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Managing Chronic Insomnia
Quality Life Forum​ Age-Related Health Challenge Series
June, 2021

Chronic insomnia is a common problem for many with its prevalence increasing with age. Chronic insomnia lasts for three months or more. Not all insomnia are the same. The problem may be hard to falling asleep (sleep onset),  struggle with asleep nightlong (sleep maintenance), or both.

Common Causes of Chronic Insomnia

The common causes of chronic insomnia for older adults including, but not limit to the following:
  • Stress and anxiety often keep you up, at conscious or unconscious level.
  • Sleep schedule factors, including daytime napping, schedule irregularity, poor sleeping environment
  • Lifestyle factors, including physical inactivity, meal time and portions, caffeine and alcohol use
  • Medication side effects – including medications for hypertension, cold, diuretics and many other drug classes. An increased use of multiple prescription drugs in aging population affect sleep is more common.
  • Medical conditions, physical discomfort and pain - including neurological and mental disorders, respiratory and cardiac conditions, musculoskeletal and dental pains, and more.

Sleep Stages and Physiology 

There are two main types of sleep: 

Non-rapid eye movement (NREM), also known as quiet sleep
Rapid eye movement (REM), also known as active sleep

NREM Stage 1

Stage 1 is the beginning of the sleep cycle and is a relatively light stage of sleep. Stage 1 can be considered a transition period between wakefulness and sleep. The brain produces high amplitude theta waves, which are very slow brain waves. This period of sleep lasts only a brief time (around five to 10 minutes). This stage is not a true asleep.

NREM Stage 2

Stage 2 lasts for approximately 20 minutes. During stage 2 sleep, you become less aware of your surroundings. The brain begins to produce bursts of rapid, rhythmic brain wave activity known as sleep spindles. Body temperature starts to decrease and heart rate begins to slow. According to the American Sleep Foundation, people spend approximately 50% of their total sleep in this stage.

NREM Stage 3

During stage 3 sleep, muscles relax. Blood pressure and breathing rate drop. Deepest sleep occurs.
Deep, slow brain waves known as delta waves begin to emerge. During this stage, people become less responsive and noises and activity in the environment may fail to generate a response. It also acts as a transitional period between light sleep and a very deep sleep.

​REM Sleep

During REM sleep, the brain becomes more active. The body becomes relaxed and immobilized. Dreams occur. Eyes move rapidly.

Most dreaming occurs during the fourth stage of sleep, known as rapid eye movement (REM) sleep. REM sleep is characterized by eye movement, increased respiration rate, and increased brain activity. The American Sleep Foundation suggests that people spend approximately 20% of their total sleep in this stage.
REM sleep is also referred to as paradoxical sleep because while the brain and other body systems become more active, muscles become more relaxed. Dreaming occurs due to increased brain activity, but voluntary muscles become immobilized.

The Sequence of Sleep Stages

It is important to realize that sleep does not progress through these stages in sequence. Sleep begins in stage 1 and progresses into stages 2, and 3. After stage 3 sleep, stage 2 sleep is repeated before entering REM sleep.
Once REM sleep is over, the body usually returns to stage 2 sleep. Sleep cycles through these stages approximately four or five times throughout the night.

On average, we enter the REM stage approximately 90 minutes after falling asleep. The first cycle of REM sleep might last only a short amount of time, but each cycle becomes longer. REM sleep can last up to an hour as sleep progresses.

Managing chronic insomnia

Are you facing challenges of sleeping pattern changes or losing sleep quality? Each long night can be very frustrating, with an exhausting day to follow. Not sleeping well , not feeling well, naturally. How much sleep do we need and what happens if we sleep too little or too much? go to Sleep Well to learn more.

Chronic insomnia can be effectively managed with a combination of cognitive behavior modifications,  sleep hygiene, lifestyle changes, and self-care practice. Sleeping aids are also optional.

