Sleep saboteurs - Why can’t I sleep?

There’s a reason pre-menopause and menopause age is called the ‘perfect storm’ when it comes to sleep loss for many women. Hormonal changes, mid-life weight gain, anxiety, stress, restless legs, changes in mood – all these factors can influence the ability to fall asleep, and stay asleep.

"By mid-life, women face a culmination of issues that affect sleep," says Sacramento sleep expert Lydia Wytrzes, neurologist and director of Sutter Sleep Disorders Center. “The key is to identify which of those factors are at play and then methodically work to address them.”

While researchers still don’t fully understand why getting proper sleep is so important, what they do know is that constant interruption in the natural sleep cycle, such as waking up several times a night means some older adults get less deep, restorative REM (expand brackets) sleep.

This can be just as damaging as other health issues, with numerous studies linking poor sleep to a growing list of diseases.

“Lack of sleep ages us by affecting the weakest part of our genes,” says Henry Osiecki, clinical nutritionist and co-author of Sleep, Health and Consciousness: A Physician’s Guide.

So why is it happening and what can we do? We investigate the reasons and what you can do to fix it.

Sleep patterns do change as we get older

The efficiency of the brain in carrying out sleep related duties begins to decline over time – just like other normal body functions.

It usually begins in our 40s, but we may not realize it until 50 or 60 that there’s a problem. In fact, sleep problems is one of the second biggest complaint GPs hear. “It’s a perennial problem,” says Dr Ginni Mansberg, Women's Health health expert and GP.

Although it's generally believed that older adults should get just as much sleep as younger adults, a 2008 study suggests that we actually may not need as much sleep as we get older.

When researchers asked participants to stay in bed for 16 hours a day, those aged 60 to 72 slept only 7.5 hours on average, compared to the participants aged 18 to 32, who slept an average of 9. The study authors suggest that seniors who report having insomnia may actually not need the sleep they're missing.

So if you are falling asleep at 8pm on the couch then wide-awake at 4am, melatonin – or the lack of – may be to blame. As we get older our brains produces less melatonin, meaning sleep patters will naturally shift to earlier in the day.

WHAT YOU CAN DO: Instead of forcing your body to adhere to your old patterns, it might be time for a change, such as avoiding napping in the afternoon.

Hormones

Rapid hormone fluctuations can begin as early as late 30s – long before signs of hot flashes and night sweats. But once those night sweats do kick in, it’s a sure recipe for sleep loss.

“Ten years ago, you’d be hard pressed to find research on menopause and sleep,” says Dr. Wytrzes. “Today, we’ve learned that estrogen loss indeed affects sleep. People are taking this seriously and looking for ways to solve the problem.”

WHAT YOU CAN DO: Talk to your doctor about possible supplements or other therapies to help you cope with menopause.

Bladder problems

Find yourself running to the toilet several times a night as you reach middle age? As estrogen declines, the tissues of the bladder begin to thin, leaving them more sensitive to any type of irritation. That's why so many midlife women suffer from overactive bladder, either having to go all the time or having to go suddenly without warning. Lack of estrogen also can cause the pelvic muscles to weaken, resulting in poor bladder control.
WHAT YOU CAN DO:
Cut out irritants like caffeine chocolate citrus, alcohol and spicy foods at least four hours before bed, and don’t drink liquids for several hours. Kegal exercises will also strengthen the bladder muscles. (if you don’t know how to do these, your doctor can refer you to a physical therapist)
Changes in mood

If you find yourself feeling down and it’s affecting your sleep, then menopause may also be to blame – especially if you’ve had a history of stress and anxiety.

“It’s not that women are depressed about menopause,” says Wytrzes. “But this tends to be a time where these issues can re-emerge.”

WHAT YOU CAN DO: Talk to you doctor if you’re feeling stressed, anxious or have mood fluctuations, or if you have changes in mood that concern you.

Lifestyle and stress

We need about eight hours of sleep a night to function, so if your busy lifestyle is holding you back from that, you’ll pay the consequences.

“Think of sleep as a bank account - you need to withdraw between seven and eight hours' worth a night to cover you," says Dr Mansberg. "Making a couple of excess withdrawals here and there is fine - it's not what you do on one night that makes you tired, but a pattern over time."

With busy schedules, it can be harder than ever to maintain healthy habits like home-cooked meals, regular exercise and relaxation techniques. As the stress snowballs, reliance on caffeine and alcohol can increase as well. All of these factors can influence the ability to fall into a deep, restful sleep.

