- How Sleep Works
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- Sleep Medicine
It’s a common belief that seniors need less sleep as they age. Why else would they get up so early, if they’re weren’t rested?
The problem is: seniors need just as much sleep as the rest of adults, which is 7 to 9 hours a night. However, as we age, our sleep architecture changes, which causes us to have trouble staying asleep for that same amount of time.
This insomnia, and the resulting exhaustion, impacts seniors’ health. The effects are only worsened if the senior is suffering from another chronic health condition or taking medications, either of which may cause sleep problems of their own.
Additionally, seniors are at a unique life stage, where emotional and physical changes occur that can further disrupt sleep.
Fortunately, there is much seniors can do to enjoy better sleep safely, from lifestyle changes to sleep products. But first, it’s important to understand how sleep changes in old age and what particular sleep issue is behind a senior’s sleep, so caregivers can develop a plan of attack for addressing it.
According to a survey by the American Academy of Sleep Medicine, 13% of men and 36% of women over age 65 take 30 minutes or longer to fall asleep."
Our sleep needs change throughout our youth, from the time we’re born until the time we reach adulthood. As infants, we may sleep for up to 17 hours a day. The amount of time we spend asleep each night decreases as we age, until we level out at 7 to 9 hours around age 18.
We need that same amount for the rest of our lives—although, when we hit old age, physical and emotional factors begin disrupting our sleep.
For one, our sleep architecture changes. The neurons in our brain that regulate our sleep patterns begin to die off as we age. This reduction is even more pronounced in seniors with Alzheimer’s disease (noted as “AD” in the chart below). As a result, aging brains have more difficulty falling asleep, and maintaining sleepfulness once they are asleep.
When compared with younger adults, brain scans show that seniors not only tend to take longer to fall asleep, but they also spend less time in deep sleep and experience more fragmented sleep with nighttime awakenings.
Age-related changes in sleep architecture cause seniors to have a longer sleep onset, spend more time in light sleep, and experience more fragmented sleep."
While changing sleep architecture is a big factor, a variety of physical issues also tend to uniquely affect people during old age. Sleep problems that began in menopause can continue into post-menopause. If you have a chronic health condition, such as diabetes, heart disease, or arthritis, it may be accompanied by sleep problems of its own. If you are taking medication for any of these conditions (or others), the drug may cause sleep problems as a side effect.
Because of your health condition, or simply due to the body aging, you may begin exercising less. Although, exercise is just as important in old age as it is during any other stage of your life—and it also helps with your sleep, by physically tiring out your body.
Your emotional life can have a big impact on your sleep as well. Seniors who recently retired are now faced with having to fill their day with activity, where previously it was laid out for them with a 9 to 5 job. This can cause stress and anxiety. Grief from emotional loss also tends to affect seniors at a higher rate than the rest of the population, as spouses, loved ones, and friends die. Loneliness itself seems to be linked to poor sleep. Coping with an illness can create a financial burden, serving as another source of stress and depression.
|Causes of Senior Sleep Issues|
Good sleep is important for everyone. Good sleep is uninterrupted, quality sleep for 7 hours or more. Without good sleep on a consistent basis, we start to suffer from sleep deprivation.
Sleep deprivation has negative effects on all aspects of your life. It affects your brain, making it challenging for you to retain information and process new learnings. It affects your emotional wellbeing, making you moody and quick to rash judgements. Finally, it affects you physically. You’re tired and more prone to injury.
For older adults, these effects are more pronounced:
Seniors are at a time in their life where health problems come up, if they haven’t already. Sleep deprivation just puts them more at risk—or worsens the discomfort of any conditions they currently have.
As we sleep, our brains cycle through various stages of sleep, from light to deep to REM, before starting the cycle over again. Typically, we complete 4 to 5 of these cycles each night.
Each of the sleep stages provides its own health benefits. For example, REM sleep is associated with brain health and memory. It’s the stage of sleep where we dream, process our emotions, and form memories. During a night of full, uninterrupted sleep, we tend to spend more time in REM sleep during the second half of the night.
Due to nighttime awakenings and changes in sleep architecture, seniors spend more time in light sleep, and less time in essential REM sleep. They get less sleep overall, which means less opportunity to enjoy REM sleep. They’re also more likely to wake up during the night, which causes their sleep cycle to start over from the beginning, making them less likely to reach the cycles where they enjoy more REM.
