Showing posts with label stages. Show all posts
Showing posts with label stages. Show all posts

Wednesday, 24 June 2026

Dr. Roach: How certain 'sleep' medications affect sleep quality and stages

From eu.detroitnews.com

Dear Dr. Roach: I have occasional difficulty when going to sleep and/or getting back to sleep. I have tried Ambien, trazodone, clonazepam and Lunesta. All have their pros and cons.

My question regards sleep quality. I know there are several stages of sleep that we should go through and that the brain cleans out junk during sleep. Do these sleep aids still allow a person to go through the needed sleep stages and also allow the brain to clean itself? Are any of these meds better or worse than the others for occasional use? — S.H. 

Dear S.H.: How much time we spend in the different stages of sleep is called sleep architecture. Just being asleep isn't enough; people need to have enough time in the different phases of sleep for optimal health.

For example, you refer to the body's waste removal system from the brain, called the glymphatic system. This system removes waste materials from the brain, including amyloid and tau proteins, and it's predominantly active in the N3 stage of non-rapid-eye-movement sleep (non-REM sleep, also called slow-wave sleep or deep sleep). You're quite right that many sleep medications affect sleep architecture, which is one major reason why many sleep experts recommend against the habitual use of sleep medications.

All the medicines you've used can affect sleep architecture. Ambien (zolpidem) and Lunesta (eszopiclone) are in the Z-drug class, which have small to moderate effects on sleep architecture with modest decreases in both REM and N3 sleep. Many people quickly become accustomed to using these drugs, but the occasional use of them presents a low risk.

Clonazepam is a benzodiazepine, which are among the worst offenders against sleep architecture due to their significant reduction in REM and N3 sleep. A reduction in REM sleep is associated with worsened heart disease and overall mortality, as well as emotional problems and dementia. I strongly recommend against the habitual use of benzodiazepines for sleep.

Trazodone actually increases N3 sleep and has no consistent effect on REM sleep, so it's commonly been recommended for sleep. Unfortunately, more recent studies have shown that some people can get used to the drug after only a few weeks, so it stops working as well. Furthermore, studies have only shown very small improvements (a few minutes' worth) in sleep duration. Many people feel very drowsy the following day, and older people are particularly at risk for falls. There are other uncommon but serious side effects, and I've mostly stopped prescribing trazodone to my patients.

Whenever possible, I avoid drugs for the treatment of insomnia. Cognitive behavioural therapy for insomnia is, at least, as effective as medication and has none of the medication-associated risks. There are free cognitive behaviourial therapy programs for insomnia (CBT-I) for mobile devices.

For people who don't do well with CBT-I or people who can't receive it, the medications that are currently considered the safest are low-dose doxepin and dual orexin receptor antagonists (DORAs), such as suvorexant (Belsomra). Both of these medications have minimal negative effects on sleep architecture, and they increase REM sleep. Unfortunately, DORAs are very expensive (around $500 per month, not often covered by insurance), compared to doxepin (less than $50 per month without insurance). 

https://eu.detroitnews.com/story/life/advice/2026/06/23/dr-roach-how-certain-sleep-medications-affect-sleep-quality-and-stages/90570052007/

Monday, 19 January 2026

What Good Sleep Looks Like in Your 20s, 30s, 40s, 50s, and 60s

From realsimple.com

Sleep experts share how to get a good night's sleep the older you get 

As you age, your sleep patterns can change. It can become totally normal to need more daytime naps or deal with shortened sleep cycles at night. Some of it is due to the number of birthday candles on your cake, but your environment and lifestyle can also play a huge role in your sleep health. How often you exercise, the food you eathow much water you drink and your stress levels can all impact quality of sleep.

"Once you reach your 20s, your body has more or less established a stable sleep-wake cycle," explains Nicole M. Avena, Ph.D., assistant professor of neuroscience at Mount Sinai School of Medicine and author of Sugarless: A 7 Step Plan to Uncover Hidden Sugars, Curb Your Cravings, and Conquer Your Addiction. "However, many people may not understand this cycle until later in life, such as in their 30s or 40s." Just in time for things to change!

