Seniors and Sleep Problems
Sleep problems are common for seniors but there are some remedies
ILLUSTRATION BY elizabeth ellis
To sleep, perchance to dream — it’s the wish of many seniors. Unfortunately, slumber can be elusive to older adults for a variety of reasons.
“As you age, the architecture of your sleep changes,” says Brooke Judd, MD, director of the Sleep Disorders Center at Dartmouth-Hitchcock Medical Center in Lebanon and section chief for Sleep Medicine. “Sleep is lighter, you get less deep sleep, and in the lighter stages of sleep you tend to have more awakenings.”
Because of this, she adds, seniors tend to report more insomnia, frequent awakenings and more tiredness during the day. This, in turn, can lead frequently to daytime napping, which sets up a vicious cycle of getting less at night and tending to make up for it during the day.
While Grandpa or Grandma dozing in their chair may be a stereotypical image of a senior citizen, it’s actually a myth that seniors need more sleep; they just need better sleep. According to the National Sleep Foundation, as a general rule newborn babies need about 12–18 hours of sleep, school-age children require about 10-11 hours and teenagers could use (but hardly ever get) 8.5–9.25 hours of shut-eye. This amount then decreases even more as we near adulthood, to between 60 and 90 fewer minutes of sleeping time than an adolescent. So on average, seniors tend to need the same amount as other adults, about 7–9 hours of sleep each night, say experts. Unfortunately, with more interruptions at night, seniors may not be getting the zzzs they need. What’s more, while the quantity of sleep is a good guideline, the quality of those hours of sleep is what makes the real difference.
Research has shown is that sleeping too little can put both your health and your safety at risk: people who don’t get enough good-quality sleep are not as productive or able to remember information as well. They have a harder time paying attention and their reaction time is slower. Because of this, there is an increased risk of motor vehicle accidents associated with people who don’t sleep enough. Health issues linked to poor sleep include higher risk of obesity, diabetes and heart problems, as well as depression.
And a new study out this past October from Johns Hopkins Bloomberg School of Public Health suggests that poor sleeping habits may increase an individual’s likelihood of developing or experiencing a worsening of Alzheimer’s symptoms. While it’s well known in the medical field that people diagnosed with Alzheimer’s tend to sleep poorly, this new research suggests a chicken-and-egg conundrum — that poor sleep might be a cause, rather than an effect, of the cognitive degenerative disease.
What makes sleep just out of reach for seniors can be due to underlying health issues, says Noel Wheeler, MD, chairman of the Critical Care Committee and director of the Sleep Disorders Center at Wentworth-Douglass Hospital in Dover. Things like chronic heart and lung conditions lead to fragmentation of nighttime sleep, he says, which further leads to daytime sleepiness and frequent napping. “Some of these may occur due to the natural aging process and degenerative changes,” he says.
Bladder or prostate problems can cause seniors to have to get up to go to the bathroom more often at night, further interrupting their sleep patterns, as can chronic pain from arthritis and side effects from prescription medications (which can affect sleep in both ways, sometimes making them more sleepy and sometimes more stimulated), says Judd. Seniors are also more apt to develop sleep disorders such as insomnia. In a poll by the National Sleep Foundation, 44 percent of older persons experience one or more of the nighttime symptoms of insomnia at least a few nights per week or more. According to the NSF, insomnia may be chronic (lasting over one month) or acute (lasting a few days or weeks). Restless Leg Syndrome, a disorder where the person feels the urge to move their legs at night to get rid of itchy “pins and needles,” painful or generally uncomfortable symptoms also affect older people and tend to gets worse as they age. And Obstructive Sleep Apnea (OSA), when upper air passages are relaxing more and blocking the airway, is another common disorder for seniors. What’s frustrating about OSA is that most people aren’t even aware that they have it, says Judd.
“Your brain is not going to let you stop breathing, so you wake up briefly,” she says. “It’s usually their bed partner who notices the issue, so for those [elderly people] who don’t have a bed partner, they usually just come in for an appointment saying they are tired.”
As people age they can also fall into a pattern where they wake up really early at 3 or 4 a.m. because they’re going to bed at 7 or 8 the night before. Judd says that’s an altered circadian rhythm, the brain’s internal clock telling a person when to be sleepy and when to wake up. “Some of this shift stems from biological changes in the brain, but a lot is environmental or behavioral as well,” she says. “If [senior citizens] are not engaged in activities and not outside in a lot of natural light enough, they will shift into going to bed early and waking up early.” Luckily, there are non-medical interventions seniors can use to help shift back onto a more normal schedule, she adds. One suggestion is to engage in activities — that may mean just going outside or going to a senior center to keep busy — being physically active, and exposing yourself to natural light or certain levels of artificial light to have your brain wake up. People who are exposed to that kind of light in early evening can stay awake longer and fall back into a normal sleep schedule, she says.
Wheeler agrees that good “sleep hygiene practices” for seniors can help them to develop better quality sleep and that along with light exercise daily and exposure to sunlight, limiting consumption of alcohol and caffeine and avoiding daytime naps are also useful to catching your proper 40 winks.
Keeping your bedroom dark, quiet and at a comfortable temperature can also help. In addition, says Wheeler, people should limit screen time as bedtime approaches. “Seniors should avoid bright light in the evening and turn of all electronic devices — computers, iPads, Kindles, smartphones — and TV at least 1–2 hours prior to bedtime,” he says.
“Some of these habits are difficult to change and sometimes it might help to develop practices in the evening to calm the mind and body with relaxation exercises like yoga, tai chi and meditation,” he says. Others may also benefit with Cognitive Behavioral Therapy provided by trained psychologists.
Sleeping pills should be avoided because of their risk of dependency, but Judd says that an elderly person who is having trouble sleeping may respond to the use of melatonin in the evening, which is a gentle sleep aid. Seniors should check with their doctor about any medication they are on, to see if the dose or the time it’s taken can be adjusted to make for a better night’s rest. After all, good sleep is not just a good idea, it’s essential to a good quality of life.
Getting a good night’s sleep
Here are some tips from the National Institute on Aging to help you sleep better.
- Try to follow as close to a regular sleep schedule as possible by going to bed and getting up at the same time each day — even on weekends. Also, try to avoid napping in the late afternoon or evening.
- Develop a bedtime routine, taking time to wind down before bed. And avoid screen time for at least an hour or two before you go to sleep.
- Keep your bedroom dark, quiet and at a comfortable temperature.
- Exercise regularly — but not within three hours before you go to bed.
- Get outside into the sunlight each day.
- Avoid eating large meals close to bedtime.
- Eschew caffeine (not just coffee and tea but also soda, hot chocolate, etc.) and alcohol before bed, both of which will hinder sleep.