How much sleep is needed varies greatly by age and from individual to individual. Newborns can sleep away three-fourths of the day. Toddlers and preschoolers need 11 to 14 hours of sleep each day. This need gradually declines until adulthood, when most people require around 7 to 8 hours—although seniors may find their sleeping patterns fluctuate due to changes associated with aging.
Unfortunately, seniors aren’t the only ones who struggle with a sound night’s sleep. According to the National Institutes of Health, more than 70 million Americans experience insomnia. That means they have trouble falling or staying asleep, or they wake up before they’ve gotten enough sleep.
Although we usually define insomnia as having a difficult time getting to sleep, the most common pattern involves frequent awakenings during the night. In addition, some individuals awaken too early and are unable to get back to sleep. Nearly all suffer the consequences: feeling sleepy and tired during the day and any other time they’re not trying to sleep. With impaired concentration, attention and memory, persons with insomnia are less productive at work and more vulnerable to mistakes. Studies show that inadequate sleep is associated with slower reaction times and more automobile and other accidents.
Insomnia is not a disease, although it may be a symptom of an underlying medical condition. Left untreated, it can cause headache, upset stomach, irritable mood and problems with interpersonal relationships. Over the long term, recent research suggests it’s a major risk factor for high blood pressure, type 2 diabetes, depression and weight gain. According to one study, lack of sleep is a greater risk for early death than smoking, hypertension or heart disease.
If problems persist, the causes may be complex and require the help of a doctor and sometimes a sleep laboratory to sort out and resolve. The first step is usually to look for medications or medical conditions that may be contributing to the problem. Commonly used drugs or substances that can contribute to insomnia include amphetamines, some antibiotics, anti-migraine drugs, beta blockers, thyroid preparations, bronchodilators, corticosteroids, decongestants, caffeine, and nicotine. Medical conditions than can cause sleeplessness include restless leg syndrome, breathing disorders, snoring, arthritis pain, headaches, panic attacks, night time urination, heartburn, or depression.
Hot flashes are a common source of insomnia for menopausal women. You might find your sleep interrupted by night sweats during menopause. For a male, an enlarged prostate can cause urinary problems and frequent night-time trips to the bathroom that interfere with sleep.
Nocturia–a medical term meaning having to urinate frequently during the night–is a common curse of late life. In fact, 65 percent of adults age 55 and over responding to a Sleep in America poll indicated that they often had to get up one or more times a night. When interruptions are more frequent–up to five or six a night–getting a good night’s sleep becomes virtually impossible. To make matters worse, nocturia tends to occur at a time when aging brings about changes in sleep architecture, with lighter and more easily interrupted sleep.
A bed partner’s snoring might keep you awake. On the other hand, sleep apnea is cause for the snoring and insomnia. A serious breathing disorder, apnea is marked by loud snoring and periods when breathing briefly stops. Finally, restless legs syndrome is a nerve disorder that causes uncomfortable sensations in the legs. The condition may interrupt sleep for the person affected as well as his or her bedmate.
No matter the cause, it can’t hurt to discuss your sleep problems with your doctor or pharmacist. We can go over the list of medications or supplements you’re taking to see if any could be interfering with your sleep. You can do many other things to improve your sleep.
To prepare your body for sleep, avoid stimulating activities and substances during the evening hours. This includes alcohol, heaving eating—especially spicy or high-sugar foods—fluids, nicotine, or caffeine. Be sure to exercise, but do it at least a few hours before you go to sleep. Make the time right before bed really relaxing—with calming activities and soft lighting. A bubble bath by candlelight, perhaps?
Wearing earplugs or eye masks or using a fan, or heavy curtains may also create an environment more conducive to sleep. If you use night-lights, make sure they’re not too bright.
If all else fails, talk with your doctor about other ways to promote sleep, such as relaxation techniques or behavioral therapy. Sleep aids such as melatonin might help, but know that these are not regulated the way prescription medications are.
When insomnia has become serious enough to require treatment, the easiest–although not always the best–course involves medication. Over-the-counter sleeping pills are rarely the answer and should not be used for more than a few days in a row to avoid a habituating or rebound effect. If depression is part of the problem, antidepressant medication and therapy may have a positive effect on the insomnia. A doctor may also prescribe one of several sleep-promoting medications.
Hypnotics are prescription medications that promote sleep. Antidepressants are often used for sleep, especially if depression is also a problem. Anxiolytics can ease anxiety that may be interfering with sleep, but are not usually used for long periods of time. Ambien, Lunesta, Sonata and Ambien CR all have a sedating effect, and they differ mainly in how long they last. Another drug, Rozerem, works in an entirely different way, affecting melatonin receptors that regulate the sleep/wake cycle. Although these medications are less likely than older sleeping pills or over-the-counter remedies to cause habituation, tolerance or side effects, the safest course is still non-drug treatment.
Several short-term behavioral techniques, requiring two to five sessions with a trained therapist, have been found effective. These may be combined with relaxation therapy, such as progressive muscle relaxation. Stimulus control therapy focuses on promoting the bedroom as a place to sleep and have sex, and nothing else. TV, books and other distractions should be removed. The patient may also be advised to get out of the bedroom when attempts to fall asleep are proving futile, thereby re-establishing positive associations between the bed and sleep.
Cognitive therapy focuses on correcting distorted attitudes about sleep and relieving the anxiety that eventually tends to consume the person with insomnia. A National Institutes of Health expert panel has endorsed the behavioral/cognitive approach. While conceding that newer sleep medications show promise and have few severe side effects, they pointed out that the long-term safety of these substances has yet to be established. In addition to being safer, cognitive/behavioral approaches have been found more effective, at least for certain individuals and certain situations.
Michelle Herbert Thomas, PharmD, CDE
Clinical Director, Richmond Apothecaries, Inc.
Rev. 1/2010 MHT
