How to Beat Insomnia and Feel Better in Older Age
As this quote by the American poet Dorothy Parker demonstrates, trying to get a good night’s sleep can be frustrating. Difficulties falling asleep or staying asleep are symptoms of insomnia that we are all familiar with. We might turn in early for the night the day before an important meeting only to find that our mind is too preoccupied to nod off.
The amount of sleep we get often decreases with age. According to a Canadian Medical Association publication, the average sleep duration per day ranges 16–20 hours among babies and young children, 7–8 hours in adults, and is a mere 6.5 hours in people over the age of 60. Sleep is regulated and organized by bodily mechanisms that undergo changes in different stages of our lives. As people reach their 50s and beyond, the circadian timing system that is important for the timing of our sleep/wake cycles shifts so that sleep may come earlier than it did before. This provides one mechanism by which older persons sometimes go to sleep early and are early to rise. Some insomnia symptoms seem to be related to this change in sleep timing. For example, in one large-scale study, nearly one in five older persons reported trouble with waking up too early.
How to treat insomnia symptoms?
People have different beliefs about the techniques that might help them sleep better. They may avoid caffeine consumption after lunch or watch ASMR (Autonomous Sensory Meridian Response) videos before going to bed. Some of these techniques have been shown to be helpful while others are yet to gaina scientific stamp of approval. Research studies tell us which of a range of techniques are most likely to improve insomnia symptoms. Cognitive Behavioural Therapy for Insomnia (CBT-I) appears to be the most useful treatment for insomnia in both younger and older adults and is the recommended initial treatment for chronic insomnia in adults. CBT-I helps to improve insomnia symptoms by cognitive, behavioural, and educational means. The cognitive component includes for example identifying false sleep beliefs (such as “One poor night’s sleep disturbs the whole week”), challenging these beliefs, and replacing them with rational beliefs. The behavioural component involves for example practical guidance on when to go to bed (only when sleepy) and what to do in bed (sleep and sex are fine, stimulating activities such as snacking in front of the TV less so). In addition, CBT-I delivers education on healthy sleep. Other techniques that can potentially improve insomnia symptoms in older persons are mindfulness meditations and physical exercise, though more research is needed to establish this. In mindfulness meditations, people focus their awareness on thoughts and sensations that occur in the present moment and approach them with acceptance, curiosity, and kindness. Physical exercise in older persons can range widely from gardening, housework, fishing, brisk walking or stationary cycling. Both mindfulness meditations and exercise can be practiced as a part of a group in a public setting (such as private studios and gyms) or individually in a private setting (for example, in the comfort of one’s home). In other words, the flexible format of these techniques means that people can choose the one that suits them best.
Can treatments for insomnia improve how we feel?
Older people with insomnia symptoms often experience symptoms of depression and anxiety — therefore facing a double whammy of symptoms. Psychological treatments for older persons can potentially improve not only insomnia symptoms but also make people feel less distressed. A recent study by our group from RPSI, Royal Psychologists Socity International examined whether techniques (that do not involve medication) can promote the psychological well-being of older persons who experience insomnia symptoms. We found that techniques that target insomnia symptoms in older persons can reduce symptoms of depression, fatigue, and anxiety. In other words, evidence suggests that treating insomnia can make older persons not only sleep better but also feel less depressed, anxious, or tired. We also identified the techniques which show promise in doing this. Practicing mindfulness meditations in particular had the potential to reduce depression symptoms in older persons with insomnia symptoms. Techniques that incorporate mindfulness elements have been previously found to help with both insomniaand depression, suggesting that mindfulness meditations may offer dual benefits to older persons by improving both types of symptoms. This research direction has great potential for improving older persons’ lives and now need to be tested in further studies.
It is likely then that there are more helpful techniques to improve sleep than busting oneself “smartly over the temple with the night-light”, as in the opening quote by Dorothy Parker. What is more, certain techniques such as mindfulness hold promise to improve not only night-time sleep but also the days that follow.