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Rest in Peace

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For at least the past 10-15 years, Mary has had trouble sleeping at night. Always a light sleeper, even in her early 40s, she’s more likely to be tuning in to some movie classic at 3 a.m. than enjoying restorative, uninterrupted rest.

Now 81, the Main Liner (who prefers not to use her real name) has tried a litany of remedies over the years, to no avail. She has a good bedtime ritual, designed to quiet her mind and body. She has a comfortable bed and an electric blanket for those bitter February nights. And when she needs it—which is most nights—she has medication designed to help her find that golden slumber, or at least slow her down a bit.

But it doesn’t always work. In fact, talk to Mary most days, and she’ll answer the question “How did you sleep?” with: “Like I always do, in fits and starts.”

Mary is resigned to the fact that a full seven-hour block of sleep, during which her body cycles through all the stages of prolonged rest, is something for others. And she’s not alone. As we age, it becomes harder to fall asleep—and extremely difficult to stay that way. A variety of causes exists to explain this. Thankfully, a collection of remedies and therapies are out there to help.

“Sleep medicine is coming into its own,” says Dr. Helena Schotland, medical director of Bryn Mawr Hospital’s Sleep Medicine Services. “There are now real sleep fellowships doctors can do. The area is getting a lot of attention. Because of the health effects of sleep disorders, we are paying more attention to it.”

As you can imagine, the medical community has been researching sleep apnea and other disorders—particularly how they relate to aging—for quite a while. A long-term study by the department of psychiatry and psychology at the University of Pittsburgh School of Medicine found that sleep deprivation could lead to an earlier death. Mary Amanda Dew, who administered the study, reported that a low percentage of REM (rapid eye movement) sleep, which is vital to memory consolidation, puts older people at risk. You may not consider yourself old, but reversing bad sleep habits and managing the ability to get rest within a framework of existing medical conditions—apnea, hypertension, etc.—are vital to long-term health, no matter how young a person is when the trouble starts.

Most therapists recommend that their patients begin with what they call “sleep hygiene.” This has less to do with making sure your hands and face are washed before bed than it does with the process that leads you there. “If you have a routine that you use that gets you a good night of sleep, nobody can knock it,” Schotland says. “In a way, we’re like kids who take a bath and read a book. We need structure. When structure changes, sleep suffers.”

So the first thing to do if you’re having trouble is to review your bedtime routine. It sounds juvenile, but it’s vital. Schotland recommends ending activities that can keep your mind and body active well before your head hits the pillow. “You need a little downtime,” she says.

Read some, or take your time getting things ready for the next day. Make a to-do list; lay out your clothes—anything that signals to you that it’s time to shut it down and sleep.

Don’t smoke before going to bed, because nicotine is a stimulant. And for that matter, so are caffeinated drinks. Alcohol doesn’t help, either. It may be a depressant and make you tired, but in the long run, it will interrupt your sleep.
 

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Schotland recommends going to sleep at the same time every night, “give or take one hour.” And only go to bed when you are sleepy. She’s also very particular about a bed’s uses. There are two: sleeping and sex. “Nothing else,” she says. “You don’t watch TV in bed or pay bills or any kind of multitasking.”

Once in bed, it’s important to adhere to some strict rules. First, no clocks. Looking at the time every 10-15 minutes and panicking about how much sleep you’re not getting is counterproductive. If you don’t fall asleep right away, get up and do something relaxing. Watch a little TV (not in bed) or read.

Dr. Allan Pack, director of the Center for Sleep and Respiratory Neuro-biology at the University of Pennsylvania, believes sleep hygiene is important, but he understands that it isn’t always the answer. For some, he recommends waiting until 2 or even 3 a.m. before turning in. That way, the person is exhausted and will absolutely sleep. “There is real pressure on the body to sleep then,” he says.

People who go to bed that late consolidate their sleep into one chunk. Sure, it may only be four hours at the start, but it’s reliable and uninterrupted.

From there, Pack recommends that his patients back up their bed times a half-hour per week. By going to bed earlier gradually, Pack believes the periods of consistent sleep will increase naturally.

“If you consolidate your sleep, you break a vicious cycle,” he says. “If you’re going to bed anxious, you won’t sleep.”

Such methods can work, but often those who have trouble sleeping are fighting bigger problems. Chronic pain, restless leg syndrome, an enlarged prostate, sleep apnea and medications taken for other conditions can make it difficult to get good sleep.

It’s important for sleep therapists to work with patients’ primary-care physicians to find out what medications are in play and how making some changes could improve sleep without compromising care. In some cases, surgical options exist, such as repairing throat abnormalities that can cause sleep apnea, which not only robs a person of needed slumber but also can lead to heart disease, diabetes and increased risk of serious car crashes due to drowsiness. Surgery is an option, but so are some behavioral modifications like weight loss and smoking cessation.

Schotland believes that cognitive therapy is also important. This process, accomplished under the care of a psychologist, helps patients deal with life issues that can have an affect on sleep. “Cognitive therapy can help them relax,” she says.

One of the more popular solutions—at least among those looking for a quick fix—is medication. Ads for sedatives like Lunesta and Ambien make the products seem like cure-alls: Take them and sleep. Pack allows patients using sleep medications to continue to do so, but he prescribes them in a cycle. To him, it’s better to address the physical and psychological causes of sleep deprivation, rather than just going for the knockout punch.

Schotland recommends sleep medications to some patients—but carefully. “They can be effective, but they can be crutches,” she says. “Some can’t tolerate them [because of side effects]. Some can have problems with dependence. For some, they don’t work after a while.”

There is no set approach for everyone. For some, it’s about hygiene. Others need to modify behaviors or medications they’re taking. Cognitive therapy is successful for others, while more radical measures may be required for those with serious conditions. In the end, it’s important to investigate what’s available and commit to a program that works. “I like to attack the problem a couple different ways and see what makes it crack,” Schotland says.

And hopefully, it’s enough to bring back those sweet dreams.
 

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Understanding OSA

Obstructive sleep apnea (OSA) is caused by excess tissue in the upper airway that collapses and blocks the airflow to the lungs. Those at the greatest risk for OSA are men (women’s risk increases after menopause) who are obese and have a neck size greater than 17 inches. Symptoms include fatigue, early-morning headaches, snoring, falling asleep during the day, depression and irregular breathing while sleeping.

OSA is most commonly treated with a special mask worn at night that provides increased pressure to the inside of the airway, keeping it open and allowing air to pass freely into the lungs. Other treatments include weight loss, special devices worn in the mouth, and surgery to the upper airway.

Source: Penn Sleep Centers

Sleep Soundly: 5 Things to Remember

1. End activities well before your head hits the pillow.
2. Don’t smoke before you sleep.
3. No caffeinated drinks or alcohol before bed.
4. Go to sleep at the same time every night.
5. Bed is for two things only: sleep and sex.

Source: Dr. Helena Schotland

 

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