WHAT YOU CAN DO: If stress and being over stimulated is what is keeping you from sleep, then this is what you need to prioritize in addressing. If meditation, yoga and stress release, such as having a warm bath before bed, isn’t working, visit you GP who may refer you to a special clinic for an overnight sleep study, which involves having your brainwaves, bloody oxygen levels and breathing monitored. The study might uncover symptoms that had previously gone unrecognized .

Technology

Experts have been warning us away from technology before bed time for a very good reason – science has proved that screens, or to be specific blue light from TV, computers and car headlights are our sleep nemesis.

“This specific light frequency (430-460 nm) suppresses the release of melatonin, the hormone that tells our body to sleep, and disrupts our circadian rhythm,” says Osiecki.

Melatonin is released by the pineal gland from about 9pm to 7.30am, but blue light delays or shuts it down, making it harder to fall asleep. “Even light-emitting diodes (LEDs) on mobiles and digital alarm clocks disrupt sleep,” says Osiecki.
If your room is full of TVs, computers, tablets phones and multiple alarm clocks around your bed, then your room is overloaded with electromagnetic fields (EMFs) which can cause disruption to the pineal gland and the production of melatonin and serotonin, both of which are essential for getting a good night's sleep.

Plus, if you’re focused on watching right to the very end of the double bill of NCIS then you may miss your body’s signs telling you it’s ready for bed.

"It's easy to miss the window of opportunity," says Dr David Cunnington of the department of respiratory and sleep disorders medicine at Melbourne's Western Hospital.

Exercise

If you really want to banish stress and insomnia, then an easier, and cheap alternative is exercise. And if you’re too tired to exercise, then exercise is the only thing that will stop you feeling that way!

“Traditionally, we’ve said to do exercise before 2pm so you don’t get an endorphin rush that keeps you up, but after work is better than not doing it at all.”

"Studies show a very strong link between lack of physical activity and fatigue, especially among women," says Dr Mansberg. "You cannot feel full of beans if you don't break out in a sweat with 30 minutes of aerobic exercise on most days of the week."
But, avoid working out too late – experts recommend between 5pm and 7 is the opportune time, any later and your adrenalin will still be rushing at bed time.

Snoring

Anyone that’s slept next to a snorer knows how badly it can disrupt a good nights sleep - and that goes for the person doing the snoring as well as you’re more likely to wake up tired and experience and disruptive sleep.

WHAT YOU CAN DO: There are many solutions to snoring these days, ranging from surgery to mouth guards – your doctor can advise you of more.

Embrace the dark side

Even the smallest sliver of light can disturb sleep. This is because light affects your circadian rhythm (sleep patterns), and your body's production of melatonin and serotonin.

WHAT YOU CAN DO: Consider investing in heavy curtains and turn LED clocks to the wall - this is doubly helpful as constantly checking the time (and getting anxious about it) can increase insomnia.

Practice good ‘sleep hygiene’

Many people will find significant improvement in their sleep by carefully following tips for good sleep hygiene – this means going to bed and waking up at the same time, keeping your room dark and technology free, exercising and keeping a journal noting the hours of sleep, the number of wakings, time of wakings and any other information that may be of note.

The final fix

Dr Delwyn Bartlett, the psychologist and insomnia expert at the Woolcock Institute says the GP is your next stop.

“They can offer good advice and, if needed, can write you a referral to a sleep clinic,” she says.

“By talking to your doctor and finding treatment for these potential causes, you may find that your sleep—and how you feel during the day—improves a great deal.”

Also try:

1 Having a low-GI snack, like yoghurt or dried apricots, an hour before bed - hunger can disrupt sleep.
2 Avoiding large, late or spicy meals that can make you feel restless. Try smaller, earlier, less fiery dinners.
3 That midnight trip to the loo can kill your snooze, so drink lots during the daytime, then cut back on fluids from 6pm.
4 Cut back on alcohol and don't drink coffee after3pm. Both mess with sleep.
5 Get rid of your laptop, TVs and iPhones an hour before bedtime.
6 Insomniacs need to get into a good bedtime routine by going to bed and getting up at roughly the same time every day (even on weekends). This can retrain your brain to sleep at night.

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BLACKMORES HEALTHY AGEING INFORMATION:

Healthy ageing community
Exercise for healthy ageing
Heart health foods for healthy ageing
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What's your health age?
Five ways to age your brain gracefully