Every year around 30% of the adult population will experience some sleeping problems, and amongst the elderly insomnia rates can be as high as 45%. These are broadly divided into sleep onset insomnia (in which there are difficulties getting off to sleep) and sleep maintenance insomnia (in which there are difficulties staying asleep through the night).
What causes insomnia?
Disturbance of your body’s biorhythm is a common cause of insomnia, especially in shift workers who work overnight or when you get jet lag. As you get older your biorhythms also change and insomnia and afternoon naps become more frequent. This is a normal process.
Psychological factors such as stress, anxiety and tension often cause insomnia. Racing through your work day feeling pressured and buzzed up with high levels of stress may impact negatively on your ability to relax into a deep and refreshing sleep cycle at night, as will worry and anxiety.
Certain foods and drink may also cause sleep problems, especially stimulants such as coffee, tea, soft drinks containing caffeine, chocolate and cocoa which will help keep you awake! While alcohol is a depressant and can help put you off to sleep, unfortunately its rebound effects will only ultimately aggrevate insomnia and it should be avoided if you have sleep problems. Nicotine from cigarettes also is a stimulant.
There are a variety of medical problems (diseases) which are associated with insomnia, with either the condition itself or its treatments causing sleep problems. Mental problems such as depression are a frequent cause of insomnia.
Another important cause of insomnia, especially for drivers is sleep apnoea where the muscles at the back of the throat relax excessively during sleep, leading to a blocking of the airways, reduced oxygen intake and repeated waking struggling for breath, sometimes hundreds of times in a night. It is often undiagnosed and also causes mood disturbances and heart problems. It especially affects middle-aged males who are overweight and are smokers.
Preventing and treating insomnia
If you think you have one of the conditions mentioned above like sleep apnoea or depression you need to see your GP. Otherwise:
1. Make your bedroom a restful space
Make your bedroom as pleasant and restful as possible. Clear away mess and clutter; ventilate it well at night and make sure you have thick, dark curtains to create a very dark sleeping space.
2. Adopt a regular pre-sleep pattern
Habit is important for sleep, so try building a good pre-sleep and wind-down routine. Try going to bed and waking at the same time every day; don’t go to bed too early; establish a “before bed” routine such as a warm bath and a cup of relaxing herbal tea; avoid day-time napping; do regular exercise but not close to bedtime, and avoid caffeine, alcohol and smoking.
3. Exercise means deeper sleep
If you drive to work, get in the lift, spend all day behind a desk and take up your night-time perch in front of the television, you’re setting yourself up for chronic sleep problems. Regular aerobic exercise is important for deep restful sleep at night. Exercise in the morning or early evening, but not directly before bedtime.
4. Sleeping tablets are not the answer
Popping a sleeping tablet at night is not the answer to your long-term sleep problems. Sleeping pills are usually benzodiazepines (tranquilisers), antihistamines or a class of drugs called Z drugs (e.g. zopiclone). There is no doubt that medication will help you sleep in the short-term, but their long-term use is setting you up for some big problems. Benzodiazepines are addictive, have a lot of side-effects and actually produce abnormal sleep cycles, so it’s easy to get into a vicious cycle of disordered sleep with their use. Sleeping medication tends to leave many people with daytime drowsiness.
5. Dealing with insomnia in the elderly
This is a normal aging effect, however underlying the problem can be a chronic pain condition such as arthritis; psychiatric problems such as anxiety or depression (which are also more common amongst the elderly); night urination; breathing problems and reflux/acid in the stomach. It is important that the underlying cause of insomnia is found and resolved, rather than simply relying on long-term use of sleeping medication. Sleeping medications in the elderly are associated with falls, accidents and hip fractures and should be avoided.
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