This lack of REM sleep can result in memory loss for seniors—an acute concern given their risk for Alzheimer’s disease and dementia. Some researchers have even posited poor sleep as a unique risk factor for cognitive decline and Alzheimer’s.
Researchers believe poor sleep may be a risk factor for Alzheimer’s and dementia."
The main sleep issues affecting seniors include insomnia, as well as other sleep issues that often contribute to insomnia—sleep-related breathing and movement disorders.
Restless leg syndrome
Periodic limb movement disorder
REM sleep behavior disorder
Insomnia refers to a general difficulty falling or staying asleep.
These symptoms often cause daytime effects, too. Seniors are more likely to experience excessive daytime sleepiness, leading them to nap, which only makes it harder to fall asleep at night—creating a vicious cycle.
Seniors may also start feeling sleepy earlier in the day. This is known as advanced sleep-phase, when a person’s natural inclination to fall asleep and wake up becomes out of synch (and shifted forward) with that’s considered a “normal” sleep schedule. Falling asleep earlier than younger loved ones can lead to depression, as a senior feels like they are missing out on social activities they previously were awake enough to engage in.
Insomnia can be treated with cognitive-behavioral therapy, alternative therapies like relaxation techniques, natural sleep aids like melatonin, and lifestyle changes. There are a lot of behavioral changes seniors can take to address their insomnia, which we discuss in a following section.
CBTI is proven to be one of the best natural treatments for insomnia regardless of age. Researchers have confirmed it’s beneficial for older adults as well. Over a period of sessions, the senior talks with their therapist about their sleep patterns and behaviors, learning to recognize the behaviors and thoughts they have around sleep that may be contributing to their sleep problems. Then they work through how to address those behaviors. Because CBTI gets at the core of what’s causing the person’s insomnia, from unconscious habits to emotions, it tends to be extremely effective for reducing insomnia in the long run.
Sleep apnea is a sleep-related breathing disorder where the individual experiences lapses in breathing while they sleep. Even if the person remains unconscious, the brain has to “wake up” in order to start normal breathing again, disrupting the quality of their sleep.
Due to its disruptions in breathing (and subsequent restarting of the sleep cycles), sleep apnea is often linked to insomnia. Even if an adult sleeps through the night, they may feel tired during the day. This sense of sleepiness, combined with reports from loved ones that you’re snoring loudly, may be an indication that you have sleep apnea.
Seniors may develop sleep apnea because the muscles that control your breathing begin to atrophy with old age and weaken. As a result, they’re less equipped to keep your airways open. As the airways collapse, loud snoring occurs, and perhaps episodes of apnea.
Beyond contributing to insomnia, sleep apnea can also increase a senior’s risk of stroke, memory loss, or high blood pressure, so it’s important to get it diagnosed and treated as soon as possible.
Treatment for sleep apnea often involves getting fitted for and sleeping with a continuous positive airway pressures (CPAP) machine, changing your sleep position to facilitate the opening of your airways, and following the behavioral sleep tips we outline below.
If you are diagnosed with sleep apnea, your doctor may recommend CPAP therapy. CPAP therapy is the most effective treatment for sleep apnea, a finding that holds true no matter your age. In a year-long study among seniors with sleep apnea, researchers found CPAP therapy significantly reduced their Epworth sleepiness score, in comparison to “best supportive care.” The improvements were stronger among individuals who adhered to their CPAP treatment more consistently.
Also contributing to insomnia are sleep-related movement disorders like restless legs syndrome (RLS), periodic limb movement disorder (PLMD), and REM sleep behavior disorder (RBD).
RLS is an uncomfortable movement disorder where the individual experiences a burning, tingling, or numbing sensation in their lower limbs, often whenever they lie down. The only way to find relief is to move the limbs, which makes it difficult to relax sufficiently to fall asleep.
RLS affects between 10% to 35% of seniors.
RLS may be caused by an iron deficiency, in which cases adjusting the senior’s iron level can significantly ease their RLS symptoms. Behavioral changes to improve sleep, as outlined below, have also proved helpful.
PLMD is characterized by jerky, involuntary movements of the limbs frequently during sleep. As you can imagine, this makes it difficult for people with the disorder to fall asleep.
Prescription medications can improve symptoms, but consideration should be taken in regards to how they may interact with other medications the senior is currently taking. Regular exercise and relaxation techniques during the day can also be helpful.
Individuals with RBD may physically act out their dreams during REM sleep, leading to injury or causing them to fall out of bed or injure themselves.
