“I just can’t sleep,” grumbles 77-year-old Charlie. “No matter when I go to bed, I’m awake at 3 a. m.”
Charlie isn’t alone. Our National Institutes of Health estimate 50 to 70 million Americans chronically suffer from one of some 90 different sorts of sleep disorder. Their symptoms include inability to fall asleep or stay asleep, resulting in daytime sleepiness.
Poor sleep has a greater cost than many people realize. For instance, the National Highway Traffic Safety Administration estimates at least 100,000 annual police-reported crashes are the result of drowsy driving — some with resulting fatalities.
In addition, sleep disorders are known to have both long- and short-term effects on health by increasing the risk of obesity, memory problems, chronic diseases, mood disorders, hypertension, stroke and heart failure, as well as other impairments to the quality of life.
Surprisingly, although more physicians are asking patients about their levels of pain, they seldom inquire about sleep. This is unfortunate because diagnosing and correcting sleep problems — often lumped together as insomnia — can “cure” a surprising number of complaints.
Many contributing factors
Common factors in sleep problems include naturally changing sleep patterns as people age, some medications, stress, allergies, pain, asthma, depression, being overweight, jet lag, sleep apnea, and sleep-related medical, psychiatric and neurological disorders.
As people age, their sleep patterns often change and awakening in the night is common. For some people, this may not be a problem. In fact, hundreds of years ago it wasn’t unusual for people to go to bed when it got dark, then arise in the middle of the night for a small meal, to read, or even to visit neighbors. Today, some people who awaken in the middle of the night simply use the time to have a snack, read a book, or listen to music before falling asleep again without being bothered by their wakefulness.
Pain — whether chronic or temporary — is a major disrupter of sleep. In some cases, relaxation techniques and rituals as well as adjusting the timing of a pain-relief medication can help. Melatonin, a hormone found naturally in the body and made synthetically, appears to reduce the time it takes to fall asleep and the number of sleep interruptions in elderly people with sleep-wake cycle disturbances and dementia. It may interact with some medications, so check with your healthcare provider about its safety.
Obstructive sleep apnea (OSA) can be another problem. It’s often marked by snoring and/or periods when the sleeper stops breathing. People with OSA awaken still feeling tired, and when untreated, it can cause serious health risks. Aging and being overweight are common contributors. Treatment includes weight loss and, in serious cases, the use of a device which uses a mask and small machine to supply steady air pressure during sleep.
What to do
Studies show that people with insomnia are ten times more likely than others to become seriously depressed, but it appears to be a chicken-and-egg situation. Depression can cause sleep problems, but sometimes sleep problems can lead to depression. Treatment may include medications. Cognitive Behavioral Therapy (CBT), a “talk” therapy which studies show is effective, focuses on changing the thoughts and behaviors leading to both insomnia and depression.
If you experience problems with sleep, check out our pointers for getting a good night’s sleep. If after several weeks of consistently following these suggestions, you are still having trouble, try some self-diagnosis by using a simple sleep diary.
The American Academy of Sleep Medicine has a downloadable, printable form on its website which keeps track of things like medications, caffeine, alcohol, exercise, plus time spent napping or sleeping. Visit http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf. Some wrist-worn fitness monitors measure sleep patterns and there are even apps for sleep diaries.
If you still cannot uncover the cause of sleeplessness, take your sleep diary of at least two weeks to consult with your physician. He or she may have suggestions such as lifestyle changes, adjustments to medication, cognitive behavioral therapy, weight management, visiting a sleep clinic, and even surgery.
Charlie, who had trouble sleeping, discovered several likely contributors to his insomnia. He started exercising more vigorously in the morning, stopped his two-hour afternoon nap, and tried a cup of warm milk instead of a glass of wine for his nightcap. Within a week, his sleep pattern had improved remarkably.
Pointers for better sleep
• Daily exercise that makes your body tired is frequently an effective prescription for good sleep since people can be tired mentally, but not physically. If you have physical limitations, find pulse-raising exercise you can pursue such as water aerobics. Don’t exercise vigorously in the two hours before bedtime.
• Go to bed and get up at the same time every day with a routine such as a light snack or a warm bath to signal your body it’s time for sleep.
• Avoid watching TV, checking emails, or surfing the web in the hour before bedtime. Just the lighting on your electronics can be stimulating.
• Be aware of caffeine in coffee, energy drinks, sodas, teas and even pain relievers.
• Alcohol close to bedtime can make you drowsy, but disrupts sleep later when your body rouses itself to counter alcohol’s effects.
• Limit daytime naps to 20 or 30 minutes and take them in the early afternoon.
• Keep your bedroom cool, dark and peaceful. If it’s not quiet, consider “white noise” such as a fan or a device that creates the sound of rain or the ocean. If you share a bed, be sure your partner (or pet) isn’t disrupting your sleep.
• Put aside thoughts about what you must do tomorrow and dwell on something pleasant in the past. One woman mentally walks room by room through her grandparents’ home where she spent happy summer vacations.
• During periods of stress, find ways to calm down. Try yoga, talk with a friend or therapist, keep exercising and make lists of what you can do (and do it) and cannot do (and accept it). One man, greatly concerned about his wife’s failing health, found that setting a daily 3 p.m. “worry time” was surprisingly helpful. When he grew stressed, he reminded himself wait until 3 p.m. to worry. Ironically, he found it difficult to worry on demand, so the tactic made a big difference.
