Sleep Talking

Taken from the July/August 2013 issue of the Women's Health Activist Newsletter.

Sometimes it’s like this: At bedtime, I put my head on the pillow, exhausted, and am immediately wide awake, and I mean wide awake; or, it takes me an hour or more to fall asleep; or I fall asleep quickly but then wake up 1½ hours later, wide awake, and unable to fall asleep again; or, I go to sleep quickly, sleep deeply and then wake up at 4:00 am or so and can’t get back to sleep. Then, there are the nights I spend the whole night “sleep-surfing,” not really awake, but not sleeping deeply, either. All of these lead to days where I’m bleary and irritable.

I have been dealing with sleep problems for years, but they’ve only gotten worse as I age (I’m now 65). So, when the NWHN asked me to write an article about sleep problems in older women, I thought, great, maybe in the research I’ll learn something helpful. Unfortunately, dear readers, there’s not much information out there that I didn’t know or that I found particularly useful. But, here goes, because maybe some of this will be useful to you.

What Causes Insomnia?

The most common causes of insomnia are worry and depression (of course, the most common medications prescribed for depression, selective serotonin reuptake inhibitors [SSRIs] can cause insomnia). If you have any underlying medical or psychological problems, these should be dealt with first, which may end the insomnia. Many medications cause insomnia as a side effect, so check the medications you are taking, both prescription and over-the-counter (OTC). Insomnia may also be caused by a particular event, like the death of someone close, and then may resolve itself over time.

Some women experience insomnia during and after the menopausal transition when nighttime hot flashes cause us to wake up sweating, rip the covers off, fall asleep — and then wake minutes later, freezing. This scenario may repeat many times during the night, leaving us exhausted.

For people over age 60, insomnia is the most common medical problem and can lead to poor quality of life, accidents, falls, and illness. Sleep problems are reported more commonly in women than in men. According to the National Sleep Foundation, 28 percent of women report having problems with sleep, compared to 16 percent of men. And, insomnia is more common for people without a bed partner: 28 percent vs. 19 percent (do pets count as bed partners).i There is some evidence that older people spend more sleep time in the lighter stages of sleep, and therefore never really feel rested.

What Can You Do About It?

If serious conditions, like sleep apnea, chronic pain, or discomfort (like acid reflux) have been ruled out, try these recommendations for dealing with insomnia:

  • Don’t take your anxiety about not sleeping to bed with you. Try relaxation techniques or meditation at bedtime, or take a hot bath. Have a routine of reading or listening to music before bed. (I would avoid The Ramones or articles about Syria.)
  • Drink less in the evenings. This may help reduce waking up because you have to urinate (a problem I have).
  • Go to bed at the same time and get up at the same time each day. Avoid naps or take just a short daytime nap.
  • Exercise in the afternoon, not at night, at least three hours before bedtime.
  • Get some sunlight every day in the afternoon to help regulate your circadian rhythm.
  • Avoid OTCs that contain antihistamines, because they can make you sleepy without helping you get restorative sleep.
  • Avoid stimulants, like chocolate, at least three to four hours before bed
  • Avoid alcohol, which, like antihistamines, may make you sleepy, but is not conducive to staying asleep.
  • Have a light snack before going to bed. Carbohydrates make tryptophan (which promotes sleep) more available and proteins help create tryptophan, so a combination of protein and carbohydrates may help (i.e., cereal and milk, nut butter on toast, crackers and cheese).
  • Use your bed only for sleeping or sex.
  • Make sure your bedroom is the right temperature, neither too hot nor cold (is this the Goldilocks Effect?), and keep the room dark and quiet. A white noise machine may help.
  • If you can’t fall asleep in 20 minutes, get up and read or meditate for a while and then get back in bed.
  • Keep a sleep journal to record and identify problems and whether things you’ve tried are successful. (This is something I haven’t done yet, but plan to.)

OTC & Prescription Remedies

There are herbal remedies, OTC and prescription medications that are supposed to help you sleep. Personally, I’ve tried all of the herbs from my local health food store and haven’t found any of them to be helpful, but maybe your experience will be different.

Some of the websites I visited mentioned that melatonin levels may decrease with age and that taking melatonin before bed may help with sleep. But, the National Institute of Health (NIH) reported a five-year study that showed no difference in age-related melatonin levels for either men and women, although this study excluded anyone with health problems or who suffered from insomnia, which seems like a serious problem with the study design.ii Melatonin is not recommended for use by pregnant and nursing women or people who take certain medications, including birth control and herbal supplements. Side effects can be unpleasant: depression might worsen, grogginess, dizziness, and stomach cramps. If you want to try melatonin, check for contraindications on the National Library of Medicine site (see below under Resources).

The most commonly used prescription medication for insomnia is zolpidem (Ambien and others). This is my drug of choice. Some people experience bad side effects, including drowsiness, sleep walking, driving, and engaging in bad behavior when the sufferer thinks she is sleeping. Be aware that, this January, the Food and Drug Administration recommended that women, who take longer to metabolize this drug, should cut the dosage for both the regular and the controlled release in half to avoid grogginess that leads to driving impairment. Zolpidem is habit-forming.

At the end of this I can’t help asking: since insomnia is the most common problem in people over 60, why are there so few studies on effective treatments? Since it affects women in greater numbers than men, why aren’t there more studies on hormonal changes and insomnia, and how to cope? Those of us who suffer from insomnia need effective, safe treatments. Until more information is available, though, I’ll have to continue doing what I do when I can’t fall sleep: breaking a 5 mg zolpidem in half and, when I wake at 4:00 am, unhappily listening to the birds.


Resources


Laura Kaplan authored The Story of Jane, and is an activist for women’s health, reproductive justice, and domestic violence. She served on the NWHN’s Board of Directors for 8 years and co-founded Woodstock Immigrant Support. Now retired, Laura continues her activism through volunteering.

Read more from Laura Kaplan.


The continued availability of external resources is outside of the NWHN’s control. If the link you are looking for is broken, contact us at nwhn@nwhn.org to request more current citation information.


References

i. National Sleep Foundation, What Makes A Good Night’s Sleep, Arlington, VA: National Sleep Foundation. Available at: http://www.sleepfoundation.org/what-makes-good-nights-sleep

ii. National Institute for Aging, (NIA) Press Office, Study Casts Doubt That Melatonin Goes Down as Age Goes Up, Bethesda MD: NIA, November 5, 1999; about: Zeitzer, JM, Daniels JE, Duffy JF, et al., “Do Plasma Melatonin Concentrations Decline with Age?” American Journal of Medicine 1999; 107(5): 422-436.