Sleep and Aging: Sleep Tips for Older Adults

Aging and sleep

As we age, we often experience normal changes in our sleeping patterns, such as becoming sleepy earlier, waking up earlier, or not sleeping as deeply. However, disturbed sleep, waking up tired every day, and other symptoms of insomnia are NOT a normal part of aging.

Sleep is just as important to your physical and emotional health as it was when you were younger. A good night’s sleep helps improve concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system, which in turn helps to prevent disease.

Older people who don’t sleep well are more likely to suffer from depression, attention and memory problems, excessive daytime sleepiness, and experience more nighttime falls. Insufficient sleep can also lead to serious health problems, including an increased risk of cardiovascular disease, diabetes, weight problems, and breast cancer in women.

To improve your quality of sleep it’s important to understand the underlying causes of your sleep problems. The following tips can help you identify and overcome age-related sleep problems, get a good night’s rest, and improve the quality of your waking life.

How much sleep do older adults need?

While sleep requirements vary from person to person, most healthy adults require seven to nine hours of sleep per night. However, how you feel in the morning is more important than a specific number of hours. Frequently waking up not feeling rested or feeling tired during the day are the best indications that you're not getting enough sleep.

How does aging affect sleep?

As you age your body produces lower levels of growth hormone, so you'll likely experience a decrease in slow wave or deep sleep (an especially refreshing part of the sleep cycle). When this happens you produce less melatonin, meaning you'll often experience more fragmented sleep and wake up more often during the night. That's why many of us consider ourselves “light sleepers” as we age. You may also:

• Want to go to sleep earlier in the evening and wake up earlier in the morning.
• Have to spend longer in bed at night to get the hours of sleep you need, or make up the shortfall by taking a nap during the day.

In most cases, such sleep changes are normal and don't indicate a sleep problem.

Sleep problems not related to age

At any age, it's common to experience occasional sleep problems. However, if you experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder:

• Have trouble falling asleep even though you feel tired.
• Have trouble getting back to sleep when awakened.
• Don't feel refreshed after a night's sleep.
• Feel irritable or sleepy during the day.
• Have difficulty staying awake when sitting still, watching television, or driving.
• Have difficulty concentrating during the day.
• Rely on sleeping pills or alcohol to fall asleep.
• Have trouble controlling your emotions.

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Causes of insomnia in the elderly

Many cases of insomnia or sleep difficulties are caused by underlying but very treatable causes. By identifying all possible causes, you can tailor treatment accordingly.

• Are you under a lot of stress?
• Are you depressed? Do you feel emotionally flat or hopeless?
• Do you struggle with chronic anxiety or worry?
• Have you recently gone through a traumatic experience?
• Are you taking any medications that might be affecting your sleep?
• Do you have any health problems that may interfere with sleep?

Common causes of insomnia and sleep problems in older adults

Poor sleep habits and sleep environment. These include irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on. Make sure your room is comfortable, dark and quiet, and your bedtime rituals are conducive to sleep.

Pain or medical conditions. Health conditions such as a frequent need to urinate, pain, arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, and Alzheimer's disease can interfere with sleep. Talk to your doctor to address any medical issues.

Menopause and post menopause. During menopause, many women find that hot flashes and night sweats can interrupt sleep. Even post menopause, sleep problems can continue. Improving your daytime habits, especially diet and exercise, can help.

Medications. Older adults tend to take more medications than younger people, and the combination of drugs, as well as their side effects, can impair sleep. Your doctor may be able to make changes to your medications to improve sleep.

Lack of exercise. If you are too sedentary, you may never feel sleepy or feel sleepy all the time. Regular aerobic exercise during the day can promote good sleep.

Stress. Significant life changes like retirement, the death of a loved one, or moving from a family home can cause stress. Nothing improves your mood better than finding someone you can talk to face-to-face.

Lack of social engagement. Social activities, family, and work can keep your activity level up and prepare your body for a good night's sleep. If you're retired, try volunteering, joining a seniors' group, or taking an adult education class.

Sleep disorders. Restless Legs Syndrome (RLS) and sleep-disordered breathing—such as snoring and sleep apnea—occur more frequently in older adults.

Lack of sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to get at least two hours of sunlight a day. Keep shades open during the day or use a light therapy box.

Tips to improve sleep habits as you age

In many cases, you can improve your sleep by addressing emotional issues, improving your sleep environment, and choosing healthier daytime habits.

Since everyone is different, though, it may take some experimentation to find the specific changes that work best to improve your sleep.

Tip 1: Improve your sleep environment

Naturally boost your melatonin levels. Artificial lights at night can suppress your body's production of melatonin, the hormone that makes you sleepy. Use low-wattage bulbs where safe to do so, and turn off the TV and computer at least one hour before bed.

Don't read from a backlit device at night (such as an iPad). If like to read from a tablet or other electronic device, switch to an eReader that requires an additional light source.

Make sure your bedroom is quiet, dark, and cool. We often become more sensitive to noise as we age, and light and heat can also cause sleep problems. Using a sound machine, ear plugs, or a sleep mask can help.

Ensure your bed is comfortable. Using an adjustable base, for example, can benefit both your upper and lower body, provide sleep apnea relief, and reduce back pain as you age.

Use your bedroom only for sleep and sex. By not working, watching TV, or using your computer in bed, your brain will associate the bedroom with just sleep and sex.

Move bedroom clocks out of view. The light can disrupt your sleep and anxiously watching the minutes tick by is a surefire recipe for insomnia.

