Willow Glen Resident

Columns

Seniors

Tips on how (yawn) to get good nightzzz... slee ... zzz

By Andrea Dorey

One of the benefits of being a retired senior is having plenty of time to get all the sleep one needs. How frustrating it is, then, to discover that most of us are not getting all the sleep we need. In fact, 56 percent of all adults in the United States experience one or more symptoms of insomnia several nights per week. Why are so many of us having trouble sleeping?

Many patients hold misconceptions about sleep that lead to maladaptive behavior, says Jack Edinger, and they unwittingly sabotage their sleep. Edinger, an associate clinical professor of psychiatry and behavioral sciences at Duke University Medical Center in Durham, N.C., believes patients too often develop performance anxiety, and that seniors, as soon as they are retired, often adopt ad lib sleep/wake schedules that undermine circadian regulation.

Normal sleep is required for optimal functioning. Normal wakefulness should be effortless and free of unintended sleep episodes. Unfortunately, "problem sleepiness" is common in our society. It occurs when people don't get enough sleep because of primary sleep disorders (such as obstructive sleep apnea, insomnia, restless legs syndrome or narcolepsy), other medical conditions (such as chronic bronchitis or congestive heart failure) or lifestyle factors. Sleep-deprived people exhibit levels of impairment that range from poor functioning at home or work to potentially life-threatening automobile crashes and industrial accidents.

Obstructive sleep apnea, a potentially life-threatening disorder, is produced by a narrowing or collapsing of the upper airway during sleep that restricts or prevents breathing. Symptoms of obstructive sleep apnea include chronic, loud snoring, gasping or choking episodes during sleep, excessive daytime sleepiness and drowsiness while driving.

People with insomnia complain sleep is difficult to initiate or maintain, or the sleep they get is neither refreshing nor restorative. Insomnia is the most prevalent sleep-related complaint; approximately 30 percent of adults in the United States report occasional insomnia, and nearly 10 percent report chronic insomnia.

The symptoms of restless legs syndrome are commonly reported and include sensations of creeping, crawling, pulling and tingling, which cause an irresistible urge to move the legs. These symptoms usually occur before sleep onset, making it difficult to fall asleep.

Narcolepsy is a chronic sleep disorder that results in an excessive and overwhelming daytime sleepiness, even after adequate nighttime sleep.

Other causes of sleeplessness include medical conditions such as asthma, chronic bronchitis and heart disease, or painful conditions such as rheumatoid arthritis, back pain and sickle cell disease. Additionally, over-the-counter or prescribed drugs can interfere with normal sleep or contribute to daytime drowsiness. Even caffeine, alcohol and nicotine can have substantial and surprisingly extended durations of effects on sleep and sleepiness.

Sleepiness is regulated by two primary processes: the body's circadian rhythm, which causes an increase in sleepiness twice during a 24-hour period (in general, during the hours between midnight and
7 a.m. and for a brief period in the midafternoon, between 1 and 4 p.m.); and the physiologic need for sleep, which is increased by sleep loss and sleep disruption.

Once the medical issues have been addressed by a health provider, seniors can use the following recommended techniques to affect an agreeable change in sleep patterns. Edinger's recommendations are included in the following tips:

* Review with your health adviser medications that might have effects on sleep.

* Determine how much sleep you need by going to bed at the same time each night and sleeping until you awaken without an alarm.

* Learn relaxation therapies, such as progressive muscle relaxation, autogenic training, self-hypnosis and visual imagery.

* Restrict your time in bed to the average time actually slept plus 30 minutes. This strategy addresses the tendency of many insomniacs to spend long, anxious hours in bed. As you sleep longer, add 15 minute increments.

* Get up about same time each day.

* Eat meals and take medications at regular hours.

* Exercise regularly, at least two hours before bedtime.

* Spend time outdoors each day, at least two hours in bright light.

* Nap fewer than 30 minutes a day.

* Limit caffeine and alcohol intake.

* Don't smoke.

* Restrict liquids near bedtime. Eat dinner at least two hours before bedtime.

* Go to bed only when drowsy.

* Don't worry, think or plan in bed, since these activities are incompatible with sleep. Write down nagging worries with any possible solutions, and put aside to deal with the next day.

* Keep the bedroom quiet, dark and cool. A fan or other "white noise" machines can block outside noises.

* Make sure your bed is comfortable. Try therapeutic pillows.

* Don't keep a television set in the bedroom.

For more information, contact the National Heart, Lung and Blood Institute Information Center at 301.251.1222 or visit http://www.nhlbi.nih.gov/nhlbi/.

Andrea Dorey has been a medical writer for 25 years. She can be contacted at andi@ wrytor.com.