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According to the US National Sleep Foundation more than
50% of adults miss out on a good night's sleep.
Sleep complaints whether short-lived or chronic are especially
common in women and in older people.
An occasional bout of sleeplessness is usually nothing
to worry about. Jet lag, concern about a work problem or
a relationship, traumatic events such as the death of or
separation from a loved one, or discomfort from an injury
or illness can cause short-term sleep difficulties.
Chronic
sleeplessness is more complex and may require medical help.
When a sleep problem lasts for a month or more, we begin
to pay for it - in daytime drowsiness, trouble concentrating,
irritability, increased risk of falls and accidents, and
lower productivity. Long-term sleep loss can also cause
several physical and psychological conditions, including
high blood pressure, heart disease, stroke, depression,
and even sudden death.
How much sleep do we need? Some of us seem to do well
with five or six hours a night, while others may need 10
hours to feel their best. Research suggests that eight
hours is about right for most people.
Women's sleep troubles
Family and work stresses are the main reasons for tossing
and turning at night. But certain factors that affect sleep
are unique to women.
About one-third of women have difficulty sleeping at night
during their menstrual periods; about one in six says that
she sleeps poorly in the week before she menstruates. Discomfort
and changing hormone levels may also disrupt sleep during
pregnancy. Some women report that hot flashes disturb their
sleep before and at menopause.
Postmenopausal women sometimes develop sleep apnea, a
serious sleep disorder in which breathing periodically
stops or becomes shallow during the night.
As we grow older, we tend to get sleepy
earlier in the evening and wake up earlier in the morning,
apparently because of a change in the 24-hour (circadian)
body clock — a
phenomenon known as advanced sleep phase. This is why many
older people adopt an early-to-bed, early-to-rise pattern.
The amount of sleep we need does not
decrease with age, but the ability to sleep does. Healthy
older people sleep fewer hours and wake up more often
during the night (see "Stages
of sleep," below). Older people also get more light sleep
and less deep, restorative sleep. By age 45, so-called
deep sleep almost entirely disappears in most people.
Insomnia
Insomnia, the inability to fall asleep or stay asleep
enough to feel rested, is the most common sleep disorder.
More women have it than men, and it's more common in old
age than in youth. You may need help with insomnia if it
impairs your physical, social, occupational, or psychological
function.
Short-term insomnia caused by jet lag, a change in work
shift, or a stressful life event can lead to chronic sleep
problems. An individual may come to expect trouble going
to sleep and to associate the bedroom with not sleeping.
Consequently, the approach of bedtime provokes anxiety
and brooding over sleep loss, which further aggravates
insomnia.
Before seeking professional help, check your sleep environment
and change habits that might be thwarting a good night's
sleep. Here are some ideas.
- Make your bedroom a haven for sleep. Reserve
your bedroom for two purposes only: sleep and sex.
Don't watch television, read, or do crossword puzzles
in bed. Be sure the room is dark, quiet, and at a comfortable
temperature (cool is better than warm). A "white noise" maker
to mask extraneous sounds may help.
- Limit alcohol and
caffeine. Alcohol may make you sleepy, but the effect
wears off after a few hours, and then, you're likely
to waken more easily. Avoid drinking caffeinated beverages
from noon or mid-afternoon onward.
- Establish a regular
bedtime. Go to bed at the same time each night, and
get up at the same time every morning. Avoid napping.
- Wind down. Establish
relaxing bedtime rituals, such as a warm bath (if hot
flashes are not a problem for you) or a few minutes
of reading in a comfortable chair or on the couch.
Don't use this time to have potentially stressful conversations.
Although regular exercise can aid sleep, avoid vigorous
physical activity within three hours of bedtime.
- If you can't sleep,
leave the bedroom. If you're still awake after 20 minutes,
get up, and don't go back to bed until you feel sleepy.