Whether you're in your 20s, 30s, 40s, 50s, or 60s, here's everything you should know about common age-related sleep changes to look out for and what you can do to navigate them, according to sleep experts.

Sleep in Your 20s

The CDC recommends that all adults ages 18 to 60, regardless of age group, aim to get seven or more hours of sleep per night. Of course, that can be hard. Maybe you feel like you're fine with less than that. Or maybe you're in your 20s, points out Charissa Chamorro, Ph.D., Assistant Clinical Professor at Icahn School of Medicine at Mount Sinai in New York City. "Young adults often have irregular sleep patterns due to work, socializing, and screen time," she explains. She recommends keeping your sleep and wake times within one to two hours of your weekday patterns. "Establishing a stable sleep schedule can set a strong foundation for lifelong healthy sleep," Chamorro adds.

That said, life can be unpredictable. People in this age group have more flexibility in their physical needs, so there is some flexibility in how consistent they need to be in maintaining good sleep habits, says Paul Kaloostian, M.D., a California-based neurosurgeon. If you can't be perfect with your sleep schedule, aim to practice good sleep habits more often than not, Dr. Kaloostian advises.

The brain, as he explains, is "very plastic" in this age group. However, there are still steps 20-somethings can take to build lifelong healthy sleeping habits. "People in their 20s should avoid significant intake of caffeine (more than one cup a day), minimize stress, and exercise at least 30 minutes a day to ensure adequate sleep," he suggests.

Dr. Lynelle Schneeberg, Psy.D., a fellow of the American Academy of Sleep Medicine and the author of Become Your Child's Sleep Coach, says people in their 20s who are struggling to establish an earlier rise time can use simple steps to wake up earlier. The key, she says, is consistency: Getting up at the same time every day (or at least trying to) can help you wake up earlier and fall asleep earlier (and more easily). Exposing yourself to natural sunlight and eating breakfast within an hour of waking up can also help your mind associate the morning with getting ready to start the day.

Sleep in Your 30s

Avena explains that the amount of sleep people get tends to decrease with age. "Research has shown that Stage 3 of non-rapid eye movement (NREM) sleep decreases by 2 percent each decade up until the age of 60," she says. "Rapid eye movement (REM) also decreases until about 60 with each decade."

Though 30-somethings may start to feel these expected age-related effects, one of the biggest hurdles to overcome at this point in life are environmental factors (e.g. work schedule, technology use, family obligations, financial stress). Your 30s are also a smart time to address any sleep disorders, like insomnia or sleep apnoea, which can both affect overall health in the long term if left untreated.

"People in their 30s are typically now out of school and working and/or raising a family," Dr. Kaloostian says. This means parents often have to balance their own sleep (and sleep quality) on the sleep habits of their children, especially babies and toddlers. Schneeberg adds that parents in their 30s can teach their children to be good sleepers, which can then help parents develop healthy sleep patterns themselves.

"Most plans [for children] include a consistent and calming bedtime routine each night followed by the use of self-comforting objects (a blanket or stuffed animal for a younger child and a reading light and some books for older ones)," she says. "Once the routine is over and your child has items for self-comfort, you can gradually taper away your presence."

The general advice for 20- and 30-somethings remains the same: consistent sleep-wake schedules, limiting caffeine, getting enough exercise, drinking plenty of water and eating healthy foods to promote good sleep.

Sleep in Your 40s

According to Chamorro, this period is often when adults report the most disrupted sleep due to the stress of career and family life. For example, stress can make it harder to fall asleep or cause you to wake up throughout the night. "This is the decade where it is most important to establish regular self-care routines," Chamorro says. "Make it a priority to incorporate regular relaxation techniques like deep breathing, mindfulness, and yoga—both before bed and throughout the week. Establishing regular self-care routines can help you manage your stress, which will help you establish and maintain more restorative sleep."

Beyond that, Kaloostian says people in their 40s should follow the same sleep health advice as those in their 20s and 30s. During this decade it's also important to educate yourself on how your sleep may change in the decades that follow (and what you can do ahead of time to prevent some of those changes).

