Old Age and Loneliness
INTERESTING STUFF – 19 October 2019

Sleeping – or Not – While Old

Until about 18 months ago, most nights I slept for about four hours; five hours when I was lucky. There was a time, more than a decade ago, that an evening dose of melatonin kept me asleep for the more traditional seven or eight hours and I felt so much better then.

But after a couple of years it stopped working.

I got by as I always had, toughing it out during the day when there were things that must be done. I was slow to twig to the fact that I now live in a state where cannabis (that's what we're supposed to call it now – I still think of it as weed or pot) is legal.

About a year-and-a-half ago, I began using a tincture of cannabis which kept me asleep all night, seven or eight hours, until it didn't anymore. Both a dispensary “budtender” and one of my physicians said that often, sleep aids of all kinds can stop working and suggested I try alternating types of cannabis. So now I use a gummy in between the tincture.

It's been working for me. Some friends have had less success. (I always use THC cannabis; CBD does nothing for me in regard to sleep.)

Insomnia is serious but common problem for old people. Even when sleep disorders such as restless leg syndrome, sleep apnea, pain or certain medications are discounted, about one-third of people 65 and older don't get enough sleep according to a 2017 University of Michigan poll.

Today's post is not about medical conditions that cause sleep disorders but I want to pass on what the National Sleep Foundation says about sleep apnea:

”...untreated sleep apnea puts a person at risk for cardiovascular disease, headaches, memory loss and depression. It is a serious disorder that is easily treated.

“If you experience snoring on a regular basis and it can be heard from another room or you have been told you stop breathing or make loud or gasping noises during your sleep, these are signs that you might have sleep apnea and it should be discussed with your doctor.”

Note that phrase, “serious disorder that is easily treated.” How often does anyone tell us that? So if you suspect sleep apnea or any other medical cause of insomnia, get thee to your physician.

When there is not an underlying medical reason for sleeplessness, there are other reasons it happens. WebMD tells us, there is

”...a big difference between younger and older sleepers: the timing of rest. As adults age, advanced sleep phase syndrome sets in, causing the body's internal clock to adjust to earlier bed and wakeup times. But some seniors continue to stay up late, as they did in their younger years. Sleep deprivation is often the result.”

Every source I read tells us that it is a misconception that people need less sleep as they age. Research shows that sleep need remains constant throughout adulthood – seven or eight hours.

Assuming there is no underlying medical reason you can't sleep or can't sleep enough, what's an insomniac elder to do?

There are always the prescription sleep potions, right? Ambien, Lunesta, etc. In an excellent article about elder sleeplessness, Consumer Reports warns against them noting that one analysis found that people using these drugs

”...fell asleep only 8 to 20 minutes faster than people taking a placebo.

“Taking sleep meds may also cause dependency and increase your risk of car accidents, and more than double your risk of falls and fractures, common causes of hospitalizations and death in older adults, according to Consumer Reports’ Choosing Wisely campaign.

“Because of these dangers, the American Geriatric Society includes the more potent prescription sleep drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—on its list of medications that adults age 65 and older should avoid.”

This can be true of some over-the-counter sleep aids too. And if you would be inclined to try cannabis, what if you don't live in a place where it is legal? There is no dearth of advice around the web. This is one of the better lists of useful techniques. From WebMD:

⏺ Get set. Wake up at the same hour every day and exercise and eat meals at set times to help get sleep back on track.

⏺ Get Exercise. Check with your doctor to see what type of activity is best for you, and then get out and do it. You might want to do it early in the day, though, so it doesn’t keep you up at night. A little sunlight each day can make a big difference too!

⏺ Get Cool. Keep your bedroom on the cool side. And turn off all those lights and electronics. Keep the TV out of the bedroom.

⏺ Get a Routine. Anything that relaxes you—a warm shower, a few moments of meditation, a good book.

⏺ Get Out of Bed. That’s right! If you are tossing and turning after about 10 or 15 minutes, get out of bed and do something relaxing. Just don’t turn on that TV or computer.

⏺ Get checked. Some medication or certain medical problems can interrupt sleep. If a medication is to blame, your doctor can recommend adjusting the timing or dose, or possibly switching to an alternative prescription. And if it’s a medical problem that’s stealing away your shut eye, she can address that, too.

There is another list from helpguide.org – a much longer list than above – that may be helpful.

The reason you're reading this today is that the cannabis, even with two delivery systems, has stopped working for me. Well, it's been only since Monday and maybe it is just a short-term anomaly, so I'm going to give it some more time before figuring out something new.

But in case I need it, I tracked down all this information so I'm passing it along to you.

