Miya Pearson
Sleep patterns change as we age, and older adults often experience sleep difficulties. While it is commonly believed that older people need less sleep, this is a misconception. Older adults require the same amount of sleep as younger adults, which is approximately seven to nine hours per night. However, they may experience challenges in obtaining sufficient high-quality sleep due to various factors, including medical conditions, medications, changes in hormone production, and lifestyle habits. Sleep disturbances in older adults can lead to insomnia, which is the most common sleep problem in this age group, and it can have negative consequences on their overall health and well-being.
| Characteristics | Values |
|---|---|
| Recommended sleep for older adults | 7-8 hours |
| Common sleep issues | Insomnia, sleep apnea, restless leg syndrome, nightmares, nocturia |
| Causes of sleep issues | Circadian rhythm changes, pain, medication, medical conditions, alcohol, caffeine, nicotine, lack of physical activity, social isolation |
| Treatment options | Exercise, melatonin supplements, cognitive behavioral therapy, establishing a nightly routine, reducing naps |
| Sleep importance | Vital for everyday mental performance, mood, health, physical recovery, growth, energy use |
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What You'll Learn
Older people need as much sleep as younger adults
While it is often assumed that older people need less sleep than younger adults, this is a common misconception. The current recommended sleep guidelines suggest that all adults, regardless of age, should aim for at least seven hours of sleep per night. However, older adults often struggle to achieve this due to various factors affecting their sleep quality and duration.
Older adults may experience changes in their sleep patterns as they age, feeling sleepy earlier in the evening and waking up earlier in the morning. This shift in sleep timing can lead them to believe they are not getting enough sleep, even if their total sleep duration remains adequate. Additionally, older people tend to spend less time in deep sleep and experience more frequent awakenings, which can contribute to a perception of sleep deprivation.
Medical conditions, such as depression, anxiety, heart disease, and chronic pain, can also interfere with sleep in older adults. Conditions like insomnia, sleep apnea, and restless leg syndrome are more prevalent in this age group and can significantly impact sleep quality and duration. Furthermore, older adults may be taking medications that affect their sleep, either by causing daytime sleepiness or disrupting their sleep at night.
To promote better sleep, older adults can establish a nightly routine, maintain a consistent sleep schedule, and address any underlying health conditions or sleep disorders. While melatonin supplements may be beneficial for short-term use, it is important to consult a healthcare provider before taking any sleep aids or supplements.
In summary, older people need as much sleep as younger adults, typically seven hours or more per night. However, they may face unique challenges in achieving this due to age-related changes in sleep patterns, medical conditions, and medication use. By understanding these factors and seeking appropriate treatments, older adults can improve their sleep quality and duration.
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Sleep disorders and disturbances
Sleep apnea, in particular, has seen a surge in prevalence among adults. It occurs when the soft tissues in the throat block the upper airway, cutting off oxygen supply and causing brief awakenings throughout the night. This results in daytime sleepiness, a prominent symptom of the disorder.
Restless legs syndrome, which is twice as common in women, becomes more prevalent with age. It triggers an irresistible urge to move the legs when trying to fall asleep, disrupting sleep continuity. Periodic limb movement disorder, often associated with restless legs syndrome, involves repetitive cramping or jerking of the legs during sleep.
Older adults may also experience insomnia due to hormonal changes. For example, menopause can cause hot flashes that disturb sleep. Additionally, mental health issues such as trauma, depression, anxiety, chronic stress, and other mental illnesses can contribute to insomnia and sleep disturbances.
The misconception that older adults need less sleep can lead to the underdiagnosis and undertreatment of sleep problems. It is important to recognize that older adults may still require up to eight hours of sleep, and addressing underlying medical conditions and practicing good sleep habits can significantly improve their sleep quality.
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Hormonal changes
Sleep patterns can change significantly as people age, and one of the key factors influencing this is hormonal changes. The production of hormones such as melatonin and cortisol decreases with age, disrupting sleep patterns. Melatonin, for example, is typically produced in response to darkness, aiding sleep by coordinating circadian rhythms. As the body secretes less of this hormone, older adults may find it harder to fall asleep and experience a decrease in overall sleep quality.
The shift in female hormones during the menstrual cycle can also affect sleep. Progesterone levels, for instance, dip before menstruation, making it challenging for some women to get quality sleep during their premenstrual syndrome (PMS) days. Similarly, women with polycystic ovary syndrome (PCOS), which is characterised by hormonal irregularities, may experience exacerbated sleep difficulties due to the impact of these hormonal imbalances.