"Sleep doesn't just mirror your age, it mirrors your health, too," Avena explains. "Certain health conditions and even your health from day to day can impact how well you sleep at night."

While healthy sleep guidelines are mostly universal, Avena recommends tailoring them to your own specific needs for maximum benefits. "When do you function best? Early in the morning or late at night?" she says to ask yourself. "When you understand your body's internal clock, you can start to build a healthy sleep routine around that."

Establishing a ritual before bed can also help signal to your brain that you'll be going to sleep soon, Avena continues, "like taking a shower and brushing your teeth before hopping into bed." Avoiding too much napping (especially later in the afternoon) can also be helpful in sleeping better through the night.

Sleep in Your 50s

Your 50s may bring on the most pronounced sleep changes. "People in their 50s start to develop medical co-morbidities often requiring numerous medications, which can greatly affect one's ability to obtain adequate sleep," Kaloostian says. In addition to leading a healthy lifestyle, he also suggests consulting with your primary care doctor to "ensure that there are no medications contributing to causing insomnia."

This decade in life also sees gender-based sleep changes, particularly for women going or beginning to go through menopause. "During menopause, rates of insomnia in women drastically increase," Avena says. The latest studies suggest that up to 26 percent of menopausal women experience sleep difficulties that qualify as insomnia. "This means that we may see sleep quality decline in the 50s for women specifically."

Kaloostian adds that a decreased function of the hypothalamus portion of the brain, and changes in melatonin and cortisol hormones, begin to occur in the 50s age group as well, which can also impact quality and duration of sleep. This is why people often begin to sleep less as they get older or wake up more frequently throughout the night.

A great way for people in their 50s (and everyone, really) to promote good sleep is to get as much natural sunlight as possible, which Kaloostian says people tend to get less of as they get older. Stress management is also crucial for falling and staying asleep better (here are some helpful strategies for managing stress).

Sleep in Your 60s

It's common to experience more fragmented and less restful sleep during this decade for numerous reasons, according to Chamorro. "As we age, our bodies produce less melatonin, which can make falling and staying asleep more difficult," she says. "In addition, health conditions like arthritis, sleep apnea, or the need to use the bathroom at night can also contribute to disrupted sleep," Chamorro points out. Sleep may also feel less restorative because older adults spend more time in the earlier, lighter stages of sleep and less time in the later, deeper stages of sleep, Chamorro adds.

What's more, people in their 60s tend to nap during the day, which only exacerbates their sleeping problems at night, Avena says.  "Daytime napping can disturb circadian rhythm," Avena says.

To get the best sleep possible, you'll want to stick with all the basics: Have a consistent sleep schedule, limit alcohol, avoid caffeine past 1 p.m. get physical activity throughout the day, and keep your bedroom cool, dark and quiet, Chamorro advises. If you can, establishing a nighttime routine can help signal your body that it's time to wind down, she says. "I encourage people to create a routine that they can follow and enjoy. This may include first washing your face, then enjoying a warm cup of herbal tea, engaging in some light stretching, and finally, reading a book or listening to a sleep story before bed," Chamorro says.

The bottom line: regardless of age, leading a healthy lifestyle is important to quality sleep. Whether you're in your 20s, 30s, 40s, 50s or 60s, give yourself enough time to get a good night's sleep and take care of yourself throughout the day by eating healthy foodsexercising regularly, and drinking plenty of water. For any sleep concerns, always consult a doctor first to figure out a sleep management plan that works best for your individual needs.

https://www.realsimple.com/sleep-health-in-20s-30s-40s-50s-11886849


Monday, 1 April 2024

The golden 90 minutes of deep sleep and how to get it

From telegraph.co.uk

By Anna Magee

An extra hour of sleep doesn’t mean anything, unless it’s the right kind. Here’s how to get restorative, deep sleep that makes a difference 

There was a time when I would celebrate the clocks going forward combined with a bank holiday Monday lie-in. I would make sure my alarm was off the night before and sleep as much as possible the next morning expecting to feel well-rested. I wouldn’t make plans until midday the next day, and instead stay under the covers until I felt energised enough to get up.  

