Sleep quality naturally declines during aging. For example, sleep duration and sleep consolidation both deteriorate as we age. (Less consolidated sleep is more fragmented, with shorter mean sleep bout duration). Moreover, impaired sleep quality is a sensitive prodromal sign of future cognitive decline and Alzheimer’s disease (AD).
Improving sleep quality often translates to improved mood, enhanced cognitive function, and general well-being. We’ve cataloged ten of the most relevant ways to improve sleep quality. The first few tips apply more to healthy subjects; the latter suggestions are aimed at individuals struggling with clinically significant insomnia.
- Circadian rhythm is coupled to light cues from the environment.
Individuals who sleep in an environment that is not dark enough will have a blunted circadian rhythm (e.g., impaired expression of the proteins that regulate sleep/wake oscillations). To maximize sleep quality, use black electrical tape to cover all light sources (e.g., blinking electronics).
- This tip is an extension of the previous one. Download the f.lux app, which calibrates the wavelength of the light emitted by your laptop screen (or monitor) according to the time of day.
Screens normally emit high-energy/low wavelength blue light which interferes with the biological block. With flux activated, at night your laptop will emit warm, red/orange light (like a sunset), which is less likely to cause the “circadian rhythm phase delay” that impairs sleep onset.
- Turn the thermostat down at night to slightly chilly temperatures.
Internal body temperature drops to a trough at around 4 AM. Low temperatures at night are considered an environmental cue that entrains the biological clock and helps facilitate sleep initiation.
- Vigorous exercise before bed has been consistently noted to improve sleep quality.
- Practice good sleep hygiene by going to bed and waking up at the same time.
Humans are creatures of habit, and following a regular schedule can help synchronize your body clock. Limit stimulating activities in the evening.
For years, I played computer games until 2 am right before going to bed. Suffice it to say, I had vivid dreams and sleep quality was not ideal.
- Nutraceuticals that show promise in alleviating (mild) insomnia
- Magnesium (bioavailable salts such as glycinate, aspartate or taurate are recommended)
- Melatonin (low doses, e.g. 1-2.5 mg are paradoxically more effective than higher doses)
- Glycine (an inhibitory neurotransmitter and co-agonist at NMDA receptors)
- Herbal tea with lemon balm, passionflower, and chamomile
- If you have clinically significant insomnia, do not be deterred from using prescription drugs to manage your symptoms.
Long-term sleep loss is extremely taxing on the body and mental health. Often primary insomnia will not respond to tips #1-6. It is tempting to dismiss patients with clinically significant insomnia with soft-core interventions like “get more exercise” but that just won’t cut it for this patient population.
Unfortunately, when it comes to sleep aids, there is an inverse relationship between long-term safety and efficacy. The most effective sleep aids are more likely to adversely affect brain health. This cost/benefits analysis and the trade-offs of different medications should be weighed by your clinician.
When shopping for sleep aids, start with the safest, most suitable agents for long-term use:
- Ramelteon (Rozarem)
- Suvorexant (Belsomra)
- Hydroxyzine (This antihistamine has a long half-life but has negligible anticholinergic activity and is a first-line agent for primary insomnia)
- Alpha-adrenergic receptor blockers (E.g., prazosin or Trazodone)
- Other antihistamines and sedatives (e.g., low-dose Mirtazapine)
- Z-drugs (e.g., Ambien)
- Benzodiazepines (e.g., Xanax)
- Resolve/treat contributory diseases.
The most important disorders that can exacerbate sleep disorders are:
- Sleep apnea
- Disorders of hyperarousal (Anxiety disorders, PTSD, depression)
- Restless leg syndrome
- Delayed sleep phase syndrome/other circadian rhythm disorder
- Sometimes, chronic insomnia develops from a self-reinforcing psychological process.
Let’s say a major life event disrupts your sleep and mood for a short period of time. Many people will recover the lost sleep quality, but some people will begin to obsess about their inability to get a proper night’s rest. This results in a positive feedback loop where as you become more worried about fixing your broken sleep, your sleep quality deteriorates further.
Panic disorders often arise from a similar process, where the object of your anxiety is the anxiety itself. For example, you might be concerned that heightened anxiety will cause a heart attack (because your heart is palpitating), which adds more fuel to the fire, culminating in a full-blown panic. Harvard has devised some behavioral interventions that can be helpful for this kind of self-perpetuating neurotic sleep disorder. They suggest taking a sabbatical from work (if you can afford it), and instead of trying to go to bed, trying to stay up as long as possible. Chronically restricting the total amount of time in bed may be one of the most robust behavioral interventions for treating sleep-onset insomnia.
- A promising sleep enhancement strategy worth mentioning is the pharmacologic augmentation of slow-wave-sleep (SWS) using selective 5-HT2A antagonists.