| Insomnia is a common sleep problem, affecting almost
everyone at some point in their lives. People with
insomnia report that they can't fall asleep or cannot stay
asleep. This leads to a feeling of unsatisfactory
sleep, followed by daytime weariness and loss of
productivity, as well as irritability and decreased
enjoyment of family and social life.
Many people have occasional bouts of insomnia, often
related to a temporarily stressful situation. For some
people, however, poor quality sleep is a recurring and even
a lifelong problem.
Up to 12% of people have insomnia on a regular basis.
Getting a good night's sleep, one that leaves you refreshed
in the morning, means something different to a child than it
does to a senior citizen. Most infants sleep from 16
to 20 hours a day, while most adults sleep from 7 to 8
hours. Most seniors sleep around 6 1/2 hours a day.
Temporary insomnia usually disappears in less than a
month. Temporary insomnia can last anywhere from a
nigh or two up to three weeks and might be caused by any of
the following disturbances:
--A single stressful event
--a period of emotional stress
--Illness
--Temporary pain
--Disturbances in sleeping environment (noise, light,
strange bed)
People with chronic insomnia report a lack of good
quality sleep for long periods of time--months or even
years. This type of recurring insomnia can be caused
by
--Psychiatric conditions, such as depression or anxiety.
--An underlying medical condition.
--Stimulants, such as caffeine or nicotine.
--Acute or chronic stress.
--Chronic pain.
--Upsets in the normal seeping pattern, such as jet lag.
--Medications.
--Another sleep disorder, such as sleep apnea or restless
legs syndrome.
--Poor sleep habits.
Symptoms
--Difficulty falling asleep
--Awakening during sleep and having trouble getting back
to sleep.
--Awakening during sleep and having trouble getting back
to sleep.
--Awakening too early in the morning.
--Felling unrefreshed upon awakening.
--Daytime irritability, drowsiness, anxiety, or reduced
productivity.
It's common for older adults to sleep less deeply and for
less time than they did earlier in life, and to experience
fragmented sleep. These normal changes in sleep
patterns do not mean that older adults should expect to feel
tired, unrefreshed, or inadequately rested when they awaken.
However, routine poor-quality sleep due to health problems,
medication use, and major life changes can lead to chronic
sleep problems. Chronic insomnia in turn may increase
the chances of serious health problems, such as depression,
yet few senior seek or receive treatment for sleep problems.
Treatment Overview
If insomnia is caused by medical or psychological
conditions, treatment will focus on those underlying
conditions.
When poor sleep quality itself is the major problem,
treatment is different. For many years the primary
treatment has been sleep medications, particularly
sedative-hypnotics, to relieve symptoms. More
recently, there has been increasing support for therapies
that involve modifying behavior and lifestyles. These
two approaches--sedative-hypnotic medications and behavior
therapies--may be prescribed jointly, with the medications
helping to provide a good nights sleep and the therapies
encouraging long-lasting changes in approaches to sleep.
Sleep medications may provide rapid relief of the
symptoms of poor sleep quality. However, many of these
medications have side effects (such as high blood pressure,
anxiety, and nausea) and have not been shown to be effective
for long-term treatment of insomnia.
Sleep medications include
--Hypnotic medications.
--Antidepressants.
--Antihistamines.
--Nonprescription medications for sleep.
If you are taking any of these medications, it's usually
best if you take them only for a short time, at the lowest
effective dose, and stop taking them as soon as you can.
This is true for all people, but it is particularly true for
older adults, who can become dependent on sleep enhancers
and sometimes experienced diminished thinking capability
during and after long-term sleeping medication use.
The most successful long-term results have been achieved
by behavior therapy. Up to 80% of people receiving
such therapy benefit from the treatments, and about
one-third become good sleepers. Perhaps most
important, these results are maintained over time.
Natural Remedies
--5-HTP (5-Hydroxytryptophan):
5-HTP is converted into serotonin, a neurotransmitter that
helps regulate sleep; 5-HTP may thus be helpful for
improving insomnia. In a double-blind study of
individuals without insomnia, supplementation with 5-HTP
increased rapid-eye-movement (REM) sleep, presumably
indicating improved sleep quality. Additional research
is needed. Although evidence suggests that this
supplement may be beneficial, an effective dose has not been
clearly established. Consult with your healthcare
practitioner.
--Melatonin: (0.5 to 3 mg, one and
a half to two hours before bedtime): Melatonin is a
natural hormone that regulates the human biological clock.
It is most helpful for elderly people with insomnia, less so
for middle-aged people, and probably ineffective for young
people. Caution: Melatonin is a
potent hormone, and its long-term safety is not established.
Herbs
--Valerian (Valeriana
officinalis): A concentrated (4-5: 1) valerian rot
supplement in the amount of 300-400 mg can be taken 30
minutes before bedtime. In modern herbal medicine, the
leading herb of insomnia valerian. Valerian root makes
getting to sleep easier and increases deep sleep and
dreaming.
Dietary
Choices --Avoid caffeine:
The effects of caffeine (a stimulant) can last up to 20
hours, so some people will have disturbed sleep patterns
even when their last cup of coffee was in the morning.
Black and green teas, cocoa, chocolate, some soft drinks,
and many over the counter drugs also contain caffeine. --High-carbohydrate
food: Eating a slice of bread or some
crackers before bedtime can significantly increase levels of
serotonin, which is known to reduce anxiety and promote
sleep. --Avoid food allergens: Food
allergy may also contribute to insomnia.
Lifestyle
Options --Behavior:
A steady sleeping and eating schedule combined with caffeine
avoidance and counseling sessions using behavioral
therapy has reduced insomnia for some people, as has
listening to relation tapes. --Exercise:
The effect of exercise on sleep has not been well studied;
however, some doctors recommend daily exercise a s a way to
reduce stress, which in turn can help with insomnia --Epsom-salts
bath: Take a 15 to 20 minute hot Epsom-salts
(magnesium sulfate) bath before bedtime. One or two
cups of Epsom salts in a hot bath may act as a muscle
relaxant. --Quit smoking: Smokers
are more likely to have insomnia than are non-smokers. |
