Having Trouble Sleeping?
Sleeping vs. Aging
Are sleeping problems just apart of the aging process? The answer is “NO!” There are physiologic changes that help to contribute to insomnia, however, many environmental factors as well as chronic medical conditions also contribute to insomnia in this population.
Physiologically, the sleep patterns change as we age:
1. Sleep initiation is more difficult
2. Total sleep time and sleep efficiency is decreased
3. Sleep fragmentation increases
4. More time is spent in bed awake
5. Circadian rhythm changes, making you go to bed earlier and waking up earlier.
There are 3 categories of insomnia:
Transient – Lasts no more than a few nights at a time
Acute – Lasts less than 3-4 weeks
Chronic – Lasts more than 3-4 weeks.
Transient or Acute usually has an identifiable cause of insomnia such as acute medical illnesses, jet lag, change in sleeping environment and acute/recurring psychological stressors.
Studies have shown that medications are not always the best choice or even effective for sleep problems as they can lead to dependence and rebound insomnia if stopped. Behavior therapy is safe and has been found to produce durable and reliable changes in sleep that can have lasting effects. They include:
1. Relaxation Therapy – The goal is to lower pre-sleep cognitive arousal by progressive relaxation. This is very useful for individuals with tension and anxiety.
2. Stimulus-Control Therapy – Limiting the use of the bedroom to sleep; TV and bright lights should be avoided; bedtime needs to be perceived as a time for sleep. This is useful for patients who have irregular sleep-wake schedules.
3. Sleep-Restriction Therapy – This is used when excessive time is spent in bed. This usually requires 4-6 weeks to induce a mild sleep loss that increases the ability to fall and stay asleep.
4. Cognitive Therapy – Provides reassurance to patients that sleeping less than 8 hours a night is not necessarily unhealthy and does not always lead to dramatic consequences the next day.