RBD is the rarest condition of everything we’ve listed here, affecting fewer than 1% of adults, but it tends to be more common among individuals with Parkinson’s disease and Lewy body dementia, both of which affect older adults at a higher rate. It also seems to be more prevalent among senior men than women.
RBD is often treated with medication as well as safety adjustments to the sleep environment.
Beyond sleep disorders, the sleep environment itself can become problematic for seniors. Whether due to conditions like dementia, or the physical circumstances of advanced age, the bedroom poses unique nighttime risks for seniors.
By accounting for these hazards, caregivers can make the bedroom a safer sleep environment. This not only prevents injury on behalf of the senior, but also ensure both caregivers and seniors enjoy more restful sleep—since they don’t have to be anxious about the senior’s safety.
Elder falls and wandering are two major areas of concern for caregivers. Below we review how the bedroom contributes to these safety risks and what caregivers can do to reduce their senior’s risk.
Fall risks pose the biggest danger in the bedroom, for seniors of any age, and with any physical condition. Each year, a quarter of seniors aged 65 and over fall. Falls are the leading cause of both fatal and nonfatal injuries for seniors, according to the National Council on Aging.
Bedrooms are one of the most common places for a senior to fall in their home. Many seemingly innocuous bedroom items can become fall hazards for a senior:
Fortunately, many falls can be avoided through simple adjustments to the bedroom environment. Throw rugs can be removed. Power cords can be taped down. Clutter can be cleared before bed each night.
Since darkness is an essential element for restful sleep, caregivers can install motion-activated night lights or smart lights that turn on whenever the senior gets up, safely lighting their way out of bed and where they need to go.
Wandering is a common symptom of dementia, affecting 60% of individuals with Alzheimer’s disease or dementia. Individuals who wander may leave the home and drive or walk somewhere, becoming disoriented, confused, and lost. If not located within 24 hours, up to half of wandering individuals end up seriously injured or dead.
If you’re caring for a senior with memory problems, and they can walk, they could be at risk of wandering.
Recommendations for reducing wandering include keeping the person engaged in meaningful activity throughout the day, as well as adhering to safety precautions, such as having the senior wear a medical alert device and deadbolting all exterior doors and the bedroom door with a lock from the outside.
The best place to start with sleep issues is implementing better sleep hygiene habits. Often, making even a few of these change can lead to large improvements in sleep quality.
If a senior’s insomnia is caused by underlying stress, grief, worry—even worry about their insomnia itself—psychotherapy can help.
Seniors can also engage in other activities to reduce their stress, such as yoga, meditation, or visualization. They might keep a worry journal. Before bed, they can write their worries into the journal to release them from their mind and onto the page.
Train the mind and body to follow a sleep schedule, by going to bed and waking up at the same time every day. Seniors should follow this schedule religiously, even on weekends.
Our diet impacts the quality of our sleep. Seniors should avoid fatty and sugary foods, and instead make sure their meals are filled with healthy, sleep-promoting ingredients.
Heavy meals should be avoided later in the day, especially if a senior has acid reflux. These can cause digestive upset that make it harder to fall asleep.
Exercise physically tires the body, and it keeps seniors in good physical health. Seniors should aim to exercise every day. If possible, pair the exercise with an outdoor activity. The natural sunlight receive will help reinforce the body’s natural sleep-wake cycle, so they’re more prone to sleep when it gets dark out.
Besides exercise, getting natural sunlight in the morning helps energize the body and mind, resetting the circadian rhythms. Even when not outdoors, have curtains pulled back to let the sunshine in.
Seniors with advanced sleep phase syndrome can spend more time getting natural sunlight in the afternoon to help them stay awake for longer.
If you nap during the day, you’re likely to have a tougher time falling asleep at night. Seniors should avoid napping as much as possible.
If they are absolutely fatigued, limit the nap to 20 minutes. This is short enough to keep you from entering deep sleep, so when you wake up you’ll feel refreshed instead of even more tired.
As much as possible, avoid doing anything in the bedroom besides sleep and intimate activity. You want your brain to view it solely as a place of restfulness, not a place where you work on hobbies, talk on the phone, or entertain loved ones.
If you are caring for a senior who stays in a hospital bed for much of the day, see what you can do to help their brain make this mental shift. Perhaps you move the hospital bed to another room—or the opposite side of the room—during the day, or you use curtains at night to help them sleep.
