Carol Kuhn, MD
Most healthy older adults, age 65 or older, need 7-8 hours of sleep each night to feel rested and alert. But as we age, our sleep pattern may change.
Keep in mind that you may need less sleep as you age. Some people need only 5 to 6 hours of sleep a night, but most people do better with between 7 and 9 hours. Sleep usually occurs in three-hour cycles, so it’s important you get at least 3 uninterrupted hours of sleep.
Insomnia (trouble sleeping), sleep apnea, restless leg syndrome (RLS), and periodic limb movement disorder (PLMD) are all causes of sleep disturbance.
Common sleep changes in older adults include:
◦ Getting tired early in the evening
◦ Waking up earlier in the morning
◦ Waking up in the middle of the night and not being able to go back to sleep
◦ Having insomnia, which is a condition that makes it hard to fall asleep, and/or stay asleep
◦ Falling asleep during the day, including while driving
Older adults often see their sleep–wake cycle change. This can be caused by many different factors, including:
◦ Your body’s chemicals, and hormones. For example, as you age, your body produces less melatonin. This is a natural hormone that regulates your sleep cycle.
◦ Certain medicines, including anti-depressants, beta blockers, and cardiovascular drugs.
◦ Dealing with pain.
◦ Diabetes and prostate issues can contribute to sleep disturbance and make you fatigued as you wake up multiple times to urinate.
◦ Congestive heart failure or kidney disease. You may have trouble lying flat and getting comfortable enough to fall asleep.
If you find yourself sleeping in a recliner, waking up many times throughout the night, it is important to talk to your health provider. Underlying health problems may be the cause of your sleeping issues.
Insomnia
Insomnia is a sleep disorder that happens when you have trouble falling asleep, staying asleep, or both. Acute insomnia is short-term trouble sleeping. It may last a few weeks and then go away. Chronic insomnia is when your sleeping problem happens several nights a week and lasts for more than a few months. Insomnia is common in older adults, and more women than men have it.
Primary insomnia isn’t well understood. Things that can cause this kind of insomnia include:
· Life changes
· Long-lasting stress or emotional upset
· Travel or work schedules that disrupt your sleep routine
· Habits you form to deal with your lack of sleep (naps, worrying about sleep, going to bed too early)
Secondary insomnia is insomnia caused by symptoms or a side effect of another problem. They include:
· Emotional conditions: depression, anxiety and post-traumatic stress disorder
· Neurological disorders: Alzheimer’s or Parkinson’s disease
· Pain conditions: arthritis, headaches disorders
· Gastrointestinal disorders: heartburn, GERD
· Sleep disorders: restless leg syndrome or sleep apnea
· Breathing disorders: asthma, heart failure, or chronic obstructive pulmonary disease (COPD)
Insomnia can sometimes occur in families.
Sleep apnea
Sleep apnea is a common sleeping disorder. It causes a person’s breathing to stop and start, while sleeping. People who have sleep apnea often snore loudly. You stop breathing for 10 to 30 seconds at a time. When you start breathing again, you gasp or snort, which can wake you up. This can occur hundreds of times in a single night. Each time you wake up, it disturbs your sleep pattern. It can be harmful if you stop breathing for too long. It also causes high blood pressure, which increases your risk of a heart attack.
To treat sleep apnea, health providers typically prescribe patients a CPAP mask, which stands for continuous positive airway pressure mask. A CPAP machine sends a flow of pressurized air into the persons, mouth and nose as she sleeps. This helps keep the individual’s airway open to allow normal breathing.
Restless leg syndrome (RLS)
RLS is a condition in which you have leg pain or discomfort. It occurs when you are sitting or lying down. It can feel like your legs won’t be still. RLS can make it hard for you to sleep and it can be quite annoying.
Periodic limb movement disorder (PLMD)
PLMD is a condition in which you kick your legs while you sleep. Most of the time, you are unaware of your kicking. If you have a bed partner, they may tell you about it. It can prevent good sleep and cause daytime fatigue. Some people may have both RLS and PLMD.
Things to consider for good “sleep hygiene”. Sleep hygiene refers to maintaining daily routines in a bedroom environment that promotes consistent, quality sleep. If you find your sleep- wake cycle has changed as you get older, you might consider these tips helpful:
◦ Go to bed and get up at the same time each day, even on the weekends.
