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Saturday, August 12, 2017
Brain / Mind ... Health / Nutrition ... Personal Reflections ...

Every now and then I like to post some thoughts on how I’m adapting to old age (or sometimes not adapting too well). Perhaps something I say might be of help to someone else, just as I sometimes pick up a good tip or two from another blog or column on the web. (Unfortunately, there is so much junk to sift thru on the web these days before you find something valuable). So today I’m going to talk about sleep, or lack thereof.

Ah yes, sleep, a seemingly simple topic that is really very complex. Or at least when you start getting old like me. When I was young, sleep wasn’t much of an issue. It was once pretty easy to fall asleep whenever I chose to, and stay asleep as long as I needed to (usually 7 hours or so). When I was in college, I had a summer job on a railroad, which required me to occasionally work a night shift (or “3rd trick” as they called it). I had no trouble adjusting my sleep pattern as to fall asleep in the morning after getting home and getting up around what would be my usual supper time, feeling fully refreshed and ready for another night shift (or an adjustment back to normal daytime living).

Today I have a regular 7:30 to 4:30 job, but over the past 6 or 7 years, getting enough sleep every night has become harder and harder. I myself am a morning person, so I generally like to get up early (and thus I should get to bed early). As I got into my later 50s and now into the mid-60s, it has become harder and harder for me to sleep straight thru to the alarm clock — I started getting up too early. My problem is not on the evening side; I usually fall asleep pretty easily when I hit the pillow around 11 pm (but it should be 1030). The problems start sometime after 3 (and sometimes as early as 2:30 am), when I get up and then have trouble getting back to sleep. Basically, my problem is calledadvance sleep phase syndrome“.

Some people get by on 4 or 5 hours sleep on a regular basis, but I myself don’t do too well during the day when I get much under 6 hours. I definitely become more forgetful and probably more cranky. Thus far I haven’t had any close calls in terms of driving or crossing streets or such due to drowsiness after a bad night (a good cup of regular green tea before going out the door gives me enough of a caffeine lift), but not sleeping enough definitely cuts the margin for error. When I try to exercise, I find that I’m not able to do as much as when I sleep properly. And overall, I just don’t feel as good as I might otherwise.

Again, this isn’t so bad if it only happens one day a week. But over the past year or so, it has become more and more regular; I have been trying to get by some weeks on 4 hours of sleep per night for 3 nights in a row. That is not very much fun.

Therefore, I have been studying the problem and experimenting with various Do-It-Yourself interventions (I’m not yet at the point where I wish this to become a professional medical matter involving doctors; but if it gets worse, I might need to take that step). First off, from the fact-finding perspective; it’s pretty clear that work-stress is a major factor in my lack of sleep quality. I don’t have as much trouble sleeping on Friday, Saturday and Sunday nights; my insomnia problems usually start on Tuesday night, and get worse on Wednesday and Thursday.

Is my job really all that stressful? Actually, no. For the past few years I have been in a stable work situation, I haven’t been threatened with demotion or firing, and I have gotten along with most everyone at the office. No one seems to have it in for me. It just seems as though my mind gets more revved up on weekdays at the office versus weekend days or vacation days at home, and it just doesn’t slow down enough during the night. There seems to be some sort of “mental momentum” from the workday that keeps my mind active enough thru the night to keep me from sleeping much after 3:30 or so.

This wasn’t always so. I have been working in similar office job situations since the late 1970’s, but only in the past handful of years have I been affected so much at night by the “mental dynamics” of the workday. Again, my current job isn’t extraordinarily stressful compared with previous jobs, although it can be challenging. I probably do take my job today a bit more seriously than I took most of my jobs in the past (even though I know for sure that I’m not “changing the world” in what I do). Still, I think that because of what is happening to my body as it ages, I am now more sensitive to the “mental heartbeat” of working in a professional job than I was as a younger man. The doctors and scientists seem to say that this is not unusual; sleep problems become more prevalent with advancing age.

Oh, PS. I don’t have sleep apnea (thank goodness) nor any other particular condition that causes or contributes to my sleep problems. I don’t take any prescription drugs that would interfere with my sleep either. These are factors on the checklists that you will see when you look for advice about insomnia. We can get those things out of the way right up front.

At least some part of the physical decline and increase in disease in the elderly can be attributed to their inability to get enough sleep. This may have something to do with the declining levels of melatonin produced by the pineal gland as people age. Recall that melatonin is known as the “sleep hormone“. Some studies indicate, however, that melatonin levels are no different between elderly people who sleep well and those who don’t. And also that melatonin levels don’t fall all that much with old age.

