How Time Slips Away in Old Age – Or Maybe Not
INTERESTING STUFF – 2 June 2018

Insomnia in Elders

A month or so ago, TGB reader Salinda left this comment:

”Over the past year, sleep has become very elusive, and despite good advice from herbalists and docs, meditation, lots of exercise, no screens before bed, ETC, the situation persists.

“For now a coping strategy is to take a nap each day, whenever possible. Not only is my capability to function impaired by the tiredness, it's also more difficult to keep a positive attitude. Would love to hear how others deal with this.”

Remember what sleep was like when we were teenagers? In 1957 when I was 16 years old, I woke one morning with my bed two feet from the wall and no memory of how that could have happened without my noticing, even while asleep. Soon, radio news informed me that there had been an earthquake during the night.

There is no way I could sleep through that nowadays and for more than a decade nothing the so-called “experts” recommend to treat insomnia had helped me.

People don't take insomnia seriously enough. Even though masters-of-the-universe types and tech workers have for many years made it a point of pride to brag that they work 16, 18 and more hours a day, regular lack of sleep can have important consequences and it affects more people than I thought.

According to the National Institutes of Health, it is common problem affecting nearly 50 percent of people 60 and older and about 30 percent of younger adults resulting in significant impairment.

Lack of sleep causes difficulty with concentration, memory, reasoning, problem solving, not to mention attention lapses and slowed reacton time.

”The National Highway Traffic Safety Administration (NHTSA),” reports Medscape, “estimates that at least 100,000 crashes and 1500 deaths annually are attributable to sleepiness/fatigue.”

With so many people affected, you would think there are remedies, but there are not many that actually work well.

Insomnia is defined as difficulty falling asleep and/or staying asleep. How many jokes have you heard over the years about old men getting up half a dozen times a night to use the bathroom? I'm living proof that it's a problem not only for men and until recently, I could never get back to sleep afterwards.

Treatments fall mainly into categories of “natural,” of over-the-counter and prescription drugs, and of alternative or life-style changes. Before you try anything, be sure to find out if your insomnia is a result of an underlying disease or condition, or a side effect of medications. If not, here is a short overview.

NATURAL
Acupuncture, guided imagery, yoga, hypnosis, biofeedback, aromatherapy, relaxation, meditation and massage fall into this category. There are herbs like melatonin and valerian that work for some people.

Exercise too, including tai chi, are useful although it needs to be no later than three or four hours before bedtime.

OVER-THE-COUNTER SLEEP REMEDIES
The names of these are probably familiar to you: Nytol, Sominex, Tylenol PM, etc. They contain antihistamines which induce drowsiness and they lose effectiveness over fairly short periods of time.

PRESCRIPTION SLEEP REMEDIES
Ativan, Xanax, Valium, Restoril and others are benzodiazepines which are habit-forming, contribute to falling and can be difficult to stop using. Old people's bodies metabolize drugs of all kinds differently from younger adults and because drugs are almost never tested on people older than 65, it is hard to know what is safe.

There is a comprehensive list of safety and efficacy of sleep medications in older adults at this website.

LIFESTYLE CHANGES
These suggestions for a good night's sleep may seem obvious but many studies have shown that they work as well of and, often, better than drugs.

Keep a regular sleep schedule

Avoid heavy meals, smoking, alcohol, or caffeine near bedtime

Avoid naps during the day

Keep your sleep surroundings as dark as possible

Don't watch TV in bed (I record late-night shows for later viewing)

Don't use other tech toys in bed – no phone, tablet, etc.

A few experts suggest no reading in bed either

Make sure you have a comfortable bed in a room not too hot and not too cold

If, in the end you can't get to sleep asleep, specialists suggest you get out of bed, leave the room and return when you feel sleepy again

SECOND SLEEP

That last suggestion brings me to a historic practice that was similar: First Sleep/Second Sleep which I wrote about here in 2012. I first heard about it in a fascinating book, At Day's Close – Night in Times Past by A. Roger Ekirch who posits that from about 1500 to 1850, before the advent of artificial light, people may have commonly slept in two shifts – so commonly that hardly anyone thought to mention it.