These strategies won't work if your insomnia is caused
by depression, pain, sleep apnea, or anything else that
makes you too uncomfortable to sleep. Speak with your clinician
about treating any such underlying conditions. Insomnia
is also a side effect of many common medications, such
as certain antidepressants and antihypertensive agents,
bronchodilators, diuretics, and corticosteroids. Your physician
may be able to prescribe a different medication or dosing
schedule to treat your condition without interrupting your
sleep.
If lifestyle approaches don't help relieve insomnia, you
may want to talk to your clinician about sleep medications. Stages of sleep
Sleep occurs in cycles, which are divided
into four stages. Stage 1, the transition to light sleep,
takes about 5 minutes; body temperature drops and muscles
relax. Stage 2, the real beginning of sleep, lasts 35–40 minutes. At this time,
heart rate and breathing slow down. Stages 3 and 4 are "deep
sleep," when the sleeper is very hard to wake. Breathing
becomes regular; blood pressure falls; pulse rate slows;
and brain wave activity is very slow. Adequate deep sleep
is needed to wake up refreshed.
A normal sleep cycle lasts about 90 minutes. On average,
it takes at least four cycles to get a good night's rest.
Each begins with progressively deepening sleep and ends
in REM (rapid eye movement) sleep, when we dream most vividly.
The deepest non-REM sleep tends to occur in the early part
of the night. As we get older, we spend less time in deep
sleep. Snoring, sleep apnea, and sleep loss
About 8% of people who snore have a disorder known
as sleep apnea. In the young and middle-aged, sleep apnea
is much more common in men than in women, but after age
60, the sex ratio becomes nearly equal. About one in four
women over age 65 has the disorder.
During sleep apnea, breathing stops repeatedly for a few
seconds or longer every few minutes during the night. Age-related
changes in the breathing passages are one cause. The soft
palate gets longer, fat pads in the throat fill out, and
muscle tone decreases, making the airway less rigid. As
a result, airflow may become partially blocked. This is
obstructive sleep apnea, the most common type. Central
sleep apnea, which is much more rare, occurs when the brain
fails to send the proper messages to the respiratory muscles.
As carbon dioxide levels in the blood rise, the sleeper
snores or gasps (often loudly) to get more air.
Treating sleep apnea. Clinicians usually advise patients
to lose weight (if they're overweight), avoid alcohol and
sedatives, and try different sleeping positions. It may
help to avoid sleeping on your back. (Sewing a marble or
golf ball into the back of your pajamas will keep you from
rolling onto your back.) One very effective treatment for
sleep apnea is continuous positive airway pressure (CPAP),
which keeps the breathing passages open.
Another option is a mouth guard that keeps the airway open
by thrusting the jaw forward.
Restless legs
People with restless legs syndrome experience tingly,
creepy feelings in their legs when they lie down to rest
or sleep. The sensations can last for more than an hour
and seem to be relieved only by movement. Although mainly
a concern in the elderly - about 20% of people over age
80 have the syndrome - it also occurs in as many as 15%
of women in late pregnancy. In a related problem, periodic
limb movement disorder, the leg muscles contract involuntarily
hundreds of times throughout the night.
Treating restless legs. Some people get temporary relief
from warm baths, muscle relaxation exercises, cold or heat
packs, or massage. Avoiding caffeine and alcohol and getting
exercise may also help. More difficult cases may require
drug treatment with levodopa (Dopar, Larodopa, others),
combination carbidopa and levodopa (Sinemet), or other
drugs that increase dopaminergic transmission, such as
pramipelole (Mirapex) and pergolide (Permax). Although
these drugs are also used for Parkinson's disease, restless
legs syndrome is neither a form nor a precursor of Parkinson's
disease. Talk to your doctor before taking any medications
if you're pregnant.
Whether your problem is sleep apnea, restless legs, or
garden-variety insomnia, you can take measures to improve
your sleep, either on your own or with a clinician's help.
Realise that some changes in sleep are normal over the
years. But continued sleep deprivation can detract from
a healthy, active life.
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