Insomnia in older adults affects sleep quality

A study showed that older adults who have insomnia have their sleep quality affected, but not their sleep duration.

Reports of insomnia are common among the elderly, but a new study finds that sleep problems may stem from the quality of rest and other health concerns more than the overall amount of sleep that patients get.

An estimated 30 percent of adults report having some symptoms of insomnia, which includes difficulty falling asleep, staying asleep or waking up too early and then not feeling well rested during the daytime. Prior studies suggest that nearly half of older adults report at least one insomnia symptom and that lack of restorative sleep might be linked to heart disease, falls, and declines in cognitive and daytime functioning.

The new study found discrepancies between self-reported insomnia and outcomes recorded on a sleep-monitoring device. Older adults' perception of sleep does not always match what's actually happening when a more objective assessment is used to monitor sleep patterns and behaviors.

A study, published online by Journals of Gerontology: Medical Sciences, used data from 727 participants in the National Social Life, Health and Aging Project who were randomly invited to participate in an "Activity and Sleep Study." The activity and sleep study had two components: a self-administered sleep booklet, which included questions about the person's sleep experience, (e.g., "how often do you feel really rested when you wake up in the morning?") and 72-hours of wrist actigraphy, which is a wristwatch-like sensor that monitors sleep patterns and movements.

An author on the study, Linda Waite, the University of Chicago Lucy Flower Professor in Urban Sociology and the director of the Center on Aging at NORC at UChicago, said the researchers wanted to objectively evaluate several aspects of older adults' sleep characteristics, which is why they used the actigraphs in addition to the survey questions.

"Older adults may complain of waking up too early and not feeling rested despite accumulating substantial hours of sleep," Waite said.

The actigraph measurements showed that most of the older adults got sufficient amounts of sleep.

Even though reported sleep problems are common among older individuals, according to the survey only about 13 percent of older adults in the study said that they rarely or never feel rested when waking up in the morning. About 12 percent reported often having trouble falling asleep, 30 percent indicated they regularly had problems with waking up during the night and 13 percent reported problems with waking up too early and not being able to fall asleep again most of the time.

The actigraph provided data that showed the average duration of sleep period among the study participants was 7.9 hours and the average total sleep time was 7.25 hours. Waite said this indicates that the majority of older adults are getting the recommended amount of sleep and usually not having common sleep problems.

One other unexpected finding for the researchers was that respondents who reported waking up more frequently during the night had more total sleep time. "This suggests that a question about feeling rested may tap into other aspects of older adults' everyday health or psychological experience," said Waite.

"Our findings suggest that reports of what seem like specific sleep problems from survey questions may be more accurately viewed as indicators of general problems or dissatisfaction with sleep that may be due to other issues in their lives affecting their overall well-being. These survey questions and actigraphy may measure different aspects of sleep experience."

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Ways to treat insomnia

This article discusses insomnia and how to treat it.

Insomnia is difficulty getting to sleep or staying asleep for long enough for an individual to feel refreshed the next morning, even if one has had enough opportunity to sleep. Sleep is the natural state of unconsciousness that enables one’s body to rest. During such state, the body goes through various sleep stages in a cycle like drowsiness, light sleep, deep sleep and dreaming.  insomnia or in other word sleeplessness, is a sleep disorder which exhibits an inability to fall asleep or to stay asleep as long as desired.

Definition of normal sleep remains difficult since people differ on the basis of age, diet, environments and lifestyles – factors that play a role in determining the amount of sleep one need. Notably, insomnia is not the only sleep disorder although it is the most common sleep complaints; hence it at times becomes a symptom of another problem which differs from one person to another. insomnia can be classified as transient, acute or chronic.

Treatment of insomnia requires its cause for instance, if it is caused by an underlying medical condition or not.insomnia can be treated by the following means:

Ensuring good sleep hygiene

A general practitioner may assist you in knowing what to do in order to get sleep – also known as good sleep hygiene. Tips for good sleep hygiene include establishing set times for going to bed and waking up, making sure you relax before going to bed, ensuring a comfortable sleeping environment, avoiding a daytime nap, avoiding late night caffeine, nicotine and alcohol, avoiding exercise four hours to bedtime, avoiding eating a heavy meal late in the night, avoiding glancing at the clock all through the night and using the bedroom only when you want to sleep and sex.

