Colin Snow
It is a common misconception that older adults need less sleep than younger people. In fact, adults require about the same amount of sleep from their 20s into old age, with the recommended amount being seven to nine hours each night. However, older people tend to go to sleep and wake up earlier than they did when they were younger. Many older adults experience changes in the quality and duration of their sleep due to various factors, such as medical conditions, medications, lifestyle changes, and changes in the body's internal clock. These factors can lead to sleep disturbances and chronic sleep issues, which can impact older adults' daily activities and quality of life.
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What You'll Learn
Seniors may need a different kind of sleep
One of the main reasons seniors may need a different kind of sleep is the change in their body's internal clock, known as the suprachiasmatic nucleus (SCN). The SCN controls our 24-hour daily cycles, or circadian rhythms, which influence when we feel tired and alert. As the SCN deteriorates with age, it can disrupt these rhythms, leading to shifts in sleep patterns, such as getting tired earlier in the afternoon and waking up earlier in the morning. This is known as a phase advance or advanced sleep phase syndrome.
Additionally, older adults often experience changes in their sleep architecture, or how they cycle through the different stages of sleep. They spend more time in the earlier, lighter stages of sleep and less time in the later, deeper stages, resulting in more fragmented and less restful sleep. This can be further impacted by medical conditions and medications, which can cause pain, sleep-disruptive symptoms, or make them very sleepy during the day, affecting their nighttime sleep.
Lifestyle changes that come with aging, such as retirement, loss of independence, and social isolation, can also contribute to sleep issues. Retirement may lead to a less structured sleep-wake schedule, while social isolation can impact the quality of sleep as social interactions give important cues to our body to maintain a normal sleep and wake rhythm.
Furthermore, older adults may need to pay more attention to their sleep environment and habits. Reducing distractions in the bedroom, such as televisions, smartphones, and bright lights, can help improve sleep quality. Establishing a bedtime routine and maintaining a regular sleep schedule are also crucial for seniors to get the rest they need.
While seniors may not need less sleep, they often face unique challenges when it comes to sleep. By understanding the factors that contribute to these changes, seniors can take steps to improve their sleep quality and duration, ensuring they get the rest they need to maintain their health and well-being.
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Sleep deprivation is common among seniors
- Circadian Rhythm Changes: The body's internal clock, known as the suprachiasmatic nucleus (SCN), undergoes changes as people age. The SCN controls our 24-hour circadian rhythms, which regulate when we feel sleepy or alert. Deterioration in SCN function can disrupt these rhythms, causing older adults to feel tired earlier in the day and wake up earlier in the morning.
- Medical Conditions and Medications: Health issues common in older adults, such as depression, anxiety, heart disease, diabetes, arthritis, and chronic pain, can disrupt sleep. Additionally, medications taken for these conditions can interfere with sleep patterns, making it challenging for seniors to fall or stay asleep.
- Lifestyle Factors: Retirement, loss of independence, and social isolation can contribute to sleep problems in older adults. A less structured daily routine and increased stress and anxiety can negatively impact sleep quality and duration.
- Sleep Architecture Changes: Older adults tend to spend more time in the earlier, lighter stages of sleep and less time in the deeper, restorative stages. This shift in sleep architecture can lead to more frequent awakenings during the night and fragmented, less restful sleep.
- Nocturia: Nocturia, or nighttime urination, becomes more common with age due to physical changes in the urinary system. This can interrupt sleep multiple times throughout the night, further contributing to sleep deprivation.
- Sleep Disorders: Insomnia, sleep apnea, restless legs syndrome, and REM sleep behavior disorder are more prevalent in older adults. These sleep disorders can significantly impact sleep quality and quantity, often requiring medical intervention.
- Substance Use: Substances like alcohol, caffeine, and nicotine can disrupt sleep. Older adults may be more sensitive to the effects of these substances, and their bodies may metabolize them differently, making it harder to fall asleep or stay asleep.
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Seniors experience insomnia, sleep apnea, and restless legs syndrome
Seniors experience a host of sleep issues, including insomnia, sleep apnea, and restless legs syndrome. These conditions can significantly impact the quality of life for older adults, affecting their physical and mental health, and increasing the risk of accidents and social difficulties.
Insomnia is the most common sleep problem in adults aged 60 and older. It is characterised by difficulty falling or staying asleep, and can lead to excessive daytime sleepiness, fatigue, mood disturbances, and trouble concentrating. Insomnia in older adults can be caused by various factors, including underlying medical or psychiatric conditions, changes to the circadian rhythm and sleep-wake cycle, and medications used to treat other geriatric conditions. Treatment for insomnia in seniors often begins with sleep education and improved sleep hygiene, such as maintaining a regular sleep schedule, avoiding naps late in the day, and creating a relaxing bedtime routine. Cognitive behavioural therapy, stimulus control techniques, and bright light therapy are also used to treat insomnia in older adults.
