penelope A. Lewis depicts the cycle of sleep and awakening as a process controlled by an internal biological clock located at the base of the brain. The clock can be adjusted by exposure to daylight and the pattern of daily activity. The clock is set by nature to promote some sleepiness for a few hours early in the afternoon and more strongly from midnight to 7 a.m.
The sleep phase of the “sleep/wake cycle” is divided into:
-Dreaming or rapid eye movement sleep
-Shallow or light sleep, and
-Deep or restorative sleep
The stages of sleep change from infancy into adulthood with progressively less time spent in deep sleep and dreaming and more time in shallow sleep. In addition, as we get older more adults tend to be “early birds,” early-to-bed, early-to-rise rather than “night owls” that go to bed late and get up late.
Researchers have found when it comes to age-related change in sleep habits, most occur in the early and mid years of life, changing little in old age.
Sleep for 60+ Individuals
One measure of sleep quality is sleep efficiency, which is the amount of time asleep compared to the amount of time spent in bed. The Geriatric Mental Health Foundation points out that sleep efficiency is the only measure of sleep quality that changes significantly for those age 60 and older, and declines gradually at a rate of about 3 percent per decade.
Overall, the sleep quality of healthy older adults remains relatively constant unless there is an illness. Another validated fact of aging is that nearly 40 percent of sleeping pills are prescribed to older adults, although they make up less than 20 percent of overall population. With sleep medication comes the risks of impaired memory, awareness, ability to focus one’s attention, accidents, and dependency associated with some sleep pills.
This makes diagnosing sleep problems in an older person much more of a challenge because of the interplay between the factors of age, relationships, physical and mental illness, and the increase in medications.
The Causes and Effects of Insomnia
The National Sleep Foundations views sleep problems as the cause, effect, or complication of illnesses, mental disorders, and accidents. Just like temperature, pulse, and respiration; sleep and recovery should be considered a vital sign of health. The quality of one’s sleep and wakefulness can be a sign of health or illness.
The National Institute of Health (NIH) thinks of insomnia as sleeplessness that cannot be blamed on mental disorders, physical illness, medications or simple problems with scheduling. The American Board of Sleep Medicine and other sleep driven organizations believe many times insomnia can promote excessive daytime drowsiness called primary hypersomnia, which is associated with nighttime periodic leg movements, restless legs syndrome, sleep apnea, and snoring.
In any case, to qualify as a sleep disorder, symptoms must interfere with social or intellectual function and occur three nights per week for at least a month. Obsessive worry about the lack or quality of sleep and the use of alcohol or sedatives to promote sleep may be both a cause and effect of insomnia. An occasional sleep problem can become persistent by self-defeating solutions and self-medicating such as spending too much time in bed, abandoning a regular schedule of sleep and waking, or using alcohol as a sleep aid. A few days of insomnia or poor sleep can be the result of a common cold or a change in routine, like staying in a hotel.
However, insomnia lasting four weeks or longer likely has a more complex cause. Any individual with insomnia that lasts four weeks or longer should consult a physician. When you talk with your physician, be sure to tell them how long you have had problems sleeping. The length of time you have experienced these symptoms is important both for diagnosis and treatment, which is why you should keep a sleep journal. Also, tell your doctor about your sleep habits and any medications, illnesses or recent events that may have contributed to your change in sleep.
To find out what’s sabotaging your slumber, the toll it takes on your well-being, and what you can do to log in more quality sleep time, check out the following snoozing stats
Power Naps or general napping, more than often; disrupt a good night’s sleep. If you must nap, take one short nap of about an hour in the early afternoon before 3 p.m. If you can eliminate naps altogether, you may sleep better at night.
Amount of Sleep
At night, limit your time in bed to 7-8 hours to ensure that sleep is continuous rather than broken up over a longer period of time. A person who tries to make up for poor sleep with extra time in bed will instead experience more awakenings and disruptions in the natural sleep pattern. By limiting your time in bed to 7-8 hours nightly, you may increase the quality of your sleep and improve your daytime well being and alertness.
“You can’t pull an all-nighter and still learn effectively,” says Matthew Walker, Ph.D., a sleep scientist at the University of California, Berkeley.
Lack of zzzzz’s affects a part of the brain called the hippocampus which is key in the creation of memories.
Like daily exercise or good nutritional habits; as you introduce new sleep habits, follow them every day of the week. An important element in getting good sleep is sticking to a schedule. So even if you have not had a restful sleep, get out of bed at the same time every morning. This helps the “sleep clock” at the base of your brain function better.
There is a 40% decrease in your ability to remember information when you haven’t had a full night’s sleep. “Exposure to light is one of the main environmental cues for creating regular sleep-wake pattern,” say Ivy Cheung, a doctoral candidate at Northwestern University.
To enhance your shut-eye, schedule time-outs during the day hours to increase your daylight exposure. Researchers found morning light to be most important for the regulation of the circadian rhythms.
By trying different strategies, you can positively affect sleep habits that may lead to falling asleep more easily. Through daily practice of relaxation techniques, you become more aware of your mind and body and learn to recognize and reduce muscle tension. By practicing relaxation methods consistently, you can improve your natural relaxation response.
There are a variety of techniques for those who seek sleep. One method encourages the individual to progressively tense then relax muscle groups in a step-by-step manner from head to toe, then they are instructed to reflect on the feeling as tension is released.
