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Getting a restful night’s sleep

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December 25th, 2012

It s 9 a.m. and your two energetic grandkids will be at your house in an hour. You love playing with them, but today you re not looking forward to it. You are tired. You want to get more sleep at night, but in recent years, you find you re getting less and less. In adults over age 60, insomnia is the most common sleep problem. A poll conducted by the National Sleep Foundation found that up to 44% of seniors have some form of insomnia at least a few nights a week, whether it s difficulty falling asleep, waking often in the night, or waking too early and not being able to go back to sleep. Insomnia means more than feeling tired. It can lead to falls, memory problems, and has been associated with other medical problems such as heart disease. It can also affect your emotions. Adequate sleep is imperative for good mental health, says Roberta Feldhausen, PMH-CNS, BC, director of mental health services for Erickson Health Medical Group. Along with appetite and pain level, sleep is one of the top three items I assess during mental health visits.

Why it happens

As we age, changes occur in what we call sleep architecture, says Shelby Harris, PsyD, CBSM, director of the behavioral sleep medicine program at Montefiore Medical Center s Sleep-Wake Disorders Center in New York, N.Y. We cycle through several stages of sleep during the night, and older adults tend to spend less time than younger adults in the deep sleep stages. So is it inevitable to experience insomnia in your older years? Not necessarily, Harris says. The differences in sleep architecture do not lead to insomnia. In fact, despite these changes, many healthy older adults report that they sleep well and feel fine during the day. Healthy is the key word. Any existing medical problem can interfere with quality sleep, and people with these problems tend to report dissatisfaction with sleep quality, Harris says. Problems including restless leg syndrome, sleep apnea, chronic pain, depression, and anxiety can all contribute. Medication side effects may also be a factor.

Getting better sleep

Some people may not do anything about insomnia because they think it s normal. That s not true, Harris says. Seniors need anywhere from six to nine hours of sleep each night. The first thing you need to do is to have a thorough evaluation by your doctor, she advises. Once any medical problems have been addressed and treated, you can establish some new sleeping habits. Start with some simple sleep hygiene dos and don ts (see sidebar). And then take a look at your lifestyle. One of the biggest factors that can lead to insomnia is a change in your daily structure, Harris says. After retirement, many seniors stop having a schedule. They may wake later or at different times each day. Try to maintain regular sleep and waking times. If you wake up at night and can t get back to sleep after about 20 minutes, get out of bed and do something relaxing for an hour or two such as reading, Harris advises. Your bed should be reserved only for sleeping and intimacy. Harris offers another tip: Try staying in bright light until about an hour before you want to settle down to sleep. This can be helpful, especially if you find yourself falling asleep too early and then waking up at three or four in the morning.

To nap or take medicine

Daytime napping is okay as long as it doesn t interfere with your nighttime sleep. Try to nap for only about 20 minutes and keep it fairly early in the day, preferably prior to 2 p.m., Harris says. Even a five-minute nap in the evening can rob you of sleep at night. Beware of dozing in front of the TV or while reading. Most experts advise against the use of over-the-counter sleep medications. Those containing diphenhydramine (Benadryl) can be especially harmful, Harris says. This medicine has been associated with accidents, falls, and memory problems. Before you try anything, even a supplement such as melatonin, talk to your doctor first. Some people may benefit from a prescription sleep medicine, but only after a careful evaluation by their health care provider, Feldhausen says. We have to be careful of interactions with other medicines and other health-related concerns. Another option for treating insomnia that is gaining in popularity is cognitive behavioral therapy (CBT). This type of therapy usually lasts for about 4 to 12 sessions, Harris explains. You learn about sleep hygiene, relaxation techniques, sleep scheduling, and how to determine the optimal amount of sleep for you. CBT helps you slowly increase your amount and quality of sleep. It can work as well as any medication. CBT is available at Erickson Living campuses, Feldhausen says. Ask your primary care provider about it.

Sleep hygiene dos ' and ' don ts

Sleep hygiene is not about washing the sheets. Follow these tips for a peaceful slumber: DO something relaxing before bed such as reading or taking a warm bath. DO keep your bedroom quiet and dark. DO use a good mattress and pillow. DO maintain a steady room temperature not too hot or cold. DON T exercise within three hours of bedtime. DON T eat a large meal before bed. DON T drink caffeine late in the afternoon or evening. DON T drink alcoholic beverages to go to sleep.

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