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The medical word for sleeplessness is insomnia, which can mean many things. Some lie awake at night, tossing and turning, before sleep finally comes. Some wake frequently during the night. Others wake early in the morning and cannot get back to sleep.
Medically, sleep disorders are classified by their time course and cause. Transient insomnia lasts less than a week, and is usually a response to changes in schedule, like travelling through time zones or sleeping in a strange place. Acute (or short-term) insomnia can last up to six months, and is usually a response to a stressor like moving to an unfamiliar environment, or mourning the loss of a loved one. Chronic insomnia, the most dreaded of the lot, can be related to medications, illnesses, or lifestyle factors.
No matter how insomnia is classified, it affects a lot of people. Some people have medical problems that affect sleep, but others unintentionally prevent themselves from sleeping because of bad sleep habits. Many sleep problems can be solved with simple changes to the sleeping environment.
Sleep disorders are not limited to sleep. They affect waking health as well. A poor night's sleep can cause daytime drowsiness, which can lead to car crashes and falls. A night spent tossing and turning can leave too little energy to enjoy the next day's activities. Sleep-deprived people also can be moody or unable to cope well with stress.
As we grow older, some sleep changes are normal and expected. Although adults in their forties require seven to eight hours of sleep, seniors over 70 may require as little as five and a half hours. The amount of sleep one requires is very individual, and the number of hours itself should not be cause for worry.
Sleep latency, the time between getting into bed and actually falling asleep, is normally a half hour or less, whether we are young or old. However, the amount of deep rapid eye movement (REM) sleep decreases as we get older. This can mean shallow sleep with more frequent wakefulness.
Although a certain amount of change is natural, trouble falling and staying asleep that results in daytime sleepiness should not be considered normal.
Sometimes medical problems are at the root of poor sleep. For instance, a change in sleep patterns can be one of the earliest signs of depression or anxiety. Someone who wakes gasping for breath and needs to get to a window for fresh air is experiencing a symptom of congestive heart failure. Overweight people or long-time snorers are at higher risk for obstructive sleep apnea, in which sleepers stop breathing for a few seconds at a time, at times waking themselves and disrupting sleep. Sleep apnea can lead to high blood pressure and daytime drowsiness.
All of these problems should be mentioned to a doctor. Treatments that do not involve sleeping pills exist.
Getting up at night to go to the bathroom is normal, but some people do this to excess. As a rule of thumb, if you go more than once a night in your 60s, twice a night in your 70s, or three times a night in your 80s, you may have a physical problem. Diabetes, heart failure, and bladder infections can cause frequent nighttime bathroom trips. Those on water pills (diuretics like furosemide, spironolactone or thiazides) also pass urine more often. Taking these pills in the morning instead of the evening may solve the problem. Discuss this with your doctor.
To cut down on passing urine at night, there are simple fixes. Keep getting lots of fluids, but try to drink most of them in the morning. Avoid substances that cause excess urine production like pop, coffee or tea, and other foods that contain caffeine, such as chocolate. Make a trip to the bathroom, whether you feel you need to or not, each night before getting into bed.
Most sleep problems can be solved by changes that you make in your lifestyle. First, make sure you get up in the morning and go to bed in the evening at about the same time every day. This way, you set your internal clock to expect your bedtime each evening, making you sleepy at the right time. Although young adults are often told not to nap for fear that they will not be tired in the evening, studies show that a short hour-long nap in the early afternoon can improve sleep quality in older people. It is worth a try if other changes are not helping.
Remember to use the bedroom only for sleep and activities related to sleep. For instance, do not pay your bills while sitting up in bed.
Even a small amount of light can disturb sleep if you are sensitive to it. If you have a night light or a bright digital clock, try turning it off or moving it. Instead, place a flashlight by your bed for midnight bathroom trips. If you find yourself staring at the clock, watching the minutes tick by while you try to sleep, take it out of the room altogether.