Tip 3: Keep a regular bedtime routine

Maintain a consistent sleep schedule. Go to bed and wake up at the same times every day, even on weekends.

Block out snoring. If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.

Go to bed earlier. 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. Taking a bath, playing music, or practicing a relaxation technique such as progressive muscle relaxation, mindfulness meditation, or deep breathing can help you wind down before bed.

Limit sleep aids and sleeping pills. Many sleep aids have side effects and are not meant for long-term use. Sleeping pills don't address the causes of insomnia and can even make it worse in the long run.

Combine sex and sleep. Sex and physical intimacy, such as hugging, can lead to restful sleep.

Tip 3: Learn the best ways to nap

If you don't feel fully alert during the day, a nap may provide the energy you need to perform fully for the rest of the day. Experiment to see if it helps you.

Some tips for napping:

• Keep it short. Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 minutes. You may feel groggy and unable to concentrate after a longer nap.
• Nap early. Nap early in the afternoon. Napping too late in the day may disrupt your nighttime sleep.
• Be comfortable. Try to nap in a comfortable environment preferably with limited light and noise.

Tip 4: Use diet to improve sleep as you age

As well as eating a sleep-friendly diet during the day, it's particularly important to watch what you put in your body in the hours before bedtime.

Limit caffeine late in the day. Avoid coffee, tea, soda, and chocolate late in the day.

Avoid alcohol before bedtime. It might seem that alcohol makes you sleepy, but it will actually disrupt your sleep.

Satisfy your hunger prior to bed. Have a light snack such as low-sugar cereal, yogurt, or warm milk.

Cut down on sugary foods. Eating a diet high in sugar and refined carbs such as white bread, white rice, pasta, and French fries can cause wakefulness at night and pull you out of the deep, restorative stages of sleep.

Avoid big meals or spicy foods just before bedtime. Large or spicy meals may lead to indigestion or discomfort. Try to eat a modest-size dinner at least 3 hours before bedtime.

Minimize liquid intake before sleep. Limit what you drink within the hour and a half before bedtime to limit how often you wake up to use the bathroom at night.

Tip 5: Exercise for overcoming sleep problems in older adults

Exercise—especially aerobic activity—releases chemicals in your body that promote more restful sleep. Even if you have mobility issues, there are countless activities you can do to prepare yourself for a good night's sleep. But always consult your doctor before embarking on any new fitness program.

Try:

Swimming/water exercises. Swimming laps is a gentle way to build up fitness and is great for sore joints or weak muscles. Many community and YMCA pools have swim programs just for older adults, as well as water-based exercise classes.

Dancing. If you love to move to music, go dancing or take a dance class. Dance classes are also a great way to extend your social network.

Lawn bowling, bocce, or pétanque. These ball games are gentle ways to exercise. The more you walk, and the brisker the pace, the more aerobic benefit you'll experience.

Golfing. Golf is another exercise that doesn't require vigorous movement. Walking adds an aerobic bonus and spending time on the course with friends can improve your mood.

Cycling or running. If you are in good shape, you can run and cycle until late in life. Both can be done outdoors or on a stationary bike or treadmill.

Tip 6: Reduce mental stress

Stress and anxiety built up during the day can also interfere with sleep at night. It's important to learn how to let go of thoughts and worries when it's time to sleep.

• Keep a journal to record worries before you retire.
• On your to-do list, check off tasks completed, list your goals for tomorrow, and then let them go.
• Listen to calming music.
• Read a book that makes you feel relaxed.
• Get a massage from a friend or partner.
• Use a relaxation technique to prepare your body for sleep.
• Seek opportunities during the day to talk face to face with a friend about what's troubling you.

Getting back to sleep when you wake up at night

As you get older, it's normal to wake up more often during the night. However, if you're having trouble falling back asleep, the following tips may help:

Don't stress. Stressing over the fact that you can't get back to sleep only encourages your body to stay awake. Try to stay out of your head and focus on the feelings and sensations in your body instead.

Make relaxation your goal, not sleep. Try a relaxation technique such as deep breathing or meditation, without getting out of bed. Although not a replacement for sleep, relaxation can still help rejuvenate your body.

Do a quiet, non-stimulating activity. If you've been awake for more than 20 minutes, get out of bed and do a non-stimulating activity, such as reading a book. But keep the lights dim and avoid 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 it will be easier to resolve.

When to talk to a doctor about sleep problems

If your own attempts to solve your sleep problems are unsuccessful, keep a sleep diary and take it to your doctor. Write down when you use alcohol, caffeine, and nicotine, and keep track of your medications, exercise, lifestyle changes, and recent stresses. Your doctor may then refer you to a sleep specialist or cognitive behavioral therapist for further treatment, especially if insomnia is taking a heavy toll on your mood and health.

Sleep aids for the elderly vs. therapy

There are many different prescription sleeping pills, over-the-counter sleep aids, and herbal sleep supplements that are available for older adults. In many cases they can be effective when used sparingly for short-term situations, such as recovery from a medical procedure or jet lag. However, it's important to weigh the benefits against the risks that can come with some sleeping pills and sleep aids.

Sleeping pills and sleep aids won't cure your insomnia. In fact, they can actually make insomnia worse in the long term. To permanently address your sleep issues, you may want to consider cognitive-behavioral therapy (CBT).

This form of psychotherapy treats sleep problems by addressing the negative thoughts, worries, and behavior that prevent you from sleeping well at night. A study at Harvard Medical School found that CBT was more effective at treating chronic insomnia than prescription sleep medication—but without the risks or side effects. CBT can be conducted individually, in a group, or even online.