Other relaxation techniques to combat insomnia can be found in a New Harbinger Self Help Workbook called The Relaxation & Stress Reduction Workbook by Martha David, Elizabeth Robbins Eshelman, and Matthew McKay. These authors provide powerful relaxation techniques from a variety of proven treatment methods, including progressive relaxation, autogenics, self-hypnosis, visualization, and mindfulness and acceptance therapy.
Education about sleep and changes in sleep habits are helpful for most persons with sleep problems. However, other treatments may be needed for those who cannot maintain good sleep habits or who rely on sleeping pills, sedative/hypnotics.
Medication may be necessary for individuals whose insomnia is not helped through changes in sleep habits and therapy and for those individuals who experience periodic limb movements or restless legs syndrome. As a first step, the individual should withdraw from stimulant beverages (like coffee and tea) and over-the-counter medications that interfere with either the quality of sleep or the performance of routine activities during the day, such as driving.
Always check with your doctor first before starting, changing, combining or stopping any over the counter or prescribed medication.
Common over-the-counter medications that impair sleep include:
. Pain relievers (analgesics) with caffeine
. Some cough and cold medicines
. Decongestants with phenylpropanolamine or pseudoephedrine
Persons with sleep disorders should not use over-the-counter medications that are marketed as sleep aides or “PM” pain relievers (analgesics) that contain the antihistamines diphenhydramine or doxylamine. In older people, these may cause side effects, such as mental confusion or bladder or bowel disturbances.
The Food and Drug Administration (FDA) do not regulate the use of natural products such as Melatonin used as a “natural” sedative. Melatonin varies considerably in content from one brand to the next, and there is little research to support its use. For persons wishing to use an herbal product, teas made from German chamomile (Matricaria recutita) or passion flower (Passiflora incarnata) or capsules of valerian (Valeriana officinalis) are popular. However the FDA does not regulate herbal remedies and they may vary considerably in content from one brand to the next.
Patients should understand that sleeping pills are a temporary solution and should be reduced and then stopped after two to three weeks under a doctor’s care. Changes in sleep habits offer the best chance of long-term improvements in sleep but require the most effort.
Cognitive Behavioral Therapy Gregg D. Jacobs author of Say Good Night to Insomnia, has developed a six week drug free program based on cognitive behavioral therapy combines elements of positive sleep habit change in a structured format and offers long-term benefits. Cognitive behavioral therapy and changes in sleep habits can lead to a gradual reduction in the use of sleeping pills. This approach is typically more successful than simply trying to cut down on pills without professional help.
With therapy, the individual and provider work on identifying and managing situations and habits that disrupt sleep in order to establish a better, more regular sleep/wake cycle. By establishing daily routines, the quality of sleep can improve for many older adults.
You’re Never Too Old to Get a Good Night’s
Problems with getting a good night’s sleep are common among older adults. But sleep quality can be improved with simple steps. This involves learning about sleep; practicing good sleep habits, and stopping bad habits. Treatment for sleep disorders may also include reducing or stopping medications that interrupt sleep, treating disorders like depression that directly affect sleep, and, in some cases, properly using sleeping pills. A doctor providing help for a sleep disorder may discuss your individual sleep habits often called “sleep hygiene” and needs, and suggest changes in your habits and in your environment.
First, know what to avoid. You can try many of these sleep strategies to promote better sleep by reducing those things that make you too alert. The following can help sleep:
. Make sure the bedroom is quiet, restful and comfortable
. 7AM is prime time when it comes to exercise if you want a good night sleep and your blood pressure may lower up to 10 percent through out the day and 25 percent by night fall
. Use the bed only for sleep and intimacy, not for snacking, listening to radio, or watching television
. Go to bed and wake up at the same time each day
. Develop a get-to-sleep ritual that will let you relax before bedtime
. Avoid exercising within 4 hours of bedtime
. Avoid caffeine and/or cigarettes for at least 4 hours before bedtime
. Avoid alcohol for at least 2 hours before bedtime, and do not use alcohol as a sleep aid
. Try wearing socks to bed; this lowers your core temperature and promotes sleep
. Avoid being too hungry or too full at bedtime
. Avoid drinking large amounts of fluid after 6 pm
. Get regular exercise and daily exposure to outdoor light
. Take a hot bath 90 minutes before bedtime
. Ask your doctor when you should take medications for your heart, blood pressure, breathing or pain for improved sleep.
Resources: Edward F. Pace-Schott, Mark Solms, Mark Blagrove, Steven Garnad, Sleep and Dreaming: Scientific Advances and Reconsiderations, Cambridge University Press, 2003.
Penelope A. Lewis, The Secret World of Sleep: The Surprising Science of the Mind at Rest, Palgrave Macmillian 2013.
Martha David, Elizabeth Robbins Eshelman, Matthew McKay, The Relaxation & Stress Reduction Workbook, New Harbinger Publications, Inc., 2008. Karyn Repinski, SHAPE Magazine, April 2014, p. 154.
National Sleep Foundation. 2003 Sleep in America Poll. Online: www.sleepfoundation.org
Gregg D. Jacobs, Say Good Night to Insomnia: The Six-Week, Drug-Free Program Developed at Harvard Medical School, Henry Holt and Company 1998.
Your Guide to Healthy Sleep. U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No. 06-5271. November 2005.
American Insomnia Associationwww.americaninsomniaassociation.org American Sleep Apnea Association www.sleepapnea.org
Narcolepsy Network, Inc.www.narcolepsynetwork.org
National Sleep Foundationwww.sleepfoundation.org
Restless Legs Syndrome Foundationwww.rls.org
American Board of Sleep Medicine www.absm.org
Geriatric Mental Health Foundation www.gmhfonline.org