How to Beat Insomnia and Feel Better in Older Age

This article was originally written by Rotem Perach and published on Medium. Read the original article.

“How do people go to sleep? I’m afraid I’ve lost the knack. I might try busting myself smartly over the temple with the night-light. I might repeat to myself, slowly and soothingly, a list of quotations beautiful from minds profound; if I can remember any of the damn things.”

As this quote by the American poet Dorothy Parker demonstrates, trying to get a good night’s sleep can be frustrating. Difficulties falling asleep or staying asleep are symptoms of insomnia that we are all familiar with. We might turn in early for the night the day before an important meeting only to find that our mind is too preoccupied to nod off.

The amount of sleep we get often decreases with age. According to a Canadian Medical Association publication, the average sleep duration per day ranges 16–20 hours among babies and young children, 7–8 hours in adults, and is a mere 6.5 hours in people over the age of 60. Sleep is regulated and organized by bodily mechanisms that undergo changes in different stages of our lives. As people reach their 50s and beyond, the circadian timing system that is important for the timing of our sleep/wake cycles shifts so that sleep may come earlier than it did before. This provides one mechanism by which older persons sometimes go to sleep early and are early to rise. Some insomnia symptoms seem to be related to this change in sleep timing. For example, in one large-scale study, nearly one in five older persons reported trouble with waking up too early.

How to treat insomnia symptoms?

People have different beliefs about the techniques that might help them sleep better. They may avoid caffeine consumption after lunch or watch ASMR (Autonomous Sensory Meridian Response) videos before going to bed. Some of these techniques have been shown to be helpful while others are yet to gaina scientific stamp of approval. Research studies tell us which of a range of techniques are most likely to improve insomnia symptoms. Cognitive Behavioural Therapy for Insomnia (CBT-I) appears to be the most useful treatment for insomnia in both younger and older adults and is the recommended initial treatment for chronic insomnia in adults. CBT-I helps to improve insomnia symptoms by cognitive, behavioural, and educational means. The cognitive component includes for example identifying false sleep beliefs (such as “One poor night’s sleep disturbs the whole week”), challenging these beliefs, and replacing them with rational beliefs. The behavioural component involves for example practical guidance on when to go to bed (only when sleepy) and what to do in bed (sleep and sex are fine, stimulating activities such as snacking in front of the TV less so). In addition, CBT-I delivers education on healthy sleep. Other techniques that can potentially improve insomnia symptoms in older persons are mindfulness meditations and physical exercise, though more research is needed to establish this. In mindfulness meditations, people focus their awareness on thoughts and sensations that occur in the present moment and approach them with acceptance, curiosity, and kindness. Physical exercise in older persons can range widely from gardening, housework, fishing, brisk walking or stationary cycling. Both mindfulness meditations and exercise can be practiced as a part of a group in a public setting (such as private studios and gyms) or individually in a private setting (for example, in the comfort of one’s home). In other words, the flexible format of these techniques means that people can choose the one that suits them best.

Can treatments for insomnia improve how we feel?

Older people with insomnia symptoms often experience symptoms of depression and anxiety — therefore facing a double whammy of symptoms. Psychological treatments for older persons can potentially improve not only insomnia symptoms but also make people feel less distressed. A recent study by our group from Goldsmiths, University of London examined whether techniques (that do not involve medication) can promote the psychological well-being of older persons who experience insomnia symptoms. We found that techniques that target insomnia symptoms in older persons can reduce symptoms of depression, fatigue, and anxiety. In other words, evidence suggests that treating insomnia can make older persons not only sleep better but also feel less depressed, anxious, or tired. We also identified the techniques which show promise in doing this. Practicing mindfulness meditations in particular had the potential to reduce depression symptoms in older persons with insomnia symptoms. Techniques that incorporate mindfulness elements have been previously found to help with both insomniaand depression, suggesting that mindfulness meditations may offer dual benefits to older persons by improving both types of symptoms. This research direction has great potential for improving older persons’ lives and now need to be tested in further studies.

It is likely then that there are more helpful techniques to improve sleep than busting oneself “smartly over the temple with the night-light”, as in the opening quote by Dorothy Parker. What is more, certain techniques such as mindfulness hold promise to improve not only night-time sleep but also the days that follow.

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Pill-free treatments can tackle insomnia and depression

This article was originally written by Pete Wilton and published on Goldsmiths News. Read the original article.