”...fragments in several languages...,” writes Ekirch, “give clues to the essential features of this puzzling pattern of repose.

“Both phases of sleep lasted roughly the same length of time, with individuals waking sometime after midnight before returning to rest...Men and women referred to both intervals as if the prospect of awakening in the middle of the night was common knowledge that required no elaboration...”

“After midnight, pre-industrial households usually began to stir. Many of those who left their beds merely needed to urinate...

“Some persons, however, after arising, took the opportunity to smoke tobacco, check the time, or tend a fire. Thomas Jubb, an impoverished Leeds clothier, rising around midnight, 'went into Cow Lane & hearing ye clock strike twelve' returned 'home & went to bed again.'”

I've tried this in the past and it worked for me to a degree except that too often, I stayed up several hours then slept in too late in the morning than I felt comfortable with.

CANNABIS
For the past several months, I've been using a tincture of cannabis to help me sleep and now, after at least a decade of not sleeping more than three or four hours a night, it feels like a miracle to me.

I use a tincture of THC (the non-high-producing CBD works for some people) and I'm easily getting seven or eight hours of sleep a night. Plus, when I get up to use the bathroom, I can go right back to sleep when I return to bed.

I could give you a long list of online websites to consult but it's just as easy for you to search “insomnia remedies” or “insomnia treatment”. There is an enormous amount of information and with minor discrepancies, most agree with one another.

Meanwhile, let's help out Salinda. What is your experience with insomnia? What have you tried that did not work and what have you used that does?

(Remember: no medical advice, no recommendations of medications, no links to other websites.)


Comments

I am so tired of hearing about sleep remedies because absolutely nothing works for me and hasn’t for 20 years. I’ve had sleep studies, taken Ambien (which btw did not turn me into a racist), naps/no naps, etc. I stopped fighting it and now spend about half the night in my comfy chair listening to an audio book. I generally sleep from 12-4 or 5 am. I do take a nap in the afternoon from 12-2 while listening to NPR. I would love to try cannabis but I live in Texas where the evangelicals mind my morals.

About a half cup of warm milk with cocoa, plus a dash of brandy now and then.
Eating a very small amount of a high protein food -- hard-boiled egg, piece of chicken. . .

meditation or yoga background music

as comfortable a bed as I can create

a very quiet tube-type fan set on the lowest setting (I think mine says "whisper"m but what ever is very gentle) about four feet from my bed, level with my face

deep, slow meditation-type breathing

quietly or even silently, just in my mind, repeating simple mantras

when I really feel desperate for a sound night's sleep, valerian (in capsules or tea) works well for me

Still, there is no magic bullet. I typically go to sleep quickly, but sleep only four or five hours. If I wake very early I often turn over and go back to sleep, but that seems to be when I have the weirdest dreams and wake up an hour or two later, tired from those. I should probably just get up when I wake up, regardless of the time.



Sadly I agree with Florence, nothing works. I’ve tried herbal remedies, prescription meds, meditation, controlled breathing and still none of it has worked for me.

Eluding sleep has been my constant, unwelcome, unfortunate companion for a long stretch of time. And multiple attempts to remedy. At 75, I walk most mornings at dawn, do TaiChi 2x/week and follow advised food/drink guidelines. Still, it persists. As do I when looking for solutions.

My acupuncturist said some are helped by a walk about an hour before bedtime. Being that is ~9:30-10(naturally sleepy then), I've started doing that this week and it's worked as hoped. I'm dreaming away for 8 hours.

Also tried CBD last week, which also worked fairly well. It was very relaxing and kept my mind from its trying attempts to keep me awake. It is an expensive alternative, however. Another popular combo is CBD(getting to sleep) with melatonin(staying asleep). So there's more to explore.

When all else fails and I need sleep for a busy day, I resort to a prescription, minimum dose. I easily can stay awake most of any night when the monkey mind takes over.

