Disturbed Sleep

Improving sleep quality

August 2008 - Research from the UCLA Cousins Center for Psychoneuroimmunology published in Sleep found that practising tai chi chih, the western version of an ancient Chinese martial art, helped improve sleep quality in older adults. It has previously been shown to be effective in reducing tension headaches and high blood pressure and in boosting the immune system of elderly people with shingles.

Researchers explain that 58 per cent of adults age 59 and older report difficulties in sleeping. The majority (85 per cent) do not seek treatment. The remainder tend to rely on costly, sometimes inaccessible behavioral therapies or more commonly on sedatives with possible side-effects. Poor sleep is associated with significant health problems in this age group.

Lead author Michael Irwin, professor of psychiatry and biobehavioral sciences commented:

"It's not uncommon for older adults to experience daytime confusion, drowsiness, falls and fractures, and adverse interactions with other medications they may be taking."

The study randomly assigned 112 healthy adults ranging in age from 59 to 86 to one of two groups for 25 weeks The first practised 20 simple tai chi chih moves; the second group received health education classes that included advice on stress management, diet and sleep habits. Participants were asked to rate themselves using the Pittsburgh Sleep Quality Index, a questionnaire that assesses sleep quality, duration and disturbances over a one-month period.

Researchers found that, compared to the health education group, those practising tai chi chih reported improvements both in sleep patterns and in associated problems such as daytime drowsiness and inability to concentrate. There is general support for the role of physical exercise in improving sleep; the gentle slow movements of tai chi chih offer an attractive option for older people.

Michael Irwin concluded:

"It's a form of exercise virtually every elderly person can do, and this study provides more across-the-board evidence of its health benefits."

Daytime napping and disturbed sleep

May 2008 - Poor sleeping at night has been linked to daytime napping for older adults according to a study just published in the journal SLEEP.

Suzanne E. Goldman, PhD, of Vanderbilt University Medical Center in Nashville, Tenn., and her colleagues measured the sleeping habits (day and night) of 235 people with an average age of 80.1 years. They used wrist monitors and sleep diaries for an average of amlmost a week. Three quarters (75.7%) of the subjects recorded naps of at least five minutes in their sleep diaries. Participants who showed higher levels of fragmented sleep at night, respiratory symptoms, diabetes, or pain were more likely to report napping.

Participants who said they had diabetes averaged 43% longer nap duration, while those who reported pain averaged 27.5% shorter nap duration.

According to Suzanne Goldman:

"Our study is important both clinically and for future research. It points out the need for health care providers to discuss nighttime sleep and daytime napping with older individuals. It also points out the need to identify the causes of disturbed nighttime sleep in order to determine appropriate treatment. Our study suggests that that older adults nap because of health problems and disrupted sleep at night. Thus the napping may reflect needed sleep."

Poor sleep can lead to problems, and these are more likely for older adults. Such problems include:

• depressed mood, attention and memory problems
• daytime sleepiness
• night-time falls, and
• more use of over-the-counter or prescription sleep aids

Recent studies have also associated a lack of sleep with a number of serious health problems such as increased risk of obesity, cardiovascular disease and diabetes.

Most people need seven to eight hours of sleep a night to be at our best the next day but as we age we may find this harder to obtain. Some advice for improving sleep patterns:

• Establish a routine sleep schedule.
• Avoid using your bed for anything but sleep or intimacy.
• Avoid substances like alcohol or caffeine that disturb sleep,
• Avoid napping during the day. If you have to nap, limit napping to less than one hour and no later than 3 p.m.
• Stick to rituals that relax you before bed such as a warm bath, a light snack or a few minutes of reading.
• Try not to take your worries to bed (perhaps easier said than done).
• When you can't fall asleep, leave the bedroom and engage in a quiet activity. Go back to bed only when you are tired.
• Keep the bedroom dark, quiet and cool - but not too cold.

Midday Siesta a Napping Good Idea

Research from the University of Athens Medical School (UAMS) and Harvard School of Public Health (HSPH), published in the Archives of Internal Medicine in 2007 found that taking regular midday naps (siestas) was associated with reduced risk of death from heart disease over a six-year period for Greek adults, especially working men.

Researchers comment that siesta is a common habit in many parts of the world, including the Mediterranean and Central America but previous studies into the association with reduced coronary mortality have produced conflicting results The current research is the first large prospective study of individuals who were healthy when recruited and that controlled in detail for other risk factors.

Researchers led by Androniki Naska, lecturer of hygiene and epidemiology in UAMS, and Dimitrios Trichopoulos, professor of cancer prevention and epidemiology at HSPH studied 23 681 Greek men and women aged 20 to 86 with no history of heart disease, stroke or cancer when they enrolled in the study between 1994 and 1999. New participants were asked if they took midday naps, and if so, the average frequency and duration. They also reported levels of physical activity and dietary habits over the year prior to enrolment.

Over an average follow-up period of 6.32 years, 792 participants died including 133 from heart disease. After other cardiovascular risk factors had been factored in, individuals who took midday naps, whatever the frequency and duration had a 34 per cent lower risk of dying from heart disease than those who did not. Researchers found that "systematic nappers", those taking a siesta for 30 minutes or more at least three times per week, had a 37 per cent lower risk of coronary mortality. Occasional nappers showed a statistically non-significant 12 per cent reduction.

These rates were significantly higher for working men, with those taking occasional or systemic midday naps recording a 64 per cent lower risk of death from heart disease, while non-working men (mostly retirees) who napped had a 36 per cent reduction in risk. There were only six deaths among working women making comparisons impossible.

The researchers comment:

"We interpret our findings as indicating that among healthy adults, siesta, possibly on account of stress-releasing consequences, may reduce coronary mortality. The fact that the association was stronger in working men, who likely face job-related stress, than non-working men is compatible with this hypothesis."

Dimitrios Trichopoulos added:

"The public health message is clear-if you can take a midday nap, do so."

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