If your insomnia lasts more than four weeks, your general practitioner may either recommend cognitive and behavioral treatments or short course of sleeping tablets for immediate relief.

Cognitive and behavioral treatments

This is aimed at changing unhelpful thoughts and behaviors that may be contributing to insomnia. This includes stimulus control therapy which helps remove factors that condition one’s mind to resist sleep, sleep restriction therapy – increasing the time one spends in bed by improving sleep, relaxation training to help you calm your mind and body through muscle relaxation, imagery and meditation, paradoxical intention which refers to letting go of any worry that keeps you awake and biofeedback – a method that allows the observation of biological signs like muscle tension and heart rate and shows you how to adjust them. CBT-I is at times performed by a specially trained general practitioner or a clinical psychologist.

Sleeping tablets

Sleeping tablets are drugs that promote sleep. They are usually used when you have a severe insomnia, to relieve short term insomnia and in case the above mentioned behavioral treatments prove ineffective. Doctors are mostly reluctant to administer sleeping tablets as they don’t treat the cause of insomnia and have side effects such as a feeling of hungover and daytime drowsiness. Examples of sleeping tablets are discussed below.

Benzodiazepines are tranquillizers that can lessen anxiety and encourage coolness, relaxation and sleep. This medicine should only be given to a person with severe insomnia or if it causes acute suffering as it makes that person sleepy and can also lead to dependency.

Z medicines are current kinds of medicines that work in a comparable way to benzodiazepines. Z medicines include zaleplon, zolpidem and zopiclone.

Zaleplon should be used in people with insomnia who have problem falling asleep and in lowest possible dose as it has side effects such as memory problems, painful periods in women, sleepiness, apathy, balance and coordination problems, concentration problems, changed sense of smell, dizziness and hallucinations.

Zolpidem is for unbearable insomnia causing severe stress. Its side effects are diarrhea, dizziness, nausea, vomiting, headaches, tiredness and sleep difficulty like sleep walking and stomach pains.

Zopiclone is for short-term treatment including waking up during the night, difficulty falling asleep causing severe distress. It should be used in its lowest possible dose as side effects include dry mouth, metallic taste in the mouth, sleepiness, dizziness, nausea, vomiting, drowsiness and headaches.

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Causes and Cures for Insomnia

This article discusses symptoms of insomnia as well as what could be causing it, and how to cure it.

We have all had nights when sleep will not come, but for some people not being able to sleep is a chronic condition — they suffer from insomnia.

People with insomnia may have a hard time falling asleep even though they are tired, or they may wake up in the middle of the night and then lie awake for hours, unable to return to sleep. Sometimes insomniacs do sleep, but the sleep is unrefreshing and they wake up feeling as drowsy and fatigued as if they had experienced no sleep.

Understanding insomnia

Insomnia is not about failing to get eight hours of sleep at night. Rather, it is the inability to get the amount of sleep you need to feel rested. We all need different amounts of sleep, so insomnia is defined by the quality of your sleep and how you feel after sleeping — not by how many hours of sleep you get, or even by how quickly you fall asleep. If you only sleep five hours but feel great you do not have insomnia.

Insomnia usually is not just a sleep disorder; typically, there are other causes at the root of the problem. Insomnia is often the symptom of other issues that are interfering with your ability to sleep. These issues may range from having too much caffeine during the day to medical conditions to psychological issues.

Symptoms

• Difficulty falling asleep even if you are tired
• Waking up repeatedly during the night
• Difficulty falling back to sleep once you have woken up
• Not feeling rested after sleeping
• Needing to rely on sleeping pills or alcohol to fall asleep
• Waking up too early
• Feeling drowsy, tired and irritable during the day
• Having trouble concentrating during the day

Common causes

Many of us experience temporary insomnia — the kind that lasts just for a few days and then goes away. Usually this type is due to nerves over something at work, a relationship issue that is later resolved, jet lag, or some other brief hiccup in our routine.

But when insomnia continues for weeks and months, then it is time to talk with your doctor.

