Do you toss and turn all night? Do you wake at 3 a.m. and find yourself unable to go back to sleep? Feel tired in the morning, even though you slept through the night? If you answered yes to any of these questions, you're in good company. A National Sleep Foundation survey found that 44 percent of Americans ages 55 to 84 have at least one of these symptoms of insomnia a few nights a week or more.
Getting older can take a steep toll on your sleep. Yet contrary to the common wisdom, the need for sleep, which varies from person to person, does not diminish as we age. "Most people are born needing a certain amount of sleep and it's pretty stable throughout life," says Michael Breus, Ph.D., author of Good Night: The Sleep Doctor's 4-Week Program to Better Sleep and Better Health (Dutton, 2006). What sleep doctors call "sleep architecture" does change, however, resulting in a reduction in the overall quality of sleep. "The restorative, 'wake-up-and-feel-great' sleep stages are disrupted," he says.
The stresses and worries of the midlife yearsfrom sending kids to college to caring for aging parentscan certainly keep you awake at night. At the same time, if you're over 50 you may have more health problems or take medications that interfere with sleep.
People 65 and older can experience a circadian cycle phase shift, causing them to fall asleep early in the evening and wake up at the crack of dawn. (One reason: The lenses in their eyes become cloudier, which blocks certain wavelengths of light, disrupting the sleep-wake cycle.)
Add menopause to the mix, and "it's a train wreck," says Michael Decker, Ph.D., a sleep researcher and associate professor at Case Western Reserve University in Cleveland. "Abrupt changes in hormone levels can result in soaking night sweats, insomnia and unrefreshing sleep that lasts for weeks to many months."
Women also tend to gain weight with menopause, which can lead to obstructive sleep apnea (OSA). With this condition, the soft tissue in your throat blocks to obstruct your airways, resulting in loud snoring and repeated wakings to catch your breath throughout the night. The National Heart, Lung, and Blood Institute estimates that one in 50 middle-age women and one in 25 middle-age men have sleep apnea.
Why You Need Sleep
Courting a sleep debt has negative health consequences, from premature skin aging to diabetes, obesity and heart disease. Sleep deprivation disrupts the body's endocrine system, which regulates appetite and blood sugar, among other functions. Women who sleep five or fewer hours a night have a 30 percent greater chance of developing coronary heart disease, according to the Nurses' Health Study. And research from Texas Tech University found that sleeping less than seven hours doubles the risk of becoming obese.
Scientists are also solving the enduring mystery of why we need to sleep. A new study from the University of Rochester Medical Center shows that shut-eye acts like a brain cleaner, clearing neurotoxic waste that accumulates in the central nervous system when we're awake. Toxic by-products of a normally functioning brain, such as beta amyloid, a substance found in the brains of people with Alzheimer's disease, are flushed out when we sleep.
Solutions for Sleep Problems
Sacrificing sleep can make you feel lousy. Fortunately, our five strategies can help you get the rest you need.
1. Learn to UnwindMany doctors recommend sleep "hygiene" measuresadjusting your lifestyle to favor better slumberincluding sleeping in a cool, dark bedroom, limiting caffeine and alcohol late in the day and not exercising close to bedtime.
Dr. Breus recommends establishing a "power-down" hour before going to bed to condition your body for sleep. Take 20 minutes to prepare for the next day (pack lunches; set out clothes), 20 minutes for hygiene (bathe; brush your teeth) and 20 minutes to de-stress: read, stretch, meditate or practice progressive relaxation, which involves tensing and relaxing each part of your body from head to toe.
2. Retrain Your BrainWhile effective for many people, "sleep hygiene is rarely sufficient to help someone with chronic insomnia," says Colleen E. Carney, Ph.D., C.Psych, an associate professor and director of the Sleep and Depression Laboratory at Ryerson University in Toronto.
If your insomnia is ongoing (a few nights a week for months or years), Dr. Carney recommends cognitive behavioral therapy (CBT), a short-term, goal-oriented type of talk therapy in which the therapist helps you change sleep behaviors and challenges beliefs about sleep that might be causing you anxietyand making sleeping problems worse.
Behavioral changes include establishing a regular morning rise time, going to bed only when sleepy, getting out of bed when you are unable to fall asleep and avoiding napping. New studies have shown that CBT is not only effective at alleviating insomnia but can treat depression as well. "For many years, experts saw sleep problems as a symptom rather than a cause of depression," says Dr. Decker. "New research shows that it goes both waysdisruptions of sleep can be harbingers of mood disorders yet to emerge." If you suffer from both conditions, CBT does double duty.
3. Consider Meds Short-TermSleeping pills can be helpful when tackling insomnia over the short-term. "Sometimes a medication is needed to break the cycle of sleeplessness," says Dr. Breus. Unlike older sleep medications, which took up to 72 hours to leave the system and could lead to dependency, newer sleep agents (Ambien, Lunesta) go to work fast, are less apt to cause drowsiness the next day and are not physiologically addictive.
4. Be Savvy About SupplementsFor mild sleep problems, relief could come from a supplement. "There's some data that magnesium and calcium can help," says Dr. Breus. Magnesium is important for regulating the sleep cycle and may also relax muscles; calcium is needed to release melatonin. (Taking melatonin in supplement form, however, is coming under new scrutiny, as some doctors believe it may have negative side effects.)
Talk to your doctor before taking the herbal supplement valerian. While it may be useful for some, it can interact with other medications. And because herbs are not regulated the way drugs are, you can't be sure that the contents of a bottle are safe or even have enough of the active compounds to be effective.
5. Address Sleep ApneaLosing weight can help you avoid sleep apnea. Or your doctor may recommend a Continuous Positive Airway Pressure (CPAP) machine, a mask that goes over your nose to gently blow air into the back of the throat, keeping the airways open. If that doesn't work you may be a candidate for surgery to remove the soft tissue that's blocking your airways.
From our sister publication REMEDY'S Healthy Living Spring 2014