Good sleep is just what doctor ordered

Just because you are aging does not mean your sleep will get worse.

“If you are a healthy older person, your sleep should remain stable after 50-60,” said sleep researcher Michael Vitiello, a psychologist and professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. “Most of the sleep changes occur in early to middle-adult years (20-60).”

Older people may be sleeping poorly because of other factors like illness, sleep apnea, pain, grief, and other psychosocial factors and learned behaviors. Vitiello has been researching sleep and aging for 40 years. He was a principal investigator in a study of a behavioral intervention for older people with chronic insomnia and osteoarthritic pain.

In the study, published Feb. 22 in JAMA Internal Medicine, participants received six 20-minute telephone calls over eight weeks that provided coaching on how to get better sleep. Participants improved in terms of sleep, pain, and daytime function. The improvements in sleep and daytime function persisted 12 months after treatment.

The study, conducted with researchers at the University of Washington School of Nursing and Kaiser Permanente Research Institute, showed that sleep is a powerful influence on health.

Improved daytime function and reduced pain are associated with  better sleep. Insufficient sleep puts people at risk of diabetes, dementia, hypertension, depression and other illnesses, said Vitiello. And when people get these illnesses, they sleep even worse, so it can become a downward spiral.

Vitiello has these suggestions for better sleep:

1. Prioritize your sleep.
   Sufficient sleep is the other major component of a healthy lifestyle, diet and exercise. Do not compromise your sleep. Get sufficient nighttime sleep that allows you to function throughout the day without sleepiness. If you are sleepy during the day and it is compromising your ability to function, you need to take measures to improve  your sleep. You can never truly catch up on lost sleep. Sleep is not like a bank account. There is always a biological cost for not getting enough sleep. It might be small, but it adds up over time.
    
2. Maintain regular bed and rise times, particularly rise times.
   Your body responds well to regularity. The body is timed to wake you up at a certain time. If you push it too late at night, you should keep your regular rise time. Lock in that rise time seven days a week. That will eventually facilitate your falling asleep at the same time every night. The caveat is if you are a robust sleeper and are not adversely impacted by some variation in bed and rise times, then you have more flexibility around this principle.
    
3. Develop a regular pre-sleep routine / ritual.
   Different people can do different things. Something that is mundane where you are not thinking about problems of the day. This allows you to transition to a relaxed state.
    
4. Match your bedtime to your sleep need.
   Do not spend a lot of time in bed while not asleep. If you are staying in bed longer because you think you will get more sleep, you will not. Get up if you cannot sleep and try again after a short period of time. The bed should be a predictor of sleep not being anxious because of difficulty falling asleep.
    
5. Optimize your bedroom for sleeping.
   Determine the right bedroom temperature. Have appropriate bedding. Couples can use electric blankets with dual controls or have their own bedding. Each person should be comfortable. And drapes may be needed. Summer in Seattle, for example, gets 16 hours of light. That may impact sleep. And do not use your bed to pay bills, or lounge. Keep it for sleeping and romance.
    
6. Develop healthy daily daytime habits.
   Regular moderate exercise, light exposure, not smoking and no or moderate alcohol can all help achieve better sleep. Alcohol does not facilitate sleep. It makes you dehydrated and could lead to fragmented sleep. If you drink a glass of wine before bed and it does not bother you then the rules can be flexible. But if you have a glass of wine and your day-time function is compromised, then cut out drinking before bed.
    
7. Nap deliberately.
   Determine if napping can help you function better while awake. Consider napping regularly and for a short period of time, say 20 to 30 minutes. If you nap a lot, it could impact your night-time sleep. If a person needs more energy in second half of day, a 20-minute nap might be needed. You should not nap for an hour and a half. That might impact your ability to have a full night’s sleep.
    
8.  Explore how these tips are best personalized for you.
   Every person is different so determine how these tips should be applied to you. If these tips do not improve your sleep, then consider discussing it with your primary care provider or consult a sleep center. Recognize that sleep centers specialize in treating sleep disorders and will likely better able to address your concern than your primary care physician.

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