Nonetheless, melatonin is a popular and widely available “over the counter” supplement that many people use to to get better sleep (or try to). My own web-research indicates that different people get very different results from melatonin — some people find melatonin to be a very reliable and effective sleep aid, and others don’t. I will discuss my own experience with melatonin in just a bit.

Two of the most basic and common recommendations from medical and mental health professionals regarding sleep problems like my own are 1.) improve your “sleep hygiene“, and 2.) try “light therapy“, i.e. getting a lot of bright light in the early evening, even from an artificial light source (especially needed during the winter season). I’ll start with the second technique first. Light therapy is supposed to be overseen by a medical professional, but it easily lends itself to a “DIY” approach. You can easily purchase a light therapy lamp to sit next to in the evening, so as to convince your subconscious that the sun is still up and it is not yet time to start cranking out the sleep hormones.

I shelled out $60 for such a lamp, and for the past two years I have used it regularly between 6 and 8 pm during the winter months. Does it help? Well, to be honest — not much. Maybe a little, but I’m still having sleep problems during the long days of late spring and summer. Perhaps the bright light at the dinner table during the cold and dark months might lift my spirits a little bit, but light therapy did not turn out to be the “magic bullet” that got me sleeping like a baby once more.

Next, let’s talk about “sleep hygiene“. What is sleep hygiene? Well, it’s mostly a list of common sense ways to prepare yourself for a night of sleep. E.g., make sure your bedroom is comfortable and quiet, don’t drink caffeine or other stimulating stuff before going to bed, and get to bed a consistently at your own regular time. And yes, this is all important stuff that can help. My biggest “hygiene” problem involves the home computer and the discipline in getting away from it at least an hour before bedtime. Various studies show that staring at a computer screen (even a smartphone screen) is just as jarring for the nervous system as a full-brewed cup of coffee.

Unfortunately, sleep hygiene is much easier said than done! There is always one more email or message to answer, one more Tweet or Facebook post to ponder, one more website to check out (e.g. the weather forecast for tomorrow). If you jones for political news as I do, the Trump Administration has severely impacted your sleep hygiene. And it ain’t easy for sports junkies either, especially those on the East Coast wondering about the scores coming in from out west.

But after a bad night and a zombie day at work, I will impose some discipline upon myself and turn off the computer by 930 pm. This often helps, but once again, it is not the magic bullet. There are nights when I am on the computer right up to the moment when I jump into bed, and yet I sleep just fine. And there are other nights when I break from the screen by 9 and relax myself as I prepare for bedtime, and yet I will be staring at the clock come 3:15 am.

So, the next step for me was chemical warfare, i.e. the various supplements that are marketed as sleep aids. You can get some of them right in your local supermarket or WalMart, while others require a visit to a specialty vitamin shop or web merchant (although many of the big web sellers such as Amazon have a wide range of different supplements available). Actually, I had been experimenting with low-level versions of chemical sleep aides for some time, as I have been a fan and a user of herbal teas for several decades now. I have tried various herbal mixtures of chamomile, valerian root, lavender, skullcap, passionflower, hops . . . and in some cases, they helped a bit. But a nice cup of hot tea at bedtime mostly helps to get to sleep, which for the most part I don’t have a problem with. They don’t do much to KEEP you asleep. I have tried drinking sleep-inducing herbal brews at 3:30 am, but have generally found teas to be useless in trying to get back to sleep during the wee hours.

Oh, and one other side-note before I review my experience with melatonin and other sleep compounds that come in concentrated pill doses (such as valerian, where the pills generally have about 5 to 10 times more ingredient than what you get in a cup of herbal tea). I have also used aromatheraphy to some good effect. I read that lavender oil and marjoram oil are good for calming you down and are used by some people to help get to sleep. So I keep some small cotton or cloth patches soaked in lavender and marjoram oil in a container near my bed. I sometimes put one next to my pillow when I get up too early and am just lying there awake. And once again, aromatherapy seldom gets me back to sleep. (Nor do essential oils help me to stay asleep if I start using it at 11 pm, when I’m drifting off).

HOWEVER — I have found that aromatherapy DOES make me more comfortable during those unfortunate hours between waking up and needing to get out of bed to start the day. Too often, I get restless after waking up during the night, and so I toss and turn in my bed with my mind running back and forth between what seems like a million different things. A bit of lavender and marjoram aroma seems to slow my mind down and help me to just lay still. The hours between 3:30 am and the alarm at 5:30 am seem to go faster when lavender is in the air. I can’t say that this makes me feel like I’ve had a full night of sleep during the course of the following day, but it certainly helps to keep things from becoming even worse.