Sleep apnea is another common sleep disorder in older adults, affecting millions of Americans. It is a disorder that causes a person to repeatedly stop breathing while asleep, disrupting deep, restorative sleep. The most common type is obstructive sleep apnea, which occurs when muscles in the throat relax and block the airway. Sleep apnea can lead to serious health complications, including heart failure, liver problems, and type 2 diabetes. Treatment options range from lifestyle changes, such as weight loss and smoking cessation, to the use of continuous positive airway pressure (CPAP) machines or oral devices to keep the airways open during sleep.
Restless legs syndrome (RLS) is also prevalent in older adults, affecting 10-35% of individuals over 65. RLS causes unpleasant sensations in the legs, typically in the evening, and results in motor restlessness. It can lead to insomnia and depression, and is often treated with dopaminergic therapy.
These sleep disorders can have a significant impact on the health and well-being of older adults, and it is important to seek medical advice and treatment to manage these conditions effectively.
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Seniors are more susceptible to health issues, anxiety, and medication side effects
As people age, they become more susceptible to health issues. This is partly due to the natural deterioration of the body's internal clock, which is located in the hypothalamus and is known as the suprachiasmatic nucleus (SCN). The SCN controls our 24-hour daily cycles, or circadian rhythms, which influence when we feel sleepy or alert. As the SCN deteriorates, circadian rhythms are disrupted, affecting sleep patterns. Seniors also produce less melatonin, a hormone that helps promote sleep.
Additionally, older adults often experience chronic health conditions that require treatment with multiple medications, increasing the likelihood of experiencing unwanted drug side effects. Seniors tend to take more prescription drugs than younger people, with almost 90% regularly taking at least one prescription drug and nearly 80% taking at least two. This is because older adults are more likely to have multiple chronic medical disorders, such as high blood pressure, diabetes, or arthritis.
Older people are more susceptible to the side effects of drugs for several reasons. Firstly, as people age, the amount of water in the body decreases while fat tissue increases. This causes drugs that dissolve in water to reach higher concentrations and drugs that dissolve in fat to accumulate more. Secondly, the kidneys and liver become less efficient at removing drugs from the body. Older adults also tend to take more medications, increasing the risk of drug interactions.
Anxiety disorders are also common in older adults, affecting up to 20% of the senior population. Generalized Anxiety Disorder (GAD) is the most prevalent, with older women being more susceptible than men. Other types of anxiety disorders in seniors include social anxiety disorder, phobias, and obsessive-compulsive disorder (OCD).
Certain medications can also contribute to anxiety in older adults. Benzodiazepines, commonly used to treat anxiety and insomnia, can increase the risk of falls and cause confusion. Sleeping pills, such as zaleplon (Sonata) and zolpidem (Ambien), can have similar side effects. Additionally, side effects of medications for other conditions, such as steroids and stimulants, can trigger anxiety in seniors.
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Seniors should address the root cause of sleeplessness
There are many reasons why older people may not get enough sleep at night. Feeling sick or being in pain can make it hard to sleep. Some medications can also keep people awake or make them very sleepy during the day. Seniors should talk to their doctor about any medications they are taking and whether they could be causing sleep issues.
In addition, seniors should consider whether certain substances are impacting their sleep. For example, alcohol, caffeine, and nicotine can all make it hard to fall asleep and stay asleep. Seniors should also avoid large meals late in the day, as these can also interfere with sleep.
Lifestyle changes, such as retirement or social isolation, can also impact the quality of sleep for seniors. Exercise and social interactions can help to maintain a normal sleep/wake cycle. Seniors should try to get regular exercise and stay socially active to improve their sleep.
Finally, seniors should focus on improving their sleep hygiene and developing healthy habits. This includes following a regular sleep schedule, avoiding naps in the late afternoon or evening, and developing a bedtime routine that includes relaxing activities such as reading or listening to soothing music.
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Frequently asked questions
No, this is a common misconception. The National Sleep Foundation recommends that people between 18 and 64 should aim for seven or more hours of sleep a night, and people 65 and older should get seven to eight hours each night.
Older people tend to go to sleep earlier and get up earlier than they did when they were younger. They also spend less time in deep sleep and wake up more frequently throughout the night.
Insufficient sleep can lead to memory problems, falls or accidents, and mental health issues such as depression. It can also increase the risk of chronic diseases such as heart disease and type 2 diabetes.
Sleep disturbances in older adults can be caused by various factors, including medical conditions, medications, pain or discomfort, lifestyle changes, and mental health issues.
Older adults can improve their sleep by maintaining a regular sleep schedule, avoiding naps, reducing exposure to light and electronics before bed, exercising regularly, and developing a relaxing bedtime routine.
