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Friday, 20 November 2009

How Well Do You Sleep?

category_bug_journal2.gif As I have undoubtedly mentioned here from time to time, I don't sleep worth a damn. If it's not that I need to pee, it's waking at ungodly early hours - like 2:30AM - without a chance of going back to sleep. On nights when that doesn't happen, the cat's circadian rhythm has him poking me by 4AM or 4:30AM with breakfast in mind. He is the personification of persistence.

In just the past two weeks, however, I've regularly been sleeping for seven or eight hours without interruption. Even the cat has slept past 4:30AM on a few occasions. I can't say what changed, but I'm grateful for it.

Even so, since there is no telling how long my new-found full-night's sleep will last, I was eager when I was invited by the International Longevity Center to take part in a teleconference earlier this week with four of the authors - all medical doctors and all experts in sleep and aging - of new report published this year in The Journal of the American Geriatrics Society (paid subscription required) outlining new recommendations for treating sleep disorders.

Many people believe that sleep disturbances are a normal part of getting old. Not so, say the authors. Nevertheless, 30 to 50 percent of elders report problems with insomnia – that is, difficulty falling asleep and/or staying asleep. Other sleep disorders that effect smaller numbers of people include

• sleep apnea
• restless leg syndrome
• circadian rhythm disorders
• parasomnias
• hypersomnias
• disorders associated with nursing homes

Lack of a good night's sleep has a strong impact on elders' quality of life contributing to balance difficulties leading to falls, an inability to concentrate, frailty and decreased cognitive function. The causes are many – among them, hypertension, stress, depression, some illnesses, any medications that affect neurotransmitters, use of nicotine, alcohol, caffeine, some herbal and over-the-counter medicines.

Certain changes in our bodies as we get older also affect sleep. Circadian rhythms appear to change so that old people tend to fall asleep earlier and wake earlier than when they were younger. The amount of light sleep increases and the amount of deep sleep decreases.

I asked about the effect of the last item. It is known, the doctors told us, that growth hormone which is needed for a body to repair itself, is secreted primarily during deep sleep. It is not yet known what causes the decrease or its effect on old people.

As Dr. Robert N. Butler, the president and CEO of the International Longevity Center, noted during the teleconference, sleep is a profound piece of the human condition. It deserves more attention than we or our physicians often give it. Few doctors ask about sleep problems; I know I have never, when young or old, been asked how I sleep.

Elders need to be more pro-active and let our physicians know if we have trouble sleeping and discuss possible treatments. Be wary of hypnotic drugs such as Ambien and Lunestra which, say the researchers, are often prescribed because it is easiest thing to do rather than search out causes.

Depending on the type of sleep disorder, treatment can include changing medications, light therapy and cognitive behavioral therapy, among others.

Here are the researchers' tips for a better night's sleep. We all sort of know these things, but don't necessarily follow them. I often read and watch television in bed.

• Go to bed and wake up at the same time every day
• Develop a sleep ritual
• If you cannot fall asleep in 20 minutes, get up and do something relaxing until you feel sleepy
• Avoid exercising within two hours of bedtime
• If you must nap during the day, limit it to 30 minutes and try to nap before 3:00PM
• Use the bedroom only for sleep and sex; do not watch television or work in bed
• Get regular exercise and exposure to outdoor light


The PBS series, Life (Part 2) continues. This week's episode deals with what makes us happy. Here is a short clip of a whole lot of people answering that question.

You can watch the whole episode here.


At The Elder Storytelling Place today, Clarence Bowles: A Pet Peeve


Posted by Ronni Bennett at 02:35 AM | Permalink | Email this post

Comments

An "Op Ed" off topic and then on topic:

I've concluded that the only way the government is going to find money to pay for health care is to lower amounts applied to seniors and redistribute to younger people.

We'll maintain our desired levels of care only if we have private gap health insurance.
Those that don't--good luck.

We are expendable. We cost too much. They don't even want to pay our social security--if they can get away with it.