But let’s get to the drug counter — sleep supplements. I call the supplement market a “drug counter” because many sleep supplements are really unregulated drugs that can have significant effects on the workings of the brain and body. I don’t take them lightly; they must be used with caution and respect as they can have significant and unexpected side effects. What I want, along with most other insomnia sufferers (I would guess) is something that works reliably but doesn’t cause depression or constipation or stomach upset or drowsiness on the way to the office. And given my “phase advance” i.e. my natural early-to-bed pattern, I want something that can provide another two hours of sleep if I take it at 3 am, yet not cause me to run a stoplight at 7 am.

There are a variety of supplements that are marketed for sleep, but the three that I have tried out are melatonin, valerian and l-theanine. In a nutshell, each drug has its pros and cons. And for each, there have been occasions where they worked well, and other occasions where they didn’t see to help one bit. So far though, none of them have caused any serious side effects — mainly because I try to use relatively low doses.

First, melatonin. I’ve read some articles that cite studies which indicate that lower doses of supplemental melatonin are best (around 1/3 to ½ mg); whereas, higher doses could have tricky side effects (and go way beyond the normal level of melatonin found in the blood). The most common melatonin doses available seem to be 3 and 5 mg, and you can get pills up to 10 mg. I decided to go with the small-is-better theory and bought some 1/3 mg melatonin pills, in two forms – regular and timed-release. Regular quick-release melatonin should possibly help someone trying to get to sleep, but my problem is staying asleep after 3 am (liquid melatonin should be quicker than the pills). So for me, a timed release pill would make more sense, as some of the melatonin is still being released about 5 hours after swallowing it.

How has it worked so far? In a nutshell, not very reliably. There have been some nights when I got it just right – I took one or two 1/3 mg pills at just the right time, and slept thru past 5 am. In one instance, I woke up feeling so good just to be lying there. I used to have that feeling when I was younger, when lying in bed in the morning felt great and I didn’t want to get up. But in other instances, it was back to waking up at 3 am and tossing and turning. I was tempted to escalate the dose, as I know some people who swear by 3 mg doses of melatonin. However, I respect the fact that melatonin is a hormone and can interact with other hormones in the body. You don’t know where you are headed when you start going into big doses like 3 or 5 mg. I haven’t read of anyone dying or being seriously hurt by melatonin, but taking big doses seems like playing doctor with yourself, while not understanding just what could be happening. So I still try low-dose melatonin occasionally, but for the most part, I am not very enthusiastic about it.

Next, there is l-theanine. That supplement is well-regarded by a lot of people on the self-medication websites. It is a key ingredient in green tea; supposedly it is what keeps you feeling mellow after drinking green tea even though it has caffeine in it. L-theanine is advertised as a relaxing agent, one that does not make you drowsy. It has a calming effect, but does not have a knock-out punch like a sleeping pill. Supposedly you can remain alert after taking l-theanine, but many people use it to help get to sleep when they are worried and anxious about things.

My own experience? Again, mixed and unreliable. I had one or two nights when I took 150 mg or 200 mg pills, and they did help me sleep through to sunrise. But on various other nights, they had no effect. And in certain instances, l-theanine seemed to keep me from falling asleep, it seemed to stimulate my mind a bit (even though I did feel generally calm). Bottom line, l-theanine might be OK for occasional use in fighting daytime tension and anxiety, but at night, it is not a reliable sleep aid. For me, anyway.

OK, so what about valerian root pills?

They have given me somewhat better results – although with possible (though relatively mild) side-effects. Valerian is said to have sedative effects because it influences the GABA neurotransmitter in the brain; I can usually feel myself getting sleepy after taking a dose. I also find valerian to be relatively short-acting (it seems to wear off for me about 2 to 3 hours after ingestion; also it takes at least 30 minutes for me to start feeling any effect, so I experience a sedation period of around 2 hours).

Actually, that is good — valerian’s predictable short-term effect helps me to avoid any undesired grogginess after getting up to start the day. If it is 3:30 am and I can’t sleep, a dose of valerian will mostly have worn off by 7, when I have to be in my car driving to work. And of all the remedies that I have tried at 3:30 am, valerian (in a strong enough dose, not just a cup of tea) is the one most likely to help me get some sleep for the remaining 2 or 3 hours of the night. It works maybe 50% of the time, but that still beats the results I had at that time of night with melatonin and l-theanine. Of course, if I had tried bigger doses of those drugs, I might have gotten back to sleep; but the question is would I then be OK to drive to work in 3 hours? Valerian seems to have the most “precise” and predictable effect, in my experience.