Some people are also sensitive to sound and temperature. Keep your bedroom as cool and quiet as possible, or try white noise like mild static from a radio to drown out disturbing sounds. ‘Sleep machines,’ electronic devices that play soothing sounds such as ocean waves, are sometimes helpful.
If you lie awake at night worrying, it may help to write down your worries in a journal. Likewise, keeping a list of tasks to be done the next day may save you from lying awake pondering them the night before. Schedule a relaxing period before going to bed to start unwinding.
Regular exercise has been shown to improve the quality of sleep. Try going for a walk in the afternoon. Exercise should be done several hours before going to bed. In one study done of older women, brisk walking in the afternoon increased total sleep time by one hour and led to better quality sleep. However, brisk walking can be difficult for some people due to other medical problems.
Try not to eat large or fatty meals within three hours of bedtime. The early bird special may not just be cheaper – it is better for your sleep habits. Even though you get drowsy after a large meal, studies have shown that sleep after meals is of poor quality. If you must eat in the evening, stick to a small snack containing carbohydrates, like toast or crackers. The old-fashioned remedy of warm milk before bedtime has a scientific basis. Milk is rich in the amino acid tryptophan. This is the building block of serotonin, a chemical found in our brains that reduces anxiety.
Caffeine stays in your system longer than you might realize. For those who are sensitive to caffeine, these effects can last up to 20 hours. Caffeine causes a fast pulse, nervousness, high blood pressure, and restlessness. These are exactly the things you do not need if you are trying to fall asleep. Coffee, cola and black teas are the worst offenders, but herbal teas, green teas and chocolate also contain small amounts of caffeine. Even decaffeinated coffee can contain enough caffeine to disturb sleep.
Read the labels of your medications carefully. The pain pills Anacin™ and Excedrin™, for example, contain caffeine. It is best to avoid caffeine completely if you have sleep problems.
Smoking close to bedtime or in the evening acts as a stimulant. Studies have shown that people of all ages who smoke have more sleep disturbances than those who do not. Smoking makes it more difficult to fall asleep and causes less time actually sleeping.
Other medicines, even if they do not contain caffeine, can still keep you awake. Theophylline for asthma, certain antidepressants, and over-the-counter cough syrups with pseudoephedrine (read the label!) can also prevent sleep. If you must take cough syrups or over-the-counter painkillers in the evening, choose those that say ‘night time’ on the box. If in doubt, ask your doctor or your pharmacist.
Relaxation techniques may also help those who have difficulty falling asleep. Lie in bed and tense your muscles, one muscle group at a time, and then relax them completely. Start by flexing your ankles down, then up. Move up your legs by tensing your calves, then your thighs. Move on to your buttocks, stomach, chest, and arms.
If you still having trouble sleeping, keep a diary that records your bedtime, quality of sleep, waking time, food and drink patterns, and exercise patterns. Show this to your doctor – it may be very valuable to finding the true cause of your problem.
If changes in habit and diet have not been successful, you may have true chronic insomnia. After a thorough medical work-up looking for medical conditions that contribute to the problem, your doctor may prescribe a medication that promotes sleep.
Benzodiazepines are sometimes prescribed for chronic insomnia. These are diazepam, lorazepam, oxazepam, triazolam, temazepam, and others, under the brand names of Valium™, Ativan™, Serax™, Halcion™ and Restoril™. However, these drugs can be addictive, and may lose their effectiveness after a while. When they are stopped, sleeplessness may increase. They also have known side effects that are linked to daytime sedation, including confusion, falls, hip fractures, and related car crashes. They should be used cautiously and only for a short time, if at all.
Other drugs like zopiclone (Imovane™) are less addictive and have fewer side effects. One effect noted is a bitter, metallic taste in the mouth. Some antihistamines, like diphenhydramine (Benadryl™) or hydroxyzine (Atarax™), are also mild sedatives, although they may also cause confusion. Be very cautious when starting a sleep medication for chronic insomnia, and make sure you have exhausted your other options first.
Using some of the strategies mentioned, and in consultation with your family doctor, a restful night’s sleep is not far away.
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