Introduction to senior sleepIntroduction to senior sleep

Sleep is just as important to our physical and emotional health in our senior years as earlier years. We need sleep to recharge our mind and body in order to function properly. As we age we will experience changes in our sleeping patterns. We may become sleepy earlier, wake up earlier, or enjoy less deep sleep. Although these changes are a normal part of aging, waking up tired every day experiencing symptoms of insomnia are not a normal part of aging. Over-medication can also easily lead to poor senior sleep.

About half of those who complain to their doctors about poor sleep end up with a prescription drug. Not only are these unnecessary but they also are habit-forming and can cause side effects, and weaken the sleep and daytime energy levels long-term.

Typical sleep patterns vary throughout life, but they also vary from person to person so it can be difficult to say what’s ‘normal’ for an older person.

However research does suggest that in later years, people tend to need slightly less sleep. A recent study by the National Institutes of Health suggests that healthy older people may require about one and a half hours less sleep than younger adults, or an average of seven and a half hours per night. The study indicates that seniors sleep less even when given the opportunity for more sleep because of age-related changes in the ability to fall asleep or remain asleep.

Common — and normal — sleep problems, which plague up to 40% of the elderly, include light sleep, frequent waking, and daytime fatigue. Among older people, there is also a decrease in the deep-sleep stage and an increase in periods of wakefulness during the night.

For seniors, a good night’s sleep is especially important because it helps improve concentration and memory formation. Furthermore it allows the body to repair any cell damage and refresh your immune system, which in turn helps to prevent disease. Older adults who don’t sleep well are more likely to suffer from depression, attention and memory problems, and excessive daytime sleepiness.

However, many elderly people do some napping at daytime, meaning they prefer to divide their sleep into 2 segments. This can help seniors to get through the days better with higher energy levels towards the evenings.Quality is as important as quantity. Some seniors (and adults) mistakenly believe they have a sleeping problem because they go to bed expecting to be asleep for eight or nine hours of sleep a night. Some times less is enough.

As we age our bodies produce lower levels of growth hormones, so we are likely to experience a decrease in deep sleep. When this happens we produce less melatonin (the sleep hormone), meaning we will often experience more fragmented sleep (more rapid sleep cycles) and more awakenings between sleep cycles. As our circadian rhythm (the internal clock that tells you when to sleep and when to wake up) changes, we may also find yourself wanting to go to sleep earlier in the evening and waking up earlier in the morning. Sleep experts recommend to adjust our bedtimes routines and expectations to these changes. This said, it’s normal for older adults to wake up more often during the night.

Stress and anxiety can easily get in the way of a good night’s sleep. Everyone has worries and lists of things to do, but it is important to teach yourself to let go of these thoughts when it’s time to sleep. There are lots of tips to learn relaxation in the ‘treatments’ section.

At any age, it’s common to experience occasional sleep problems. However, if you experience any of the following typical insomnia symptoms (problems falling asleep, problems staying asleep, waking too early, feeling tired/irritated next day, etc) on a regular basis, you may be dealing with a sleep disorder and/or insomnia and it’s recommended you to seek for help.

Common causes for poor senior sleep

Many cases of insomnia are caused by underlying but very treatable causes. While emotional issues such as stress, anxiety, and depression can cause insomnia, the most common causes in seniors are a poor sleep environment and poor sleep and daytime habits. Try to identify all possible causes of your insomnia; once you figure out the root cause, you can tailor treatment accordingly.

Most common causes for poor sleep among the elderly:

  • Bad sleep habits/hygiene and sleep environment
  • Depression, anxiety, excessive worrying
  • Chronic pain or medical illness
  • Medications
  • Lack of exercise
  • Dementia
  • Sleep disorders
  • Learned response
  • Heart disease
  • The need to visit the toilet

Tips to sleep better at older age

Poor sleep habits, including a poor sleep environment and poor daytime habits, can be the main causes of sleep problems and low-quality sleep in seniors. In many cases, older adults develop these poor sleep habits over a lifetime but find they create more and more problems as they age (when our quality of sleep naturally deteriorates). Fortunately, bad habits are easy to improve with some will power. Basically the guidance for good sleep is very similar as with adults.