Valerian comes in pills, usually 500 mg (but there are some 1000 mg products out there; for me, that would be a really big hit of valerian). You can also buy it as a liquid concentrate, and thus customize your own dose based on how you plan to use it. That is what I usually do. If it is 3 am, I might want a 400 mg dose; if it is 4 am and I just want another 90 minutes, I would ratchet down to 250 mg or so. Again, it doesn’t always work, but around half the time, it does.

Oh yes, what about side effects? Well, if I take 500 mg pill doses for two or three days, I sometimes become mildly constipated. And sometimes my stomach feels a little bit “off” the next day for an hour or two after getting up. But nothing too terrible. I once noticed a mood decline after using valerian, but at other times, I don’t. That might just be my usual moodiness in action.

So, a careful use of drug therapy seems to help somewhat. (There are other supplements that people have used as sleep aids; I have not tried but have read about, including 5-HTP and GABA. But those drugs seem a bit more exotic, and for now, I am not experimenting with them.) But there is one last tactic that I have tried, and when used in just the right way, it seems even more effective than even valerian (although sometimes valerian can be used to enhance it). That is the idea of “bi-phase” or “bi-modal” sleep.

It’s a pretty simple idea – instead of getting all of your night’s sleep in one 7 or 8 hour stretch, you split your sleep up in to two shifts. h I have been experimenting lately with a two-shift system; my initial sleep phase goes from about 8:15 pm to 10:15 pm, and the second phase extends from 12:30 am to 5:30 am. How’s that working out for me? Actually, not bad! On a normal week-night when I’m not otherwise all jagged up about some personal crisis, the bi-phase sleep arrangement seems to help me get in at least 6 hours of real sleep. But let me admit — there is a trick to it, it does require timing. There have been some failures, some nights when even the bi-phase arrangement left me with only 3 and 1/2 or 4 hours of sleep.

Bi-phase sleep seems to make it easy for me to stay asleep to just about the time I would normally awake. In fact, since I started trying two-shift sleep, I have been awakened by the alarm clock rather frequently, something that hardly ever happens when I sleep “straight thru” (in one stretch). But it’s not always easy to get back to sleep when I start the second period of sleep; if I’m not careful, I can lose an hour or two before entering dreamland (footnote, I do most of my dreaming during the second sleep period under this arrangement). And that is just about as bad as the old arrangement; if I don’t get back to sleep OK when “bi-phasing”, I only get about 4 to 5 hours of sleep, hardly any more than with straight-thru sleep.

The biggest trick for me regards what I do or don’t do during the 2 hours or so between the two sleep spells. The 2-phase sleep arrangement requires that I delay what I previously would do between 8 and 10 pm (after cleaning up from dinner and before getting ready for bedtime) until the 10:30 pm to 12:30 am inter-sleep period. That would generally be computer time for me, but could also include some exercise or chores and light repairs around the apartment, or maybe walking over to the local ATM to get some cash. Can this stuff be pushed into the inter-sleep period and not mess up the benefits of bi-phased sleep?

The bi-phase arrangement works for me because I find it fairly easy to fall asleep at around 8. I usually finish my dinner just after 7, and the digestive process itself makes me sleepy. But my natural sleep “cycle”, which is biased towards “early to bed, early to rise”, also helps. Since I am still digesting my food at 8, I don’t lay flat in bed; instead I sit up in my reading chair and put my feet up on an ottoman cushion. I pull out a book, and after 10 or 15 minutes the book falls out of my hands and I quickly fall into a rather deep sleep. I probably don’t dream during the first sleep period. After 10 pm, I start to wake up, but I don’t just snap back to full alertness. I remain rather groggy for at least 5 minutes.

And that turns out to be important!! When I wake up from phase 1, I’m still in a semi-somnambulant state. This can actually be rather nice, as I feel quite relaxed; the day’s worries seem left behind temporarily. The trick is not to lose this feeling before turning back in for Sleep Part II (this time lying down in bed). Does this mean staying away from the computer and cell phone?

Actually, I am able to do some computer work while not losing the “sleepy wave”. I can read e-mails and check some articles, so long as I don’t let anything “get my goat”. But if I get my mind involved and revved up by something (e.g. a distressing e-mail or a glitch on my blog site), then I will have trouble falling back asleep. And if I don’t get back to sleep soon enough after midnight, I’m just about as bad off as I was trying to do all my sleep in one stretch, as previously mentioned. Basically, I need to maintain very good “sleep hygiene” during the inter-sleep period.