Cognitive behavioral therapy for insomnia is a structured professional program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep.  The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

Following the CBT-I principles, you may benefit from practice self-care at home - 

1. Regulate emotions to be peaceful
  • Calm your mind, meditation or soft music may be helpful to wind down and reduce anxiety
  • Don’t bring your emotions to bed, let go of the day, no matter good or bad.
  • Learn to relax your muscles and regulate breathing mindlessly 

2. Improve sleep hygiene
  • Get up when awake or unable to sleep, don’t force sleep in bed
  • Avoid caffeine, especially later in the day.
  • Avoid alcohol use and smoking cigarettes before bed.
  • Don’t eat large meals in the evening, nor be hungry for bed.
  • Avoid using computers, smartphones, TV, or other technological devices an hour before bedtime.

3. Lifestyle modifications
  • Keep regularity of sleeping schedule (bed time and get up time), including weekends and holidays.
  • Engage in regular physical activity, plan full workout during the day and an evening yoga stretch or Tai Chi is ideal.
  • Track your daily sleep time. Limit a day time nap no more than 30 min and avoid taking nap in the late afternoon or evening.

4. Making sleep environment comfortable
  • Keep your bedroom dark or use a sleep mask.
  • Keep your bedroom in a comfortable temperature.
  • Minimize the noise level.
  • Make sure your bed and bedding are comfortable.

OTC sleep aid options may include:
  • Melatonin -  a hormone that is naturally produced by the body and is involved in the sleep cycle, available as supplements commercially.
  • Valerian root - a perennial flowering herb native to Europe and Asia
  • Chamomile tea - Chamomile flowers are best known for their role in tea but are also found within calming blends in herbal supplements.
  • White noise app or device – a device to produce soft nature sounds, such as water flow, rain, winds, etc.

If you require prescription medications for insomnia, it should not be used longer than 3 months to prevent drug dependency. Also be aware of the side effects.

In summary, chronic insomnia is a common issue for many with its prevalence increasing with age. Not all insomnia is the same. With better understanding of how we sleep and why we can’t sleep, chronic insomnia can be effectively managed with a combination of cognitive behavior modifications,  sleep hygiene,  lifestyle changes, and self-care practice. Sleeping aids are also optional.

If you are suffering chronic insomnia, take action today; don’t put it off. Feel free to contact QualityLifeForum@outlook.com for support. Health coaching can help you achieving your personal health goals.


© All rights reserved

References:
https://www.sleepfoundation.org/insomnia/what-causes-insomnia
https://www.healthline.com/health/chronic-insomnia#causes
https://www.verywellhealth.com/the-four-stages-of-sleep-2795920
https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677

Disclaimer: This information is for educational and informational purposes only. It is not medical advice. Consult your healthcare professional for personal conditions.

