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Three out of four older adults (77%) rate the quality of their
sleep as excellent, very good, or good, according to a National
Sleep Foundation poll.
•
A slightly greater proportion of 65-84 year-olds (79%) rate the
quality of their sleep as excellent, very good, or good,
compared to 55-64 year-olds (73%).
•
At the same time, a significant proportion of older adults rate
their sleep as fair to poor with 55-64 year-olds (26%) more
likely to rate the quality of their sleep this way than 65-84
year-olds (21%). |
Insomnia Patients Being Taught How to Sleep
June 2, 2005 – Insomnia drugs have been much in the
news recently but Baby Boomers and Senior Citizens who have trouble
sleeping - about half - may want to try another approach being used by
doctors at the University of Michigan Behavioral Sleep Medicine Program.
They are teaching people how to sleep.
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Sleep Problems for Older People Often Caused by Aging Ailments |
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24% of those ages 65-84 have been diagnosed with
four or more medical conditions. Of this group, 80% reported
having a sleep problem
As we age, there is an increased incidence
of medical problems, which are often chronic. In general, people
with poor health or chronic medical conditions have more sleep
problems. For example:
Hypertension is associated with both snoring
and sleep apnea - both increasing as we age.
Heart failure affects approximately 5
million Americans and as many as 40% of people with heart
failure also have sleep apnea.
Menopause, with its accompanying hot
flashes, changes in breathing and decreasing hormonal levels can
lead to many restless nights. (See
Menopause)
Recent studies indicate that up to 50% of
cancer patients experience sleep problems.
GERD (gastroesophageal reflux disease)
causes difficulty both falling and staying asleep. Of heartburn
sufferers, about 80% experience nighttime heartburn, causing
discomfort and awakenings. This is more likely to occur while in
the prone (on your back) position.
(See GERD)
Sleep patterns among people with dementia
are typically fragmented and this fragmentation increases as
dementia worsens. Sleep-disordered breathing also occurs more
frequently in those with Alzheimer's disease. Those with
Parkinson's disease are more likely to have RLS symptoms.
Depression is most closely associated with
insomnia; depression is a risk factor for having difficulty
sleeping while poor sleep also contributes to depression. This
is especially true for those who have chronic insomnia. It is
estimated that 50% of people with depression have some type of
sleep impairment.
The pain and discomfort of arthritis, and
other musculoskeletal conditions such as back pain, make it
difficult to sleep through the night.
Other conditions such as diabetes mellitus,
renal failure, respiratory diseases such as asthma, and immune
disorders are all associated with sleep problems and disorders.
Medications for chronic medical conditions
and the interactions that can occur when someone takes multiple
medications for several illnesses can adversely affect sleep.
- National Sleep
Foundation |
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A recent poll by the National Science Foundation
found that only 50 percent of Americans get a good night’s sleep a few
nights each week. According to the 2003 National Sleep Foundation’s
Sleep in America poll, 44% of older persons experience one or more of
the nighttime symptoms of insomnia at least a few nights per week. The
NSF defines older people as those between the ages of 55 and 84.
When interruptions to sleep become a chronic
problem, doctors at the University of Michigan, offer patients a
multidisciplinary approach to treating insomnia that teaches them how to
sleep.
Jane Heibel, 44, began having problems sleeping
about three years ago.
“On and off, I’d have terrible nights of insomnia
where I would fall asleep easily enough, but then I would wake up on and
off and maybe get three hours of sleep the entire night,” she says.
“I would come to work in the morning so tired that
I was nauseated and I could barely function. I felt like my work was
suffering. I was short with people. I would have to look things over
twice or three times and I’d find mistakes. It just wasn’t efficient.”
When Heibel’s lack of sleep began to interfere with
her daily activities, she went to J. Todd Arnedt, Ph.D., director of the
Behavioral Sleep Medicine Program, for treatment.
Insomnia, the most common sleep disorder, affects
40 percent of women and 30 percent of men. It is characterized by
difficulty falling asleep or staying asleep, waking early with the
inability to fall back asleep, or just waking up feeling tired and
un-rested from poor quality of sleep.
“About 33 percent of individuals suffer from some
form of insomnia on an occasional basis at some point in their lives. We
estimate that 10 percent to 15 percent are actually chronic sufferers,
which we define as three or more nights per week for six months or
more,” Arnedt says.
Heibel’s treatment
Part of learning how to get a good night’s sleep is
understanding how environmental factors affect your ability to sleep.
“Medications are the first line of defense against
sleep problems. But when insomnia becomes a chronic problem, there are
inevitably patterns of thinking and behaviors that contribute to the
ongoing problem that medications cannot address,” Arnedt says.