However, good hygiene is not always possible. And as with the normal “straight thru” arrangement, this is when the drug counter comes in handy. I’m still experimenting, but having some initial success with valerian as a means of getting back to sleep. I’ve tried melatonin once or twice, but that is more tricky than valerian for me (although melatonin has a fairly good reputation of helping people to get to sleep, more so than for staying asleep thru the night). One advantage of “doing drugs” in a bi-phase arrangement as compared against the straight-thru situation is that I have a longer spell for whatever you take to wear off before getting up. E.g., if I need to take something at 1 am when bi-phasing, it will probably be mostly out of my blood by 5:30 am when I get up, as opposed to something that I take at 3:30 am when waking up too early.

So, I’m still adapting and trying things out, but I am hopeful that bi-phase sleeping habits will help me to get more sleep on week nights. (Usually I still sleep “straight thru” on Friday, Saturday and Sunday evenings – as mentioned above, those are the nights when I do better with a normal sleep schedule). If anyone reads this whole blog, they must also be having sleep problems (although my plodding style of writing might put you to sleep before you finish — which might be a good thing!). So if you are still with me at this point, let me wish you the best in getting your own sleep habits into a better and more healthy groove. I know that everyone’s sleep situation is different, but I hope that at least some part of this essay will be of help to someone.

◊   posted by Jim G @ 9:13 pm      

  1. Jim, You do a good job of describing your problems with sleeping and a good job also of explaining what you are doing to help yourself. A lot of people would just say to a doctor, I can’t sleep; give me a sleeping pill, which isn’t the best solution. So you are really studying the problem. I really don’t know how to add much or to disagree much with anything you have here. I do have, tho, a couple of comments to make. (Wouldn’t you know?)

    While you are “getting older” you are by no means “old”. As I look back on my 60s, I think they were a pretty good decade for me. They were one of the better decades than some that were really hard to get thru. I doubt a doctor would consider you “old”. I just checked the average life expectancy of somebody in the U.S., and if I read it correctly, the average age is 80+ years! Thus you have at least another 20 years to go. My attitude is what are you going to do, worry about life for 20 years? Twenty years is a good chunk of one’s life; why not do something useful and interesting with that score (plus) of years.

    I think a doc starts to consider “old” when a person reaches 75; they will fuss with you about keeping well, tho. But hit 80? Definitely OLD; higher than that: no doubt about being “old”. So give yourself a break and consider that you may yet have some very good years ahead of you, come retirement. (And somewhere you use the word “elderly” and that certainly is nowhere near appropriate to you.)

    My next tho’t was: Perhaps you might consider retirement the first year you are eligible. That would eliminate a lot of work stress and give you time to do a lot of things you don’t have time for now. Just a tho’t.

    I also am glad you are not going along with the heavy doses of some of the “plant medicines” (what I’m going to call them). That’s exactly what they are: Medications. So many of the meds we have now were developed from plants (think penicillin that was developed from mold growing on food). So those in ancient times who were knowledgeable in what plants were helpful to cure human medical problems were “doctors” for all intents and purposes. Thus, I think it’s foolish to think that herbal remedies cannot have serious effects on the human body. I’d be careful of them.

    I can think of two things you do not mention that some people (depending on the individual, I suppose) use and find effective. One is homeopathic meds, which are not at all like plant meds; they have a totally different approach to how to “cure” a problem and are very safe to use. Some people have found homeopathic sleep remedies useful. (I’ve used homeopathic remedies for flu almost every year and find it very useful.)

    Another thing two men I know use religiously is “light classical music”, say Chopin, Mozart, perhaps certain Beethoven pieces, Liszt, etc., have a calming effect, can give the mind something other to use to “push out” work and personal things one tends to ruminate over when it’s difficult to sleep. Again: Just a tho’t. (And then this morning I heard on the news that classical music played at work has a calming effect on workers! Who knew?)

    Being well over 80 at this point, I’ve developed a solution to the sleep problem: When I can’t sleep, I get up and do something useful (“useful” being defined as what I feel like doing at the moment, be it reading, writing, watching TV, etc.) Then, when I get tired and know I can sleep; I do. Works pretty well. HOWEVER, one has to be retired to do that, which is why I mentioned retirement at your first opportunity if it’s something possible for you.

    You’ve really done a thorough and useful study of how to help yourself re sleep. Wish there was a magic soporific for sleep, but seems one has to make due with life and how one’s mind/body works. MCS

    Comment by Mary S. — August 15, 2017 @ 9:53 am

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