• Psychological causes: Depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder.
• Medications: Antidepressants, cold and flu medications with alcohol, pain relievers with caffeine, diuretics, corticosteroids, thyroid hormone, high blood pressure medications
• Medical causes: Asthma, allergies, Parkinson's disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain and others.
• Sleep disorders: Sleep apnea, narcolepsy, restless leg syndrome

Cures for simple causes of insomnia

• Look at your behavior — are you consuming too much caffeine (soda, coffee, energy drinks)? Try cutting back.
• If you are using alcohol or sleep aids to fall asleep, cut back. These actually disrupt sleep over the long term. Try warm milk to soothe you.
• Shut off your brain at least an hour before bed — no Internet, no TV, no computer, and no vigorous exercise within two hours of bedtime. Unwind with a relaxing book, meditation, etc.
• Keep your bedroom dark, cool and quiet. Try white noise machines, sleep masks or earplugs if need be.
• Do not smoke, especially at night. Nicotine will keep you awake.
• Keep your bedroom only for sleep and sex — not work or other activities.
• Make sure you get good exposure to natural light during the day, but minimize your exposure to artificial light at night. Maintaining this balance will help your body's natural wake/sleep cycle.

When the cause is psychological

If you answer "yes" to any of these questions, it may be helpful to see a psychiatrist regarding your insomnia issues.

• Am I under a lot of stress?
• Am I depressed? Do I feel devoid of emotion and hopeless?
• Do I have chronic feelings of anxiety or worry?
• Have I experienced panic attacks?
• Have I undergone a traumatic experience?

If the cause is chronic anxiety, depression, chronic stress, post-traumatic stress disorder, and the like, then you should consult a psychiatrist. These conditions can be treated with consultations, medication, or other therapies.

A therapist can also instruct you in relaxation techniques that can help you cope better during the day and unwind at night.

When to get help

If you answered "yes," to the questions listed under "When the cause is psychological," then you should consult with a psychiatrist. Professional insomnia treatment is also advised if you experience the following:

• Your insomnia is causing problems at work, home or school.
• Your insomnia hasn't responded to self-help tips like those listed under "Cures for simple causes of insomnia"
• Your insomnia is getting worse, occurring almost every night

Nature intended our minds and bodies to rest. If you are chronically unable to get restful sleep, get help. A good night's sleep can be an amazing restorative to your mental and physical health.

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Sleep Disorders in College - Highly Prevalent

An interesting article discussing the severity of sleep disorders for students as well as the prevalence throughout the US. JR

Brittany Barnhill had been awake for three days.

A University of Georgia senior from Thomson, Barnhill has struggled with insomnia since entering college.

Her condition is cyclical, meaning she is sporadically unable to sleep. But one of her worst experiences came during her sophomore year, when a night of studying for organic chemistry turned into a three-day sleepwalk.

“I had a lot of trouble with organic chemistry. It was the bane of my existence for a very long time,” Barnhill said. “I had an exam coming up for it and so one night I stayed up to study for it and pulled an all-nighter. That was Monday night.”

Monday night bled into Tuesday morning, and Barnhill planned to sleep that night, but found herself unable.

“I couldn’t get to sleep because I was stressed out about the exam the next day,” she said. 

Though she passed the test, Barnhill said the erratic sleep schedule of a college insomniac is hardly healthy.

“My roommates thought I was dead,” Barnhill said. “[Being tired is] like I’m walking through a haze. I won’t recognize people, things. I definitely shouldn’t drive. It feels like I’m swimming.”

Barnhill’s tale, while extreme, is familiar for college-aged students, who are more likely to experience sleep disorders than other age groups. The average college student gets 6-6.9 hours of sleep a night, much less than the recommended eight hours. Less sleep can cause increased weight gain, mental illness and automobile accidents, while resulting in decreased academic performance, according to the University Health Center. 

Students with sleep problems can find relief at the health center. If a student’s insomnia is cyclical, an assigned physician may prescribe sleep aids or advise altered sleep habits. But if the condition has psychological roots, the student may also seek aid from Counseling and Psychiatric Services.

“Sleep is probably one of the number one problems on campus, so it’s something a lot of students come in for,” said Liz Cheely, the case manager at the health center. “They need to do a phone screening, which takes about 15 minutes, where they tell us what is going on...after that, we get them scheduled for an intake [counseling session], which takes about an hour.”

A psychologist might then write a prescription for sleep aids or offer further psychiatric sessions.

Alexis Havrilla, a sophomore from Cumming, said her experiences with chronic (long-term) insomnia led to a lost scholarship and disappointing class results.

“I lost [the HOPE scholarship] because I got two C+ grades in classes because of my sleep habits,” said Havrilla, who is working with CAPS to address her condition. “I didn’t get enough sleep. It affected study habits. I just felt like doing other things because I don’t like to sleep — I do have a sleep fear.”

