The Third Third

Sleepless at Sixty

I was going to post this story yesterday, but I needed a nap. Mistake Number One for Insomniacs: Napping. More mistakes: Reading in Bed. It’s for sleep only. Oh, and sex. (But that’s another story.) Sleeping in. Believing that an extra glass of wine will help you sleep. Worrying that you won’t be able to go to sleep when you go to bed. Drinking iced tea in the afternoon. Thinking the pills might help. Insomniacs are 60 million strong in this country according to medical surveys, including one undertaken by Congress in 1988, which resulted in the 1993 report **Wake Up, America!** Insomnia is probably under-diagnosed at that, and the chances you can’t sleep are 40 percent higher if you are a woman over 40, and even higher if you are 60. Insomnia is not a specific one-size-fits-all lack of sleep. It is a personal assessment that you are not getting enough good (deep) sleep, either because you have trouble falling asleep at night, or because you wake up after three or four hours’ sleep and can’t get back to sleep, or both. Its symptoms are not simply fatigue and irritability, but even more costly: a decrease in the ability to concentrate, memory impairment, failure to accomplish daily tasks, decreased cognitive skills, auto accidents, poorer health overall, and the likelihood of an earlier death. Medical conditions which can cause insomnia include: AIDS, arthritis, cancer, cystitis, degenerative nerve disorders, enlarge prostate, fibromyalgia, heart or lung problems, heartburn, overactive thyroid, low back pain, and menopause. **But doctors believe 50 percent of the incidence of insomnia can be linked to psychological causes, including depression, anxiety and stress.** Specific, medically treatable sleep disorders, diagnosed on the basis of overnight sleep studies (polysomnograms) which measure breathing, heart rhythm, brain activity, eye movements, and body movement, include sleep apnea, restless leg syndrome, and leg movement disorder. So the Good News for anyone “Sleepless at Sixty” (or any other age) is that you are not alone. The dark and lonely nights you lie in bed, mind racing, wondering if you should turn on the light and read or listen to a book on tape (Maybe), get up and watch TV (No), calm yourself with gentle music (Perhaps), pray (If it works for you), or cry (Ditto) may in fact be dark, but they need not be lonely. Lots of us are with you in spirit. One study reports a third of all adults ages 55-64 wake up feeling unrefreshed. Another estimates that 4 to 5 percent of the entire U. S. population is taking sleeping pills in any given year! But do the pills work? In a way, yes. As a cure, like an antibiotic, no. The first class of prescription drugs used to treat insomnia were sedative-hypnotics called Benzodiazepines. Examples of these include ProSom, Dalmane, Doral, Restoril, and Halcion. Readily addictive, with a lasting lethargy or “hangover” effect, these are less often prescribed today because of the availability of a less-debilitating class of drugs known as Non-Benzodiazepines. Also sedative-hypnotics which similarly depress the activity of the central nervous system to effect sleep, these drugs, which include Lunesta, Sonata, and Ambien, clear the system more completely in a shorter period of time and have fewer day-after side effects. Another new drug – you’ve probably seen it advertised recently -- Rozerem, targets the body’s “natural” circadian rhythms to achieve better sleep. Because none of these medications can effect a cure, they are but temporary fixes, a way, when used properly by physician and patient, to intervene and re-set one’s body rhythms and sleep cycles. I’ve taken Ambien – I feel drunk the day after, and useless – Sonata – it’s very short-acting (just four hours) and not much help if you wake up anyway – and Lunesta – which gave me eight hours of sleep but did not make me feel rested. This general dissatisfaction and a fear of becoming addicted, despite assurances neither Sonata nor Lunesta are habit-forming, caused me to seek new solutions. Again, I am not alone. Weblogs abound detailing the Travails of the Tired. (Simply Google Insominia.) And there are countless books on the topic, among them: *Insomniac* by Gayle Green; *Snooze. . . or Lose!* By Dr. Helene Emsellem; *Desperately Seeking Snoozin’* by John Weidman; and *No More Sleepless Nights*, by Dr. Peter Hauri. It seems to come down to this (*Yawn!*): You have to change your behavior; I have to change mine. And according to my research, the most important thing we can do is **Get up every morning at the same time.** Ouch. Rising, we are told, sets our clocks. As for going to bed, we are advised to **go to bed later**, reducing the hours in bed to an absolute minimum (as low as 6 hours) so as to increase the percentage of time in bed that we are asleep. Eventually, as your sleep cycle is re-established, you can shift the go-to-bed time earlier in 15 minute increments to get back to “normal.” And, finally, again, **NO NAPS**. That’s going to be the hardest for me! Then there’s “Sleep Hygiene.” • Reduce the light in your bedroom. • Limit noise in the environment. • Set the thermostat to slightly cool. • Take a warm bath or shower 30 minutes or so before bedtime (not immediately before). • Prepare for sleep with calming music or books on tape the 30 minutes before bedtime. • Do not engage in any particularly stimulating activity – mental or physical -- in the 2-3 hours before going to bed. • Do not read in bed. As always, with anything having to do with our good health these days, there’s the Diet and Exercise component, too. • Avoid late-night eating and drinking. • Avoid caffeine after lunch. • Limit alcohol at night. (It may make you sleepy, but it won’t help you sleep well.) • No nicotine close to bedtime. • Exercise early in the day, not in the evening. But exercise five days a week. • Treat any pain (head aches, back pain, etc.) about 30 minutes before bedtime. Psychology can help, too. One suggestion is as simple as not thinking negatively (\"I\'m afraid I won\'t be able to\") about going to sleep. Another recommends that when racing thoughts start overtaking your overtired mind, you convert the script of words running through your head into images which may, if it works, lull you to sleep. Cognitive therapy with a licensed counselor may be helpful in establishing these and other behavioral changes. No studies have been conducted on my last piece of advice. However, I found that reading about Insomnia for several hours also induces sleep. Good luck. And nighty-night. Please share your tales of sleep lost and found in the comments below. And for additional information: (American Academy of Sleep Medicine) (American Board of Sleep Medicine)
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