I'm sure we would all like to hear about your own adventures in sleep – or not - too. Just remember that you may recommend NO PRESCRIPTION DRUGS nor any other treatment except in the context of what has worked or not worked for you. And no links.



Comments

I also now use cannabis for sleep. Like you Ronni, if I don't, I'm lucky to get 4 hours of sleep.
I've tried napping during the day (hubby takes a 2 hour nap daily) but for reasons I don't comprehend, I'm no longer able to nap. Instead, I "rest" with a book.
I would rather use cannabis, a natural remedy, than any type of sleeping pill that contains chemicals that could potentially cause harm, not to mention addiction.

I agree that CBD with a small bit of THC has been very helpful in producing restful sleep for me. I'm not quite sure if what wakes me up is the continual turning over due to neck pain, or age, but I do know I wake up feeling better when I use a tincture. I find that it also helps to take a break from it for a few days now and then, and also to use a higher dose, full spectrum only.

I tried Benadryl for awhile. The equivalent of the dose my mom took for 12 hours of allergy relief back in the sixties. She invariably spent the first, three hours sleeping. By golly it worked - I fell asleep within minutes.

Within a few weeks I felt like the walking dead. Google “Benadryl hangover. “

What works for me, so far and knock wood, is a cup of warm milk with vanilla, nutmeg, and (optional) a bit of honey. If there is any pain, say, in the feet or legs because of a long walk with the dog earlier in the day, I add an extra strength acetaminophen or two. That’s the only time I use the painkiller, so don’t worry about it.

Thanks for this, and the link to the really informative article. It was very timely as I have an appointment in a few days to talk with my Dr about my insomnia. This has been very helpful.
Carole

I live in a state where cannabis is legal; however, I can't afford to purchase it. Have tried sleeping medications in the past, but most studies indicate they do not provide quality sleep and shouldn't be used long-term. And none of them ever gave me 8-hour-nights of sleep.

I was diagnosed with sleep apnea about 5 years ago and have used a CPAP to prevent unwanted health consequences. However, I don't sleep any longer with CPAP usage. I average about 6-6½ hours per night, but I function much better with 8.

I have been attempting to adhere to a sleep hygiene regime: wake and go to bed each day at the same times, no caffeine after 10 AM, no eating within 2-3 hours of bedtime, get out of bed if not asleep within 20-30 min. I have been having trouble with exercising regularly (I have 1-2 migraines per week), and I don't always keep my routine. Would love to keep my bedroom cool, but in Arizona in the summer it is prohibitively expense for me (on a limited income) to keep the temperature in the low 70s.

I won't give up my attempt to get more sleep, to get better quality sleep, but it is a struggle. And for myself, I realize that the ongoing tiredness affects the frequency of migraines, affects my ability/desire to be social, affects my mood/outlook on life. I so long to sleep 8 hours nightly!!!!!

Under the heading of "Full Disclosure" I must tell you I am a retired RN, Ronni, and try to walk that fine line of being helpful without giving what could be interpreted as "medical" advice. At 82 I have my share of sleepless nights too, usually related to that old bugaboo...worry about family or aching joints. Sometimes writing down the disturbing thoughts helps clear my mind and give me a helpful idea or approach for tomorrow.

Like, Ronni said, "Get Out of Bed" and I sit in my recliner with a cup of warm apple juice or chamomile tea and a book until I get chilled and tired enough to go to sleep again works the best for me.

In old age the protective functions of the liver and kidney aren't as efficient as they were and cannot edit out the harmful (or useless) elements of anything we consume. I have learned that 1 Tylenol still works for night time joint aches and 2 leaves me with a residual dull headache in the morning. Tylenol PM is not wise for older folks at all, in my opinion, due to its long half-life. If someone takes it repeatedly, and then more and more builds up in the tired old body, a mild confusion is the result. Be cautious and write down what and when you take anything in the evening. It will help a lot if you wake feeling unsure. Antihistamines are similar, by the way.

Many folks report that sleeps aids only work for a while. My personal notion is that the body slowly builds resistance to protect you from the chemical nature of most aids. Injury or surgery are different matters, but beware of long term use anything you don't fully understand.

I have sleep apnea, diagnosed over 25 years ago. I wear a mask and sleep comfortably. My other sleep aid is to listen to an audio book on my iPad, turned down low. One lasts me for days as I fall asleep pretty quickly--20 minutes or so of listening. (I'm listening to Piers Anthony's xanth books at present.)

I get between 5-7 hours if sleep each night.

I take prescribed Tylenol4, twice a day, with one ordinary Tylonol, 500mg , to augment these.

