Thoughts about Insomnia

10 Tips to Beat Insomnia

If you are suffering from insomnia, there are many steps you can take to change behaviors and lifestyle to help you get to sleep. Here are some tips for beating insomnia.

  1. Wake up at the same time each day. It is tempting to sleep late on weekends, especially if you have had poor sleep during the week. However, if you suffer from insomnia you should get up at the same time every day in order to train your body to wake at a consistent time.
  2. Eliminate alcohol and stimulants like nicotine and caffeine. The effects of caffeine can last for several hours, perhaps up to 24 hours, so the chances of it affecting sleep are significant. Caffeine may not only cause difficulty initiating sleep, but may also cause frequent awakenings. Alcohol may have a sedative effect for the first few hours following consumption, but it can then lead to frequent arousals and a non-restful night's sleep. If you are on medications that act as stimulants, such as decongestants or asthma inhalers, ask your doctor when they should best be taken to help minimize any affect on sleep.
  3. Limit naps. While napping seems like a proper way to catch up on missed sleep, it is not always so. It is important to establish and maintain a regular sleep pattern and train oneself to associate sleep with cues like darkness and a consistent bedtime. Napping can affect the quality of nighttime sleep.
  4. Exercise regularly. Regular exercise can improve sleep quality and duration. However, exercising immediately before bedtime can have a stimulant effect on the body and should be avoided. Try to finish exercising at least three hours before you plan to retire for the night.
  5. Limit activities in bed. The bed is for sleeping and having sex and that's it. If you suffer from insomnia, do not balance the checkbook, study, or make phone calls, for example, while in bed or even in the bedroom, and avoid watching television or listening to the radio. All these activities can increase alertness and make it difficult to fall asleep.
  6. Do not eat or drink right before going to bed. Eating a late dinner or snacking before going to bed can activate the digestive system and keep you up. If you suffer from gastroesophageal reflux (GERD) or heartburn, it is even more important to avoid eating and drinking right before bed since this can make your symptoms worse. In addition, drinking a lot of fluids prior to bed can overwhelm the bladder, requiring frequent visits to the bathroom that disturb your sleep.
  7. Make your sleeping environment comfortable. Temperature, lighting, and noise should be controlled to make the bedroom conducive to falling (and staying) asleep. Your bed should feel comfortable and if you have a pet that sleeps in the room with you, consider having the pet sleep somewhere else if it tends to make noise in the night.
  8. Get all your worrying over with before you go to bed. If you find you lay in bed thinking about tomorrow, consider setting aside a period of time -- perhaps after dinner -- to review the day and to make plans for the next day. The goal is to avoid doing these things while trying to fall asleep. It is also useful to make a list of, say, work-related tasks for the next day before leaving work. That, at least, eliminates one set of concerns.
  9. Reduce stress. There are a number of relaxation therapies and stress reduction methods you may want to try to relax the mind and the body before going to bed. Examples include progressive muscle relaxation (perhaps with audio tapes), deep breathing techniques, imagery, meditation, and biofeedback.
  10. Consider participating in cognitive therapy. Cognitive therapy helps some people with insomnia identify and correct inappropriate thoughts and beliefs that may contribute to insomnia. In addition, cognitive therapy can give you the proper information about sleep norms, age-related sleep changes, and help set reasonable sleep goals, among other things.

In some cases, doctors will prescribe drugs for the treatment of insomnia. All insomnia medications should be taken shortly before bed. Do not attempt to drive or perform other activities that require concentration after taking an insomnia drug because it will make you sleepy. Medications should be used in combination with good sleep practices.

