Dog tired? The six rules that will help cure your midlife insomnia

As you get older, you’ll sleep for fewer hours, and those who are deprived of it may be prone to dementia. What do the experts recommend?

You can learn how to turn a bad sleeping pattern into a better one.

As if ageing doesn’t deal enough blows, there’s another to add to the list: poor sleep.

“Studies have estimated that 40 to 70 per cent of older adults have chronic sleep problems,” says Emma Sullivan, a psychologist and sleep researcher at the University of York.

Even worse, those who don’t get enough sleep between their 40s and 60s could be more prone to developing dementia, according to a recent study of more than 22,000 midlifers published in Age and Ageing journal. None of the participants – who were aged 46 or older when the study started – had been diagnosed with dementia or heart disease when the study started, yet those who reported insomnia symptoms during the 19-year follow-up also experienced a greater incidence of dementia.

And in findings from the Study of Women’s Health Across the Nation, which involves more than 3000 middle-aged women, by a team from the University of Pittsburgh, those with persistent insomnia – defined as trouble falling asleep, waking up in the night or waking up earlier than planned on three or four nights – “had a 60 to 75 per cent increased risk of cardiovascular disease events over the two decades of follow-up”.

Yet although poor sleep is associated with a range of illnesses, it is not yet proven that it is a cause of disease, according to Kevin Morgan, emeritus professor of psychology at Loughborough University’s clinical sleep research unit.

“There is not a direct relationship between what your sleep tracker is telling you and your risk of something like dementia,” Morgan says.

“If your health is declining for whatever reasons in middle age, then that is likely to impact your sleep, and there are also some degenerative processes that affect both sleep and the subsequent onset of disease. But there is not enough data to confirm that poor sleep in your 40s and 50s leads to illness in later life.”

What is known is that our sleep quality declines as we age.

“These are normal ontogenetic changes that basically mean the more candles on your birthday cake, the less likely you are to sleep well,” Morgan says.

Sleepless nights often hit hardest in midlife because it is the point at which the lifestyle habits of our 20s and 30s collide with the inevitable physiology of ageing.

“Nobody in their 60s goes on a late-night bender assuming they will get away with it,” Morgan says.

“In our 40s we might still treat our body as if it were 28 years old and think we can do this, but the reality is that sleep becomes gradually less resilient to this sort of abuse.”

There is evidence that our “sleep architecture” also changes.

How we sleep is principally governed by levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which works by blocking impulses between nerve cells in the brain, reducing anxiety and enabling the body to relax and sleep soundly.

“There is less GABA about as we get older,” Morgan says. “And levels of hormones and other neurotransmitters that help to align our sleep within the light and dark 24-hour circadian cycle, including melatonin, dopamine and serotonin, also reduce over time.”

Greg Elder, professor in psychology and associate director of the Northumbria University Centre for Sleep Research, says many of the brain regions involved show changes from middle age onwards.

“Ageing seems to reduce the number of neurons that are involved in producing orexin, another important neurotransmitter that plays a key role in regulating our sleep,” Elder says. “Sleep is an incredibly complex process.”

While insomnia can affect anyone, gender can play a role. It is known that the female hormones oestrogen and progesterone are involved in the processes that regulate sleep, and that changing levels during menstruation, pregnancy and perimenopause can result in issues.

“A lot of women do not realise they are predisposed to insomnia until they have a baby and their sleep patterns head on a new trajectory,” Morgan says. Menopause also affects the sleep patterns of many women, he adds.

All midlifers may clock changes in how they sleep.

For many, says Morgan, “It’s not waking up in the night that is problematic but getting back to sleep again that’s tricky. Or you might find that you start waking too early in the morning.”

What, if anything, can be done? Here’s what the experts advise.

1 Expect to sleep up to 20 minutes less in your 50s than you did in your 30s

“Our total sleep time declines linearly with age, with one study suggesting a loss of up to 10 minutes per decade,” Sullivan says.