Remove rugs, clutter, and power cords that might cause seniors to trip, and install a motion-activated night light to guide their way to the bathroom if they wake up in the middle of the night. Kennel or crate all pets at night, or have them sleep outside of the bedroom.
If a senior has RLS or PLMD, invest in guard rails for the bed or get a low-profile bed frame with floor pads to minimize injury should they fall out of bed.
If they have Alzheimer’s, caregivers should remove objects form the floor, and gate any areas to bar access to areas where the senior could hurt themselves, such as over the stairs.
Turn off all the lights and close the blinds or curtains. In total darkness, there’s less for a restless mind to worry about. Darkness also communicates to the brain that it’s time to sleep.
Develop a calming bedtime routine for seniors to follow in the 30 to 60 minutes before bed. All of the activities should be calming, such as reading a book, listening to quiet music, or knitting.
The serenity of the activities will calm the mind and body, while the routine will help the brain recognize that these activities, performed in this order at night, are a signal that sleep should follow shortly.
If it’s safe for the senior to get in and out of the tub, they might add a warm bath to the bedtime routine.
The drop in body temperature we experience as the warm water evaporates from our skin helps facilitate the body’s natural thermoregulation process. Our body core temperature naturally cools slightly in the evening, preparing us for sleep.
For seniors with RLS, a warm bath, paired with massage and stretching exercises, has proven helpful for soothing symptoms.
The blue light in electronics is especially disruptive to our brains when we’re trying to fall asleep. Our brains perceive this light as sunlight, so they get tricked into thinking it’s daytime and try to keep us up and alert instead of sleepy.
Seniors should turn off all electronics at least 2 hours before bedtime. If electronics can’t be avoided, turn on the red-light filter for smartphones and e-readers, or invest in blue-light blocking glasses to watch TV.
Nighttime bathroom trips are a major source of nighttime awakenings for seniors. To avoid being woken up by their bladder, seniors should limit the amount of fluids they drink at night, and go to the restroom right before bed.
Unfortunately, nighttime awakenings are to be expected on at least an occasional basis, even if one implements all of these tips.
If seniors wake up during the night, try to fall back asleep using these tips. If it takes longer than 20 minutes, they should get up and go into another room, where they can repeat some of the activities from their bedtime routine until they get tired again.
If, after implementing the behavioral tips we listed above, a senior is still experiencing significant sleep problems, it could be due to an underlying disorder or a side effect of their medication.
Tell the doctor about the sleep issues they’re experiencing, and the efforts they’ve taken to address them. The doctor may be able to evaluate their medication and find a suitable alternative with fewer, sleep-related side effects.
There are a variety of sleep products caregivers can purchase to make it easier for seniors to fall asleep faster, and wake up feeling energized. In addition to better sleep, there are also safety product that address the nighttime hazards affecting seniors, especially those at risk of falling or wandering.
More than a third of seniors take some form of sleep aid to help them fall asleep at night. However, this isn’t always the safest idea.
Melatonin is the sleep hormone that regulates your sleep-wake cycle. Your brain increases melatonin production in the evening, in preparation for sleep.
According to multiple studies, melatonin does appear to be a safe and effective treatment for insomnia in the elderly. Studies show that it improves sleep quality, shortens sleep latency, and in cases of Alzheimer’s patients, reduces sundowning symptoms.
However, melatonin supplements are not regulated the same way other drugs are, so seniors should always check with their doctor first about whether or not a melatonin supplement would be safe, and to receive dosage recommendations.
Safe doses can range from 0.5 to 6 mg for adults. It’s best to take the minimum amount necessary to avoid unpleasant side effects, like increased daytime sleepiness or headaches.
Sleeping pills are not recommended for older adults.
Experts advise that seniors opt for natural sleep remedies over sleeping pills for three main reasons. First, sleeping pills are not intended to be a permanent solution for insomnia. These relieve temporary insomnia. If you take sleeping pills, you will only be using a band-aid solution, and you may develop a dependency on the sleeping pill in the meantime. Second, sleeping pills may interact negatively with other medications the senior is already taking. Third, one of the main side effects of sleeping pills is dizziness or impaired balance, which significantly increase a senior’s fall risk.
If seniors plan to take a sleeping pill, they should speak to a doctor first. They will be able to confirm that it won’t interact with other medication to create a dangerous side effect.
While melatonin is generally considered safe, seniors should always advise a doctor before taking a sleep aid. Sleeping pills are not recommended for older adults."
For more information on safe sleep for seniors, check out the resources below.