I so dislike taking pills. I take a slew of heart medications and 2 others for Trigeminal neuralgia. This last causes immense pain on occasion. It, also, was diagnosed many years ago.

My wife and I agreed to use a "Smart Nora" as written up in WSJ. Yep, set us back about $300 but it worked! My snoring had kept her awake for 30 years. She even heard me downstairs. I did not have sleep apnea, but the quiet motion of the pillow worked just enough to move my throat to stop the snore. No labor intensive mask for me. We have no TV in the bedroom and no tech equipment at all. Elaine will get up sometimes, but usually I get a full night's sleep.
So far, so good. I'm 71. B

I can sympathize, but not empathize... I sleep like the proverbial "log". Always have the TV on, and often really really want to watch the program, but 10 minutes into it, I'm gone.

Bed times change.. but somewhere between 8 PM and 11... usually earlier. No open window... and only get up about 3 - 4 times in the night to use the bathroom, and then right back at it.

When I wake I am a zombie for the first hour. Right now, at 10:45 AM, I am beginning, finally, to function. I got out of bed at 9! Why do I sleep so long and hard, when others do not? No meds other than a handful of prescribed Rx's that haven't changed for months.

I wish I could share my good fortune for all who need it!

So much depends on the reason one can't get to sleep. I have had a lifelong difficulty getting to sleep, though once I am there I usually don't wake in the night, or if I do, I get back to sleep easily. However, this has become worse as I have aged and leaves me frustrated. It has also made travel difficult for me, since being away from home makes the problem worse. Over time I've figured out that a lot of my problem has to do with overstimulation. I am an introvert and I get overstimulated easily. Then when it's time to go to bed I can't "come down" and relax enough to sleep.

Here's the method I've developed that works about 90 percent of the time: I go into a room by myself with the light out. Then I listen to a guided meditation through an app on my phone (there are lots of these available online; you can also get them in CDs or tapes). I usually do about a 10 or 15 minute meditation--and not the same one over and over.

When I'm done with that I use a device called Muse, which is pricey but has been worth it to me. There is a band that goes around your head and "listens" to your brain signals, classifying them as "calm," "neutral," or "active." You also plug earphones into your phone and listen to an app that gives you sound effects, such as rain or ocean waves. If your brain waves become more agitated, the sound of wind and crashing waves increases. As you calm down, you hear bird song. At the end of the session you get a report telling you how many minutes your brain was in the three states. Over time you can train yourself to have more calm time. Like the meditation session, I time this for 10 minutes, though you can set any time you want.

When I have finished with all this, I take a hot bath, which I find relaxing, then go to bed. As I said, it's been pretty effective, and no medication necessary. It's been an enormous relief to have something that works; it had gotten to the point where I was so worried about not getting to sleep that the worry prevented me from getting to sleep. A real vicious circle. Now, when it's about half hour before my usual bedtime, I tell my husband I'm going for my wind-down. The extra time has been well worth it for me.

Hi Ronnie:
I'm a first year reader of your blog and truly enjoy it. I am a firm cannabis advocate in Washington State. I am commenting for the first time today.

Though you are likely aware, please note for your readers that types and strengths of THC vary greatly. How many milligrams in any product also vary...good 'ol Google are wonderful resources for shoppers.

Many cannabis edibles only contain 10mg's of THC, which is an extremely small amount to receive any lasting effect. One can find 10 to 500-mg's of THC concentration when reading the labels, which will help customize the experience for each individual...

I feel so fortunate to live through cannabis legalization. It truly is a miracle plant!

I am 79 yrs. old and have used temazepam on and off over the years...Last January I took 7.5 mg and the next morning fainted in the shower and fractured my fibula. No more sleeping pills for me!!! And it's not the fracture that is the trouble: after 7 weeks with my foot in a boot and being inactive, I developed shortness of breath and have had to go to pulmonary rehab.
Emily Tall

I do use Ambien on a regular basis. I'm sure they'll discover it does some hideous thing to us, but in the meantime, I feel human and well-rested for the first time in my later adult life. I have had not a single one of the bizarre effects that were all over the media several years ago.

Initially, I had high hopes for cannabis which is legal in my state. However, I ended up being very disappointed. It did not help with pain or sleep; in fact, I felt even more anxious, irritable and restless. It's possible, I suppose, that I haven't found the right THC/CBD mix, but I'm reluctant to try again at this point. I have taken Tylenol-PM for years and, despite all the "no-no's", I'll likely continue since it works reasonably well.