Psychological techniques used to combat insomnia in older people can also reduce symptoms of depression, anxiety, and fatigue, a new analysis has shown.

The analysis, led by Goldsmiths, University of London, found that mindfulness-based interventions can potentially improve psychological wellbeing in people aged over 55 who experience insomnia symptoms. Out of other approaches not involving medication, and behavioural sleep restriction techniques were also shown in qualitative analyses to potentially reduce depression symptoms in older insomnia sufferers.

A report of the research is published in the journal Sleep Medicine Reviews.

Rotem Perach, study author and Teaching Fellow in Psychology at Goldsmiths said: “Our evidence suggests that pill-free approaches to treating insomnia can make older people not only sleep better but also feel less depressed, anxious, or tired.

“We also conducted qualitative analyses to identify which techniques show the most promise with practising mindfulness meditations in particular potentially able to reduce depression symptoms in older insomnia sufferers. What is encouraging is that such techniques may offer dual benefits to older persons by improving both types of symptoms.”

The team behind the study believes that randomized controlled trials are needed to confirm the effectiveness of approaches such as mindfulness or moderate exercise in treating older persons with comorbid insomnia and clinical and subclinical depression.

The researchers involved in the report came from the University of Kent and University of Sussex in the UK and the University of Murcia and IMIB-Arrixaca in Spain. This research, supported by The Dowager Countess Eleanor Peel Trust, was led by Alice Gregory, Professor of Psychology at Goldsmiths and author of the book ‘Nodding Off: The science of sleep from cradle to grave’.

A report of the research, entitled ‘The Psychological Wellbeing Outcomes of Nonpharmacological Interventions for Older Persons with Insomnia Symptoms: A Systematic Review and Meta-Analysis’, is published in Sleep Medicine Reviews.

What lies behind ghosts, demons and aliens – according to sleep researchers

Alice_Gregory_Oct_2015Alice M. Gregory is Professor of Psychology at Goldsmiths, University of London. She is a member of the Advisory Board for a digital parent education endeavor on infant and toddler sleep that is being supported by Johnson’s Baby. She is a Corresponding Editor (Sleep) for the Journal of Child Psychology and Psychiatry. She has previously received funding to support her work from multiple sources including the MRC, ESRC, Leverhulme Trust and the British Academy. Alice’s book Nodding Off: The Science of Sleep was published by Bloomsbury in June, 2018. .

This article was originally published on The Conversation. Read the original article.

If you believe in the paranormal you might not be surprised if you hear stories of deceased loved ones appearing during the night, huge explosions heard just as someone is drifting off with no obvious cause, and other peculiar occurrences. But what if you don’t?

My interest in the paranormal started with an impromptu coffee with a colleague, Chris French, who researches reports of paranormal experiences. He told me stories of countless people who had recounted such events. These experiences tended to start while lying in bed. Then something unusual would happen – perhaps a demon would appear or the environment would seem strange or there would be a sensed presence. The person having this experience might also report being glued to their mattress, tarmacked into the bed, totally unable to move.

It’s unsurprising that people who experience such things might interpret them as paranormal. But certain phenomena such as sleep paralysis provide an alternative to paranormal explanations for such occurrences. Hence my interest in the subject, as a sleep researcher.

Sleep paralysis

When we sleep, we cycle through different stages. We start the night in non-rapid eye movement (NREM) sleep – which gets progressively deeper. We then cycle back until we hit rapid eye movement (REM) sleep. During REM sleep we are most likely to have vivid dreams. At this stage we are also paralysed, perhaps as a safety mechanism to stop us acting out our dreams so that we don’t end up attempting to fly.

But during sleep paralysis, features of REM sleep continue into waking life. Those who experience it will feel awake yet might experience dream-like hallucinations and struggle to move. This experience is pretty common, occurring in around 8% of people (although estimates vary dramatically depending on who we are asking). It’s even possible to induce sleep paralysis in some people, by disrupting their sleep in specific ways.

Certain researchers, French among them, believe that this explains a huge number of paranormal accounts. Information about sleep paralysis is finally seeping into public awareness, but we now need to understand more about this common complaint.

Our preliminary work, which I recount in my new book Nodding Off: The science of sleep from cradle to grave, hints at possible genetic and environmental explanations for why some people are more likely than others to experience sleep paralysis. This now needs to be replicated using much larger samples. Reviewing the literature, we have also highlighted a host of other variables associated with this common experience, including stress, trauma, psychiatric difficulties and physical illnesses.