I've had some success with relaxation recordings. Some of these are just music, but most include a quiet voice instructing me in progressive relaxation or asking me to visualize peaceful scenes. The key for me is to have several of these to use. I've found that if I use the same one over and over I sort of get used to it and then it doesn't work anymore.

I have a variety of other techniques that I've used as well, but the recordings are what I turn to when I'm really having a hard time.

Obviously, there's no one magic potion; everyone has to find what works for them. Fortunately, I'm a good sleeper. And what works for me is reading a book, in bed, before sleep. If I wake up in the night and can't get back to sleep, pick up the book and start reading again. Works every time (for me).

I listen to the BBC - Melvin Bragg usually "In our Time" 40 to 45 minute programs about subjects from maths to science to history to philosophy! I am usually asleep before the end of the program and then finish it off after I've gone to the loo in the middle of the night. I'm not sure why it works but it does.

o/

Ronni,
I'm curious, does your THS have CBD in it also?

I use cannabis for sleep. From everything I've read and experienced, sleep is enhanced best by using a product with a mix of CBD and THC -- there's a synergistic effect. I regularly review various products on my blog.

I live in California where cannabis, in all forms, is legal. I first had a medical marijuana license, but that is no longer necessary. While I admit to being a 60's hippie who dabbled in marijuana, I have rediscovered its benefits and now use it for anxiety, as a sleep aid, and sometimes, recreationally. I use good sense and don't drive high, and over time have learned what "dose" is appropriate for me to feel a sense of well being and relaxation.
Under California law I am allowed to grow my own marijuana and have done so for the last 3 years. I only grow 1 plant in the summer and have found that its "crop" lasts me an entire year. It's certainly cheaper than buying from a dispensary!

Simone...
First I tried a CBD-only tincture. Nothing happened. Then I tried half CBD/half THC - nothing. What I use now is a tincture of 9-to-1, THC to CBD, which works really well for me. The 9 to 1 is the closest I could get at my dispensary to 100 percent THC.

One problem with antihistimines is that regular use of them has been shown to increase risk of dementia. That's scared me off of them unless I'm sneezing my head off with allergies.

I use 1 mg. of melatonin, and in about an hour I'm ready to sleep. If I'm traveling, I'll up the dose to 2 mg. Men typically need an extra mg. However, melatonin will get you to sleep -- as long as you recognize you won't be sleepy for about 1 to 1-1/2 hours after taking it (sublingual). BUT... at least for me it doesn't guarantee you'll go back to sleep after a 1 or 2 AM bathroom break.

I used to keep a serious tome of a book by the bed. A book I really wanted to read but which would be difficult reading. If I couldn't get back to sleep, 15-20 minutes of that kind of book typically had me right back in slumberland(!)

I took Lunesta for years, when working in corporate...and then Advil PM. A dear friend gave me a bottle of CBD oil (no THC) and it has been amazing in helping support sleep for me, and I feel so much better...actually good for inflammation and more. My dog takes it as well for inflammation related to her two surgeries!

When I have had trouble falling asleep, I use an old Yoga (I think) technique -- start to relax your body from the tips of your fingers and toes up gradually to your hands and feet to your forearms and then to your upper arms and then shoulders. Along with that, another old Yoga (again, I think) is to repeat the universal sound of "Ohmmmmm" silently in my head until I fall asleep. You have to be persistent with it ... you can't let other stresses into your brain with it. In a short time, it usually drives all those crazy thoughts and whirling things in your head after a long stressful day with kids or offices or family. Keep doing it until all other thoughts are pushed away.

Sleep mask! For some reason I never encountered this idea or rejected it because I didn’t like the idea of something over my eyes. It's particularly relevant to me because my husband needs a small light on at night.

I have struggled with sleep for years unable to fall asleep or, more often, wake after a few hours and that's it. I have had some success with thc/cbd tincture. Helps about half the time. I have read much research also tried melatonin pills, meditation tapes, and medication which I use only in emergencies.