My husband and I used to have terrible nights, full of nightmares and restlessness. I have a permanent tear to my rotator cuff that precipitates migraines, and I lived in a migrant fog until I accidentally discovered that the bedtime brownies that were legal in Alaska would not only make me sleep, but I stopped having migraines as long as I was using it at night. I have been making brownies since the 60's, but have not always had legal access and wouldn't try to get the medicine any other way. First the Alaskan Supreme Court made personal possession "legal", and while I lived there, I used that. Then we moved back to Oregon and I got a medical marijuana card. I am extremely careful, we never leave the house, and we only use this at night. We sleep 8 to 10 hours, don't remember our dreams, and I don't have migraines. My husband literally weaned himself off the opioids that he was given for back surgery and its complications (at one point 16 a day) using a tiny square of brownie, and now we are both the poster children for this method. It has never "worn off." I seldom feel high, I just go to sleep. And stay asleep. My husband can navigate safely to the restroom at night, so it's all good. Being in a medical marijuana state that has recently approved recreational, I also get a big discount at the dispensary. I am well aware this is not a federally approved drug, and caution people to be safe and responsible (never give to pets or young people, period).

Curse spell check. I mean a "migraine fog" not "migrant fog." Now I wonder what my unconscious was trying to tell me.

My mom puts a tiny transistor radio under her pillow. Soft music helps her fall asleep. I tucked that idea away for now.

Back in my teaching days, there were some sleepless nights when I was trying to figure out how to motivate certain troubled students.

The high school day began at 8 a.m. Owo!

Nowdays I close my eyes lightly and picture a breathtaking sight from past trips, such as the bird sanctuary boardwalk in South Padre Island, Texas.

We followed our guide to a lookout spot.

There, way out in the salt marsh, thousands of migrating birds huddled together like proud survivors.

Proud survivors.

Who managed to fly across the Gulf of Mexico.

Our guide-

"Close your eyes. Imagine the perils these birds faced. Imagine their determination."

"Think of these birds the next time you are tired, in a funk or you just can't sleep."

If visualizing lovely scenes doesn't work for me, then it's get up, comfy chair, read.

Sleep tight!


Doctafill's ideas are great and mirror my own.

If I truly can't sleep, I give up after a half hour or so and read for an hour. Then, I try again. Almost always works. I give myself "permission" to get up again if I still can't get to sleep in a half hour for another hour of reading and another half-hour of "trying," but I haven't had to go that far. Yet.

If I'm pretty sure I'll drop off eventually, I skip the whole "reading" thing, do some deep breathing and mentally "walk" a route I may not have seen for years. For some reason, this is highly effective.

It's amazing how easy sleep USED to be! I used to fall off the proverbial cliff at night, but no more.


For years I typically take about an hour to fall asleep at night unless I’ve had a lot of outdoor physical work which I haven’t done for a long time. I did make the mistake of indulging my night owl tendencies when I became a widow —that, and spending too much time learning to use a computer, troubleshooting tech glitches and hassling user foibles. Inadvertently starting my blog with excessive time writing for it I eventually realized played havoc with my life style, sleep, etc. Adding recent years nocturnal bathroom visits, sinus issues trying to keep an airway open interfere with sleep for me. I’m comfortable laying in bed for hours without sleep, not fretting, stewing about it or worrying about anything as can occur the whole night long — best for me not to get up or turn on light as I’ve experimented doing so.

I’ve recently reconciled myself to the fact I must have a more regular sleep schedule which includes going to bed a couple hours before midnight. I’ve started reading a book chapter or so before turning off my bedlight. Sometimes I leave radio on softly and think soothing orchestral instrumental-only music, on occasion nature scene visualizations, and/or also simple body relaxation exercise from head to toes are useful.

I’ve never used sleep medications but am intrigued with cannabis accounts described here, so would likely try them as a preferable treatment should I decide to seek such sleep assist. My husband took Ambian and on occasion arose at night to come into living room where I was still up, and he was clearly having some orientation and other issues. The next day he would have no memory of any topics he had discussed the previous night. He had a sleep study and used a CPAP also, had constant back pain and had Pacemaker. Cannabis might have been a good potential treatment for him had it been legal in Calif. as it is now.

I appreciate all the info others are sharing here.

Culprit #1 is the need for 2 or 3 trips to the bathroom per night.
I therefore I divide the night into two or three sleep sessions with a break in-between for a poddy stop. During the first break, I will eat a banana and it puts me right back to sleep. After the second poddy break, I will sometimes each a frozen waffle with syrup and 9 of 10 times it puts me to sleep for the duration. Sometime I will enhance the process with 4.5 mg melatonin or 12.5 mg of Diphenhydramine (in the rare occasion the waffle does not do the trick) , the latter being quite effective, the former just a general enhancement but not a stand-alone remedy. 12.5 mg of Diphenhydramine works well and the small dose greatly reduces the hangover effect.