“One of the first things Dr. Arnedt talked to me
about was my routine,” Heibel says. “I would generally go up to bed
pretty early but I would bring my checkbook, taxes, a book to read,
whatever it was that I was working on, even my telephone, so I could
make calls. I was turning my bedroom into a little office. I learned
that was an absolute ‘no-no,’” she says.
The Behavioral Sleep Medicine Program uses a
three-pronged approach to treatment, which includes using cognitive and
behavioral therapy techniques and education. Treatment takes place in an
office setting, over four to eight sessions. Each session lasts from 40
to 60 minutes. The treatment takes anywhere from four to six months to
complete.
“Experts in psychological, behavioral and medical
aspects of sleep problems provide a thorough evaluation to determine
each individual’s sleep issues and the factors that contribute to
triggering their sleep problems,” Arnedt says.
Key to the program’s approach is targeting poor
sleep habits and maladaptive behaviors that have developed over time and
perpetuate insomnia; targeting patterns of thinking that can lead to
frustration and worry about one’s sleep; and teaching individuals new
behavioral strategies.
“In some instances, we are re-teaching people how
to sleep properly by helping to reshape their maladaptive behaviors and
to implement more consistent good sleep practices,” Arnedt says.
“We teach people specific behavioral strategies to help them sleep, and
how to address the cognitive issues that arise in people who have
repeated bad nights of sleep.”
When people repeatedly have difficulty sleeping,
they naturally fall into certain patterns of thinking, like worrying if
they are going to fall asleep, becoming anxious about their sleep, and
even becoming depressed about their sleep, which may perpetuate the
problem. Arnedt calls this anticipatory anxiety.
“Research shows that these cognitive behavioral
therapies provide improvement in 70 percent to 80 percent of patients,”
Arnedt says.
“I don’t bring my work to bed with me anymore. The
treatment taught me to separate the place I sleep from everything else.
I sleep much better now – it’s like night and day,” Heibel says. “The
best thing about the treatment was that it wasn’t a big investment. I
took the handouts and information I learned from my visits and started
applying what I learned.”
Tips for getting a good night’s sleep
Arnedt suggests following the Principles of Sleep
Hygiene:
> Go to bed and get up at the
same time each day, even on the weekends
> Avoid daytime naps or limit them to one
mid-afternoon nap
> Avoid drinking alcohol in the evenings
> Avoid caffeinated drinks late in the day
> Eliminate tobacco use, especially at night or in
the evening
> Exercise regularly during the day, but avoid
evening exercise
> Use the bedroom only for sleep or sex; avoid
school work, business affairs, TV, exercise, or other activities that
could teach you to associate your bedroom with these experiences
> Keep the bedroom dark, quiet and comfortable
> Avoid stress and worrisome thoughts in the evening
before sleep by establishing a regular bedtime routine to help signal
your mind that the time to relax and sleep is approaching
In addition, people who have trouble sleeping
should relax 30 to 45 minutes before bedtime by engaging in quiet
activities such as reading or watching TV, as long as the content of
those activities is not over-stimulating. The bedtime wind down should
be done in a relatively dim-lit environment, because light is the
strongest cue for the brain. If there is too much light, you will want
to stay awake.
If you find yourself lying in bed, wide-awake,
Arnedt also suggests getting up and moving around or engaging in some
other activity until you feel tired before returning to bed. In
addition, you should block out the light and noise from your bedroom to
minimize disruptions once you have fallen asleep.
Risk factors for insomnia
Research has shown that there are several risk
factors for developing insomnia, including:
> Gender: Women tend to have more insomnia-like
problems than men
> Age: Older individuals tend to suffer more, but it
is not clear whether this is due to their age or relative inability to
sleep due to medical conditions or medications
> Chronic medical conditions
> Psychiatric disorders, such as anxiety and
depression
In particular, Arnedt says that people who are
physiologically hyper-aroused, and especially people who have irregular
sleep schedules, are prone to develop sleep problems.
“This program is for people who have chronic sleep
problems, are tired of being frustrated about their sleep and wish to
gain a sense of mastery and control over their sleep. While the program
takes time, the good news is that it really works,” Arnedt says.
For more information on insomnia and the treatment
of related disorders, visit
U-M Health Topics A-Z: Insomnia
http://www.med.umich.edu/1libr/aha/aha_insomnia_crs.htm
U-M Health System Sleep Disorders Center
http://www.med.umich.edu/neuro/sleeplab/index.htm
UMHS News release: Does the Sleeping Brain ‘wake
up’ …
http://www.med.umich.edu/opm/newspage/2004/sleep.htm
National Institutes of Health Brain basics:
Understanding sleep
http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
familydoctor.org: Insomnia: How to get a good
night’s sleep
http://familydoctor.org/110.xml
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