The Medical Perspective
Keep track of what medicines you are taking and when you take them. Bring a list of your medicines or the pill bottles when you see your caregiver. Learn why you take each medicine. Ask your caregiver if the medicines you are taking could be affecting your sleep.
Caregivers may give you medicine for a short time to set up regular sleep patterns. Avoid taking sleeping medicines (also called sedatives) for long periods, unless your caregiver says it is OK. These medicines can be addicting. Over time you may find that you need more of the medicine to get the usual results, or find that the same amount of the medicine does not seem to work as well. Ask your caregiver for information about addiction to sleeping pills (sedatives) if you think this may be a problem.
Some sleeping pills have side effects including memory loss, daytime drowsiness, and falls. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment. Do not take over-the-counter sleeping pills or pills given to you by friends. Always take your medicine as directed by your caregiver. If you feel it is not helping, call your caregiver.
Some sleeping pills can interact with other medicines such as medicines for depression or allergies. Taking some of these medicines at the same time can cause serious side effects.
Your doctor may also suggest that you see a specially trained caregiver for sleep or relaxation therapy.
Cognitive (COG-ni-tiv) behavior therapy: Caregivers will teach you how to change your beliefs about sleep that may be causing your insomnia, or making it worse.
Sleep restriction (ree-STRIK-shun) and sleep consolidation therapy: At first, this therapy limits your sleep time so that when you do sleep, it is a more restful sleep. The time that you wake up in the morning stays the same. Your sleep time is then increased each night, until you reach a normal amount of sleep. Your caregiver may recommend that you do not take naps so that you can sleep better at night.
Medicines Two Choices for You
The Alternative Perspective
Working with your Holistic Chiropractor to understand what is out of balance and developing a well-rounded, multifaceted approach to address all the underlying imbalances associated with your sleep concern is important. And considering any of the following tips may be helpful in addition.
How to sleep well tip 1: Understand how sleep changes as you age
Some changes in your sleep are natural as you age. Your body produces lower levels of growth hormone, so you’ll likely experience a decrease in slow wave or deep sleep, and less melatonin often means more fragmented sleep (more rapid sleep cycles) and more awakenings between sleep cycles. As your circadian rhythm (the internal clock that tells you when to sleep and when to wake up) changes, you may also find yourself wanting to go to sleep earlier in the evening and waking up earlier in the morning. If you don't adjust your bedtimes to these changes, you may find that you have difficulty falling and staying asleep.
Older adults also tend to wake up more often during the night. Consequently, you may have to spend longer in bed at night to get the hours of sleep you need, or you may have to make up the shortfall by taking a nap during the day. In most cases, such sleep changes are normal and don’t indicate a sleep problem.
Sleep problems not related to age
At any age, it’s common to experience occasional sleep problems. However, if you experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder:
- Have trouble falling asleep even though you feel tired
- Have trouble getting back to sleep when awakened
- Don’t feel refreshed after a night’s sleep
- Feel irritable or sleepy during the day
- Have difficulty staying awake when sitting still, watching television, or driving
- Have difficulty concentrating during the day
- Rely on sleeping pills or alcohol to fall asleep
- Have trouble controlling your emotions
How to sleep well tip 2: Identify sleep disorders and sleep problems
Many cases of insomnia are caused by underlying but very treatable causes. While emotional issues such as stress, anxiety, and depression can cause insomnia, the most common causes in seniors are a poor sleep environment and poor sleep and daytime habits. Try to identify all possible causes of your insomnia. Once you figure out the root cause, you can tailor treatment accordingly.
- Are you under a lot of stress?
- Are you depressed? Do you feel emotionally flat or hopeless?
- Do you struggle with chronic feelings of anxiety or worry?
- Have you recently gone through a traumatic experience?
- Are you taking any medications that might be affecting your sleep?
- Do you have any health problems that may be interfering with sleep?
Common causes of insomnia and sleep problems in older adults
The most common causes of insomnia and sleep problems in older adults include:
- Poor sleep habits and sleep environment. Examples of poor sleep habits are irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on.
- Pain or medical illness. Pain can keep you from sleeping well. In addition, many health conditions such as a frequent need to urinate, arthritis, asthma, diabetes mellitus, osteoporosis, nighttime heartburn, menopause, and Alzheimer's can interfere with sleep.
- Medications. Seniors tend to take more medications than younger people. Combinations of drugs, as well as the side-effects of individual drugs, can impair sleep or even stimulate wakefulness.
- Lack of exercise. If you are too sedentary, you may not feel sleepy or feel sleepy all of the time. Regular aerobic exercise during the day, at least 3 hours before bedtime, can promote good sleep.
