The Seniors Health Network each month poses a question to health-care professionals. This month, Dr. Brendan Byrne, was asked:
I am a 78-year-old woman and my husband died last year. I’m getting used to living alone and have wonderful friends and a very supportive family. My only problem is that I’m having trouble sleeping at night. I can’t seem to fall asleep and then I wake up a number of times during the night. I don’t want to take sleeping pills but wondered if there is anything else I can do to improve my sleeping.
I’m glad that you’re doing so well adjusting to living alone and I think I can help you with your sleep. You are very wise to avoid sleeping pills as they frequently cause more problems than they solve.
Your problem sleeping is shared by many; lack of sleep has become epidemic in our society and is increasingly common as we age. There are many causes for poor sleep, some of which need medical assessment, but mostly our ability to sleep well is within our control. Without knowing more about your physical and emotional health, here is a safe and proven framework for sleep. If you are not sleeping well after implementing this, a visit with your physician is warranted.
A good night’s sleep is all about optimizing your behaviours and environment to fit your body’s natural rhythm.
As humans we have evolved to be awake when it is light and to sleep when dark. Supporting this circadian rhythm are a cascade of different hormones that signal the body to be alert or sleepy. Our days start with a morning burst of the stress hormone cortisol, signalling that it is time to get up and greet the day. Over the course of the day our cortisol wanes, until in the evening our body releases melatonin to signal that it is time for sleep. Along with melatonin, levels of adenosine in the blood also tell us that we are tired. Adenosine is a by-product of energy expenditure – the more active we are the greater our levels of adenosine.
Aligning our behaviors to our body’s hormonal symphony is relatively straight-forward:
First, avoid substances that will alter hormones and affect your sleep:
• Alcohol – as a general rule, when you aren’t sleeping well you should stop all drinking. Once you are sleeping well again you can resume light (one drink per day) alcohol intake.
• Caffeine – if you aren’t sleeping, stop all caffeine. Once your sleep has been restored, it’s OK to have some caffeine but stop after 12 p.m.
• Some medications – check with your doctor whether any of your medications/supplements (or the time you take them) could be affecting your sleep.
Next, optimize your daytime activities:
• Be active during the day as this will drive up adenosine, telling your body it needs rest.
• Get some exercise, but finish at least three hours prior to bedtime.
• Eat more during the day avoiding heavy meals late in the evening. Don’t eat anything within two hours of bedtime.
• Get some natural light during the day and avoid bright lights in the evening.
Next, optimize your environment for sleep:
• Keep your bedroom dark – black out curtains, eyeshades.
• Keep your bedroom quiet – “white noise” can help – humidifiers, fans or “white noise machines.”
• Keep your bedroom cool.
• Create a comfortable sleep environment – invest in your bed, your sheets, your pillow.
• Keep your electronics out of the bedroom.
• Your bed is only for sleeping (once you have re-established your sleep, you can try reading in bed again).
Optimize your sleep ritual:
• Two hours before bedtime, shut down the screens - TVs, computers and phones. The blue light from these devices will suppress your body’s release of melatonin and the content (especially the news) will often get your mind racing.
• 60 minutes before your bedtime begin a process to relax yourself – reading, light yoga, meditation followed by a sauna or hot bath. This ritual will help you wind down from the day, quiet your mind and set your body up for a great sleep.
• Have fun with this - your sleep ritual should be a joy. Think of the rituals we create for our children - playtime after dinner, followed by a bath, a good read in bed and a loving tuck-in. We should all treat ourselves to such a nightly send-off.
Most often, adopting this framework is all it takes to restore sleep.
What do you do if this doesn’t work?
This is where sleep restructuring comes in:
• Go to bed at the same time every night.
• Get up at the same time every morning
• Since you are having trouble sleeping – do not nap.
Plan for a set amount of sleeping:
• Calculate the total amount that you are currently sleeping (albeit broken) and use this to set your new sleep hours.
• So if you are sleeping six hours in a broken fashion set your wake-up time exactly six hours after the time that you go to bed.
• Then go to bed and wake up at the set times – no exceptions – even if you have had three hours of sleep you need to get up and start your day. You will be tired during the day but resist all urges to nap, come bedtime that fatigue will help you get to sleep.
• Once you are sleeping soundly through that six hours, add 15 minutes to your sleep (go to bed 15 minutes earlier or set the alarm for 15 minutes later).
• When you find that you are sleeping through the night and waking refreshed your sleep has been restructured. Generally, the total amount of sleep needed will be between seven and eight hours per night. Resist the urge to stay in bed longer than the sleep you need as this morning time slumber may result in your sleep deteriorating again.
Barbara, I realize that this might be a lot to take in, but given the importance of sleep, I think it will be well worth the investment. Happy dreams!
Brendan Byrne has been a physician and digital pioneer for the past 25 years. He currently serves as Chief Innovation Officer for TELUS Health. Brendan’s deep passion is to use the latest science to help people change their behaviors and optimize their health. He recently opened the Wellness Garage on Russell Avenue in White Rock.