Wake up to the value of a good sleep

Craig Skelton, 67, says he is lucky to get four hours good sleep a night and always feels sluggish and bad-tempered when he wakes up. He finds himself falling asleep when he sits down in the daytime and nearly always has a nap in his chair in front of the TV early in the evening.

He is sadly typical of many people in the over 60s demographic.

The problem of getting a good night’s sleep is not to be dismissed lightly because a whopping 50 per cent of people over 55 complain that it is a contributing factor to their diminished health and thus adversely affects their quality of life.

Medical experts agree with them, and thus chronic sleeplessness is now recognised as a major issue.

There is no shortage of advice on sleep problems, not just on the internet but in books especially written on the subject, but much of it is trite, telling us what we already know.

Craig Skelton says he leads a healthy life and is careful about his diet. He tries not to eat food with high acid or saturated fat content.  He walks every day and plays tennis twice a week.  He rarely drinks alcohol and prefers tea (three or four cups a day) to coffee.

He has his main meal in the evening and says it’s substantial because he has a good appetite.

Because he finds it difficult to get to sleep and usually only does so for a couple of hours before waking again, he usually gets up and has a hot drink and a snack around midnight.  “And then I lie awake for hours, or watch TV, before dozing a bit before getting up at about 8.30am.”

Some causes of sleeplessness in older people are obvious: pain caused by arthritis or other inflammatory conditions, medications that cause wakefulness, frequent urination, restless leg syndrome and sleep apnoea.

All of these can be treated medically but most drugs become ineffective after a while or cause undesirable side effects that affect quality of life.

In an extreme example, a drug that controls the levels of dopamine in the brain has also been known to cause impulse control disorders – one patient suddenly developed a gambling habit and lost his home before his doctors realised what had caused this disastrous change in behaviour.

Ask any group of older folk what most disturbs their sleep and, even if they don’t suffer from any of the foregoing problems, they will answer “anxiety”.

Anxiety is experienced by younger people too, but usually the cause is particular and readily identifiable, while as we age, we often suffer from a nameless anxiety, closely linked to its nasty cousin, depression.

One woman interviewed (name withheld on request) says that in the last few years she wakes at night worrying about things that seem unimportant in the morning. Or worrying about nothing that she could name.

“This went on so long it was affecting my heart,” she says. “I’d had my share of grief and loss, which happens to us all at this age, but I thought I was handling it well and had no idea I was clinically depressed until it was diagnosed.”

As she points out, old age is tough and we have a lot to be anxious about.

“Our children, grandchildren, partner if we still have one, our health, not having enough money, being alone, the fear of becoming helpless and dependent, dying” … she has jotted all these worries and more in a notebook to show the psychiatrist who is trying to treat her underlying depression.

Every source consulted for this article agrees that chronic sleeplessness, whatever the cause, can only be effectively treated by a sleep specialist and today there are many of these available.

One of them, Australian psychologist and author Olivia Arezzolo, has devoted her career to it and uses a range of treatments, including behavioural and psychological strategies.

“As we get older, sleep-promoting hormones decline in the body,” she says.

“Those hormones include melatonin, the hormone that causes us to feel sleepy, as well as testosterone, progesterone and estrogen. Their decline compromises the quality of our sleep, making it harder to get enough deep sleep – the sleep stage that promotes mental and physical restoration.

“That’s the reason why even if you spend the same number of hours in bed as you did in your 20s or 30s, you’re probably not going to wake up feeling as well-rested.”

Another factor, Arezzolo says, is that as we age our brains can build up a neurotoxin called beta-amyloid, which interferes with sleep and affects our brain health.

The less we sleep, the more beta-amyloid builds up, and the more beta-amyloid we have in our brain, the harder it becomes to sleep – it’s a vicious cycle.

Every older person, it seems, has a theory about how to deal with this all-too-common problem. Some swear by natural remedies such as a hot milky drink or chamomile tea before bed.  Others recommend meditation. Soothing music is a common prescription.

There are apps, now, created to help us sleep.

But none of these remedies have proved to be totally effective for those who lie awake night after night, tortured by the inability to switch their brains over to sleep mode.

Much research today focuses on the changes in “sleep architecture” that particularly affect us as we age. Our sleep patterns shift, and we tend to experience a decrease in deep, or “slow wave” sleep and an increase in lighter sleep stages, thus fragmenting our sleep pattern and making us feel less rested on waking.

This has a lot to do with the alteration to our circadian rhythms which are a sort of body-clock that regulates the sleep-wake cycle.  If you fall asleep in front of the TV early in the evening and then can’t get to sleep later, or wake too early, it’s an age thing!

As yet, there is no one-size-fits-all prescription for good sleep.

People develop very different sleeping patterns during their lives, due mostly to childhood training and lifestyle.  Some describe themselves as morning people, others as night-owls. And that can be a problem for us as we age. We may be locked into a pattern that is no longer working for us, in which case a lifestyle change is indicated.

Research being undertaken by major health organisations such as the Mayo Clinic in the US and the Australian Sleep Health Foundation tells us that whatever our particular problems, it’s of paramount importance to develop good habits.

Keeping regular hours is important.  Go to bed and get up at the same time each day. Don’t try and sleep in if you’ve had a bad night but try and take a nap in the middle of the day (but not in the evening). The best sleep pattern is said to be from 10pm until 6am.

Exercise during the day, every day, so that your body is tired and needing rest.

Meditation before bed might calm you down but even if this is not for you, watch or read something relaxing and not too stimulating.  Or disturbing.  Many people read themselves to sleep but the use of backlit digital “blue light” screens such as iPads can cause sleep disruption.

Don’t eat for at least three hours before going to bed; acid reflux is one of the most common disturbers of good sleep.  A warm, non-stimulating drink will soothe your nerves and provide nourishment during the night.

Taking a bath or shower just before going to bed is relaxing.

Make sure you have a comfortable, quiet sleep environment with as little light as possible (darkness stimulates the release of melatonin in the brain).

Sleep on your left side; this is the natural position of the stomach and helps coordinate your digestive system while lying down.

Sleep alone.  This may be controversial, but research shows that many people find deep, continuous sleep difficult because their partners, rather than themselves, have developed problems – excessive snoring, sleep apnoea, restless leg syndrome and other health issues that impact on the sleeping comfort of both.

One woman expressed this problem in typical terms: “My husband and I shared a bed for half a century, but he now has a couple of health conditions that mean he is very restless in bed, getting up several times and wanting to put the light on to read.  I am his carer, so I need my sleep and have had to move into the spare bedroom or I’ll go mad.”

Routine becomes very important as we age and that is particularly true of good sleeping habits.  We need to “tell” our brains that this is when and how we do certain things and the brain responds by remembering.

If you are in the habit of going to sleep at 10pm and waking at 6am your brain will record it and stick to that pattern.  How many times have you woken in the night and known exactly what the time is, or set an alarm clock and found yourself awake just before it rings?

Sleep is a mysterious thing, and we still have much to learn about how it works and why.

What we do know is that every sentient creature on Earth needs sleep because it has a profound effect on our health and wellbeing.  That’s why we wish people a “good night”!