- Psychological stress or psychological disorders. Significant life changes like the death of a loved one or moving from a family home can cause stress. Anxiety or sadness can also keep you awake, which can, in turn, cause more anxiety or depression.
- Sleep disorders. Restless Legs Syndrome (RLS) and sleep-disordered breathing such as snoring and sleep apnea occur more frequently in older adults.
- Learned response. People with a legitimate cause for having trouble sleeping—after suffering a loss, for example—may lie in bed and try to force themselves to sleep. Eventually their bodies learn not to sleep. Even after your original reason for sleep disruption has passed, the learned response of not sleeping can remain.
How to sleep well tip 3: Improve sleep habits to overcome sleep problems
Poor sleep habits, including a poor sleep environment and poor daytime habits, can be the main causes of sleep problems and low-quality sleep in seniors. In many cases, older adults develop these poor sleep habits over a lifetime but find they create more and more problems as they age. Fortunately, these habits are easy to improve.
Improve daytime habits for better sleep
- Be engaged. Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep. Try volunteering, joining a seniors’ group, or taking an adult education class.
- Improve your mood. A more positive mood and outlook can reduce sleep problems. Find someone you can talk to, preferably face-to-face, about your problems and worries.
- Exercise regularly. Exercise releases endorphins that can boost mood and reduce stress, depression, and anxiety.
- Expose yourself to sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to get at least two hours of sunlight a day. Keep curtains and shades open during the day, move your favorite chair to a sunny spot, or consider using a light therapy box to simulate daylight.
- Limit caffeine, alcohol, and nicotine. All are stimulants and interfere with the quality of your sleep.
Encourage better sleep at night
- Naturally boost your melatonin levels. Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy. Use low-wattage bulbs where safe to do so, and turn off the TV and computer at least one hour before bed.
- Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a soft bedside lamp.
- Make sure your bedroom is quiet, dark, and cool, and your bed is comfortable. Noise, light, and heat can cause sleep problems. Try using an eye mask to help block out light.
- Use your bedroom only for sleep and sex. By not working, watching TV, or using your computer in bed, you’ll come to associate the bedroom with sleep alone, so when you get into bed your brain and body get a strong signal that it’s time to nod off.
- Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep is a surefire recipe for insomnia. Light emitted from a clock, telephone or other device can also disrupt your sleep.
Keep a regular bedtime routine for better sleep
- Maintain a consistent sleep schedule. Go to bed and wake up at the same times every day, even on weekends.
- Block out snoring. If snoring is keeping you up, try ear plugs, a white-noise machine, or separate bedrooms.
- Go to bed earlier. Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.
- Develop bedtime rituals. A soothing ritual, like taking a bath or playing music will help you wind down. Relaxation and stress management techniques, such as deep breathing and progressive muscle relaxation, take some practice but their benefits can be substantial.
- Limit your use of sleeping aids and sleeping pills. Many sleep aids have side-effects and are not meant for long-term use. Although it may be tempting to continue using them, they are crutches that only address the symptoms not the causes of insomnia. In fact, sleeping pills can often make insomnia worse in the long run. Therefore, it’s best to limit sleeping pills to situations where a person’s health or safety is threatened.
- Combine sex and sleep. Sex and physical intimacy, such as hugging and massage, can lead to restful sleep.
Can napping help with sleep problems?
People are biologically programmed to sleep not only for a long period in the middle of the night but also for a short period in the middle of the day. Naps can enhance visual, motor, and spatial skills, and have even been shown to decrease the risk of coronary heart disease. So, if you don’t feel fully alert during the day, a nap may be just what you need. For many people, taking a brief nap can provide the needed energy to perform fully for the rest of the day.
Experiment with napping to see if it helps you.
Some tips for good napping:
- Short – Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 minutes. You may feel groggy and unable to concentrate after a longer nap.
- Early – Nap early in the afternoon. Napping too late in the day may disrupt your nighttime sleep.
- Comfortable – Try to nap in a comfortable environment preferably with limited light and noise.
How to sleep well tip 4: Use diet and exercise to overcome sleep problems
To promote good sleep, pay particular attention to your pre-bedtime diet.
Bedtime Diet Tips to Improve Sleep
Limit caffeine late in the day
Avoid caffeine (from coffee, tea, soft drinks and chocolate) late in the day.
Avoid alcohol before bedtime
Don’t use alcohol as a sleeping aid. It might seem to make you sleepy, but will disrupt your sleep.
Satisfy your hunger prior to bed
Have a light snack such as crackers, cereal and milk, or yogurt or warm milk.