We also spend more time in light sleep than deep sleep as we age. In addition, the time spent in rapid eye movement sleep drops very subtly and slow wave sleep, another deep sleep stage thought to be important for memory consolidation and emotion regulation, also declines by about 2 per cent per decade.

Don’t stress too much as long as you sleep about seven to nine hours a night.

“Our bodies and brains are real­ly good at letting us know when we need more or less,” Elder says. “Not everyone needs exactly the same amount.”

2 Avoid the camomile tea (you can have a small nightcap)

A little booze has been shown scientifically (and anecdotally) to help some people fall asleep faster but taking a nightcap will not guarantee good sleep.

“A small amount of alcohol – we are talking a nip of whisky or sherry – might make you feel calm and sleepy, encouraging sleep onset,” Morgan says.

A nip could be as much as a single shot or a small glass of sherry, he says, if people habitually drink that and it works for them.

“But more than that saturates your system, with alcohol withdrawing and abandoning you after about four hours when you might wake up and not feel good.”

Having a glass or mug of any fluid – alcohol, cocoa, camomile tea – within a couple of hours of bedtime is almost guaranteed to exacerbate the problem of waking up. “The antidiuretic hormones that regulate fluid balance and are pumped out at night decrease from midlife, so our ability to retain fluid diminishes,” Morgan says.

3 Try cognitive tricks

Studies have shown that approaches such as guided meditation, relaxation techniques and cognitive behavioural therapy for insomnia (CBT-I), a guided habit-changing program, can be highly effective in helping midlifers sleep better.

One review of 20 published studies in the journal Annals of Internal Medicine concluded that CBT-I helped people with chronic insomnia drop off 19 minutes sooner, spend 26 minutes less time awake in the middle of the night and increased total sleep time by eight minutes.

Even simple cognitive distraction techniques can help to slow a racing mind when you are falling asleep, Sullivan says.

These include attempting to count backwards in sevens from 1000. “If your sleep is severely impacting your day-to-day life you should probably seek professional advice from a GP,” Sullivan says.

4 Whatever time you go to bed, always get up at the same time

Why we wake up more in midlife is thought to be associated with the impact of ageing on two main drivers of sleep: the homeostatic driver, governed by the time we spend awake, and the circadian driver that is controlled by our body clock.

“If you want to amplify the homeostatic pressure of sleep, you go to bed earlier or later and don’t nap in the day,” Morgan says.

“But the real magic comes from a circadian standpoint and if we want to keep our sleep anchored we should always get up at exactly the same time, regardless of our bedtime, to ensure our body clock stays in tune.”

5 Apply the 15-20 rule if you wake up at 3am

If you are predisposed to insomnia you’ll probably have a style of thinking that kicks in at 2am to 3am when you find yourself awakened by the slightest noise.

“You lie there, eyes closed, in the dark and generating cognitive arousal by thinking about stuff,” Morgan says. “Sooner or later you will bump into worry-thinking.”

The worst thing you can do if this happens is to lie there ruminating. Sullivan suggests applying one of the CBT-I techniques called the 15-20 rule.

“If you are lying in bed trying to sleep at any time of the night and you feel it has been around 15 minutes and sleep is not happening, then you should get out of bed and go and do a quiet activity such as reading or knitting until you feel sleepy again and want to go back to bed,” Sullivan says.

Habitually lying there trying unsuccessfully to get back to sleep means you are just learning to hate your bed and reinforcing the belief that you won’t sleep.

6 Don’t use a sleep tracker

“Worried sleepers buy into trackers to learn about their sleep attributes, including stages of sleep,” Morgan says. “There’s this universal assumption that more deep sleep is good and, by default, other sleep is bad, but nothing is further from the truth and if you don’t have balanced sleep across all stages, including light, you will suffer.”

His biggest bugbear with trackers is that there is not much you can do with the sleep data other than go to bed earlier. If a device says you got 55 minutes of deep sleep, you can’t open a bottle and take something to ensure you get 90 minutes of it the next time.

“A tracker just provides feedback,” he says. “We can’t will ourselves to sleep more deeply.”

The Times