Improve daytime habits for better sleep

  • Be social. Social activities, family,community  and work can keep your activity level up and prepare your body for a good night’s sleep.
  • Be positive. A more positive mood and outlook can reduce sleep problems.
  • Exercise regularly. Exercise releases endorphins that can boost your mood and reduce stress, depression, and anxiety.
  • Expose yourself to light. Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to get at least two hours of sunlight a day.
  • Limit caffeine, alcohol, and nicotine. All are stimulants and interfere with the quality of your sleep.

Encourage better sleep at night

  • Naturally boost your melatonin levels. Avoid artificial lights at night.
  • Don’t read from a backlit device at night (such as an iPad).
  • Make sure your bedroom is quiet, dark, and cool, and your bed is comfortable. Noise, light, and heat can cause sleep problems.
  • Use your bedroom only for sleep and sex.
  • Don’t check clock at night.

Establish regular bedtime routines

  • Go to bed and wake up at the same times every day, even on weekends.
  • Block out snoring. If snoring or other noise is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.
  • Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.
  • Develop ‘soothing’ bedtime rituals (a bath, favourite music, relaxation practises, deep brathing, etc)
  • Limit your use of sleeping aids and sleeping pills.
  • Touch, sex and physical intimacy can help more restful sleep.

Can napping help?

People are biologically programmed to sleep not only for a long period in the middle of the night but also for a short period in the middle of the day. Naps can enhance visual, motor, and spatial skills, and have even been shown to decrease the risk of coronary heart disease. So, if you don’t feel fully alert during the day, a nap may be just what you need. Find more about naps in the ‘treatments’ section.

Most people benefit from limiting naps to 15-45 minutes (so that you don’t enter the deep sleep stages). Sleeping beyond 45 minutes may let you feel groggy and unable to concentrate after a longer nap. Napping too late in the day may disrupt your nighttime sleep, try to nap before 3 pm.

While seniors need some of each type of exercise, studies have shown that participating in moderate endurance (aerobic) activity can have the greatest impact on improving sleep.

Can exercise help?

A recent study by the Feinberg School of Medicine at Northwestern University found that aerobic exercise resulted in the most dramatic improvement in patients’ reported quality of sleep, including sleep duration, on middle-aged and older adults with a diagnosis of insomnia (Source: National Sleep Foundation).

There are countless activities you can do to increase strength, improve aerobic capacity, burn calories, and prepare yourself for a good night’s sleep at the end of the day.  Swimming, walking, dancing, bowling, petanque, pilates, yoga and golf are among favourite sports among the elderly. Always consult your doctor before embarking on any new fitness program.

Getting some exercise for at least 30 minutes earlier in the day is a good, realistic goal and should have positive benefits on your sleep.

How to get back to sleep at night?

It’s normal to wake briefly during the night but if you’re having trouble falling back asleep, the following tips may help:

  • Don’t worry. Try not to stress over the fact that you can’t get back to sleep, because worries related to your sleep keep you awake. Focus on the feelings and sensations in your body instead.
  • Focus on relaxation and slow breathing. Try a relaxation technique such as deep breathing. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.
  • After 20 minutes, do something else. After 20 minutes of trying to sleep unsuccessfully, do a non-stimulating activity, such as reading a book in a dim light. Avoid all screens.
  • Postpone worrying. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve.

As a final note: avoid using sleeping pills to help you sleep, if possible. They can lead to dependence and can make sleep problems worse over time . Your health care provider should assess your risks of daytime sleepiness, mental (cognitive) side effects, and falls before you begin taking sleep medications.

References & Disclaimer

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