Insomnia leaves students searching for limited answers. Insomniacs are advised by most physicians to avoid caffeine, maintain a regular sleep schedule and develop other sleep-friendly habits. But students report habit-changing techniques as only marginally effective.

When the techniques work, they seem to only work for a short time. Even then, it’s difficult to change unhealthy habits while meeting the demands of college life.

Potent sedatives and antidepressants, such as Ambien and Trazodone, provide a quick fix for sleeplessness, but their addictive nature deters some students.

“It just seems like with the medicines and choices that are there, they aren’t very long term,” Barnhill said. “It’s all habit forming and you get dependent on it, and I don’t want to be stuck on that for the rest of my life.”

There is another option for students. 

The Athens Sleep & Wellness Center, located on Prince Avenue, conducts overnight sleep tests to diagnose common sleep ailments. The test, which costs about $150 for patients with insurance, provides answers to the uncertainty surrounding sleep deprivation.

Meredith Petry, the Sleep Lab Administrator at the center, said it was important to diagnose the root of insomnia, rather than mask symptoms.

“The actual true, true insomnias are much more rare than you think of,” Petry said. “Most students should not go on sleep aids, because it’s usually pretty clear that they have bad habits and that they can be corrected. You don’t want to just give them a sleep aid to knock them out when they want to go to sleep or try to go to sleep because it’s not that simple.”

The Southeast in particular struggles with insomnia, with 13.1 percent to 19.3 percent of adults reporting insufficient rest in the past 30 days, according to a study done by the Centers for Disease Control and Prevention in Atlanta.

The region’s higher reported rates of insufficient sleep could be traced to higher obesity rates.

“If you look at that map, with obesity and weight, it’s going to be very close,” Petry said. “There is much more of a weight issue in the Southeast than there is in the West. The more of a weight issue there is, it’s probably highly correlated.”

Petry said students make up a low percentage of the center’s patient base because most students don’t prioritize sleep.

“Maybe five percent would be students, if that,” Petry said. “But what it should be is at least 20 to 25 percent. There are a lot of students with these issues, but sleep gets put so low on the priorities.”

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Music as a Therapy for Insomnia

New research looks at how music can be used as therapy to treat insomnia instead of other substances and therapies commonly used such as medication.

If you are among the 50 percent of Americans who suffer from insomnia, then you have probably tried everything -- from warm milk to melatonin pills or prescription medications to induce sleep -- with varying degrees of success and side effects. But what if sleep could be achieved not by a substance, but through 'balancing' brain activity?

Researchers at Wake Forest Baptist Medical Center have conducted a pilot clinical study to determine whether a non-invasive approach, that uses musical tones to balance brain activity, can 'reset' the brain and effectively reduce insomnia.

The study, was published online in October, advance of print, in the journal Brain and Behavior. It was funded by a $26,696 grant from Brain State Technologies, LLC, Scottsdale, Ariz., the company that owns the technology used in the study.

Charles H. Tegeler, M.D., professor of neurology at Wake Forest Baptist and principal investigator of the study explained how the technology works. "The human brain is made up of the left and right hemispheres that work together as parallel processors. When a person undergoes trauma or a major stressor, their autonomic survival responses kick in and the brain can become unbalanced. If those imbalances persist, symptoms such as insomnia can result. Our study looked at a new technology that is intended to facilitate greater balance and harmony in brain frequencies, which may result in improved symptoms."

The new technology is called HIRREM, high-resolution, relational, resonance-based, electroencephalic mirroring or, as it's commercially known, Brainwave Optimization™. The non-invasive procedure uses a system that is designed to reflect the brain's frequencies back to itself using musical tones. Resonance between the musical tones and the electrical energy in a person's brain can bring balance to the two hemispheres of the brain.

Study results were based on a change in the Insomnia Severity Index (ISI) which measures the severity of sleep disruption using a zero-to-28 point scale; the median ISI for study participants was between 18.7 and 18.9, which is considered moderate-to-severe insomnia. Researchers found that the HIRREM group had a 10.3 point drop in ISI, improved insomnia symptoms and, clinically moved into a category of 'no insomnia' or 'sub-threshold insomnia'. The control subjects, who continued their existing insomnia treatment without HIRREM, showed no change in ISI. However, when the crossover control group received HIRREM therapy, the results were indistinguishable from those of the original HIRREM group.

