Monday, December 29, 2014

INSOMNIA



One of the best things about retirement is being able to sleep late at least some of the time. For many years when I was in school or working, I had to get up very early even if I had gone to bed late.  As a result of being sleepy I often tended to eat or drink too much, and found it hard to concentrate. I would have been healthier and happier if I could have slept more. Like most students and office workers, though, I had no choice. Now that I am retired, I often choose to stay in bed!


The joy of sleeping is occasionally interrupted by insomnia—typically for me at three o’ clock in the morning. I may toss and turn for an hour or more before going back to sleep. Surprisingly, I have insomnia more often at home than when traveling in our motorhome. This may be because I am more relaxed when away from the annoyances that go along with home ownership.

 As people age, we tend to go to bed earlier and rise earlier than when we were younger. However, insomnia interferes with sleep for many of us. Some of us wake up extremely early and are unable to go back to sleep. Worrying about problems may cause sleeplessness. In addition, age affects the type of sleep people have. The deepest, most restful sleep is called non-REM (rapid eye movement). The elderly tend to spend less time in non-REM sleep and more time in REM sleep, when there is more dreaming.

However insomnia affects people, it can leave them tired and irritable. They may find it hard to think clearly, may feel depressed, and even may be more likely to have falls and accidents if they are not well rested.

Over-the-counter or prescription sleep medicines may help, but they are a temporary aid for insomnia. Developing good sleep habits and treating physical or emotional problems that may affect sleep can lead to a permanent improvement. Sleep habits that can help include:
  •  Provide a safe, restful environment for sleeping. Lock the doors and windows of the home, have a telephone and lamp within easy reach of the bed, and turn on nightlights in the hallways and bathroom. Don’t watch television there or read thrillers in bed. Have a pillow that supports your head and neck properly and enough blankets in cold weather.

  •  Never smoke in bed. If a heating pad is used, be sure it is turned off before you fall asleep.

  • Do not eat large meals or drink coffee or alcohol in the evening. Drink less liquid of any type during the evening if it makes you get up to use the bathroom at night.
  •  Exercise during the day, not within three hours of bedtime. Try not to nap during the day if you have trouble sleeping at night.

  •  In daytime, get out in the sunlight.

  •  At bedtime, do anything nontoxic that you know will help you sleep: Drink a little milk, make a to-do list for the next day so that you will not lie awake thinking about things you need to do, or do whatever else you find effective.

For many people, these habits will help greatly. Some conditions, though, call for more extreme measures. If a medicine is causing insomnia, it may be possible to substitute another drug for it. Some disorders that interfere with sleep can be cured or alleviated. Anti-anxiety drugs are useful for some people.

One sleep-disturbing condition is apnea. The apnea sufferer stops breathing periodically during sleep, gasping for air and snoring loudly. During the day, apnea causes sleepiness. Left untreated, it can even cause hypertension, stroke, or loss of memory. Specialists in sleep problems can diagnose sleep apnea and treat it. The standard treatment includes a device that delivers what is called continuous positive air pressure (CPAP), which pushes air into the lungs during the sleep. Other treatments may use dental devices or surgery.

Other conditions that can cause sleep disorders are restless legs syndrome and periodic limb movement disorder. With restless legs syndrome, which tends to be worse at night, people feel sensations in their legs such as tingling, pins and needles, or crawling. Periodic limb movement disorder makes people jerk and kick their legs often during sleep. Medications for both conditions can be prescribed.
Anything that interferes with sleep should not be ignored. As Macbeth said in despair, "sleep knits up the raveled sleave of care," restoring us every morning.


(Much of this post is based on my reference book Geriatrics [Greenwood Press, 2011].)