Having trouble sleeping through the night? Do you often find yourself awake, early in the morning before your alarm goes off? Sleep-onset insomnia (commonly referred to as insomnia) may be described as trouble falling asleep. However, one form of insomnia termed sleep maintenance insomnia, is difficulty staying asleep or early morning awakenings. While insomnia is most common in younger adults, insomnia coupled with waking up too early and being unable to get back to sleep is a common complaint amongst older adults at midlife and in particular, among women.
Causes of Sleep-Maintenance Insomnia
Midlife is often a time of psychological stress associated with a variety of factors in one’s life. Such stress accompanied by possible health problems such as depression may result in chronic early morning awakening and the inability to get back to sleep. With progressing age, the normal sleep cycle of a person becomes shorter and they spend lesser amount of time in deep sleep. Irrespective of the initial cause, difficulty in remaining asleep may often lead you to worry about not getting enough rest for the upcoming day. Absurd, isn’t it? To be worried and stressed about a day which has not even begun yet! This further interferes with your sleep and results in a vicious cycle.
1. Practicing sleep hygiene and developing habits that promote healthy sleep cycles
– Stay away from stimulants such as caffeinated beverages after 5 p.m., consumption of alcohol less than 2 hours before bed-time, smoking or secondhand smoke.
– Avoid naps during the day.
– Get regular exercise.
– Try to maintain a regular sleep-and-wake schedule.
– Keep the bedroom cool, dark, quiet, and free from disturbances such as the television or computers.
– Finish dinner several hours before bedtime.
– Avoid exposure to a blue and green light from your alarm clock, phone, tablet, or computer as they can make you feel more alert.
– Avoid activities that might cause stress, such as work or emotional discussions before bedtime.
– Minimize nighttime trips to the washroom by limiting the consumption of fluids before bedtime.
– Some experts also recommend sleep re-training or staying awake longer to ensure sleep is more restful.
2. Cognitive Behavioural Therapy (CBT)
CBT is an effective treatment supported by empirical evidence, for chronic insomnia which produces sleep improvements that are sustained over time. CBT for insomnia is usually a brief treatment comprising of 4-8 sessions which may be administered in groups or individually. Research has shown that CBT is highly effective for older adults and may provide for better long-term management of chronic insomnia as compared to pharmacotherapy or sleep medications. There have been at least seven published randomized controlled trials with older adults that compared CBT to no-treatment or placebo treatments. All of these studies showed that CBT was associated with significant improvements in sleep-wake cycles compared to control treatments. In addition to the above, several small studies suggest, online CBT programs/CBT apps which teach good sleep hygiene, relaxation techniques, and other strategies can help people with insomnia, sleep better.
A good night’s sleep paves the way to a good day and vice versa. A balanced approach including good health habits such as a healthy diet, regular exercise, and stress reduction, and good sleeping habits at night, is the best way to get the sleep you need.
Reviewed by: Dr. N. Nayak, MBBS, MD