Society of Certified Senior Advisors: As We Age, Healthy Sleep Without Prescription Drugs

Numerous surprising new products help restore and improve slumber for older adults who don’t want to resort to drug therapy.

Many seniors have trouble getting to sleep or staying asleep. As we age, insomnia increases due to various factors, including the use of caffeine, tobacco and alcohol; poor sleep habits; medications; and disease.

Particularly as we enter our 50s and beyond, the amount of slow-wave sleep we get decreases. This occurs even if we are still getting a good eight hours of sleep a night. Slow-wave sleep is also called “deep sleep.” It’s considered to be important for memory consolidation and processing. Studies of sleep deprivation with human volunteers suggest that the most important function of slow-wave sleep is brain recovery from the daily stress of mental activity.

Insomnia is the inability to experience restorative sleep, and it’s a problem for about half of adults over the age of 60 in the U.S. Insomnia may result from an inability to fall asleep, or multiple episodes of wakefulness during the night. It can even happen if you wake too early and are unable to get back to sleep. Whatever the cause, insomnia leads to a feeling of exhaustion and “brain fog” the next day.

Primary insomnia is a condition that arises independently, but older adults often tack on secondary insomnia due to medical conditions or the side effects of prescription medications.
Sleeplessness should not be taken lightly. The condition has been linked to depression, anxiety and other psychiatric disorders. New research even points to sleeplessness as a cause of cognitive dysfunction, diabetes and Alzheimer’s. Researchers have found that the protein deposits that are characteristic of this cognitive disease may clear during deep sleep.

Try This First

You may be able to modify your habits and/or environment to get a better night’s rest without resorting to drugs or technical sleep aids. Altering even one of these may be the key to improved rest, so make sure you can tick off each item before you give up. Even if you need further adjustments, you will have created a solid foundation.

Behavioral modifications:

Don’t nap during the day.
Don’t use your bed for activities like reading or watching TV.
Exercise every day.
Avoid alcohol, tobacco and caffeine, especially within four hours of bedtime.

Environmental modifications:

Keep the bedroom very dark at night.
Keep the bedroom quiet.
Make sure the temperature and humidity are conducive to sleep.
Use comfortable bedding.
Get plenty of light exposure during the day.

What About Marijuana

More and more people of all ages are beginning to consider marijuana for various health issues. Of course, your doctor should approve any drug before you try it. Cannabis has a reputation for helping users fall asleep. Two of the main components of marijuana are cannabinoids and terpenes, both of which affect slumber.

Cannabinoids, including CBD, are being studied for their beneficial effects on depression, anxiety, Alzheimer’s and Parkinson’s, among others. They also appear to help induce sleep. THC, the product that gives the “high” associated with marijuana, has sedative effects. Recently, it’s been found to improve breathing during sleep (potentially helpful for sleep apnea). Studies also seem to show that THC increases time spent in slow-wave sleep.

Terpenes are the tiny molecules in marijuana that create its distinctive smell and taste. They also occur in many other plants, fruits and flowers. Among the many terpenes, several have been shown to have sedative effects. Some terpenes improve mood by elevating serotonin levels, and others reduce anxiety and stress, or ward off depression.

For a more complete discussion of marijuana and sleep, see a blog on the topic by Dr. Michael Breus.

Alternative Answers for Better Sleep

There is a plethora of pills that doctors prescribe to help induce or extend sleep. Check this list of pharmaceutical sleep aids. However, many older adults want a better solution because they don’t want to risk unwanted drug interactions with medications they are already taking. Others simply don’t want the risk of side effects from prescription drugs, and are looking for an alternative. Indeed, there are several recent developments to counter sleep-onset insomnia that look appealing.

Ebb Insomnia Therapy. Created by a doctor, this device “gently cools the forehead” to a temperature within a therapeutic range to reduce abnormal elevations in frontal cortex metabolism that can inhibit sleep. It’s FDA-cleared for primary insomnia, and can calm “racing minds” that prevent restful slumber. A randomized, placebo-controlled study of 106 adults showed significantly reduced time to get to both Stage 1 and Stage 2 sleep (the two stages of light sleep). A licensed physician or nurse practitioner has to write a prescription for a patient to get the device.

Nightingale. If troublesome noises are a problem, Cambridge Sound’s Nightingale may be the answer, even if you’ve tried other noise machines. Dual units work in tandem to create a sound curve, immersing the room to mask disruptive noises. Because there are two speakers, the brain can’t locate the source of the sound, making it more effective than traditional machines that mask noises. Nightingale is not regulated by the FDA, nor is it reimbursable as therapy. It is available without a prescription.

Kortex. This general wellness device combines virtual reality (VR) with neurostimulation that “stimulates the brain to produce serotonin and melatonin while lowering cortisol” to enhance sleep. Born from the Fisher Wallace Simulator medical device, the Kortex is designed for the everyday consumer who needs help getting to sleep. Less than 1 percent of patients were found to suffer any side effects in trials, and these were minor, such as temporary headaches and dizziness. There are also no contraindications with medicine, and you don’t need a prescription to get one.

2breathe. Leveraging the known benefits of slow breathing and soothing music, this smart device and app pair guided breathing with a wireless respiration sensor and realtime coaching technology. Personalized, adaptive guiding tones from the user’s breathing have been shown to reduce neural sympathetic activity within minutes — with absolutely no training. Research on device-guided breathing technology has demonstrated stress reduction for cardiovascular therapy, and now for mitigating insomnia. It is not FDA-regulated but comes with unlimited customer support.

Dreampad. As the Dreampad plays music through vibration that travels to the listener’s inner ear, it triggers a relaxation response. The music is specifically designed for sleep, helping release the listener from anxiety-based circular thoughts. Supported by research with adults and children, it works for those with minor sleep issues as well as people who have tried cognitive behavioral therapy without success. In a Columbia University Medical study, the Dreampad notably achieved statistically significant results in the areas of nighttime awakenings and deep sleep. As a relaxation tool rather than a medical device, it is not FDA approved but may be reimbursable.

Meditate Yourself to Sleep

If technical gadgets don’t interest you, try mindfulness meditation. A study on mindfulness meditation to enhance slumber in the Journal of the American Medical Association revealed that meditating was more helpful for middle-aged and older adults than learning better sleep habits. It turns out that meditation evokes a relaxation response, making it easier to get to sleep.

“Mindfulness meditation is just one of a smorgasbord of techniques that evoke the relaxa-tion response,” says Dr. Herbert Benson, director emeritus of the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. The opposite of the stress response, learning the relaxation response can help overcome depression, pain and high blood pressure. Dr. Benson notes that many sleep disorders are linked to stress.

Mindfulness meditation involves concentrating on your breathing to pull your mind away from racing thoughts and into the present moment, evoking the relaxation response. The study found that 20 minutes of meditation every day achieved results. It should be done sitting up or moving (such as with yoga) to avoid nodding off! And it’s easy to learn.

First, choose a calming focus. This can be your breath, a sound, a short prayer or word. If you picked a sound, say it aloud or silently as you exhale. Second, don’t worry about how well you are meditating. Your mind will wander, especially when you are first learning to meditate. When you notice thoughts coming in, take a deep breath, repeat your calming focus, and pull your attention back to the focus.

Older adults may have more challenges getting to sleep and staying that way, but there are plenty of alternatives to prescription drugs that may help reduce or eliminate the problem. Whether you choose to change your sleep environment, add in meditation or embrace a technological sleep aid, a good night’s rest may not be far away.