The benefits of a good night’s sleep: missing your nighttime zzz’s could leave you feeling fuzzy in the morning. Here are some ways to sleep better
You toss and turn for hours and hours before falling asleep. You awake in the middle of the night, when you should be in your deepest sleep. Your eyes open long before the sun rises. You are among half of all older adults who sleep fewer than seven hours a night, a quarter of whom say they have a sleep problem, according to a recent Gallup survey.
Getting a good night’s sleep is just as important to your health now as it was when you were younger, yet sleep is often harder to come by. “As we get older, sleep problems become more prominent,” explains Stasia Wieber, MD, director of the Center for Sleep Medicine at Mount Sinai Medical Center. Many older adults have difficulty falling asleep (called “sleep onset insomnia”) or difficulty staying asleep (called “sleep maintenance insomnia”).
As you get older your circadian rhythm, or internal clock, changes. You may be going to bed and waking up much earlier than you did when you were younger. So even if you’re getting enough hours of sleep, you won’t feel well rested and refreshed the next day, Dr. Wieber says.
There are also a variety of health problems that can keep you up at night:
* Sleep apnea, an obstruction of the airway, can cause you to stop breathing repeatedly during the night, forcing your brain to keep waking you up to restart your breathing.
* Restless legs syndrome (RLS) can make your legs so tingly that you feel an uncontrollable urge to move them.
* REM behavior disorder can cause you to kick, punch, or otherwise act out your dreams.
* Prostate problems, urinary incontinence, or a urinary tract infection can make you run to the bathroom several times a night.
* Medications such as antidepressants, decongestants, and high blood pressure drugs can have a stimulating effect on your brain.
If you don’t sleep well at night, you can lose your mental sharpness during the day. You may have trouble concentrating, feel a lack of energy, and might even doze off–possibly behind the wheel.
Poor sleep also can affect your overall health, particularly if the cause is a condition such as sleep apnea. Cardiovascular disease, stroke, and diabetes are all risks associated with sleep apnea. That’s why it’s so important if you’re not sleeping well to get a correct diagnosis, Dr. Wieber says.
“The first thing I recommend is a consultation with a sleep doctor,” she says. The doctor will ask you a number of questions about your health and sleep history. You may need to stay overnight at the hospital for a sleep study, a test that can identify sleep apnea and other problems.
Treating the underlying condition can often resolve sleep issues. For example, sleep apnea is treated with a mask that delivers continuous positive airway pressure (CPAP) to help you breathe during the night.
You can relieve restless legs (RLS) by cutting back on the caffeine and tobacco use, taking a hot bath before bed, massaging your legs, and making sure you’re getting enough iron, folate, and magnesium. The FDA recently approved the first drug for treating RLS-ropinirole HCL (Requip). Although this drug appears to be effective, be aware that it can cause side effects such as drowsiness, dizziness, and nausea.
Better sleep hygiene
Many companies advertise mattresses and other products they claim will help you sleep better. You don’t need fancy gadgets, though, when there are a number of simple techniques that can help you improve the quantity and quality of your sleep.
The best way to sleep well is to ensure that you have good sleep “hygiene.” Go to bed at the same time every night and wake up at the same time every morning. Avoid eating a big meal, drinking alcohol, or taking stimulants (including caffeine and nicotine) close to bedtime. Exercise regularly, but early in the day (exercising late at night can actually have a stimulating effect). Engage in a relaxing activity (such as taking a warm bath, reading, or listening to soft music) before bed.
You can also try one of several cognitive behavior therapies, such as visualization (picturing a relaxing scene), or decatastrophization (learning ways to relieve your anxiety about insomnia). A recent review of 23 studies suggested that behavioral interventions such as cognitive behavioral therapy, relaxation, and sleep behavior changes might benefit older insomniacs more than medication because they are safer and can be used over a longer period of time.
If you’ve tried everything and you’re still feeling sleepy, it’s perfectly fine to take a nap during the day. In fact, a 2005 study found that seniors felt more alert and performed better physically after taking an afternoon nap. Try to keep your naps to 20 minutes or less, though, because a longer nap could disrupt your nighttime sleep cycles. Also be aware that taking a nap during the day cuts into the overall number of sleep hours your body needs to restore itself, so you might sleep less at night.
Even though a large percentage of older adults have trouble sleeping, many shy away from prescription sleep medications. About three-quarters of the people interviewed in the Gallup survey said they were concerned about the long-term effects of prescription sleep drugs. Research is showing that their concerns are at least somewhat warranted.
Benzodiazepines are among the most commonly prescribed sleep drugs, but because they work by slowing down the nervous system, they can make you feel dizzy, confused, or groggy. In a 2005 review of 24 studies involving people aged 60 and older, these types of sedatives did improve sleep duration, but they also led to increased falls and impaired cognitive function. “Usually I try to prescribe them only temporarily until my patient’s sleep cycle gets back to normal,” Dr. Wieber says. The newer generation drugs such as zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta) tend to be safer and have fewer side effects than older sleeping pills, but are also only meant to be taken over the short term.
Even over-the-counter sleep drugs can have significant side effects. Tylenol PM, Nyquil, and similar medications contain an ingredient called diphenhydramine (Benadryl), which can make you feel groggy and out of sorts when you wake up in the morning.
Any type of sleeping pills, whether over-the-counter or prescription, should be a temporary solution until you can get your sleep problems straightened out, and should only be taken under the guidance of your physician.
How do you know whether you’re getting a good night’s sleep? The definition is different for every person, Dr. Wieber says. Some people do well on 7 hours of sleep, while others need up to 11 hours. What matters most is how well rested you feel when you wake up.
If you’re consistently feeling tired or mentally slow during the day, be sure to let your doctor know about it because she probably won’t bring it up during an examination.
WHAT YOU CAN DO
To improve your nighttime sleep, follow these guidelines:
* Get on a regular sleep schedule. Go to bed and wake up at the same time each day.
* Don’t eat a big meal or drink alcohol within two hours of bedtime.
* Limit sodas, coffee, tea, and chocolate before bed.
* Exercise, but do it early in the day.
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