By Sandra Gordon
Don't underestimate the importance of a good night's sleep. Studies have linked chronic sleep deprivation to an increased risk of type 2 diabetes, plus a slew of memory and attention problems. Without adequate sleep, say goodbye to multi-tasking, readily absorbing new information and making sound judgment calls. Those who don't get enough sleep are also setting themselves up for a "blink-out," a short sleep burst that can happen when it's least expected, even behind the wheel of a car.
Many think that a declining quality of sleep is an inevitable consequence of getting older, but that's not the case. People don't need less sleep at they enter midlife, says Joyce A. Walsleben, Ph.D., the director of New York University's Sleep Disorders Center. "It just gets harder to sleep get as we age, which make people think that they need less. In reality, they're just getting by on less. Your sleep quotient is whatever it takes to allow you to perform well all day, even during a boring meeting. It may be seven hours, or as many as 10."
Older people do tend to get tired earlier and wake up earlier than they did when they were younger. As we age, our brain cells degenerate, says Walsleben, who is also the co-author of "A Woman's Guide to Sleep" (Crown Publishers, 2000). "And that can cause our circadian rhythm -- our biological alarm clock -- to advance." As a result, you may find yourself getting sleepy earlier in the evening and then waking up at five in the morning, instead of seven.
This shift often becomes more pronounced once women reach their late 60s, she notes. "But you can reverse the direction of your circadian rhythm by making sure you get at least 20 minutes of light exposure when you wake up in the morning, and in the late afternoon. Light at those times of day -- but especially in the morning -- can give your remaining cells a signal boost to reinforce a particular bedtime and wake-up time."
In order to ensure a good night's sleep, you need a consistent rising time and bedtime. If you're up much later than normal for some reason, she suggests, then just take the hit the next day and fall back into your regular schedule the next night.
"There also needs to be as much contrast between your days and nights as possible," says Walsleben. "Besides being bright, your days should be filled with social and physical activity -- and your nights should be as dark as is consistent with safety. This will enable your brain cells to understand when it's night and release hormones that promote sleepiness."
Suppose, though, that you've awakened in the middle of the night. The best way to get back to sleep, she says, is to be sure you do not turn on the lights. "Light enters through your eyes and activates your brain," she says. "If you get up during the night to go to the bathroom, try to use a nightlight. Also, don't look at the clock. And unless you're having palpitations and sweats and you're going to crawl out of your skin, stay in bed. Close your eyes. Shut yourself down. Just roll over and try to go back to sleep."
Once women enter peri-menopause, their sleep tends to become more fragmented because of diminishing levels of progesterone and estrogen. Progesterone makes us sleepy, and the rapid fluctuations in estrogen cause temperature changes that can disturb sleep. And at menopause, says Walsleben, hot flashes can wreak havoc on the sleep cycle. During a hot flash, your brain gets a rush of adrenaline, which makes you more alert. And, of course, you may be drenched intermittently during the night, which can mean getting up and changing your clothes.
Hormone therapy can help, but Walsleben advises women to weigh the pros and cons with their physicians. "Estrogen helps women go to sleep faster and stay asleep longer," she explains. "It enhances rapid-eye movement (REM) sleep, the stage during which dreaming occurs. Without adequate REM sleep, you're apt to feel groggy and have difficulty concentrating. It also affects memory and learning ability."
The herb valerian has been studied extensively in Europe and found to be effective for insomnia, but herbs and other supplements aren't regulated in the U.S., so consumers must exercise extreme caution. Walsleben says that she doesn't generally recommend over-the-counter sleep medications like Tylenol PM, Sominex or Benadryl. "These all contain an antihistamine, which is a broad-hitter across the brain," she notes. "It dries up everything, including the vagina, and is long-acting, so you can wake up drowsy." For someone having a lot of trouble falling and staying asleep, she recommends a medical consultation that may result in a prescription for a short-acting medication like Ambien or Sonata. "They don't cause drowsiness in the morning or dry up the mucous membranes."
Exercise and diet can also affect sleep quality. Exercise raises the body's temperature, which helps to deepen sleep later. But Walsleben advises people to work out in the late afternoon, and certainly no later than three hours before bedtime: A small rise in body temperature closer to bedtime can actually keep you from falling asleep, she says. And an early dinner -- or a main meal at midday that is digested before you turn in -- is best. If you've been having a difficult time falling asleep, have a small snack that contains tryptophan -- an amino acid found in milk products, turkey, fish and nuts -- an hour or two before bedtime. A small amount can help build chemicals in the brain that promote sleep.
"In general," she adds, "you can have a glass of wine with dinner, but you want to make sure the alcohol is metabolized before you go to bed, which takes about three hours. Otherwise, you'll spend more of the night in the lighter stages of sleep because alcohol can retard the onset of REM sleep."