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  • Home
  • Forum
    • Mind and Body
    • Feeling well
    • Feeling ill
  • Coaching
    • Coaching Programs >
      • Loneliness Breakthrough
      • Therapeutic Lifestyle Changes
      • Time-Restricted Feeding for Healthy Aging
      • Patient-centered Health Navigation Program
      • Customized program
      • A Special Health Coaching Package
    • Self-Care >
      • 2021 Aug The Milestone of Age 65
      • 2021 March Make a Self-Care Plan for Your Golden Years
      • 2018 Jan The Golden Keys for the Golden Years
      • 2018 July Golden Mindset
      • 2019 Jan Empty Nest
      • 2018 Feb loneliness Breakthrough
      • 2016 Feb Wellness Mindset
      • 2023 Jan Setting and Meeting Your Goals
      • 2019 Sept Time for change
      • 2020 Oct Process and Results
      • 2021 Sept Aging Brain
      • 2019 May Cognitive Health
      • 2021 Oct Muscle Memory and Cognition
      • 2020 July Listening to your body
      • 2019 March Body Image and Self-Care After Midlife
      • 2020 Nov Moderation
      • 2022 Aug Knowing When Doing More Is Harm Than Good
      • 2021 Nov Gratitude Power for Wellbeing
      • 2019 Dec Dealing with Difficult Emotions in Holiday Season
      • 2022 Dec Holiday Homecoming
    • Healthy Living >
      • 2022 Jan Health: the Cornerstone for Quality of Life
      • 2017 April Longevity and Quality of Life
      • Blog Are You Motivated for a Healthy Life Style?
      • 2018 June TLC Transformation
      • 2022 July Daily Routine for Healthy Aging
      • 2017 June Sleep Well
      • 2021 May Simplify Life for healthy aging
      • 2019 Aug Downsizing in the Golden Years
      • 2017 Sept Music Learning for older adults
    • Healthy Eating >
      • 2022 Sept Your Decision Power for Food Choices and Eating Behavior
      • 2022 Oct Hydration for Healthy Aging
      • 2018 Aug Nourish Your Body for Healthy Living
      • 2017 Oct Better to Eat Meat or Plant Food
      • 2020 Jan The Key Role of Protein in Healthy Aging
      • 2020 Feb Healthy Fat for Healthy Aging
      • 2020 March Healthy Aging Energy Source Carbohydrate
      • 2017 July Intermittent Fasting
      • 2020 Sept Time-Restricted Feeding Is A Healthy Lifestyle Choice
      • 2022 Nov Go green for health: A Green Tea Invitation
      • 2019 June Dietary Supplements Are Not Drugs
      • 2015 Nov Blog The Value of Vitamin and Dietary Supplements
    • Golden Age Fitness >
      • 2019 April Exercise is Medicine
      • 2017 March Exercise for Blood Sugar Regulation
      • 2017 Jan Willness Attitude and Winterizing Fitness
      • 2016 Apr Balance Training
      • 2016 Mar Get Active
      • 2018 Sept Keep Life in Motion
      • 2020 Aug Keep Fit for Your Age
      • 2023 Feb Benefits of Swimming for Healthy Aging
    • Age-related Health Challenges >
      • 2018 March Regulate Blood Pressure
      • 2018 May Blood Sugar Self-Management
      • 2018 April Lowering Cholesterol
      • 2017 Nov Immunity and Aging
      • 2016 June Vitamin D Deficiency
      • 2022 May Aging Skin and Sun Safety
      • 2022 Feb Aging Eye Facts
      • 2017 May How to Reduce Aging Eye Fatigue
      • 2022 Mar Age-Related Hearing Loss
      • 2022 April Aging and Oral Health
      • 2017 Feb Live with Thyroid Nodules
      • 2021 July Range of Motion Recovery from Frozen Shoulder
      • 2019 Nov Osteoporosis in Women
      • 2019 Feb Food Safety and H. pylori Infection
      • 2019 July GERD
      • 2016 Oct Significant Health Indicators
      • 2018 Oct Tough Fight for the Belly Fat
      • 2016 July Weight Management
      • 2018 Nov Dealing with chronic stress
      • 2021 June Managing Chronic Insomnia
      • 2017 Aug Facing a life-threatening illness
      • 2016 May Emotional Healing
    • Advocacy and Empowerment >
      • 2018 Dec The Most Valuable Gift
      • 2020 Dec Invest In yourself
      • 2016 Aug Health Literacy
      • 2016 Sept Prevention
      • 2022 June Making Transition From A Patient To An Educated Healthcare Customer
      • 2019 Oct Action is what counts
      • 2021 Nov Navigation for Healthcare Needs
      • 2016 Nov Gratitude for life
    • COVID 19 Pandemic >
      • 2020 May Hope endures
      • 2020 June Breathing and Blessing
      • 2020 April Transform Pandemic Fear to Self-Care
      • 2021 Jan Hew Year Brings New Hope
      • 2021 Feb Pandemic Winter Blues
      • 2021 April Are You Fully Vaccinated?
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