While hormonal changes primarily affects sleep in older women, men are not entirely exempt from hormonal changes impacting their sleep as they age. Testosterone levels, for instance, gradually decline in older men, which can have an impact on their sleep patterns and overall health.
Additionally, older adults with multiple health conditions are more likely to experience sleep disturbances. Certain health conditions and medications can interfere with sleep, and the interaction between these factors can further complicate sleep patterns in older adults.
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Sleep medication
Before prescribing sleep medication, a doctor will conduct a thorough review to rule out other conditions that may contribute to insomnia, such as sleep apnea, untreated psychiatric illness, endocrine disorders, neurologic disorders, chronic obstructive pulmonary disease, asthma, heart failure, and gastroesophageal reflux disease.
If no underlying factors are found or if insomnia persists after treating these conditions, then medication can be considered. Mild antihistamines can work better than sleeping pills for short-term insomnia, but most health experts do not recommend these for older people. Melatonin supplements are safe for short-term use and may help with jet lag. Zolpidem, zaleplon, eszopiclone, and benzodiazepines are other sleep medications, but they should only be used as recommended and for a short time due to the risk of dependence and addiction. These medications can build up in the body and lead to toxic effects such as confusion, delirium, and falls.
Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and dual orexin receptor antagonists. Sedating antidepressants like trazodone and mirtazapine in low doses are often prescribed at bedtime for insomnia, but their use in patients without depression is considered off-label.
Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard for treating insomnia in all populations, but it is time-intensive and does not offer immediate results.
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Treatment options
Sleep is critical to the physical and mental health of older adults. Poor sleep quality in older adults can be related to lifestyle changes, such as retirement leading to a less structured sleep-wake schedule, or increased stress and anxiety due to significant life changes. Additionally, older adults are more susceptible to insomnia and sleep-disordered breathing, such as sleep apnea and restless legs syndrome. Here are some treatment options to address sleep issues in older adults:
Lifestyle Changes
Identifying and addressing sleep problems is crucial. Older adults should examine their daily habits, such as reducing caffeine and alcohol consumption, especially later in the day, and maintaining a consistent sleep and wake schedule. Creating a comfortable, dark, and quiet bedroom environment, and adopting relaxing bedtime rituals can also promote better sleep.
Exercise
While exercise may not be a primary solution, regular aerobic exercise can improve sleep quality and duration. A study found that older adults with insomnia who engaged in two 20-minute sessions or one 30- to 40-minute session of aerobic exercise four times a week experienced improved sleep and reduced depressive symptoms.
Cognitive Behavioral Therapy (CBT)
CBT-I (Cognitive Behavioral Therapy for Insomnia) is a recognized treatment option for insomnia. It can be done in person or through online programs such as Sleepio and SHUTi. CBT-I addresses negative thoughts, worries, and behaviors that interfere with sleep and may incorporate techniques like stimulus control and sleep restriction therapy. A brief variant of CBT-I, Brief Behavioral Treatment of Insomnia (BBTI), delivered in 4 weeks, has also been found effective.
Medication
In severe cases of insomnia, doctors may approve the short-term use of over-the-counter or prescription sleep medications. However, these should be prescribed with caution as they carry risks and can worsen insomnia in the long term. Some medications with lower risks include ramelteon, which promotes sleepiness by interacting with melatonin, and suvorexant, which suppresses neuropeptides that cause arousal and wakefulness. Over-the-counter antihistamines may also be an option, but it is important to consult a doctor before starting any pharmacological treatment.
Breathing Devices and Surgery
For older adults with sleep apnea, breathing devices like Continuous Positive Air Pressure (CPAP) therapy can be effective. CPAP machines provide pressurized air through a breathing mask during sleep, reducing snoring and apnea episodes. In some cases, surgery may also be recommended to address sleep apnea.
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Frequently asked questions
No, older people do not need less sleep. The current recommended sleep guidelines suggest that people between 18 and 64 should aim for seven or more hours of sleep a night, while people 65 and older should get seven to eight hours each night.
Common causes of sleep disturbances in older adults include insomnia, circadian rhythm changes, sleep apnea, restless leg syndrome, and nocturia.
Sleep deprivation in older adults can lead to confusion and other mental changes. It is also associated with an increased risk of high blood pressure, heart disease, and dementia.
Older adults can improve their sleep quality by maintaining good sleep hygiene, establishing a nightly routine, keeping a consistent sleep schedule, and reducing hazards in the bedroom.
