Under the care of a VA psychiatrist/sleep specialist, I have been taking 7.5 MG of zolpidem for several months which has improved my sleep tremendously. However, since the medication wears out in 4–5 hours, I wake up in the middle of the night for a pitstop and have trouble returning to sleep. Since I have been using the CBT – I coach app from the VA, I follow the recommendation to get out of bed if I do not return to sleep in 15–20 minutes. I usually will read for 30–40 minutes until I feel sleepy, then return to bed where I usually am able to fall asleep until my scheduled wake up time at 8:30 – 9 o’clock in the morning.
Occasionally, I will get lucky and fall back to sleep after my nightly pitstop without getting up or rarely I can sleep through the night without getting up at all.
I will appreciate any tips on improving my sleep maintenance issues to improve both my time asleep as well as my sleep efficiency.
FWIW, I am 75, retired, and take medication for other health issues including AFib, high blood pressure and high cholesterol. I also take daily bike rides averaging 20 miles.
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Hey Patrick,
Thanks for your question. I’m sorry to hear you’re dealing with disrupted sleep.
In addition to the meds wearing off, there’s a number of possible reasons why you’re waking up in the middle of the night. It can be your sleep environment, other medications you’re taking, or psychological factors such as stress or anxiety. It’s also worth keeping in mind that what you’re experiencing is fairly common at your age.
I would start by making sure your sleeping environment is optimal. Are there any light, noise, or other disturbances that could be waking you up in the middle of the night? Are you having to use the bathroom? Does your partner snore? Look for any patterns triggering your waking and think about how to address those.
It’s good to hear that you’re having success leaving the bed and reading to fall back asleep. While this works for many people, others find the elevated heart rate from getting up and the time spent away from bed can result in less sleep overall. If you ever find this method to be less effective, you may try some sleep-inducing breathing exercises as an alternative.
In terms of your medication and any psychological factors, those should be evaluated by a medical professional.
Given it’s not abnormal to have disrupted sleep at your age and you seem to generally be able to get back to sleep, I would also consider an earlier bed time to help ensure you’re getting enough sleep when accounting for the period spent awake.
Hello Jackson,
Thanks for your response to my inquiry regarding my disrupted sleep pattern. As stated in my previous message, I have been using the VA CBT-i Coach application https://mobile.va.gov/app/cbt-i-coach to monitor and track my sleep. This is a free application that anybody can use and has helped me tremendously to track my progress during my insomnia journey.
As such, I have most, if not all of the boxes checked referenced in your response, including sleep environment in addition to helpful online lessons and information about improving sleep. I have been keeping a sleep diary with this app for over two years and have made great progress and am now averaging over seven hours of sleep per night. I also had several sessions of face-to-face counseling with a VA CBT specialist and continue to see a VA psychiatrist/sleep specialist.
Regarding your suggestion to go to bed earlier, as you may know, a vital part of CBT-i is “sleep restriction”. I update my “sleep prescription” weekly, which is based on the data that I have entered for the past seven days. Sleep restriction may be one of the most difficult aspects of CBT for insomnia as it seems anti intuitive to restrict time in bed when you are trying to get more sleep. The goal is to minimize time spent in bed while awake and improve sleep efficiency.
Another important part of CBT-i is getting out of bed if you are unable to fall asleep in 15–20 minutes. I have tried to resist doing this but have failed on several occasions as I find it more difficult to force myself to return to sleep than it is to just get up and read and listen to ambient music for a few minutes and then return to bed. No doubt this may not be the best method for everybody, but I have found it the best way to maximize my total sleep each night.
Lastly, I acknowledge and accept the fact that my age plays a big part in my sleep challenges, but also realize how important sleep is to maintain good health and am determined to do my best to continue to improve.
Thanks again for your response and I look forward to feedback from others who may be on a similar journey.
Best Regards,
Patrick Piper
217 Timberlane Dr
Palm Harbor, FL 34683
“Enlightenment: doing what you want and eating what there is.” - Jack Kerouac