The worst dreams.
Creativa Images/Shutterstock.com

Exploding head syndrome

Sleep paralysis aside, how else are sleep researchers helping to explain paranormal experiences? People sometimes describe experiencing huge explosions during the night which simply can’t be explained. There is no sign that a shelf has fallen down or a car has backfired. There is no one playing the electric guitar next to their head.

Again, this can be linked to our sleep – this time explained by “exploding head syndrome”, a term coined relatively recently by the neurologist JMS Pearce. When we fall asleep, the reticular formation of the brainstem (a part of our brain involved in consciousness) typically starts to inhibit our ability to move, see and hear things. When we experience a “bang” in our sleep this might be because of a delay in this process. Instead of the reticular formation shutting down the auditory neurons, they might fire at once.

As with sleep paralysis, this phenomenon is also under-researched. For this very reason, in 2017 my colleagues and I joined forces with BBC Focus and Brian Sharpless, a leading expert on this phenomenon, to collect data on this topic.

Imps and ghouls

Finally, what might scientists make of precognitive dreams? We might dream of a friend we haven’t seen for years only to have them call us the very next day. French thinks science can provide an explanation for this too. Referencing work by John Allen Paulos that focuses on probabilities, he explains how such an occurrence may be surprising on any single day, but over time, quite likely to occur.

Researching my book, I spoke to Mrs Sinclair, who is 70, and lives alone. She told me about what she had thought was a ghost living in her house, an imp throttling her during the night and other things that had left her petrified. Having scientific explanations provided her with immense comfort and she no longer believes in paranormal explanations for the things that she experienced.

Our hope is that scientific explanations of paranormal experiences might help others by lowering anxiety. Decreasing anxiety has also been hypothesised as a potential method by which to reduce sleep paralysis. So, perhaps providing more information about these unusual experiences might even mean that things are less likely to go bump in the night.

 

Alice M. Gregory, Professor of Psychology, Goldsmiths, University of London

Alice rests on Twitter  @ProfAMGregory

(False) Memories of Childhood: Part 1

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Professor Chris French, a former Editor in Chief of The Skeptic, is Head of the Anomalistic Psychology Research Unit at Goldsmiths, University of London (www.goldsmiths.ac.uk/apru). His previous books include Why Statues Weep: The Best of The Skeptic (with Wendy Grossman) and Anomalistic Psychology (with Nicola Holt, Christine Simmonds-Moore and David Luke). His most recent book (with Anna Stone) is Anomalistic Psychology: Exploring Paranormal Belief and Experience. He also writes for the Guardian. Follow him on Twitter: @chriscfrench .

This was originally published in The Skeptic. Read the original article.

On 5 October 2017, I, along with four other memory researchers, read out an essay on memory in front of an audience at the Wellcome Collection Reading Room in London. The following week, the essays were broadcast on Radio 3. Mine went out on 10 October 2017 and can be listened to here. Part 1 of the full text is reproduced below and Part 2 will be reproduced in my next column.

What is your very earliest memory? As a psychologist with a particular interest in memory, this is a question that I have often pondered for myself – and I’m still not sure that I can answer it. When I try to mentally time-travel back to my childhood, several images appear in my mind’s eye. I can picture a reading book we used in school when I was learning to read, featuring Old Lob the farmer and I can even remember the pictures of some of the animals on his farm – Dobbin the horse, Mr Dan the dog, and especially Percy the bad chick. I am sure other memories predate that one though – mental images of things like the gas fire we used to have in my bedroom, Peter my much-loved one-eyed toy Panda, and the stairs in my Grandma’s house. But they are just images and they seem to be a pretty random selection. Unlike my more recent memories, there is no narrative structure, no sense that first this happened and then that happened. As appears to be typical for everyone, these fleeting images are hard to date, so I suspect I’ll never be able to confidently choose just one as my first real memory.

Some people, however, claim to be able to clearly remember events from the first year or two of life, including remembering actually being born. Indeed, some go even further and claim that they can remember life in the womb. We can be fairly sure that such apparent memories are almost certainly false memories, no matter how real they may feel. All of the evidence strongly supports the idea that it is simply not possible to encode accurate and detailed autobiographical memories in the first year or two of life, probably because the brain is simply not mature enough to do so. Also, at that age we do not have the language skills that are thought to be necessary to produce the narrative structure that characterises later memories.

