![]() ![]() Medication is an option for patients who decline CBT or who have severe insomnia. Referral to a psychologist for cognitive-behavioral therapy (CBT) can help people persevere in their efforts to change sleep behaviors and negative thoughts about sleep. “It takes weeks to months to condition your body to behave differently,” Dr. Patients with insomnia often try these behaviors briefly without success. Avoiding exercise within 3-4 hours of bedtime.Controlling stimuli: No TV or computer in the bedroom, no excess noise or light at bedtime.She also recommends trying these sleep hygiene behaviors: The body eventually will go into the bedroom and remember to fall asleep,” she explains. “One of those times they will fall asleep, and that is the new conditioned response. Rundo advises patients to leave the bedroom if they do not fall asleep after 20 minutes and to read a book or listen to relaxing music. It also conditions them to expect poor sleep,” she says.ĭr. This conditions them to think it’s OK to be awake in bed. “People with insomnia often lie awake in bed for hours. Rundo addresses behaviors and beliefs that may reinforce insomnia inpatients of all ages. Step two: Modify behaviorsĪfter managing medical causes, Dr. She recommends referral to a sleep specialist for further testing. They awake multiple times at night, may have been told they snore or stop breathing, and feel excessively sleepy during the day,” Dr. “Individuals with OSA may complain of difficulty falling asleep, but more frequently we hear about difficulty staying asleep. In her experience, OSA that develops after menopause is a frequent cause of insomnia in women. “Probably 40 to 50 percent of individuals over age 60 have some sleep-disordered breathing,” Dr. Loss of muscle tone with aging contributes to collapse of the oral pharyngeal airway and OSA. “Anxious people tend to report ruminating thoughts and excessive worry that cause difficulty with falling asleep, whereas depressed people report sleeping for four or five hours and then having a hard time going back to sleep,” according to Dr. Psychological stress manifests as several insomnia patterns. Similarly, frequent awakenings by individuals with Alzheimer disease or other dementias can perpetuate insomnia. Even if the problem resolves, the disrupted sleep pattern may remain,”Dr. “A pattern of getting up frequently and having difficulty falling back to sleep can develop. Common underlying factors include chronic pain, asthma, gastroesophageal reflux, obstructive sleep apnea (OSA), restless legs syndrome, anxiety, depression and medications that affect sleep.īowel problems and frequent urination also can interrupt sleep. Step one: Identify medical factorsīegin by identifying and managing medical conditions that may be interfering with sleep, Dr. ![]() “If insomnia is affecting a person’s daytime functioning, it should be treated,” Dr. This validated self-reporting scale also can help monitor treatment over time. The seven-question Insomnia Severity Index can help quantify the severity of symptoms such as daytime fatigue and struggles with chores, work, concentration, memory or mood. “Think of insomnia if someone reports taking longer than 30 minutes to fall asleep or waking too early and being unable to go back to sleep,” Dr. This syndrome of increased confusion and agitation in the evening can interfere with sleep through the night. You could ask a family member similar questions about an individual with Alzheimer dementia who may be sundowning. Do you have daytime fatigue or sleepiness?.How much sleep do you think you’re getting at night?.Are you having difficulties with falling or staying asleep at night?.She suggests three screening questions for insomnia, which is defined as difficulty falling asleep or staying asleep for as long as desired: Despite these changes, people do not need substantially more or less sleep as they age, Dr. Sleep latency - the time it takes to fall asleep - tends to increase, and more awakenings occur at night. Sleep in later life is characterized by less slow-wave sleep (deepest stage). They might believe poor sleep and daytime fatigue are normal with aging,” she says. “Even so, insomnia is easy to miss if you don’t ask older patients about it. Some 40 to 50 percent of adults aged 60 and older experience insomnia, compared with 10 to 20 percent of younger adults, according to Dr. We do not endorse non-Cleveland Clinic products or services Policy Recognizing insomnia Advertising on our site helps support our mission. Cleveland Clinic is a non-profit academic medical center. ![]()
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