About a month ago I read an article that mentioned complete darkness is what triggers the body to produce melatonin. I immediately ordered a couple types of inexpensive sleep masks and am amazed at the effect. It took a little getting used to, especially since I'm a stomach sleeper. But it's the closest to a miracle cure I've found.

I have used Ambien successfully for ten years. There's been no need for changing the dose in that decade of use (I've seen where people have increased their dose over time--unauthorized by their docs). No sleepwalking or sleepeating. (No racism.) Seven to eight hours of sleep. Absolutely no morning "hangover." I wake clear and rested. I cannot overstate the improvement in my life.

I too have used Ambien for a long time. I've never increased the dose, and have reduced it several times because of FDA recommendations, aging, or interaction with other drugs. My sound machine (always set on thunderstorm) is essential. I live alone and it seems like the house is too quiet without it. I have a sleep mask handy for when the sun comes up too early (can't get my bedroom completely dark). My bedtime routine is so routine that even my dog has learned it. She'll sit at my feet and stare at me until I move, knowing a snack for her is part of the routine.

I lost the comment I had spent about an hour composing--not the first time this has happened, but this time I give up! I had timed out but copied my post and restarted the page--to no avail. Probably wasn't worth it anyway. . .

Back when I was working, my problems getting to sleep were always due to anxiety about events coming up -- I'd keep going over and over all the things I hadn't done, or not done well enough, in an endless worry-cycle. And I'd be lying in bed all tense, with muscles tightened ready to fight! It didn't matter how much I'd tell myself that worry wasn't useful, that the thing I needed to do NOW was sleep or I wouldn't be able to do anything the next day!

What helped was two things. First, I'd make a conscious effort to relax my muscles (and I'd have to do it again, and again, because it was so easy to tighten up.)

The other thing was realizing that worry needs short-term memory. We have two short-term memory spaces, auditory and visual. If they're both occupied, we can't get into the cycle of worry-thoughts because there's no room for it to happen. I'm not a mystic by temperament, so I wasn't going to go OMMMMM...! Instead I counted backwards from 100 in my head while visualizing the numbers in a particular font style. It worked! I'd rarely get below 50 before drifting off.

Or, at least, it did... until I got too practiced at it. After it became easy, it didn't work as well. I've discovered recently that pretty much any mental task will work. Right now, I am trying to memorize a poem. That's mostly auditory, but I use visualization of the words to make sure I'm learning the correct punctuation.

These days, my problem isn't worry, it's physical pain. That, too, gets worse when you're thinking about it. So my years of anti-worrying do still come in handy.

I have tried the following to aid with falling and/or remaining asleep:

Ambien: Worked great; slept at least 8 hr nightly; no hangover. Then there was the morning I woke to find a cake sitting on the kitchen counter. Apparently I got up during the night, baked the cake, cleaned the dishes, and went back to bed. Even turned off the oven (thankfully). To this day I have absolutely NO memory of baking that cake. This was very unsettling for me; needless to say, I quit taking Ambien.

Lunesta: Put me to sleep, but I usually only slept about 6 hr per night. After using it for a short time, I started waking with a headache every day and a hangover. Stopped using it.

Melatonin, chamomile tea, OTC meds: Did not help at all.

Sleep mask: Made no difference.

Relaxation apps, sound machines, fans/white noise: Made no consistent difference; some nights they helped, but most nights they didn't.

Cannabis: I live in a state where it is legal. However, my only income is Social Security; so this makes any form of cannabis prohibitively expensive for me.

Electronics: I decrease my usage in the evening, and I have an app on my computer which reduces the blue light starting later in the evening. This doesn't seem to help either.

Sleep schedule: I try to adhere to a regular bed time. But some nights, I just can't go to sleep so I get up and do something quiet for a while. Then back to bed to try again.

I have found nothing which helps me to go to sleep, stay asleep, and sleep for at least 7-8 hr. I am lucky to get 6 hr of sleep per night, but it is not enough. So I live my life chronically tired.