Here are some medications that can be used to treat insomnia

  • Antidepressants : Some antidepressant drugs, such as trazodone (Desyrel), are very good at treating sleeplessness and anxiety.
  • Benzodiazepines: These older sleeping pills -- emazepam (Restoril), triazolam (Halcion), and others -- may be useful when you want an insomnia medication that stays in the system longer. For instance, they have been effectively used to treat sleep problems such as sleepwalking and night terrors. But these drugs may cause you to feel sleepy during the day and can also cause dependence, meaning you may always need to be on the drug to be able to sleep.
  • Doxepine ( Silenor ): This sleep drug is approved for use in people who have trouble staying asleep. Silenor may help with sleep maintenance by blocking histamine receptors. Do not take this drug unless you are able to get a full 7 or 8 hours of sleep. 
  • Eszopiclone ( Lunesta ): Lunesta also helps you fall asleep quickly, and studies show people sleep an average of 7 to 8 hours. Don't take Lunesta unless you are able to get a full night's sleep as it could cause grogginess. Because of the risk of impairment the next day, the FDA recommends the starting dose of Lunesta be no more than 1 milligram.
  • Ramelteon ( Rozerem ): This sleep medication works differently than the others. It works by targeting the sleep-wake cycle, not by depressing the central nervous system. It is prescribed for people who have trouble falling asleep. Rozerem can be prescribed for long-term use, and the drug has shown no evidence of abuse or dependence.
  • Suvorexant (Belsomra). It works by blocking a hormone that promotes wakefulness and causes insomnia. It is approved by the FDA to treat people that have insomnia due to an inability to fall asleep or to stay asleep. The drug may cause you to feel sleepy the following day.
  • Zaleplon ( Sonata ): Of all the newer sleeping pills, Sonata stays active in the body for the shortest amount of time. That means you can try to fall asleep on your own. Then, if you're still staring at the clock at 2 a.m., you can take it without feeling drowsy in the morning. But if you tend to wake during the night, this might not be the best choice for you.
  • Zolpidem ( Ambien , Edluar, Intermezzo): These medicines work well at helping you get to sleep, but some people tend to wake up in the middle of the night. Zolpidem is now available in an extended release version, Ambien CR. This may help you go to sleep and stay asleep longer. The FDA warns that you should not drive or do anything that requires you to be alert the day after taking Ambien CR because it stays in the body a long time. You should not take zolpidem unless you are able to get a full night's sleep -- at least 7 to 8 hours. The FDA has approved a prescription oral spray called Zolpimist, which contains zolpidem, for the short-term treatment of insomnia brought on by trouble falling asleep.
  • Over-the-counter sleep aids: Most of these sleeping pills are antihistamines. There is no proof that they work well for insomnia, and they can cause some drowsiness the next day. They're safe enough to be sold without a prescription. But if you're taking other drugs that also contain antihistamines -- like cold or allergy medications -- you could inadvertently take too much.

In 2007, the FDA issued warnings for prescription sleep drugs, alerting patients that they can cause rare allergic reactions and complex sleep-related behaviors, including "sleep driving." In 2013, the FDA also warned people that taking sleeping medication at night can impair their ability to drive or be fully alert -- even the next day.

 

5 Key Ways to Lose Weight After 50

There’s plenty you can do to take control of your weight as you get older.

Whether you’ve battled the bulge for what seems like forever — or just since your last birthday — it’s true that age can have a lot to do with the number on the scale.  As with crow’s-feet and varicose veins, you’re simply more susceptible to gaining weight once you hit the big 5-0. And it’s not your imagination: It also becomes increasingly more challenging to shed those pounds once they’ve settled around your hips.

“The two big reasons people tend to gain weight as they get older are loss of muscle mass and decreased activity,” explains Caroline Apovian, M.D., a weight-loss specialist at Boston University Medical Center. People experience a 5 to 10 percent loss of muscle mass each decade after age 50, according to the American College of Sports Medicine. As a result, your resting metabolic rate declines by an average of 2 to 3 percent every decade.

And this means you can be eating the exact same amount that you did at 40 — not a morsel more — and still gain weight.

Becoming more sedentary with age can also skew the equation, especially if you begin to develop arthritis or other joint issues that restrict activity. “As we get older, we spend less time running around and physical activity decreases,” Apovian points out. “But as you get older, if you don’t use your muscles, you’ll lose them.”

And while these facts are sobering, there’s plenty you can do to take control. “You’re not doomed to failure! I’m 60, and I have more muscle on my body than I did when I was 30,” Apovian says with pride.

It's true that few of us may have the time or energy to follow Apovian’s grueling workout schedule (she rises at 5 a.m. most days to either swim for an hour or run six miles on her treadmill), but we can follow her advice, as well as that of other leading obesity specialists, on how to fit into our jeans once we enter our sixth decade and beyond.

Pile on the protein

“Protein supplementation can help build back muscle mass, which reverses the decline in metabolism,” explains Apovian. She recommends making sure that between 30 and 40 percent of your daily calories come from protein, depending on your body weight. (Imagine a lean piece of meat or fish taking up one third of your plate, and you get the idea.) By contrast, the average American gets about 16 percent of his or her food intake from protein, according to the Centers for Disease Control and Prevention.

You’ll also build more muscle if you spread your protein intake out evenly throughout the day. A 2017 study published in the American Journal of Clinical Nutrition found that consuming an equal amount of protein at all three meals is linked to more muscle strength in people over age 67. To even out your intake, try adding an egg or yogurt to your breakfast, a glass of milk or a handful of nuts to your lunch, and scaling back on your protein source at dinner.