◦ Do not take naps longer than 20 minutes during the day.
◦ Do not read, watch TV, check your phone, or eat in bed. Only use your bedroom for sleep, intimacy, or sickness.
◦ Avoid caffeine for about eight hours before bedtime.
◦ Avoid nicotine and alcohol in the evening (4 to 6 hours before you go to bed). Alcohol might help you fall asleep, but it can cause you to wake up in the middle of the night.
◦ Have a “wind down” period each night before bedtime. Try yoga postures for loosening up the body before bedtime. Try practicing yoga breathing.
◦ Make sure you have the right mattress. In general, a medium firm mattress has the minimum standard for good spine alignment in comfort.
◦ Keep the bedroom dark and free of white light from electronic devices. If you need some dim light, amber light is better than white light or blue light. Amber is midway between yellow and orange. It helps promote secretion of the sleep hormone melatonin. White or blue light interferes with the secretion of melatonin.
◦ Do not lie in bed for a long time trying to go to sleep. After 30 minutes of trying to sleep, get up and go to a different room. Do something quiet, such as reading or listening to music. Do not do anything that stimulates your brain. Then, go back to bed and try to fall asleep. This seems to be very difficult for a person to do; to get out of bed and go to another room seems counterintuitive. But it really helps.
◦ Try to be active each day. Regular exercise will often help you rest better. But do not exercise vigorously within two hours of bedtime.
◦ Ask your health provider if any of your medicines could be keeping you awake at night.
Alcohol and caffeine use deserve further discussion. Not only does alcohol affect aging, but consuming alcohol, especially in excess, has been linked to poor sleep quality and duration. A normal sleep pattern includes four distinct stages. Consuming alcohol before bedtime could have a suppressive effect on the REM sleep during the first two sleep cycles. This can diminish overall sleep quality. Dreams typically occur during REM sleep, which is restorative, and it is important for cognition, learning, and memory.
Caffeine stimulates the central nervous system, which can create a rush of energy. It quickly boosts alertness in the brain. These effects can be detrimental to getting good sleep. Studies have shown that caffeine typically prolonged sleep latency, reduced total sleep time and sleep efficiency.
So, the best way to prevent sleep disorder is to develop a good sleep routine. It may be helpful to keep a sleep diary: keep track of when you went to bed, how long you’re in bed before you fall asleep, how often you woke up during the night, what time you got up in the morning, how well you slept, the time and length of any naps, how you felt during the day (sleepy or alert), what you drank (caffeine or alcohol and at what time), when you exercised. You can review this with your health provider and identify patterns and conditions that are affecting your sleep.
The best way to treat sleep disorder is with behavioral therapy. It usually includes learning ways to relax and not worry as much about sleep. You can learn muscle relaxation and deep breathing exercises to help you relax. This is often as effective as prescription sleeping medicines. There are some over-the-counter (OTC) sleep aids that can be used for a short period of time. But be sure to check with your health provider and don’t drink alcohol while you are taking over-the-counter sleep aids. In some cases, your health provider may prescribe short-term medication to help you. Regular use of prescribed medication may lead to rebound insomnia. Your insomnia comes back even worse than before.
A good way to relax is to focus on your breathing by taking slow, deep breaths while counting to five. Then listen to the sound of your breath as you breathe out. You can also try to tighten and relax the muscle groups in your body. Begin at your feet and work your way up to your face and head. Listening to relaxation music may also help. Remember, it’s important every night to review your day and go over what you could and couldn’t control. You deserve your rest, sleep is critical to your overall health; it affects your immune function, hormone regulation, thinking ability, and mental health. A good day begins with a good night’s rest.
Resources:
1. Shakespeare, William. Hamlet, Act 3, Scene 1.
Holder, Susan DO, and Narula, Navjot, MD, MB. Common Sleep Disorders in Adults: Diagnosis and Management. American Family Physician, Volume 105, Number 4, April 2022.
Castanda, Ruben, Why Is It Harder to Sleep When You Get Older? U.S. News &World Report, January 26, 2023.
Insomnia, familydoctor.org. Resources: National Heart, Lung, and Blood Institute: Insomnia.
Sleep Changes in Older Adults, familydoctor.org. Resources: National Sleep Foundation.
Dr. Wendy C. Kasten, Writer 