I need complete darkness, which is basically impossible to find. My last really good night's sleep was in a hut in the wilds of Africa (seriously).

What I find useful (especially when my mind is racing around) is listening to AudioBooks on my phone. The trick is to find books you like but are not SO exciting that they keep you awake. It's like a bedtime story --or if at 4 a.m. a "don't really wake up" story.
Our local public library has a huge collection, yours might as well. In the app, whether the library's OverDrive or on Audible, you can set a timer for the number of minutes you want it to play. If you share a bed with someone else, put an earbud in one ear so you can turn over.

I take Ambien now, a very small dose, and get a good night's sleep, waking with no after effects. My life is stressful due to family concerns and living on the edge financially and getting restful sleep every night is vital to my well being. Thankfully, my doc agrees! I am 74 and expect to take Ambien for the rest of my life.

I think I have tried every suggestion on how to get a good night's sleep and nothing has worked consistently .

I go through a period of sleeping well and then something in my life causes stress and it's all over. If pain is keeping me awake and I take pain medication that seems to also relax me so that I will sleep for 8 or 9 hours and feel refreshed when I get up. But that only lasts for a few nights after stopping the medication.

The only thing that helps me sleep is reading in bed. When I begin to feel sleepy I gently put the book down and turn off the light. Once asleep I can fall asleep again after a toilet trip and I return to bed.

Now a new physical problem has been keeping me awake - restless leg syndrome. It is maddening and I told my doctor that if my legs were dancing the tango I wouldn't mind, but they are doing a jerky tap dance and I cannot relax my muscles long enough to go to sleep.. My doctor prescribed a medication for RLS and it put me to sleep, The problem was that it made me feel drugged the next day and I had trouble staying awake. Feast of famine. I never took it again as the side effect was worse than the problem.

So I am back to reading until I am sleepy and it works for me moist of the time. Of course I have to avoid mysteries or thrillers or I will end up reading all night.

Trazadone plus Ambien, plus some nights a Xanax (alprazolam) as well. Wake up fine.

Going to bed before the wee hours doesn't work for me at all. However, too often I used to be so sleepy I couldn't keep my eyes open, but would be completely awake the moment my head hit the pillow. Now I find that keeping my bedside radio on very low and tuned to NPR works quite well. By that time it's BBC World Service and those mellifluous British voices can be very soothing. Moreover, if I don't immediately fall asleep, at least I learn something.

Elizabeth, I also was often timed out because I spent too much time composing. Then I discovered that if I exited the TGB site after reading the comments and returned again to write my own comment, I could avoid timing out. At least it worked for me.

Thanks, Emma Jay. I thought that's what I had done when I closed the page and re-entered, but maybe I need to close down the site completely and re-start. Will try that next time. It's frustrating to spend time putting together a coherent (at least I hope so) comment and "poof"--it's up in the Cloud somewhere never to be seen again!

A new pillow worked for me. I'm used to reading my kindle in bed, but no sooner than my head hits my new pillow I'm asleep and my kindle follows on its own later. Sleeping soundly until 5 a.m., with maybe one trip to the bathroom (or maybe not) is luxury for me. And even if I wake at 4:30 or 5, I drift off again until 7 or so. Before, I would be awake, tossing and turning all night. Waking between 12 and 2 a.m. and every couple of hours after that.

Ambien for me too. I wake up rested and feeling great most mornings. I chew it before swallowing and can therefore
get by with a lower dose.

No sleepwalking, sleep-driving, sleep-eating, or racism in all the years I’ve been taking it.

I usually fall asleep very easily. But I only sleep for 2 hours - no matter when I go to sleep - it's rather odd. When I wake up, if I don't take an XXX (prescription med), I'll be awake for several hours. I try to reduce the amount (1/2 pill) but then will only get 3-4 hours sleep. If I take the entire pill, I'll get 6 or 7 hours, which is great on one level, but I'm rather groggy in the morning. And I worry about getting up for a bathroom break in the middle of my sleep, and falling (has happened twice).