That was before my sleep tracker taught me about deep sleep. Despite being asleep for eight hours at a time, apparently, I wasn’t getting enough of it. The statistics told me I was getting anything between 6-12 per cent or an average of one hour 17 minutes, when the ideal amounts are 20-25 per cent or 1.4-2 hours according to The Sleep Foundation.

Deep sleep is thought to be the most restorative stage for the brain, when the body removes potentially harmful materials from it. A study published in the journal JAMA Neurology in October last year found not getting enough deep sleep could have serious long-term effects on our cognitive health. The research from the Monash School of Psychological Sciences and the Turner Institute for Brain and Mental Health in Melbourne, Australia, showed that a lack of deep sleep could even increase our risk of dementia

                      Anna Magee's sleep tracker revealed that she wasn't getting enough deep sleep CREDIT: Heathcliff O'Malley

My biggest health fear is losing the use of my brain. So, I enlisted the help of a sleep expert to see if they could help me sort out my deep sleep issues.

Sleep stages explained


During deep sleep, growth hormones are released – promoting tissue repair and muscle growth, while the immune system renews. The brain also clears out toxins accumulated during waking hours. A lack of deep sleep has been associated with mood problems, impaired immunity and increased risk of chronic conditions (like dementia). 

“If you’re lucky, you’ll next get into stage 3 deep sleep,” says Bostock. Deep sleep, also known as slow wave sleep (SWS) or stage 3 sleep is a crucial phase of the sleep cycle when the body undergoes various physiological processes which are essential for physical and mental restoration.

“The brain starts to pulse, you get a greater circulation of cerebro-spinal fluid, the body releases toxins and about 95 per cent of growth hormones are produced during this time.” Growth hormones stimulate growth and cell reproduction and is essential to mood and cognition. “There’s no doubt that deep sleep is restorative and we tend to get more of it in the first half of the night,” Bostock asserts.

In the second part of the night, you get more REM sleep which is more similar to wakefulness than other stages. “REM sleep is an active time for the brain, and great for innovation, creativity and emotional regulation,” says Bostock. Each cycle repeats every 90 minutes.

“People often assume they should go through these stages and not wake up in between,” says Bostock. “But our ancestors evolved to be able to wake up in between sleep stages, check everything is okay and go back to sleep again. If we’re in a familiar environment then we might not even notice but the older we get the more time we spend awake during sleep. So don’t get too stressed if you wake up.”

The sleep scientist weighs in


First, I needed to stop freaking out over my tracker and take more note of how I feel, Bostock advised. She would be my deep sleep coach for a few weeks during the experiment. 

Research studies comparing various trackers shows they range from 50-60 per cent accurate for comparing sleep stages. They’re better than nothing but getting too obsessed about your sleep is one of the worst things to make insomnia worse, there’s even a name for it: orthosomnia.  

I took Bostock’s advice and put it to the test to see if it improved my deep sleep. As well as my tracker then, I would use a simple sheet of paper to record how I felt every day.

“You have quite rigid beliefs around sleep like, ‘I need nine hours to feel great’,’’ she says. “I want you to challenge these and see if you feel alright with less sleep the next day. 

“You’re getting 6-17 per cent deep sleep right now. But anything from 15-25 per cent deep sleep as an adult is actually pretty normal,” she adds. “So you’re not failing, but there are certain things you can do to try and increase that.”

My deep sleep experiment 


“If light sleep wasn’t useful you wouldn’t spend half of your night in stage 2 sleep,” says Bostock. “Light sleep is still having an impact on your health. But it’s possible to do small things to impact the amount of deep sleep you get, though the changes will be subtle, small and probably slow but every bit counts,” says Bostock. “If we can try and get you a little bit more deep sleep each night, over time that will impact how you feel.” 

Sleep hygiene advice tells us to sleep in a dark room, drink herbal tea before bed, have a hot bath and if we wake up in the middle of the night, get up and do something else, like the ironing, until we feel tired. I had read advice like that so many times, it seemed more tired than I was. I hate ironing. So Bostock and I decided on making five key changes that she felt would be most impactful for my deep sleep but that I felt were easy enough that I’d actually do them.  