One very famous account of a false memory from early life is provided by none other than the famous Swiss developmental psychologist, Jean Piaget. “I was sitting in my pram,” he recalled, “which my nurse was pushing in the Champs Elysées, when a man tried to kidnap me. I was held in by the strap fastened around me while my nurse bravely tried to stand between me and the thief. She received various scratches, and I can still see vaguely those on her face. Then a crowd gathered, a policeman with a short cloak and a white baton came up, and the man took to his heels. I can still see the whole scene, and can even place it near the tube station.”

The only problem with this exciting memory, as Piaget himself later realised, is that none of this ever happened. At the time, the family had been so grateful to the nurse for her courageous actions, they had even given her an expensive watch as a reward. The tale was often recounted at family gatherings. Years later, tormented by guilt, the nurse had written to the family confessing that she had made the whole thing up.

False Memories Feel Real

Such false memories feel subjectively just the same as memories for events that really did take place. It is just that the events in question either never took place at all or else were so different to the way you remember them as to bear little resemblance to what really happended.

Let me be clear. I am not saying that all memories of childhood are false memories. The problem is that, in the absence of independent evidence, it is simply impossible to say which memories are more or less accurate reflections of events which really did occur, which are distorted versions of what really happened, and which, like Piaget’s, are entirely false. Contrary to what many people believe, memory does not accurately record every detail of every experience you’ve ever had. Instead, remembering is a reconstructive process.

Think of a holiday that you have been on. Think of some specific event that happened on that holiday. Try to remember a scene from that event as clearly as you can and picture it in your mind’s eye. Now, ask yourself this question: Can you see yourself in your mental image? Many people, though not all, report that it seems to them as if they are watching the scene from the vantage point of an outside observer, clearly demonstrating that this memory is not simply a mental replay of what they experienced through their own eyes at the time.

Furthermore, memories are always fragmentary and incomplete. We tend to remember the general gist of what happened but forget many specific details. We often unconsciously and automatically fill in any gaps in memory with what we think we must have seen, rather than what we actually did see. A nice illustration of this is to ask people how the four is represented on most clocks and watches with Roman numerals on them. The vast majority of people will reply “IV”. The correct answer is “IIII”. In all other contexts, the number four really is represented as “IV” – but not on most clocks and watches.

For most of us, most of the time, it does not matter too much if our childhood memories are more or less accurate or not. If we have what appear to be fairly clear memories of childhood episodes, that will be enough to satisfy us that those pictures in our minds are reflections of things that really did happen to us – especially if no one ever challenges their veracity.

A Modern Witch Hunt

Sometimes, however, false memories of childhood can have extremely serious and damaging consequences. Back in the 1980s and ‘90s, particularly in the USA but in many countries around the world including the UK, vulnerable people entered into therapy in the hope that this would help them to deal with a wide range of troubling but fairly common psychological problems – such as anxiety, depression, eating disorders or problems with relationships. When they entered therapy, they had no memories of ever being the victim of childhood sexual abuse. By the time their treatment had ended, they were convinced that they had been so abused – typically by their own parents. What is more, they had detailed and horrific memories of their abuse. In some cases, the alleged abuse was particularly extreme. It was claimed by some, for example, that they had been victims of ritualised Satanic abuse. These rituals, often described in graphic detail, were said to involve the sacrifice of animals and babies, cannibalism, rape, and every sexual perversion imaginable. The consequences were that families were torn apart, alleged victims were tormented by nightmarish memories that had replaced those of relatively normal childhoods, and alleged abusers were arrested and sometimes sent to prison.

The central question was, of course, were these apparent memories recovered during therapy accurate reflections of real events – or were they completely false memories of events that had never happened at all? Psychologists were – and to some extent still are – divided in their opinions on this question. Those clinical psychologists who favoured a psychoanalytic approach to the question found it easy to believe that these recovered memories were probably memories for real events. They accepted the psychoanalytic notion of repression – the idea that when someone suffers a trauma, an automatic psychological defence mechanism kicks in that pushes the memory for that trauma deep into the unconscious mind where it can no longer be accessed by the conscious mind. Psychoanalysts believe that such repressed memories can still have a damaging effect, however, leading to the types of psychological problems in later life that might lead to someone seeking the assistance of a therapist.

In sharp contrast, experimental psychologists typically doubt the validity of the very concept of repression. They point out that traumatic experiences are far more likely to be remembered than forgotten. After all, no one ever forgot being held in a concentration camp. If repression is a myth, albeit a widely believed myth much loved by writers of fiction, it follows that most, possibly all, memories “recovered” during psychotherapy are in fact false memories.