Avoid big meals or spicy foods just before bedtime
Large or spicy meals may lead to indigestion or discomfort. Try to eat a modest-size dinner at least three hours before bedtime.
Minimize liquid intake before sleep
Limit what you drink within the hour and a half before bedtime.
The importance of regular exercise in overcoming sleep problems
Exercise releases chemicals in your body that promote more restful sleep. There are four main types of exercise:
- Endurance activities, such as walking, swimming, or riding a bike, increase your heart rate and breathing to improve the health of your heart and circulatory system.
- Strength exercises build muscle tissue and reduce age-related muscle loss.
- Stretching exercises keep your body limber and flexible, allowing a greater range of motion in your senior years.
- Balance exercises build leg muscles to reduce the chances of a fall.
While seniors need some of each type of exercise, studies have shown that participating in moderate endurance (aerobic) activity can have the greatest impact on improving sleep.
Aerobic exercise helps older adults sleep better
A recent study by Feinberg School of Medicine at Northwestern University found that aerobic exercise resulted in the most dramatic improvement in patients' reported quality of sleep, including sleep duration, on middle-aged and older adults with a diagnosis of insomnia.
The participants, aged 55 and up, exercised for two 20-minute sessions four times per week or one 30-to-40-minute session four times per week. Participants worked at 75 percent of their maximum heart rate on at least two activities including walking or using a stationary bicycle or treadmill. The regular aerobic exercise improved the participants' sleep quality from a diagnosis of poor sleeper to good sleeper. They also reported fewer depressive symptoms, more vitality, and less daytime sleepiness.
Source: National Sleep Foundation
Adding exercise to your life does not necessarily mean signing up for a gym membership. There are countless activities you can do to increase strength, improve aerobic capacity, burn calories, and prepare yourself for a good night’s sleep at the end of the day. Always consult your doctor before embarking on any new fitness program.
- Swim/Water Exercises – Swimming laps is a gentle way to build up fitness and is great for sore joints or weak muscles. Many community and YMCA pools have swim programs just for older adults, as well as water-based exercise classes such as water aerobics.
- Dance – If you love to move to music, go dancing or take a dance class. Dance classes are also a great way to extend your social network.
- Take up lawn bowling, bocce, or pétanque – Variations on throwing a ball on an earthen or grassy court are gentle ways to exercise. The more you walk, and the brisker the pace, the more aerobic benefit you’ll experience.
- Golf – Golf is a form of exercise that requires precise, strong movement of particular parts of your body, but which doesn’t require vigorous movement. Walking can be an added aerobic bonus to your game.
- Cycle or run – If you are in good shape, you can run and bicycle until late in life. Both can be done outdoors or on a stationary bike or treadmill.
If you have mobility issues, you can exercise from one position, either standing, sitting, or lying down.
How to sleep well tip 5: Reduce mental stress to overcome sleep problems
Stress and anxiety can easily get in the way of a good night’s sleep. Everyone has worries and lists of things to do, but it is important to teach yourself to let go of these thoughts when it’s time to sleep.
Keep a journal to record worries and concerns before you retire.
On your to-do list, check off tasks accomplished for the day, list your goals for tomorrow, and then let go!
Listen to calming music.
Read a book that makes you feel relaxed.
Get a massage from a friend or partner.
Use a relaxation technique to prepare your body for sleep.
Seek opportunities to talk with a friend or therapist about what is troubling you.
Getting back to sleep at night
It’s normal to wake briefly during the night but if you’re having trouble falling back asleep, the following tips may help:
- Don’t stress. Try not to stress over the fact that you can’t get back to sleep, because that very stress encourages your body to stay awake. Focus on the feelings and sensations in your body instead.
- Make relaxation your goal, not sleep. Try a relaxation technique such as deep breathing or meditation, which can be done without getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.
- Do a quiet, non-stimulating activity. If you’ve been awake for more than 15 minutes, try getting out of bed and doing a non-stimulating activity, such as reading a book. Keep the lights dim so as not to cue your body clock that it’s time to wake up, and avoid TV and computer screens.
- Postpone worrying. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve.
How to sleep well tip 6: Talking to your doctor about sleep problems and sleep disorders
If your own attempts to solve your sleep problems are unsuccessful, your doctor may be able to help with sleep problems due to:
- A sleep disorder
- Medication side-effects or interactions
- Medical conditions or illnesses
Bring with you a sleep diary. Include when you use alcohol, caffeine, and nicotine, and keep track of your medications, exercise, lifestyle changes, and recent stresses. Above all, don’t expect to sleep poorly as you age. Just as younger adults can solve their sleep problems, so can you.