BATTLING THE SLEEP DEMONS

DEAR GEORGE, Some years ago I was a Grade A sleeper. All the credit goes to my doctor who was happy to refill my Ambien prescription whenever I wanted. Ambien, in my view, is a wonder drug — like oxycodone or the polio vaccine. I would simply take a pill, fall asleep in precisely 30 minutes, sleep soundly for eight hours straight, and wake up refreshed and eager for the new day. Unfortunately that doctor retired and my new doctor was less enthusiastic about drugs. He hinted that one of his patients went out in a stupor and walked in front of a truck. Whatever the case, when I turned eighty he told me that federal guidelines prohibited him from refilling my Ambien prescription. I think that was a fib because my wife’s doctor didn’t seem subject to such guidelines. Nonetheless, my Ambien supply came to an abrupt end. And so did my good sleep. I tried all of the over-the-counter sleep aids, but none of them seemed to work. Now I often take two or three hours to fall asleep or I wake up at 3 a.m. and stay awake till sunrise. Such a drag.

I’ve been asking Google about sleep problems, and there’s a lot of info. One thing I learned is that rich people sleep better than poor people. If the world were just, this should be the reverse, but it’s not. Explanations for low-income insomnia include occupational hazards, off-hour shifts, lack of healthcare services, neighborhood stressors (e.g., noise, pollution), and daily stress. Sleep inequality in turn contributes to decreased cognitive performance, mental health issues, disease (e.g., diabetes, heart disease, stroke), weight gain, and up to a 30% greater risk of death.

Another unpleasant fact is that sleep problems increase with age. Older people often have more trouble falling asleep, sleep less deeply, wake up more often during the night, wake earlier in the morning, and wake up feeling tired. (This sounds familiar to me.) Many different factors enter into these aging-related changes: less production of hormones that promote sleep, more sensitivity to environmental stimuli, medical issues (e.g., arthritis, heart or lung disease), side effects of medications. In addition, low exercise, frequent naps, and drinking more alcohol or caffeine can contribute to sleep difficulties. Older adults with poor nighttime sleep are more likely to be depressed, experience more attention and memory problems, fall more in the night, and have a poorer quality of life. On the other hand, bad sleep is not an inevitable product of aging. Many healthy older adults report few or no sleep problems.

There are many standard sleep tips: don’t use cell phones, iPads, or TV in the bedroom; do aerobic exercise during the day (before 2 p.m.); avoid caffeine, alcohol, sugary foods, exercise, and smoking before bedtime; reduce light and noise in the bedroom; keep the same sleep schedule every day; check side effects of medications; keep a journal, listen to calming music, or read a relaxing book to reduce mental stress. I find that it sometimes helps to go to sleep if I slowly count backwards in my mind from 99 to 0, or progressively relax my muscles from my toes up to my nose, or visualize pleasant landscapes like the Menominee River. When I wake up bright-eyed at 2 or 3 a.m. I often play a game or two of computer solitaire. Winning the game seems to clear my mind and provides closure, such that I go to sleep quickly when returning to bed.

Two things bother me most about my erratic sleep. First, I don’t know why this is happening. My life isn’t that stressful, and I stay up till midnight so I ought to be tired. Second, it’s frustrating that I’m not in control of my own mind and body. I whisper to myself, “Go to sleep…go to sleep…go to sleep” fifty or more times, but my body pays no attention. Getting to sleep is, however, an interesting challenge, and I sort of look forward to it each night. I think I will eventually be successful. LOVE, DAVE

SOURCES: health.clevelandclinic.org, “22 Facts About Sleep That Will Surprise You”; healthline.com, “People with Lower Incomes Have More Sleep Issues…”; helpguide.org, “Sleep Tips for Older Adults”; sbm.org, “Insomnia in Older Adults”;sleepeduction.org, “Sleeping and Growing Older”; tuck.com, “The Inequality of Sleep”