A nightcap, she warns, is a major no-no. The alcohol it contains will initially make you drowsy, then disrupt your sleep later.
And what about caffeine? Walsleben says that women over 35 should avoid any form of caffeine after noon. This is particularly important if you're on hormone therapy; the supplemental hormones can lengthen the time caffeine stays in your system. "If you drink coffee or caffeinated soda at 3 p.m. and you're on hormone therapy," she says, "you'll still be under the influence of caffeine when you're trying to go to bed at 10 p.m."
Nor does she think it's safe to rely on caffeine to get you through the day if you haven't gotten a good night's sleep. "In general, I think caffeine is too long-acting," she says. "In lieu of caffeine, there's a prescription drug, Provigil, that's often used by night-shift workers and pilots. It's what we call a 'smooth-wake promoter' -- it doesn't affect the same neurotransmitters that stimulants do, so there's no rush or crash, and it's not addictive. If staying awake is a chronic problem, it's worth asking your doctor about. It certainly shouldn't replace sleep, but it's a quick fix that can get you through an important day."
Daytime naps are another option, she notes, but they should consistent and short -- no more than 30 minutes and preferably in the early afternoon, when everyone tends to have a dip in alertness. If you take a longer nap, you'll be more likely to fall into a deeper sleep and may wake up groggy. Napping may also interfere with your ability to fall asleep at night.
Stress, of course, plays a major role in the inability to sleep. People often worry and try to solve problems at night, which can delay and interrupt sleep. "Try to solve your issues during the day with a worry book," says Walsleben. ``Take a half-hour each day to write down everything you're worried about, and then jot down potential solutions. At the end of the half-hour, fold up your worry book and that's the end of it. It sounds silly, but it really does work."
Half of us snore by the time we reach midlife. Snoring occurs when throat muscles relax and excess tissue in the back of the mouth and throat collapses, partially blocking the upper airway. When this happens, you're forced to inhale more deeply, pulling even more floppy tissue into the airway, which causes those tissues to vibrate.
You may not know you snore unless your partner tells you. Snoring can be treated with surgery, but that's not usually necessary. However, snoring can be harmful, especially if it's linked to snorting or gasping and daytime sleepiness -- signs of obstructive sleep apnea.
Sleep apnea in women is more common after menopause, especially in individuals who are overweight and/or not on estrogen replacement, says Walsleben. It may be caused by any number of things, including narrowing of the nasal passages from colds or allergies. And while declining hormone levels don't actually cause sleep apnea, estrogen and progesterone do seem to protect against it, which is why women on hormone therapy usually don't get sleep apnea.
"When tissue encroaches on the airway momentarily," she says, "a respiratory glitch occurs and your breathing stops for a few seconds, or even as long as a minute. When oxygen levels plummet, you gasp and wake up, but perhaps not enough to realize it. Still, that glitch wakes your brain up, even for just seconds, and jolts you into a lighter stage of sleep."
This jolt can occur hundreds of times a night, most often during REM sleep. Sleep apnea affects as many as 24 percent of women over age 64, and 28 percent of men in that age group, which adds up to millions.
"It's important to treat sleep apnea early because it's associated with an increased risk of heart disease and stroke. During an episode, you actually continue to try to breathe, and the pressure from trying to open your airway puts pressure on the heart."
The first line of treatment for sleep apnea is a device called CPAP, which stands for Continuous Positive Airway Pressure. It involves wearing a mask that's connected with a flexible hose to an air pump. Simple air pressure is used to force open the blocked airway. CPAP works wonderfully -- and is easy to use -- but some people don't like the feel or the look of the mask.
"Another option," says Walsleben, "is a mandibular advancement dental device. It's a custom-fitted mouthpiece that pushes the lower jaw slightly forward to increase airflow in and out of the throat. However, the mouthpiece may aggravate TMJ sufferers."
Neither device will cure sleep apnea, she adds, but if you're overweight, losing at least 20 pounds might do the trick. Surgery is also an option, assuming your doctor can find the site of airway obstruction, which usually isn't easy.
If you're sleeping at least seven hours consistently but you still can't keep your eyes open at the meeting after lunch, try to go to bed 15 minutes earlier or get up 15 minutes later. That may make a big difference. If it doesn't, or if you snore loudly or are having difficulty falling asleep or staying asleep each night for a month, see your primary care physician.
"Besides sleep apnea, your doctor may also screen you for low iron in the blood," says Walsleben, "which is linked to restless-leg syndrome, another common midlife sleep disorder, thyroid imbalance, infection, arthritis, depression and fibromyalgia. Levels of estrogen may also be evaluated.
"If whatever your primary-care physician suggests isn't effective," she notes, "then it's time to go to a sleep center."
Sandra Gordon is the co-author of "30 Secrets of the World's Healthiest Cuisines," published by John Wiley & Sons, 2000.
2004, Sandra Gordon. Distributed by Tribune Media Services International.