Join the resistance

While any sort of exercise can help you shed girth, it’s very important that you lift weights at least twice a week to build muscle mass, which will help you lose weight. In one study, 60-something overweight adults who pumped iron lost more weight and lost less muscle mass over 18 months than those who just hoofed it for exercise. “Any sort of opportunity to build muscle — even if it’s just working with light resistance bands or swimming in a pool — will raise your metabolism and, thus, help you burn calories,” explains Reshmi Srinath, M.D., an endocrinologist and obesity specialist at the Mount Sinai Medical Center in New York City.

And keep in mind that you don’t have to do much to see results. People who lifted weights just twice a week gained about three pounds of muscle after 10 weeks, according to a review published in Current Sports Medicine Reports

Beyond strength training, if you can take your overall exercise program up a notch, do so. Older adults who did high-intensity interval training (HIIT), which entails short spurts of high-intensity exercise, not only lost weight but also had less DNA damage to muscle cells. And this helped trigger growth of new muscle.

Get enough shut-eye

“Research has consistently shown that people who are overweight or obese get less sleep than those of normal weight,” stresses Apovian. “When you’re sleep deprived, your body ramps up its production of hormones that increase hunger, like the stress hormone cortisol and the appetite stimulating hormone ghrelin.” Older men (over age 67) who get less than five hours of sleep a night are almost four times as likely to be obese as those who get between seven and eight, and older women are more than twice as likely, according to a Case Western Reserve University study.

It’s also a good idea to keep your sleep schedule consistent, meaning you get up and go to bed at roughly the same time every day. Older men and women who don’t follow this healthy habit add another risk factor for being obese into the mix, according to a study published in the International Journal of Obesity.

Try occasional fasting

We’re not talking juice cleanses. Rather, research now shows that a specific type of intermittent fasting, known as fasting-mimicking, can trigger weight loss as well as improve your overall health. People who followed this type of diet plan — where they consumed only 750 to 1,000 calories five days out of each month but otherwise ate normally — lost, on average, six pounds, shed one to two inches of their waistline, and saw both their blood pressure and levels of IGF-1 (a substance linked to increased cancer risk) drop significantly, according to a University of Southern California study published last year.

How might it work? “When you gain weight, the nerves in your hypothalamus that conduct signals from your fat cells to the rest of your brain become damaged,” says Louis Aronne, M.D., director of the Center for Weight Management and Metabolic Clinical Research at Weill Cornell Medical College. “As a result, your brain doesn’t realize that you’re full, so it keeps signaling you to eat.” 

But when you take a day to not eat very much, he says, “you’re reducing stress on your hypothalamic nerves, so it gives them time to recuperate.” That day of rest for your nerves could be especially important for older people, he says, because of the damage that oxidative stress can further do to your weight-regulating system.

As for how to start, “I tell patients who want to try it to eat only about 800 calories twice a week, focusing mainly on vegetables, protein and healthy oils such as olive oil,” he says.  

To help yourself feel fuller longer on days you’re not fasting, Aronne recommends following a low-carb diet in which about 30 percent of your calories come from protein and the rest from nonstarchy veggies, nuts and beans. Craving bread? “I tell patients that the best time to eat these types of starchy carbohydrates is at the very end of the meal, after they’ve had their veggies and protein,” he says. Aronne’s research shows that people who eat this way not only have lower levels of blood sugar and insulin after eating but also have bigger boosts in hormones like GLP 1, which help keep you feeling fuller for longer.

Practice mindful eating

If you think your weight gain may have something to do with midlife stress (aging parents, college tuition bills and managerial responsibilities at work, anyone?), this approach may be especially helpful to have in your weight-loss toolbox. “A lot of times eating, especially mindless eating, can be stress related, and meditation techniques can be helpful in terms of both alleviating anxiety and making you more conscious of how much you’re consuming,” explains Apovian.

People who practice this technique — which involves paying attention to how hungry or full you feel, planning meals and snacks, eating as a singular activity (without, say, also reading the paper or watching TV), and zeroing in on how your food really tastes — may be more successful at weight loss. People who participated in an online mindfulness-based weight-loss program, for instance, lost more weight (on average, about 4.2 pounds) than a control group, according to a North Carolina State University study presented last year at the European Congress on Obesity.

Need some tips to get you started? Eat slowly (put your fork down between bites, and chew your food well), try to have meals without any outside distractions, and follow the one-bite rule when it comes to favorite but fattening foods like desserts.