This unblinded, wait-list control, crossover study enrolled 20 participants (14 women and 6 men). Ten people were randomized to receive HIRREM sessions, plus usual care; the remaining 10 were assigned to the wait-list control group. An initial assessment determined the symmetry, or balance, in amplitude and frequencies between the brain hemispheres and data collection included a subject's ISI and other measures including blood pressure and neurocognitive function tests.

Study participants randomized to HIRREM underwent eight to 12 sessions that each lasted between 60-90 minutes. The sessions involved reclining in a zero gravity chair and placing sensors over numerous locations on both sides of the scalp. A musical tone, determined by a mathematic algorithm and based on the dominant frequency in a floating middle range of the participant's EEG frequencies, was played back to the participant through ear buds. Resonance between musical tones and oscillating brain circuits is designed to allow the brain to auto-calibrate, moving towards better balance, with associated improvement in symptoms.

The limitations of the study include the small number of study participants and the absence of a sham-placebo control group which prevented blinding. This means it is possible that the changes observed with HIRREM, could be due to a placebo effect. In addition, because HIRREM therapy involves social interaction and relaxation, there may be other non-specific mechanisms for improvement, in addition to the tonal mirroring. Although the researchers believe that the degree of improvement and length of time it persisted (for four weeks after the last session) suggests real change through HIRREM, Tegeler is planning a larger clinical trial using a sham placebo, to confirm the HIRREM effect and further explore the technology.

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Sleep Study: Resting Brain Allows Dolphins To Stay Awake For Weeks

This is an interesting article discussing how dolphins only sleep with half of their brain at a time which allows the dolphin to stay awake for weeks at a time.

insomnia in adults leaves us AWAKE with only half our brains...LOL...JR

Dolphins can stay constantly alert for more than two weeks by sleeping with only half of their brains, researchers say.

These findings suggest how dolphins can keep on the constant lookout for sharks, investigators added.

Unlike land mammals, dolphins sleep with only part of their brains at any time, past research has suggested. Half of their brains rest, while the other half remains "awake," and dolphins regularly switch which side is active.

"After being awake for many hours or days, humans and other animals are forced to stop all activity and sleep," said researcher Brian Branstetter, a marine biologist at the National Marine Mammal Foundation in San Diego. "Dolphins do not have this restriction, and if they did, they would probably drown or become easy prey."

To see just how mindful dolphins are with just half a brain, researchers tested their ability to scan the environment. Dolphins use echolocation to map the world, a biological form of sonar where they emit clicks and listen for their echoes to probe murky, dark surroundings. [Sleep Tight! Snoozing Animals Gallery]

The researchers set up a portable floating pen outfitted with eight modules, each consisting of an underwater sound projector and microphone. When a dolphin scanned any of these modules using echolocation clicks, they could respond with sounds mimicking echoes of those clicks from remote surfaces. Essentially, these modules could behave as "phantom targets" — illusions that acoustically simulated physical objects.

Dolphins were tested using underwater sound projectors. When they detected certain sounds, the dolphins had to press a paddle. The results are detailed online Oct. 17 in the journal PLoS ONE.

The scientists had two dolphins — a female, Say, and a male, Nay — continuously scan these modules. If they detected phantom targets, they were trained over the course of a year to press a paddle to get fish. The dolphin Say often gave victory squeals whenever she succeeded.

The scientists found these dolphins could successfully use echolocation with near-perfect accuracy and no sign of deteriorating performance for up to 15 days. The researchers did not test how much longer the dolphins could have continued.

"Dolphins can continue to swim and think for days without rest or sleep, possibly indefinitely," Branstetter told LiveScience.

These findings suggest that dolphins evolved to sleep with only half their brains not only to keep from drowning, but also to remain vigilant.

"These majestic beasts are true unwavering sentinels of the sea," Branstetter said.

Future research can help verify whether the dolphins stayed awake and alert for multiple days by sleeping with half their brains. This would require monitoring their brains for electrical activity via electroencephalogram, or a EEG.

"Research with freely moving humans who wear portable EEG equipment has been conducted; training a dolphin to wear a similar portable EEG backpack that is capable of withstanding and functioning in an ocean environment presents much greater challenges," Branstetter said. "However, these hurdles are not insurmountable. Also, we are interested in investigating if dolphins can perform more complex cognitive tasks without rest, like problem-solving or understanding an artificial language."

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