Expert advice on how to get the sleep you need at any age
Most of us are familiar with the awful feeling of being bone-tired but unable to sleep, of watching the bedside clock register unholy times like 2:35 and 4:01 a.m. Was it that late afternoon latte? Your premenopausal symptoms? The worries of the day?
Whatever the culprit, it's no fun to feel exhausted—and it's not healthy, either. Sleeping poorly on a regular basis ups your risk of depression, cardiovascular problems and accidents, plus it makes you irritable.
According to the National Institute of Neurological Disorders and Stroke, about 40 million Americans suffer from chronic sleep disorders each year and an additional 20 million people experience occasional sleeplessness. But in most cases, you can improve sleep with age.
Different life stages offer unique sleep challenges, but better sleep at any age is critical for physical and mental health. Almost anyone can improve the quality of his or her sleep—a sleep specialist can make the difference if self-care measures aren't enough. Here are some solutions to sleep well at any age.
Subdue Work & Parenting Stress
Why You're Sleepless: New parenthood and challenging careers have their joys, but feeling well-rested is not among them. In fact, it's during the years of wakeful babies and demanding jobs that insomnia tends to get a foothold—and once it's established, it's hard to shake. "Over time, chronic insomnia changes brain chemistry," says Rafael Pelayo, M.D., of the Stanford University Sleep Medicine Center in Redwood City, CA. "Insomniacs have higher levels of the stress hormone cortisol, which increases alertness."
Your Sleep Saviors: If you're drowsy during the day, skip caffeine-laden energy drinks. To keep yourself alert, drink water, chew gum and take short walks when possible. Maintain a quiet, cool, dark and comfortable bedroom, use your bed only for sleep and sex (not work), and go to bed and wake up at the same time every day.
In addition, shut down your computer and other screened devices about an hour before bedtime. "The blue light these produce contains a specific wavelength that actually suppresses the sleep-inducing hormone melatonin and acts as a stimulant," says Shelby Harris, Psy.D., director of the Behavioral Sleep Medicine Program at Montefiore Medical Center in New York City. If you're still tossing and turning after 20 minutes in bed, get up and do something relaxing, such as listening to soothing music or reading in dim light.
Master Midlife Changes
Why You're Sleepless: In menopausal women, fluctuations in estrogen and testosterone can cause rest-disrupting night sweats, lighter sleep and middle-of-the-night awakenings. Snoring, which regularly affects 37 million adults and leads to fragmented sleep, also tends to surface in this age group, as the muscles of the throat naturally begin to slacken.
Your Sleep Saviors: Regular exercise—but not within five hours of bedtime—is useful for anyone with insomnia, says Harris, while menopause symptoms are sometimes relieved by yoga or acupuncture. If those don't help, ask your gynecologist if you might be a candidate for short-term hormone replacement therapy (HRT).
If you snore, losing weight, avoiding alcohol or sleeping in a different position can help. Some people benefit from an oral appliance that keeps the jaw and airway open at night. The more severe form of snoring, obstructive sleep apnea (OSA), is most effectively treated with a continuous positive airway pressure (CPAP) machine, which delivers a steady stream of air through a mask placed over your nose.
Adjust to Aging's Challenges
Why You're Sleepy: As you get older, your brain produces less of the sleep-cycle-regulating hormone melatonin. "People in this age group frequently experience a shift in circadian rhythmsٳthe body's internal clock," says David Neubauer, M.D., associate director of the Johns Hopkins Sleep Disorders Center in Baltimore, MD. "So, you go to sleep too early and wake up before dawn."
Arthritis and other painful conditions can also make it difficult to sleep comfortably, and the need to urinate at night can wake you up. Restless legs syndrome (RLS), which causes involuntary limb movements during sleep, breaks the normal sleep pattern. In addition, decongestants, steroids and some medicines for high blood pressure, asthma or depression can cause sleeplessness.
Your Sleep Saviors: To reset your internal clock, keep your house lights bright during the evening, then dim them for the last hour before bed. "You are essentially creating sunset in your house, and our bodies are programmed to go to sleep at dusk," says Harris. If medical symptoms or drugs are the culprits, ask your doctor about changing medications or timing. The solution for aches and pains may be a different type of pillow or mattress.
If the need to urinate awakens you frequently, ask your doctor to check for urinary tract infection or prostate enlargement. When there's no clear underlying cause, Kegel exercises, which strengthen the pelvic muscles, may help. You might also avoid beverages—especially those with alcohol or caffeine—right before bedtime.
Whatever your age and sleep challenge, Dr. Pelayo urges people to see a sleep specialist if nothing else seems to be working. "You deserve to wake up feeling refreshed and you don't have to suffer. Almost anyone at any age can find a way to improve his or her quality of sleep."
The Sleeping Pill Story
Some people swear that warm milk helps them drift off to dreamland. Others find melatonin supplements or over-the-counter sleep aids helpful, though the latter are not recommended for more than very occasional use as they have side effects and can be addictive.
Currently, the use of prescription sleep medication is soaring, with 60 million prescriptions written in 2010. How should these be used? "We recommend prescription sleep aids ideally as tools for short-term use," says Dr. Pelayo. "While they are not physically addictive, they can become habit-forming, and they don't solve underlying causes of insomnia."
The most widely used sleep medications, which include zolpidem (Ambien) and eszopiclone (Lunesta), are known as hypnotics and work on a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). These drugs are effective in most cases but may cause side effects such as morning sleepiness in some people. Older medications, called benzodiazepines (including lorazepam and clonazepam) tend to have a more profound "hangover" effect.
For long-term sleep solutions, you might ask your doctor about cognitive behavioral therapy for insomnia. Known as CBTI, the behavioral treatment stresses getting out of bed at the same time every day, reducing the time spent in bed, going to bed only when sleepy and not staying in bed unless asleep. Studies have shown CBTI to be as effective as medication for treating chronic insomnia, especially with age.
From our sister publication, REMEDY's Healthy Living, Fall 2011