Insomnia

Insomnia

Older people need just as much sleep as other adults, about eight hours a night on average. However, their ability to sleep can be compromised for a variety of reasons.

As a natural part of aging, you tend to be more easily roused from slumber. Over time, your sleep cycles can change, too, so suddenly you’re feeling more tired earlier in the evening. insomnia enters the picture when you fight the urge to sleep and stay up later in the evening but then cannot remain asleep in the earlier hours of the morning.

Then there are the times when you will experience an occasional bout of sleeplessness because of stressful and worrisome events in your waking life. The changing nature of life, adjusting to retirement, or bereavement may cause situational or transient insomnia. The important thing is to keep these periods in perspective, says Michael Vitiello, Ph.D., professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Insomnia is wearisome but it’s usually not considered a serious hazard to your health. If insomnia lasts for more than two weeks, see your doctor. In the meantime, try practicing these tips to improve your ability to sleep and the quality of the sleep you get.

Try This First

Reset your clock. The circadian rhythm, the body’s internal clock that tells it when to sleep and when to be awake, can be influenced by the body’s exposure to the sun. This knowledge can be very useful if you start wanting to sleep at 7:00 p.m. and start waking up at 3:00 a.m. That’s a sign that your internal clock may be out of whack and needs some resetting.

To get your body clock adjusted, get as much light exposure as you can toward the end of the day, recommends Sonia Ancoli-Israel, Ph.D., director of the sleep disorders clinic at the Veteran’s Affairs Health Care System in San Diego, professor of psychiatry at the University of California, San Diego, and author of All I Want Is a Good Night’s Sleep. This has the effect of moving your body clock ahead a few hours so you feel like going to bed at your more usual hour. Eat lunch outside, go for a walk in the afternoon, and when you have to spend time outside in the morning, wear sunglasses so your eyes are exposed to a little less light. All of these strategies will move your daylight exposure to later in the day, rather than earlier. You should see results in about two weeks, says Dr. Ancoli-Israel.

Other Wise Ways

Don’t let your clock get cuckoo. Go to bed and get up at the same time of day seven days a week, and your body will thank you by becoming accustomed to that rhythm and sleeping during those hours, Dr. Ancoli-Israel explains.

Have a real rest room. Keep your room at a comfortable temperature, advises Dr. Ancoli-Israel. And you’ll find it easier to sleep as long as you should if you draw the drapes to block out early-morning light.

Leave your worries at the bedroom doorstep. The bedroom is for sleep and sex, period. Leave eating, working, watching TV, even reading for another room in the house, says Patricia Prinz, Ph.D., professor of behavioral nursing and adjunct professor of psychiatry and behavior sciences at the University of Washington in Seattle.

Tune out that TV thriller. Watching scary, violent, or otherwise disturbing movies or TV programs before you go to bed is not a good idea, says Margaret Moline, Ph.D., director of the sleep-wake disorders center at the New York Presbyterian Hospital–Cornell Medical Center in White Plains, New York. They’re often too stimulating and will keep you up. And don’t trade in your remote control for the latest paperback suspense novel. A good page turner can be just as disruptive to your sleep schedule.

Think routine. Any parent will tell you that setting up a bedtime routine for children is important. Guess what? It’s important for adults, too. “Grown-ups forget to do that,” Dr. Moline says. “But we need routines just like the little kids do, so that we can relax and get ready for sleep.” So take a bath, get in your jammies, and spend some time reading (but not in the bedroom) before you climb into bed.

Dim the lights. Exposure to bright light before you sleep may have a stimulating effect and may keep you up, Dr. Moline warns. Keep the lights in the house low as you get nearer to your bedtime.

Get up and bore yourself to sleep. If you do have trouble sleeping, doctors say, you don’t want to wallow all night in bed trying to drop off again. Try for 10 minutes and then get up, leave the bedroom, and go do something quiet and dull until you feel sleepy again.

Turn the clock to the wall. If you do wake up in the night, don’t focus on your alarm clock. “It doesn’t matter if it’s 2:30 or 3:00 a.m.,” Dr. Moline says. “The more you pay attention to external stimuli when you’re awakened in the middle of the night, the more likely it is that you’ll have trouble falling back asleep.”

Find some ease with the herb valerian. Have some valerian root to help you sleep, suggests Varro Tyler, Ph.D., distinguished professor emeritus at Purdue University in West Lafayette, Indiana, and author of The Honest Herbal. Valerian is an ancient herb that is helpful in adjusting sleep over a period of time, but you don’t need to grow it fresh or grind up the root.

