As we age, a night of good Z’s isn’t as easy as A-B-C 

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Sleep is essential for life. Every species in the animal kingdom sleeps, though with different patterns. Although adult humans ideally should get eight hours, two-thirds of adults in developed nations fall short.

UC Berkeley researcher Matthew Walker addresses the issue drolly in his book “Why We Sleep.”

“Amazing Breakthrough! Scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It wards off colds and the flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You’ll even feel happier, less depressed and less anxious.”

This “revolutionary” treatment, of course, is sleep, and Walker’s claims were based on 17,000 scientific studies.

While it’s a fallacy that older adults need less sleep, it does get more difficult to get eight quality hours as one grows older. The main culprit is a weak bladder, and certain medications and underlying medical disorders can also contribute to sleep fragmentation.

Sleep efficiency — a measure of how much time you are asleep vs. the amount of time awake in bed — of 90 percent or greater is optimal, but when we reach our 80s, it can fall below 70 to 80 percent. This translates to lying in bed awake for an hour or more.

There are more than 100 sleep disorders, the most common being insomnia (difficulty falling/staying asleep, or regularly awakening too early without returning to sleep) and sleep apnea. If you have persistent troubles, tell your doctor; many neglect to ask how you’re sleeping.

What about a sleeping aid? The problem is that prescription pills such as Zolpidem (Ambien) do not restore natural sleep, and can have next-day effects such as drowsiness, forgetfulness, increased fall risk and prolonged reaction times. Also, sleeping pills are addictive and can cause rebound insomnia when stopped.

Many people swear they benefit from taking melatonin, which does help regulate the time when sleep should start but does not produce sleep itself. A good way to give your brain a natural melatonin boost is to go for an afternoon walk.

Cognitive behavioral treatments are best, and the National Institute of Health’s “Guide to Healthy Sleep” lists 13 at tinyurl.com/13nihsleep. Here are some highlights:

Stick to a schedule. Go to bed and wake up at the same time each day, even on weekends.

Exercise. Exercise for at least 30 minutes on most days, but not too late in the day (no later than two to three hours before bedtime). Exercise raises core body temperature, which is the opposite of what’s needed to initiate sleep.

Avoid caffeine and nicotine.  Caffeine keeps you from falling asleep and sleeping soundly. The effects of caffeine last about six hours, but the older we are, the longer it takes to eliminate it from our systems. Avoid having regular or decaf coffee, chocolate or tea within six hours of bedtime.

Avoid alcoholic drinks before bed.  Although a sedative, alcohol does not induce natural sleep. It tends to fragment sleep, causing brief awakenings through the night. It also tends to suppress REM sleep, the absence of which can lead to anxiety and irritability. Adequate REM sleep can help with creative problem-solving.

Hot bath before bed. This works because dilated blood vessels on the surface of the body draw heat from the core, leading to a drop in body temperature, which can make you feel sleepy.

Good environment. This cannot be over-emphasized! Start with a bedroom temperature of 65 degrees. And NIH says “get rid of anything” that might distract you, such as noises, bright lights, an uncomfortable bed, or a TV, computer or phone. The light from an iPad can suppress melatonin release by more than 50 percent. Don’t watch TV or scroll your phone within one hour of bedtime. Kindles? Paperwhites don’t emit significant blue light (the bright light from sunlight and LED light bulbs and electronic devices that can make our bodies want to stay awake).

Don’t lie in bed awake. General rule: If you are lying in bed more than 20 minutes, get up and do something else. The longer you lie there, the more anxious you may become about falling back asleep. Some find meditation helpful in this situation, but don’t watch TV or scroll your phone (because of the light). Some like white noise.

I hope these recommendations are helpful, but if not, don’t lose any sleep over it!

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.