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with Michael Breus, PhD, ABSM

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Friday, January 18, 2013

Nighttime Worries Worst in Middle Age

By Michael Breus, PhD, ABSM

Woman Lying Awake in Bed

Does worry keep you from falling asleep at night? Do you lie awake replaying the stressful parts of your day, fretting about money, stressing about your job, wondering how your kids are doing in school? If worry keeps you up at night, you’re far from alone. Worrying at bedtime—and losing sleep to stress and anxiety—is one of the most common sleep complaints. There’s probably no sleep issue I hear about more often from my patients.

Tossing and turning with worries when we want to be sleeping is a frustrating experience. Sleep loss from worry is also hazardous to health. Studies show that people who lose sleep as a result of worry are at elevated risk for cardiovascular problems. Nighttime worriers who experience disturbed sleep are also more likely to have problems with alcohol. Disrupted sleep, and stress itself, both wreak havoc with the body’s immune system.

A recent study investigated the role that worry plays in sleep loss over the course of adulthood, from early middle age to old age, creating what researchers say is the first picture of how worry affects sleep during the bulk of adulthood. The researchers also created a long-term trajectory for insomnia during these same adult years, in order to compare the two. Their goal was to gain a sense of the evolution of worry as a factor in sleep loss over a significant portion of adulthood.

  • Sleep loss from worry was at its highest during the ages 35-55. During the period of 55-60, worry began to decline as a factor in sleep loss, and leveled off with the onset of old age during the years 66-70.
  • Women were more likely than men to suffer sleep loss from worry. For women, worry increased during early middle age (ages 34-45) before reaching its peak levels during the period of 51-60. In their 60s, women in both study groups saw their sleep loss from worry begin to decrease—this decrease started later in life than for the men in the study, many of whom began to see an ebb of sleep lost to worry in their mid-to-late fifties.

The trajectory for insomnia over the same period of adult life looked markedly different. Insomnia became more common as people went from late-middle age to old age. Women were again more likely to experience insomnia than men. Here’s a particularly interesting finding: frequent insomnia (5 or more nights a week) was found to become more likely with age. When researchers analyzed data for less severe insomnia (two or fewer nights a week), they found this type of insomnia did not become more prevalent with age.

It’s not clear why worry decreases with age as a factor in sleep loss, but researchers speculate that the drop may have to do, in part, with life changes that often accompany the shift from middle age to old age. Many of the pressures of middle age can change and diminish in ensuing years, as people retire from jobs, see their children grown and become independent, and as they themselves achieve a sense of financial stability.

How can these results help with improving treatment of disrupted sleep? For medical professionals, it’s important to address the issue of stress and worry as a barrier to sleep among working-age adults. The years of middle age are when many people are most vulnerable to the some of the major stresses of life—financial ups and downs, the death of parents, ongoing worry related to work and to parenting. We need to pay particular attention to women, because their risk for sleep loss from worry appears to be higher than men’s.

Dealing more constructively with worry-related sleep loss isn’t just a job for the professionals. We all can take basic steps to reduce our nighttime worrying and improve our sleep. Don’t wait for your doctor to bring up the subject. If you’re having trouble sleeping and worry or anxiety seem to be involved, make sure you bring up the subject with your doctor. There are a number of lifestyle changes that can help, including regular exercise, meditation and relaxation, and managing your alcohol consumption.

Here’s another strategy I recommend to patients frequently: Start keeping a worry journal. A worry journal is just what it sounds like: a place to write down all the things that are preoccupying your mind and causing you anxiety or stress. The practice of keeping a worry journal allows you to take your worries from your mind to the written page, helping you to relax.

To start a Worry Journal:

  • Select a notebook or notepad
  • On a blank page, draw a line down the center, creating 2 columns. Do this on three pages.
  • At the top of the first page, write: I need to remember to take care of…
  • At the top of the second page, write: I can’t forget to…
  • At the top of the third page, write: I am so worried about…
  • In the left column of each page, finish the sentence at the top, writing down everything that occurs to you.
  • In the right column, address the concern, worry, or task, by scheduling a time to think about it or deal with it.

Don’t judge your worries, and try not to censor yourself. This is a private exercise where you can be honest about what’s on your mind. Anything that’s worrying you—no matter how seemingly significant or not—belongs on these pages.

Stick with this daily habit, and you’re likely to find yourself better able to set your worries aside in order to fall asleep.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Photo: iStockphoto

Posted by: Michael Breus, PhD, ABSM at 6:00 am

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