Back on topic: I sure ain't gonna sleep well knowing that I'm entering the worst of times for seniors. Ronni, you picked a great topic, very timely.

John

This is certainly timely for me. I woke up at 3:30 this morning and couldn't go back to sleep. I don't know why this happens. I am not under stress, depressed, in pain (there is always some discomfort since my hip replacement, but the pain is not severe), or suffering any of the things that keep me from sleeping.

When I first go to bed I read a chapter in a book. Otherwise, only use the bedroom for sleep. (I sure don't use if for sex.) ;-)

I have done all of the things recommended to help you sleep with the exception of getting up at the same time. I just can't stay in bed for 3 or 4 hours after I wake up. How can you follow that routine and follow the advice to get up after 20 minutes if you don't go to sleep?

My doctor prescribed Gambapentin, 25mg, for sleep. It is not a sleeping pill but the side effect is extreme drowsiness. It is not addictive. I don't take it every night because I keep trying to sleep on my own.

Can anyone explain to me why nearly every elder I know complain about not sleeping and yet the experts say it is not a normal part of growing old? I question their research.

As I type this I am feeling spacey and may go back to bed, perchance to dream. zzzzzz

I too find my nights are not as restful as they used to be. I used to think it was my mid-afternoon tea, or the glass of wine with dinner, and various other little reasons. Not so. I read a bit at night, but that's mostly to relax and give me something pleasant to ponder as I go to sleep.

I have found that I need exercise, physical activity, during the day to make my nights better. Those days that I am able to walk to work or take the dog on a walk or even just park and walk in the city are followed by better sleep that night. I try to walk a mile a day, plus walk on errands, etc. As nights get longer and streets and sidewalks get hazardous, I'm aiming to pull out that treadmill again.

Here are a few things to add to your list of helpful hints, given to me by the director of a sleep center at a large teaching hospital:
To fall asleep easiily, you want to go from a warm, brightly lit environment to a cool, completely dark one.
He suggested running the heat a bit high in the evening, then shutting it way down, or opening the window, at bedtime. Or, you could take a brief, warm shower to warm yourself up before you go to bed. Your sleeping room should be at least 5 degrees cooler than where you've just been.
Also, turn on a lot of lights in the evening, then make sure your bedroom is pitch dark. Remove digital clocks, nightlights, etc. If necessary, wear eyeshades.
This routine has helped me immensely, although I still have nights when I wake up at 4 and can't go back to sleep.
When that happens, I call on emergency measures. I've tried all the pills and then some, nothing works more than once or twice. My brain figures out how to outsmart the formula. The best remedy I've found is a big, fat book of NYT crossword puzzles. Works like a charm, with few side effects. Who knew?

Hi Ronni,

This week I started sleeping with a personal sleep coach to better understand how I sleep.

http://offonatangent.blogspot.com/2009/11/we-all-have-sleep-cycles-light-deep-rem.html

--Steve

I'va always needed 8 hours sleep a night and 9 is even better. That has never changed and I'm now 73. Unless I am bothered about something, there are only 2 things that can - and do - cause insomnia for me. One is the full moon. The other is that dratted RLS (restless leg syndrome) This has been the case since I was in my 30s. I suspect the two (the full moon and the RLS) may be causally connected as they often occur together.
I am also convinced that there is some connection with the balance of calcium/magnesium/potassium.
Haven't worked it all out yet, though I do take supplements. Has anyone else looked into this?

Steve wrote:"This week I started sleeping with a personal sleep coach "

Is she pretty Steve?

She pretty, but somewhat cold with little to no personality.

Steve -- I have a better questions than mythster: does your girlfriend know about this sleep coach? Does Millie like her?

My sleep patterns have been erratic ever since I was a child but in the past year year have gotten worse. I am not a good sleeper. I aim for 7 uninterrupted hours (which seems to be the optimum time for me) but I rarely attain that. I never used to fall asleep while watching television -- now I do a lot. Medication for sleeping is not an option -- I plain damn won't take it because it all has weird side effects.

