Get some sleep

Sometimes I think I’m nothing but a leaky bucket. I’m up every couple of hours all night long. By about 4 am, my body gets fed up with all those interruptions, and won’t go back to sleep any more. So then the next day I’m a zombie, walking around in a daze, can’t get anything done. And the next night it’s the same thing all over again.

You too? We’re not alone. Over 50% of seniors have insomnia. There are plenty of possible reasons: medical or psychiatric disorders, chronic pain, medications, frequent urination at night, bereavement, financial problems, sedentary lifestyle, too much napping, and on and on. If you ask Dr Google, you’ll get lots of contradictory scientific-sounding advice, folk remedies, ads and testimonials. So I decided to search the medical literature, to see which insomnia therapies have actual hard evidence behind them.

Here’s a selective summary of what I found. I’ve included only actions you can take yourself at home, for free. Of course, you can also enroll in a sleep therapy program, but you have to pay for that. You should see your doctor to rule out or control medical conditions that might be affecting your sleep. If that results in a prescription, make sure you’ve discussed all the possible side effects and interactions with your other medications. You don’t want anything that will make you groggy in the daytime and liable to fall. It’s the same issue with over-the-counter remedies, with the added hazard that Health Canada maintains very lax standards and provides virtually no oversight over this industry. So you never know what you’re actually getting; producers can lie with impunity on their labels.

Pick whatever you want from these categories. Apparently you get better results if you use approaches from more than one category.

Stimulus control

• The goal is to associate your bed only with sleep (well, and maybe one other thing)
• Don’t watch TV, talk on the phone, listen to the radio, check your messages, read or eat in bed
• Go to bed only when you feel sleepy
• If you can’t fall asleep after 20 minutes, leave the bedroom and engage in relaxing activities like reading on the couch until you feel drowsy, then return to bed

Sleep hygiene

• The goal is to practise healthy behaviours that promote good sleep
• Exercise regularly, but not within four hours of bedtime
• Avoid tobacco, stimulants, caffeine and alcohol six hours before bedtime
• Avoid excessive liquids and heavy meals three hours before bedtime
• If you have to take naps, limit them to 30 minutes or less, before 3 pm
• Get up at the same time each morning
• Make sure that the bedroom is dark and quiet, and that the temperature is comfortable
• Increase your exposure to natural light and bright light during the day and early evening
• Don’t watch the clock

Relaxation

• The goal is to counteract stressors that interfere with sleep
• Practise progressive muscle relaxation in bed
• Avoid unpleasant or strenuous tasks right before bedtime
• Don’t watch TV or use a computer near the time you want to fall asleep
• Avoid strong or negative stimuli like computer games or horror movies near bedtime
• If you have a smartphone, turn it off at night and don’t keep it in the bedroom
• Schedule time to wind down before bed. Give yourself at least 15 – 30 minutes. Try meditation, deep abdominal breathing, yoga, crossword puzzles or a warm bath. Write down your thoughts in a journal

Sleep restriction

• The goal is to improve sleep efficiency through mild sleep deprivation
• Figure out how much time you actually spend sleeping
• Limit the amount of time you spend in bed to the number of hours you spend sleeping, but it shouldn’t be less than five hours. If you’re not sure, pick six hours
• Spend only that number of hours in bed. Adjust your bedtime, but still get up at the same time each morning
• If you are wide awake during this time, get out of bed and carry out a quiet activity like reading outside the bedroom. Go back to bed only when you feel drowsy
• Keep to this schedule for two to four weeks
• After you reach 85% sleep efficiency, increase sleep time by 15 minutes each week until you obtain seven to nine hours of sleep per night