I am lucky that these remedies work. They end up stringing together 6 to 8 hours of sleep per night and make for a refreshing morning and generally a good day.

Seems like most of us have to do some tricks to get a full nights sleep. I'm pleased that my remedies and simple and work well.

Old age is a bear.

John

I decided to just stop fighting it. If I can’t sleep, I listen to podcasts or an audiobook. I wish I could sleep uninterrupted but I can’t so I just sleep when I sleep and listen when I can’t. I’ll soon be 72.

I sleep with the window open even in winter, when it is open only a little bit. The room should be cold but my bed warm. The bed has a hot corn bag for my feet and a heating pad for my hips and lower back while I sit and read for less than half an hour. No sleep meds. As I drop off to sleep I think about something interesting but not stimulating; currently, it is about a planned kitchen remodel. When I return from bathroom trips during the night I turn the heating pad on and place it over my hips, which relieves pain. Having heat for my feet when I first drop off to sleep is crucial.

I usually sleep 7-1/2 hours a night plus a 15-20 minutes nap during the day.

I have very little problem with sleeping. My problem is that, over the years (I'm 82) I've gotten so that I stay up later and later--and I mean until 2 or 3 a.m. I think it has something to do with the night's being quiet, and feeling that the world is asleep and I somehow find that soothing. I've been known to nod off at 3 a.m. watching YouTube videos of daily life in midieval England.

My problem is that it means I get up terribly late--I wouln't complain about getting up at 9, but I'm more likely to get up at 10 or even 11 or later, and I really don't like that.

More--I suspect I need closer to 9 hours than less. And I take two OTC doxylamine succinate pills before bed, because for years I've found it tends to prevent my waking up way too early.

My project at the moment (oh, hell, it's been my project for at least a couple of years now, with not a lot of success) is to discipline myself to make sure the light is off by no later than 1, which gives me 8 hours until 9 a.m.

And now you really do know more about my sleep habit than you wanted to.

As Linda said, there is no reason not to take Ambien/Zolpidem if it works for you.
Broad prohibitions mean nothing in individual cases. It is also true that benzodiazepines are very helpful for sleep. I take Ambien and Xanax to sleep, and have done so for decades with no problems. I would not be able to function, working into my mid-70's if I did not have chemical assistance with sleep. Beware of pious anti-medication sermons and find out what helps you sleep.

When I worked I used to sleep like that log we all hear about- lucky log.

Since my auto accident in 94 ( broadsided by an 18 wheeler whose driver had fallen asleep) and subsequent chronic pain from several failed back surgeries my ability to go to sleep has suffered.
And staying asleep. Impossible.

I was on opioids for about 20 years - they helped with pain control and definitely helped me sleep but I started reading about my peers dying from respiratory suppression caused by opioids.

I’ve always used cannabis - since the ‘60s. It was easily available when illegal in both California and Oregon- now its legal on the entire west coast.
Investigating legal CBD I decided to use it to detox from opioids and help control pain. It worked for me though going through withdrawals was hell on wheels.

I do a lot of baking with cannabutter I make myself. I find a moderate THC/CBD combination, which requires 2 different strains of pot, baked into something like a healthy oatmeal cookie, helps control night time pain and allows me to have deeper sleep. Edibles like cookies or brownies or even lemon poppyseed cake don’t start to effect the body for about 90 minutes.

Because of this, I achieve a deeper sleep than I do if I just smoke a bowl full at bedtime. I have tried gummies in the past ( also easy to make) and don’t think they are as effective as a slice of cake or cookies.

What I used to spend on OxyContin, Ambien, Lunesta and other medications I now spend on good cannabis. I shop around for sales and can buy $62.00 ounces on the Oregon Coast - which I do several times a year, stocking up on ounces for my own smoking and for baking for friends. I’ve even developed vegan recipes.

I’m quite cannabis knowledgeable and happy to share recipes and what I know.

I, too, an very fortunate to live in Oregon, a fully legal state.

Husband has sleep apnea and it is not always "easily treated". He lost weight, had two surgeries, and still woke 20+ times a night, as recorded by sleep clinics. Used a CPAP machine for 4 yrs, hated it. Finally got a medical marijuana card and vaped just before bed.

Now, pot is legal in Canada, but because he's retired (so no need to be on deck in early a.m.,) he naps every day after lunch. (He stopped the pot not because it no longer worked; he also stopped smoking and wanted to quit all substances.) That's another strategy: patch together enough sleep, if 7 or 8 consecutive hours are very difficult..

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