What the numbers said


The results were a surprise as I slept a little less but my deep sleep improved by 2 per cent. I also felt much better. 

So during my quest for deep sleep what made a difference? 

Keep a regular sleep schedule (even on bank holidays)


Your body runs on a 24-hour clock and all your organs and cells operate on this so sleep consistency is not only great for our sleep but also great for the rest of our bodies. “Massively long lie ins are tempting, but if you lie in for two hours on a Saturday and Sunday and you try to get out of bed on Monday at 6am, it’s like you have just flown in from Dubai,” says Bostock. “You’re giving yourself a type of jet lag we call social jet lag.  

“If you do nothing else to improve your sleep, wake up at the same time everyday, including weekends. That allows the circadian rhythms that run within your body to be in sync and operate on the same time zone.” I was allowed to change my sleep time by 30 minutes to an hour but it’s better to stay consistent. 

Don’t snooze

“Pressing snooze is counterproductive, and makes it harder to wake up,” says Bostock. It was making me more drowsy. According to a study published in the Journal of Physiological Anthropology in 2022 that found pressing snooze prolonged sleep inertia for up to 20 minutes. Sleep inertia is that groggy feeling you get when you wake up. 

                                           Hitting snooze can leave you feeling groggy in the morning CREDIT: Heathcliff O'Malley

Exercise 


“The more hours you are awake and the more things you do, the more you burn this fuel called adenosine triphosphate or ATP,” says Bostock. “When you break down ATP it produces a waste substance called adenosine which makes you feel very tired – that builds sleep pressure which is essential for falling asleep naturally. So the more physical activity you do, the more you will feel the desire to sleep.”

Wake up to light  


“Bright light at the start of the day is a strong cue for the body to wake up. Light lands on receptors in the back of the eye which signal a master clock in the brain which tells us to get alert and get the body moving in the morning. You could just switch on the light in the bedroom as soon as you wake up.”

Avoid caffeine after midday (or give it up)


“Cutting out caffeine or avoiding it after midday is one of the changes that makes a huge difference to people,” says Bostock. “Caffeine works by temporarily blocking sleep pressure [tiredness] by interfering with the adenosine receptors in the brain so you don’t feel sleepy.” 

How do I feel afterwards?


It’s now 20 days after the experiment started. I’m still waking up at the same time each day (7am) and going to bed around the same time (11pm) give or take an hour on weekends. That was tough at first, but now I feel so much more focused and alert during the day and only really get a gnawing tiredness around 9.30pm. “That’s what we would expect,” says Bostock. “You’re building up sleep pressure so you feel tired enough in the course of a day to want to sleep at bedtime. I frankly don’t care what your tracker says, if you feel energised during the day and sleepy at night, that’s a win.”  

Every little cell in my body wants to sleep in at the weekend but I make myself get out of bed by 8am (an hour later than my usual wake time of 7am). I do feel clearer during the days, with more overall energy and lost that constant morning tiredness I used to get. I keep my phone on the dressing table, about 4 metres away so when the alarm goes off, I have to get out of bed. It’s brutish but beneficial.

I stifled a well-deserved yawn when I heard the advice to cut down caffeine. But I wanted this to work so, two days before the experiment started, I gave up the two to three strong coffees and the eight cups of tea I would usually have daily. The withdrawals left a jackhammer drilling into various bits of my skull for 48 hours but after that subsided. On stressful days where my caffeine intake slipped and I had the odd afternoon coffee, I woke up restless and fitful mid-morning. I think the change to my caffeine intake was one of the most powerful. 

My mood has improved immeasurably and I now (for once) believe all the things I’ve read about the mental health benefits of sleep – and the benefits of the simple changes you can make to get more of the deep variety. I’m sticking with these five changes and will hopefully continue to increase my deep sleep.

If you struggle to sleep, I recommend you try them. No camomile. No ironing.

https://www.telegraph.co.uk/health-fitness/wellbeing/sleep/health-benefits-deep-sleep-rem/