Quality beats quantity when it comes to sleep

Quality beats quantity when it comes to sleep
Kazuo Mishima, left, and Naoko Ayabe examine sleep data at the National Center of Neurology and Psychiatry in Kodaira, Tokyo.
Photo: The Japan News/Asia News Network

Mikiko Chiba of Kawasaki, 76, started taking sleeping pills around the time she reached menopause.

She had been going to bed at 11 p.m., but she would start thinking this and that about her volunteer activities in the neighborhood, and often end up falling asleep way past midnight.

At the end of 2015, she came across a flier at the city's community comprehensive care centre, which asked, "Do you want to measure your sleep?" The flier was soliciting people to participate in a sleep guidance programme for elderly people planned by Mika Tanaka, a public health nurse and professor of nursing science at Kitasato University.

A total of 79 people aged 60 to 86 participated in the programme, 31 of whom were taking sleeping pills.

The participants were lent a commercially available sleep monitoring device - which measures the depth of one's sleep by detecting body movements - to measure their sleep for three days.

They were then given an hour-long lecture on the basics of sleep, and later given 30 minutes of instruction on an individual basis by public health nurses.

The devices monitor and show the different stages of sleep - deep or light - and the awake state on a graph.

Chiba was told by Tanaka that she had slept well, which was surprising to Chiba because she had woken up in the middle of the night.

Deep sleep, which lets the brain rest, and light sleep, which lets the body rest, come in cycles.

As we age, we sleep for shorter periods of time and deep sleep decreases.

Average sleeping hours are seven hours for a 25-year-old, 6½ hours for a 45-year-old, six hours for a 65-year-old, and five hours and 45 minutes for a 75-year-old.

Having been told that she was sleeping well, Chiba stopped caring about waking up in the middle of the night. She also stopped taking sleeping pills on a regular basis.

One way to treat insomnia is a psychological method called cognitive behavioural therapy.

A patient learns about sleep in general and also about how he or she actually sleeps to get rid of improper habits and ideas that could be the source of the problems.

Cognitive behavioural therapy is conducted by several medical institutions, as well as in health guidance sessions in some companies.

Tanaka's guidance is a simplified version of this therapy.

"Many people misunderstand sleep. It's natural for elderly people to sleep for shorter periods of time. Quality of sleep is more important than its length of time," Tanaka said.

Change habits to relax

In her lectures, Tanaka offers advice on improving daily habits to help you sleep better.

One example is to refrain from having coffee, green tea or tea after 3 p.m.

Caffeine has the effect of stimulating brain activity, and the effect lasts four to eight hours, which has an adverse effect on your sleep.

After participating in the sleep guidance programme, Chiba has also set a limit on her intake of caffeine.

She loves green tea and used to drink it at night.

However, she switched to non-caffeinated beverages such as barley tea after 3 p.m.

"Many people feel more satisfied with their sleep just by switching to non-caffeinated drinks in the evenings or later. Some say they can sleep even if they have coffee, but without it, the feeling that you've slept well is much stronger," Tanaka said.

Participants are instructed to set a goal to better their daily habits when the programme is over.

The most common are goals such as "getting the morning sunlight" and "no falling asleep while watching television or taking a nap during the daytime."

According to Makoto Uchiyama, professor of hypnology at Nihon University, drowsiness is linked to the biological clock that creates a circadian rhythm in the body and the sleep-inducing substance that is accumulated in the brain when awake.

The circadian clock is adjusted by exposing the eyes to morning sunlight outdoors for 15 to 30 minutes.

Fifteen to 16 hours later, a hormone called melatonin is secreted to make the person feel sleepy.

Taking a long nap or dozing off during the daytime prevents the accumulation of this sleep-inducing hormone, which results in the person feeling less sleepy at night.

If you are going to take a nap, keep it to less than 30 minutes and before 3 p.m.

Another important point is to ease tension and feel relaxed before going to bed.

Katsutoshi Tanaka, a professor of occupational mental health at Kitasato University who has abundant experience in sleep guidance, said: "It will help you fall asleep if you can find your own way of relaxing before going to bed. Relaxation stimulates the body to prepare for sleeping, as if it were a conditioned response."

Doing certain things as a ritual to help you relax, such as listening to your favourite music in a dark room or stroking your pet, will induce drowsiness.

"It's easier to maintain your improved daily habits if you can sense the effects. You should try to find your own good sleeping habits," Mika Tanaka said.

Bed is where one sleeps

A 49-year-old housewife who lives in Tokyo wakes up at 6 a.m. to make a bento boxed lunch for her child and send her husband off to work.

Thinking she had to sleep at least eight hours, she used to go to bed at 10 p.m.

She could not fall asleep, so she took sleeping pills.

But she would wake up in the middle of the night and take sleeping pills again.

In the morning, the sleeping pills were still in effect, so she felt drowsy.

What's more, she would have headaches and palpitations.

She had trouble sleeping from the time she was about 40 years old.

To deal with her insomnia, she visited the National Center of Neurology and Psychiatry (NCNP) in Kodaira, Tokyo, for cognitive behavioural therapy for the first time in May 2014.

In her sleep diary, she would record when she went to bed, and how many times and when she woke up during the night.

She received instructions from a doctor and clinical psychotherapist based on these records.

Kazuo Mishima, the director of the Department of Psychophysiology at the NCNP, and others looked at her diary and found that she could sleep for more than six hours on most days, but only three hours on some days. Her average sleeping hours in a week were five hours and 45 minutes.

Clinical psychotherapist Naoko Ayabe recommended that she go to bed at 12 a.m. to make the length of time she stays in bed closer to her actual sleeping hours.

"When a person stays awake in bed for hours, the bed induces a conditioned response of generating tension, which makes the bed the cause of the insomnia. You need to be aware that a bed is where you sleep," Mishima said.

To enhance such awareness, the woman was advised to go to bed only when she feels sleepy, and to not read a book or watch TV in bed.

She was also told to go to a different room if she doesn't feel sleepy and return to her bedroom when she is.

She kept on visiting the NCNP for 1½ years, during which time she kept track of her sleep by checking her diary and acquired proper sleeping habits. She also reduced her intake of sleeping pills little by little.

It has been a little more than a year since she stopped going to the NCNP.

"Before, I would feel tense getting into bed thinking that I had to sleep for eight hours. Now I don't much care about sleeping and I don't mind if I can't sleep some days," she said. She has stopped using sleeping pills and she can still get about 6½ hours of sleep.

"It varies how many hours a person needs to sleep. If you're not troubled by drowsiness during the day, then there's no problem," Mishima said.

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