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How to get a better night's sleep

Sleep disturbances cause a raft of physical and mental illnesses, but help is at hand.

Nothing is more galling after a sleepless night than the news your partner has again slept soundly for eight hours right next to you. But help may be at hand, with good evidence that a handful of cognitive behavioural therapy sessions could significantly improve your sleep quality.

It’s estimated that up to two-thirds of adults aged 65 and older report some kind of sleep disturbance, more so during the hot summer months. Sleep disturbances affect our immune system and cause or complicate a raft of physical and mental illnesses, as well as raising the risk of premature death. Then there are the side effects of daytime sleepiness, increased risk of accidents and generally lower quality of life.

Lack of sleep is also linked to weight gain and less-nutritious eating habits. Clinical trials reveal that during periods of insufficient sleep, people snack more than normal sleepers. Those experiencing sleep loss are more likely to choose fat-containing foods rather than protein or carbs.

Lack of sleep does not occur in a vacuum. Among underprivileged New Zealand children, for example, lack of sleep has been linked to obesity. Sharing a bed or bedroom with several siblings or other relatives is not a recipe for good sleep, especially if they have respiratory illnesses.

With older adults, sleep decline is typically linked to factors that accompany aging, such as medical and psychiatric illnesses, increased medication, a higher prevalence of sleep disorders including obstructive sleep apnoea and restless leg syndrome, and changes to our body’s circadian clock.

Most patients with arthritis, chronic pain and diabetes report difficulty falling and/or staying asleep. Other health conditions that may cause insomnia include congestive heart failure, cancer, nocturia, chronic obstructive pulmonary disease, depression and Parkinson’s disease. Medications linked to insomnia include central nervous system stimulants, antihypertensives, respiratory medications, chemotherapy, decongestants, corticosteroids, thyroid hormones and antidepressants.

Given the impact of sleep, both directly and indirectly via eating habits, on our health and well-being, what can we do when we’re not getting enough? If possible, take stimulating medications and diuretics earlier in the day and sedating medications before bedtime.

The most effective treatment for insomnia is cognitive behavioural therapy (CBT). The cognitive aspect deals with misconceptions or unrealistic expectations about sleep – for example, the idea that we absolutely need eight hours or more of sleep every night – and the behavioural component involves a combination of sleep-restriction therapy, stimulus-control therapy, relaxation techniques and good sleep hygiene practices (see table). Stimulus control includes using the bed strictly for sleeping and not for other activities, such as reading and watching television; the therapy attempts to break the association between the bed and wakefulness. For example, patients are instructed to get out of bed if they fail to fall asleep within 20 minutes and stay up until they feel sufficiently sleepy.

An eight-week treatment trial for insomnia in older adults compared CBT with treatment with temazepam (medication), a combination of CBT and temazepam, and a placebo. Both treatments were more effective than the placebo in reducing night-time wakefulness immediately after treatment. But only the CBT group maintained clinical gains at follow-up three, 12 and 24 months later.

Even two short CBT sessions (25 minutes each) can reduce night-time wakefulness and insomnia symptoms. So it may be worth the time and investment to improve your sleep, quality of life and health.

This article was first published in the February 15, 2020 issue of the New Zealand Listener.

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