I put it on my list for my new doc but I've got so many issues that were neglected from the previous docs that I think she's slowly going down the list and doing one at a time so maybe as we address those I'll sleep better.

At this point, I feel it’s a normal part of aging when, like Darlene, everyone I know is troubled by their current sleeping patterns. There was an entire conversation as recent as last week regarding this at one of my Y classes. They’re all women ranging in age from 50+. We were late in getting the class going with everyone jumping in trying to figure out why we are having this problem. I don’t even know the names of these women, but now know two things (1) they like to exercise, and (2) they have trouble sleeping. When I fall asleep around 10 p.m. and wake up around 4 a.m., I think I’ve won the lottery.
Simply Sleep was recommended to me when my brother lay dying in the hospital and I did try it. However, I did not like the way I felt the next day. I now keep Ambien on hand for those extreme times.

I was always the world's greatest sleeper. Round about 45 that changed. In my case, it's the wake up around 2-3, stay awake for an hour, fall back asleep syndrome. It would be great to know what I should aim for for beat health. Do I need to keep tweaking until I'm back to 8 hours uninterrupted? Or is this little awake period OK? How to know?

One thing that keeps many oldsters from sleeping is inability to find a bodily position that remains comfortable for more than two minutes. Sleep on the stomach? Neck hurts. Sleep on the side? Shoulder hurts. Sleep on the back? Arms go numb. In addition, and unrelated to bodily position is the tinnitus that many of us endure.

Two or three straight hours of sleep and a total of five or six hours of sleep seems the norm, for me. Bleah!

I sleep like I always did which means mostly well but off and on not so well. I notice no difference yet with aging. I am more moon oriented than anything else; so full moons often leave me not sleeping so well

I have had trouble sleeping over the years. I mentioned it to my doctor and she sent me to "sleep therapy" where I learned "sleep hygiene." It was a cognitive-behavioral approach and it did really did work for me.

I have taken care in recent years to establish some semblance of a regular sleep schedule (often requires an effort to adhere to it.)

Generally awaken once during night, not necessarily for bathroom, but can always go back to sleep for several hours more. My total hours are from 5, or 6 (generally) to 7, 8 or 9 total hours. Becoming tired from physical activity greatly enhances my sleep likelihood.

Avoiding light -- definitely not using the computer best for an hour or so before bed, but again I enjoy using it in the evening and stay on too long much too easily.

Never had and never want TV in bedroom. Can read myself to sleep, but often get caught up in content and read all night, so avoid that.

Haven't considered variable sleep issues worrisome or unmanageable (even when have had erratic patterns, or during some pain periods,)so have never taken sleeping pills. Would take them only as a last resort and probably be avoiding them even then.

Being subjected to persistent exterior noise (any sounds I don't like, including some music types/other if I’m not in the mood for them) could drive me to seriously consider a knock-out drug as my mind would have a difficult time avoiding "stewing" about it.

Living on the Pacific north coast provides cool sleeping room conditions...An electric blanket on a low setting relaxes the bod...All seems to work well...Winter time brings on the "hibernation" mode for me...

Yes, I am no stranger to sleep variations. But I know what helps--not eating three hours before going to bed

being active most of the day with frequent exercise throughout

going to Arthritis Swim Class at least two or three times a week

walking in the supermarket, every aisle, twice a week in colder weather

no coffee or even dekaf

try to avoid stress by meditating or relaxing and putting everything out of one's mind
at least once a day

getting out of the house at least once a day

dancing whenever possible

sex with a partner is out of the question these days since my husband died so that plus isn't in my life. I'm 89 and my competition for dating is immense, right?

I go on the comedy stage often these days. You can catch my video about my being the oldest comic in Seattle in the archives of Evening Magazine, Channel 5, Seattle.

no drinking

Need I say more? And still once in a while I wake up and can't go back to sleep so I just play solitaire and drink a little warm cocoa and usually go back to sleep and finish my 8 hours.

I was talking to Sven about this very topic yesterday! Thought the suggestion of not watching television in the same room where you sleep was interesting.

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