Whereas there is no compelling evidence in support of the psychoanalytic notion of repression, there is a vast amount of evidence to support the notion of false memories. Statements supporting the dangers of false memories arising during therapy can be found in official pronouncements by numerous national professional psychological and psychiatric associations around the world.

 

Sleep problems are influenced by our genes – but this doesn’t mean they can’t be fixed

Alice_Gregory_Oct_2015Alice M. Gregory is Professor of Psychology at Goldsmiths, University of London. She is a member of the Advisory Board for a digital parent education endeavor on infant and toddler sleep that is being supported by Johnson’s Baby. She is a Corresponding Editor (Sleep) for the Journal of Child Psychology and Psychiatry. She has previously received funding to support her work from multiple sources including the MRC, ESRC, Leverhulme Trust and the British Academy. Alice’s book Nodding Off: The Science of Sleep was published by Bloomsbury in June, 2018. .

This article was originally published on The Conversation. Read the original article.

Some people struggle greatly with sleeplessness, whereas others appear to be able to nod off effortlessly, regardless of the circumstances. Perhaps the most obvious explanation for differences between us in terms of our sleep is the environmental challenges that we face. An unrelenting stint at work, relationship difficulties or receiving bad news are just some of the many life challenges that can lead to sleepless nights.

It’s no surprise that stressful life events are associated with disturbed sleep. The way we respond to sleeplessness in terms of our thoughts and behaviours can then perpetuate the problem – it’s not helpful to lie in bed awake willing ourselves to sleep, or to catastrophise about our sleeplessness.

Studies focusing on large numbers of twin pairs back up the idea that environmental influences are an important explanation for why sleep quality differs between one person and another. But they also highlight that sleep problems run in families: if you struggle with your sleep, it’s likely that your parents or grandparents did too. Looking at why this might be, it seems that our genes are important when it comes to our aptitude for sleeping soundly.

We’re learning more all the time about which specific genes might be important, as I explore in Nodding Off, my new book on the science of sleep. Some more recent research into this has been conducted on a vast scale. For example, one study of over a million people identified genetic variants associated with insomnia, enriching our knowledge of the biological pathways by which insomnia develops.




Read more:
Insomnia is not just in the mind


The complexity of the underlying causes of sleep problems goes further than this, and it’s been proposed for some time that genes and the environment go hand-in-hand. For example, some people are more likely to be exposed to certain environmental experiences (such as work stresses) in part for genetic reasons. Their sensitivity to these experiences (such as whether they will keep them up at night) is also influenced by our genes. Another example of genetic and environmental interplay is epigenetics, which means “above genetics”. Our genes do not change, but how they influence us (whether they are “switched on or off” or “turned up or down” like a dimmer switch) can be influenced by the environment.

Do your genes cause you to sleep badly?
Konstantin Faraktinov/Shutterstock.com

Can it be fixed?

So what does this all mean for resolving a sleep problem? You may think that the discovery that genes explain some of the differences between us in terms of our sleep quality means that some of us are destined to sleep poorly and there is nothing much we can do about it. But, thankfully, that does not follow.

One of the very first lessons that a student of behavioural genetics learns is that just because something is influenced by our genes does not mean that changing the environment can’t be the solution. The example so often given is that of phenylketonuria (PKU). This is a disorder in which the substance phenylalanine (found in certain foods) can’t be broken down by the body and can lead to brain damage. While this is a genetic disorder, the solution lies in the environment: by carefully considering diet, the negative effects of this disorder can be prevented from developing.

It’s clear that cognitive behavioural therapy for insomnia (CBT-I) which addresses thoughts about sleep, as well as behaviour (including a relaxation component and making sure people do not spend time in bed awake) is the best initial treatment for those who suffer from chronic insomnia.

But understanding more about differences between people might also eventually be useful when it comes to treatment. There is current research interest in personalised medicine, with the hope that treatment can eventually be further tailored to the individual.




Read more:
How science is using the genetics of disease to make drugs better


Nobody should feel that sleeplessness is something they simply have to endure. If you are struggling with sleep problems, talk to a doctor and try to reach a sleep expert. Different CBT-I online courses are being developed and tested and some appear to be helpful. Despite an array of different causes of sleeplessness, there is help at hand for a better night.

Alice M. Gregory, Professor of Psychology, Goldsmiths, University of London

Alice rests on Twitter  @ProfAMGregory