Mostly I don't long to be young again, except when it comes to sleep. I always thought I could sleep standing up if necessary.

I find I do not have problem sleeping when I keep myself active, both physically and mentally. I am in my late 50s by the way.

I do (1) 45mins of walking up and down a hill, or , cycle my stationery bike 4 times a week. On other days (twice a week) I work with dumbbell.
(2) about two hours a day on house cleaning, laundry or gardening. My garden only consists of a few pots. I live in an apartment.
(3) I spent 4 to 5 hours a day on deskwork : house bookkeeping, answering mails, paying bills, keeping up with the stock market, reading (this does not include leisure reading).
With this routine I sleep about 7 plus hours per night. When I am not at home, when I am on holidays, I find this length of continuous sleep not possible. When on holidays I am mostly on my feet, walking. Of course I take many breaks for tea/drinks, but my routine is more like I take midday break to return to hostel for nap, then out again for about 4 hours. At night I am able to sleep about 4-5 hours.
So I find that what I do during the day will decide on my length and quality of my sleep at night.

WOW! THANK you, all who made suggestions, and Ronni for addressing this very important topic. Several new things to try. I am so jealous of those who are able to use CBD! For now, here's what is helping me somewhat. Magnesium citrate, 250 mg., about a half hour before bedtime produces pretty good sleep and also almost completely banishes restless legs. I'm still a bit groggy in the morning, though not as much as with other herbs and prescriptions.

The walk before bedtime, more darkness, and recordings will soon be added to the mix. This being old is a sharp learning curve!

A gummy melatonin, or two if my mind is racing, works for me. Jim takes melatonin, too, although it sometimes gives him strange or bad dreams. He also takes half a magnesium and a potassium supplement to avoid leg cramps at night.

What works best for me is listening to podcasts, which are free for the taking on the App Store. I load them onto my iPod, but listening on the computer would work, too. I also listen. to each one more than once, which helps prevent me from getting overly engaged in the story. When I'm traveling, this is the only thing that I've found to work for me.

Recently the 4-7-8 method has been helping me. But sometimes one thing works and then it doesn't ... so thank you all for the multitude of suggestions which I will keep on hand.

I recommend 3mg of time release melatonin. This way when I awaken for leg cramps or the inevitable bathroom trips, I can fall right back to sleep. As a walker/dancer who has flat feet, leg cramps plague me. Recently, I have been taking a teaspoon of baking soda and to my amazement, no cramps! I am not sure if this is something that I can take every night. Does anyone know?

My other recommendation is that after 20 years of a blissful marriage, and ear plugs, I decided that my snoring and talking husband needed to be relocated to another part of the house. He can snore to his heart's content now and I am sleeping much better. My two dogs in their crates are plenty of company, although the older one is started to snore and may have to go sleep with my husband.

CBD sounds very hopeful. I will explore this and because I too live in a state where others like to decide how we live and what we put in our bodies, it could be illegal to purchase. I am not clear on that.

Thanks, Ronnie for bringing this topic up. We all can learn from each other.

Karin

Recent years I've awakened to bathroom trips during the night -- probably sometimes associated with periodic UTIs. Various approaches described by others here work on differing occasions -- especially like old standbys of soft instrumental (only) music, relaxation exercises beginning with scalp and slowly moving down the body to my toes.

Have never tried any pills, OTC or prescriptions. The prospect of trying melatonin or cannabis as some here describe successfully using seems a possibility I might try in the future. Appreciate having this input for reference.

I care for my father and something we have noticed interfering with his sleep are pressure sores. This has become more of a problem the older and less mobile he has become, I suppose the skin is less resilient now and the infrequent movement subjects his ear to more pressure over a longer period.

In any event, they were becoming quite nasty. We found the simplest solution was to use a pillow with a hole in it. This enabled him to sleep through the night without rubbing that bit of skin and making it worse. It has been a bit of a godsend and he is finally getting a reasonable night's sleep without the pain.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment

Your Information

(Name and email address are required. Email address will not be displayed with the comment.)