Dr. Tyler recommends buying concentrated valerian and using an amount equivalent to two to three grams of root a day. Valerian is also available in capsule form. Look for a standardized extract (0.8 percent valeric acid) and follow the directions on the label. Do not use valerian with sleep-enhancing or mood-regulating medications such as diazepam (Valium) or amitriptyline (Elavil). If stimulant action occurs, discontinue use. In infrequent cases, it may cause heart palpitations and nervousness in sensitive individuals.

Catch some kava. For acute insomnia such as that brought on by jet lag, you may want to try the herbal remedy kava, says Dr. Tyler. This herb is also prepackaged, but you want to check the label to make sure it has the active constituents kavapyrones or kavalactones.

Take between 60 and 120 milligrams before bedtime to help induce sleep. But because kava has a sedating effect, you shouldn’t have it if you’re already taking a sedative before bedtime, Dr. Tyler warns. Do not take kava with alcohol or barbiturates. Do not take more than the recommended dose. Use caution when driving or operating equipment, as this herb is a muscle relaxant.

Say no to nicotine. Even though some people feel the need for cigarettes to relax them, the nicotine in cigarettes is a stimulant, says Naomi R. Kramer, M.D., associate director of the sleep disorders center at Rhode Island Hospital in Providence. So it’s a bad idea to fight insomnia by lighting up. If you smoke, try to avoid doing it at night. “And if you wake up at night and want to go back to sleep, don’t have a cigarette,” Dr. Kramer advises.

Watch what you drink. Caffeinated beverages interrupt sleep, so don’t drink them after noon. And you’ll want to avoid alcoholic drinks before bedtime, too. Alcohol initially has a sedating effect, but as your body turns it into energy, it becomes stimulating, causing wakefulness in the night, Dr. Moline states.

Eat lightly. A big meal late at night might make you sleepy, but then again, it might not. If you are prone to heartburn or gastro-esophageal reflux, problems which tend to increase with age, having a huge dinner late will keep you up, says Phyllis Zee, M.D., Ph.D., director of the sleep disorders center and associate professor of neurology at Northwestern University Medical School in Chicago. Try to eat dinner earlier in the evening.

Have some warm tryptophan and cookies. Of course, if you eat an early dinner, it may not be enough to tide you over until you go to sleep. And hunger pangs can certainly keep you awake. Have a light snack to alleviate hunger before bedtime, suggests Dr. Vitiello. He recommends that you include some warm milk in that snack because milk contains tryptophan (a food substance that helps people feel sleepy). Other foods such as turkey, fish, and bananas are also rich in tryptophan.

Plug in a night-light. It’s almost inevitable. At some point, you can be pretty sure, you’ll have to get up to go to the bathroom. But if you have to turn on a lot of lights, you may overstimulate yourself and find it more difficult to fall back asleep, says Dr. Kramer. If you regularly find yourself in this situation and your eyesight and balance don’t cause you any problems, plug in a night-light or even two if it’s a long way to the bathroom. Let the small glow light your way.

Limit your sleep. If you are having a difficult time sleeping, you may think that trying to sleep more will help. But this can backfire, making insomnia worse, says Lauren Broch, Ph.D., director of education and training at the sleep-wake disorders center at New York Presbyterian Hospital–Cornell Medical Center in White Plains, New York. “You spend a lot more time in bed where you’re not sleeping, and you start learning that bed is not a place to sleep, it’s a place to ruminate and a place to be frustrated. You start associating your bed with things other than sleep,” Dr. Broch explains. As you age, the amount of sleep you need can become very individualized, so in order to fall asleep efficiently, it’s important to limit yourself to only an extra half-hour in bed awake. After that, get up.

Confine your sleep to the night. You might think a nap would be good to help combat the effects of insomnia. But any time spent napping actually takes away from the time you’ll spend sleeping at night. That only makes insomnia worse. If you feel tired during the day, try to stay awake until bedtime, suggests Dr. Broch. By then, you may find yourself so tired, you’ll fall right to sleep.

Work it out. Exercise has been shown to help sleep, says Dr. Zee. And it doesn’t have to be strenuous aerobic exercise, either. In fact, the timing of your exercise is more important than how strenuous it is. Exercise will initially make you more alert. But four to six hours after you exercise, your body temperature and metabolism drop, priming you for sleep, explains Peter Hauri, M.D. co-director of the Mayo Clinic Sleep Disorders Center in Rochester, Minnesota, and author of No More Sleepless Nights.

Schedule your workouts for four to six hours before bed, so your body temperature and energy will be declining just about the time you need to get to sleep. Any closer to bedtime and you may be too stimulated to sleep.