Sufficient, restful and sound sleep seems to be a prerogative of children and young adults, even though older people too need the same 7-9 hours of sleep at night. About half the population over the age of 60 complains of problems falling asleep, staying asleep, or worse, awakening in the wee hours of the morning. This gets worse if they nap during the day.
Some of this insomnia can be explained by the natural changes in the body's internal clock. These people tend to sleep early and wake up before dawn.
The insomnia may have a sudden onset, precipitated by an acute anxiety-provoking event. This temporary insomnia disappears in a month or so as the problems resolve. The real sufferers are those with chronic insomnia, who sleep restfully for five hours or less for six months or longer.
Chronic insomnia causes worsening of lifestyle diseases like diabetes, hypertension and heart disease. It causes cognitive decline, so decision-making and memory are poor. Coordination and balance are affected, resulting in falls. People may feel so sleep deprived that they "nap" during the day. This may seem like a temporary shutting of the eyes, but may last an hour or two. It is not refreshing and results in grogginess and depression. They may have episodes of "microsleep" when they doze off in the day but have no recollection of it. This is dangerous and can cause accidents.
Medication prescribed for other ailments may be responsible for insomnia, if the tablets have a stimulant effect. Others pills, such as diuretics, need to be taken in the morning. If they are taken in the evening, the person may need to wake up repeatedly to go to the toilet, making sleep unsatisfactory and fitful. Undiagnosed obstructive sleep apnoea makes the person stop and restart breathing several times during the night. This disturbs normal sleep rhythm.
About 60 per cent of men over the age of 60 have BPH (benign prostatic hypertrophy), a non-cancerous enlargement of the prostate gland which causes frequent urination, especially at night. Older people are also more sensitive to caffeine, so drinking tea or coffee late in the evening may interfere with sleep.
In people with iron deficiency anaemia, diabetes, peripheral neuropathy and some other conditions, the legs tingle or pain in the night. They have to be moved frequently, but often to no avail.
Busy physicians often do not have the time to delve deeply into the precipitating factors of insomnia. They prescribe "sleeping pills" which act like Band Aid. The patients often demand this as well. The sleep is often unsatisfactory and not natural. People become habituated and dependent on medication. Larger doses are needed to achieve the same effect. Some people have been on sleeping tablets for 10-15 years!
To ensure good sleep
• Go to bed and wake up at fixed times
• A TV or computer emits a blue light, which disrupts sleep. So ban them from the bedroom
• Avoid caffeine for at least six hours before bed
• The adrenaline released during exercise can keep the body alert for hours, so work out in the morning
• Melatonin, needed for good sleep, decreases with age. Expose the body to the afternoon sun to partially correct this deficiency
The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues, please write to firstname.lastname@example.org