Having Trouble Sleeping?
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Having Trouble Sleeping?

Is there anything more frustrating than spending an entire night listening to the tick of the clock on your bedside table?

Restless nights sap people's vitality and zip. Without enough rest, people become more forgetful, have difficulty concentrating, become more accident prone, and often feel irritable. Youngsters seem to experience little difficulty sleeping, but a solid eight hours of shut-eye can become a challenge as the years pass. The need for sleep doesn't change significantly, but the natural aging process, certain chronic conditions, and medications all can erode your chances of a good night's rest.

What Happens During Sleep

"Sleep is a physiological necessity," says Margaret Moline, PhD, director of the Sleep-Wake Disorders Center at New York Presbyterian Hospital. "It's part of what the brain and body need to do. Getting enough sleep is a real quality-of-life issue."

"Sleep is not unconsciousness," Moline continues. "Sleep is a diminished sense of your surroundings." Each night, sleepers cycle through multiple stages of rapid eye movement (dreaming) sleep and non-rapid eye movement (slow-wave) sleep. During episodes of slow-wave rest, sleep deepens and people are less likely to hear disruptions such as a dog barking or a partner getting up to use the bathroom.

Why Sleep Becomes Elusive

"With aging, there's less slow-wave, deeper sleep," Moline explains. "Therefore, older persons are more likely to be awakened by noises in the environment."

According to the National Sleep Foundation a number of health problems can make sleeping difficult:

  • Pain: People with arthritis may have difficulty falling asleep or staying asleep because of painful joints. A 1996 Gallup Poll found that 30% of all nighttime pain sufferers experience arthritis pain at night. The number rises to 60% for those over age 50. If you suffer from arthritis, ask your doctor about treatment for the pain. In that same poll, back pain, headaches, muscle aches, leg cramps, and sinus pain were also cited by those who had nighttime pain.
  • Heartburn: Nighttime heartburn is marked by wheezing and chronic cough, with repeated awakenings and daytime sleepiness. Raising the head of the bed may alleviate symptoms, or medication may be needed.
  • Respiratory ailments: Asthma, chronic interstitial lung disease, and various neuromuscular diseases can cause awakening. One study found that 74% of people with asthma were awakened from sleep in any given week.
  • Menopause: The hot flashes and breathing changes associated with menopause appear to disturb sleep. In one study, hot flashes were associated with arousals once every eight minutes on average.
  • Medication: Ask your doctor or pharmacist if your medications can cause insomnia or drowsiness, and if changing the time the drug is taken could help overcome these problems. "Older people have to get up to use the bathroom," Moline says. "If it happens somewhat frequently, it interferes with sleep."
  • Chemical changes: Production of the hormone melatonin, which influences sleep and wakefulness, decreases with age, just at the time when the likelihood of sleep disorders increases.

Sleep Disorders: A Whole Other Ball of Wax

The National Center on Sleep Disorders Research estimates that more than 40 million Americans suffer from more than 80 different sleep disorders and don't know it. Some of the most common include:

  • Insomnia: More than half of adults surveyed by the National Sleep Foundation complain of difficulty falling or staying asleep or waking too early.
  • Sleep apnea: Noisy, irregular breathing can signal this treatable sleep disorder. In severe cases, the sleeper wakes several hundred times during the night due to a partial obstruction that temporarily blocks air flow. Untreated sleep apnea may lead to high blood pressure, heart disease, and an increased risk of diabetes.

Good Sleep Habits

What about a glass of warm milk? This old-fashioned home remedy contains the chemical tryptophan, which might have some sleep-inducing properties in and of itself. But it's worth trying for another reason. "It's the soothing routine that's important," Moline says. "If you're too alert, you're not going to fall asleep." Winding down with a book, a glass of milk, soaking in a hot tub, or other regular routines set the stage for a good night's sleep.

More good sleep habits:

  • Go to bed at the same time each night.
  • Reserve your bed for sleep and sex. Watch television or read in another room.
  • Avoid caffeine, alcohol, and cigarettes, especially in the afternoon and evening.
  • Don't lie in bed watching the clock. If you can't fall asleep within half an hour, get up and listen to calming music or read.
  • Exercise 20 to 30 minutes at least three days a week—but not too close to bedtime.
  • Limit naps and don't nap longer than 30 minutes.
  • Take a walk outside during the day.
  • Sleep in a cool, quiet, dark room. Wear earplugs or eyeshades to block out light and sound.
  • Sleep on good bedding.
  • Limit drinking liquids a few hours before bedtime.
  • Don't go to bed hungry or overstuffed. Both may cause physical discomfort.
  • Save scary movies, strenuous exercise, and serious family arguments for daytime.

Think a Nap Will Help? Think Again

"It's important to understand that the need for sleep is across 24 hours," Moline says. "If you nap for one or two hours, it may affect the ability to sleep another eight hours at night under normal conditions." Typically, off-the-shelf sleep medications contain an antihistamine that can cause daytime drowsiness, leading to daytime naps.

Sleep Medications and Herbal Remedies

"Sleeping pills are meant for short-term use," says Moline. "We look to improving sleep hygiene and see if the judicious use of sleep medications is warranted."

A study reported in the Journal of the American Medical Association found behavioral changes provided longer-lasting benefits in the treatment of insomnia than did sleep medications. With a diary of your sleep and wake habits, your doctor may help determine the cause of and solution to your sleeplessness.

Melatonin supplements are not approved by the Food and Drug Administration (FDA) and lack sufficient evidence proving that they can aid sleep. New research indicates, however, that melatonin might be beneficial for patients with circadian rhythm sleep disorders, including blind patients. A new subtype for cells has been recently discovered in the retina that regulates the light-dark cycles and therefore influences melatonin levels.

Valerian, an herb, has been used all over the world to induce sleep and, except for its unpleasant odor and taste, seems to have few side effects. In a recent trial, a combination of valerian-hops had a modest sleep inducing effect when compared to a placebo.

Inform your doctor if you are taking any herbal supplements.

Lights Out!

Remember that sleep is a necessity, not a commodity. It's as much a part of overall health as good nutrition and regular exercise. So don't settle for two to three hours per night. Draw yourself a bath, pour a glass of warm milk, crawl into a comfortable bed, don your earplugs, and turn off all the lights. You deserve it. And call your doctor if you need help.

Resources:

American Academy of Sleep Medicine
http://www.aasmnet.org/

Early to Rise: Research Offers Clues to Older People's Sleep Habits. National Institute on Aging
http://www.nih.gov

National Sleep Foundation
http://www.sleepfoundation.org

Sleep Information. National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Better Sleep Council Canada
http://www.bettersleep.ca/

Canadain Sleep Society
http://www.css.to/

References

Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation. Apr 2003;107(12):1671-8.

Brennan R, Jan JE, Lyons CJ. Light, dark, and melatonin: emerging evidence for the importance of melatonin in ocular physiology. Eye. Sep 22, 2006.

Morin CM, Koetter U, Bastien C, Ware JC, Wooten V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep. Nov 1, 2005;28(11):1465-1471.

Tasali E, Mohkalesi B, VanCauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest. 2008;133(2):496-506.



Last reviewed June 2008 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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