Colin Snow
Sleep is essential for both physical and mental health, and this doesn't change as we age. Older adults need around seven to nine hours of sleep per night, but many struggle to get enough rest due to various factors. Changes in the body's internal clock, located in the hypothalamus, can disrupt sleep patterns, causing older adults to go to bed and wake up earlier. Age-related health conditions, such as arthritis, diabetes, and heart disease, can also impact sleep quality. Additionally, older adults tend to take more medications, which can interfere with sleep. Lifestyle factors, such as diet, exercise, stress, and social engagement, also play a role in sleep quality. Understanding these factors and making healthy choices can help improve sleep for older adults.
| Characteristics | Values |
|---|---|
| Sleep duration | Total sleep time stays the same or is slightly decreased (6.5 to 7 hours per night) |
| Sleep quality | Older people tend to have shorter and lighter sleep, and may wake up more often during the night |
| Sleep disorders | Insomnia, sleep apnea, restless legs syndrome, narcolepsy, hypersomnia, and periodic limb movement disorder are more common in older adults |
| Medical conditions | Older adults are more likely to have medical conditions and take medications that affect sleep |
| Circadian rhythms | Changes in the body's internal clock, specifically the suprachiasmatic nucleus (SCN), can disrupt circadian rhythms and influence when older adults feel tired and alert |
| Hormone production | Changes in hormone production, such as decreased melatonin and cortisol, can impact sleep |
| Daytime napping | About 25% of older adults take naps, which can disrupt nighttime sleep if not managed properly |
| Sleep environment | It is important to make the bedroom a sleep zone, reducing risks of falls and accidents, and ensuring easy access to a phone for help if needed |
| Sleep hygiene | Establishing a regular sleep schedule, a bedtime routine, and healthy daytime habits can improve sleep quality |
| Exercise | Regular aerobic exercise promotes good sleep, while lack of exercise can disrupt sleep patterns |
| Substances | Alcohol, caffeine, and nicotine can negatively impact sleep in older adults |
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What You'll Learn
Sleep disorders: insomnia, sleep apnea, restless leg syndrome
As we age, our sleep patterns change. Older adults tend to go to bed earlier and wake up earlier, and sleep tends to be shorter and lighter. Many older adults experience insomnia, which is the most common sleep problem in adults aged 60 and older. Insomnia is characterised by trouble falling or staying asleep at least three nights a week. Short-term insomnia can be caused by stress or changes in routine, while chronic insomnia lasts longer than three months and cannot be fully explained by another medical cause.
Sleep disorders become more common with age, and older adults are more susceptible to insomnia due to various medical and psychiatric conditions. Advanced sleep-wake phase disorder is common in older adults, causing them to feel tired in the early evening and wake up between 3 am and 5 am. Sleep apnea, another prevalent sleep disorder in older adults, involves pauses in breathing during sleep, often accompanied by loud snoring. Risk factors for sleep apnea include high blood pressure, type 2 diabetes, chronic lung disease, thyroid disorders, and obesity.
Restless leg syndrome (RLS), a sleep-related movement disorder, also affects many older adults. RLS is characterised by an urge to move the legs or a feeling that they are moving on their own, ranging from tingling and twitching to painful aches and itching. The prevalence of RLS increases with age, and women are more commonly affected than men. While there is no definitive cause known for RLS, low iron levels are believed to contribute, and addressing iron levels can be a treatment option. Other treatments for RLS include lifestyle changes, drug-free techniques, and prescription medications.
To improve sleep quality, older adults can practice better sleep habits, such as maintaining a regular sleep schedule, having a bedtime routine, finding ways to relax before bedtime, and creating a comfortable sleep environment. Additionally, regular exercise, avoiding late-day naps, and limiting caffeine intake can contribute to better sleep.
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Medication: side effects and interactions
Older adults should try non-drug treatments first to improve their sleep, as there may be safer alternatives to medication. Sleeping pills can have side effects and special risks for older people, such as confusion, memory issues, and balance problems, which can increase the risk of falls and hip fractures. They can also cause constipation and difficulty urinating.
Sleeping pills are available over the counter and by prescription, but they are not recommended for long-term use. They can be habit-forming, and many people develop a tolerance, increasing their dosage over time, which results in more severe side effects. It is important to consult a doctor if you are experiencing severe side effects, such as sleepwalking, allergic reactions, or dependence on the medication.
The most common side effects of sleep medications include drowsiness, difficulty with movement, impaired focus, and a hangover effect the next day, with approximately 8 out of 10 people experiencing this. Other side effects include a burning or tingling sensation in the hands, arms, feet, or legs. Some people also experience parasomnias, or complex sleep behaviours, such as sleepwalking, sleep eating, making phone calls, or even sleep driving. While rare, parasomnias are difficult to detect and can be dangerous.
Sleeping pills can also interact with other medications, supplements, or health conditions, so it is important to consult a doctor or pharmacist before taking them. For example, sleeping pills can interact with heart medications, beta-blockers, antidepressants, cholesterol medicine, Alzheimer's drugs, stimulants, asthma medicine, and cold and allergy medications.
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Lifestyle: diet, exercise, stress, and socialising
Lifestyle factors such as diet, exercise, stress, and socialising play a crucial role in improving sleep quality, especially in older adults. Here are some ways in which you can improve your sleep through these lifestyle factors:
Diet: Eating a healthy and nutritious diet is essential for maintaining overall health and can also improve sleep quality. Firstly, it is important to avoid stimulants such as caffeine, especially later in the day, as it can make it difficult to fall asleep. Having dinner earlier in the evening and avoiding eating too late can also help, as it gives your body time to digest before sleeping.
Exercise: Regular exercise can significantly improve sleep. Aim for moderate exercise a few days a week, and try to avoid working out too close to bedtime, giving your body a few hours to wind down before sleep. However, it is important to note that sleep also aids muscle recovery and provides energy for physical activity, so they are interdependent.
Stress: Stress is a natural response to life's demands, but chronic or long-term stress can have negative health impacts, especially for older adults. Sleep deprivation can also lead to elevated cortisol levels, further exacerbating stress. Therefore, it is important to manage stress effectively. Social support from family, friends, or pets can help reduce stress and improve overall well-being. Retirement, for example, can cause stress, but having a supportive community can help mitigate its impact.
Socialising: Social isolation can increase stress and anxiety, negatively impacting sleep. Maintaining social connections and engaging in social activities can help reduce stress and improve sleep quality. Social support can also help manage stress, making it easier to cope with challenging situations.
In conclusion, addressing lifestyle factors such as diet, exercise, stress, and socialising can significantly improve sleep quality in older adults. These factors are interconnected and influence overall health and well-being. It is beneficial to seek personalised advice from specialists, such as nutritionists, exercise physiologists, and sleep specialists, to make tailored improvements.
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Hormones: melatonin and cortisol
As we age, our sleep patterns change. Older adults tend to go to bed earlier and wake up earlier, and the amount of time spent in each type of sleep decreases. Sleep tends to be shorter and lighter, and older adults may wake up more frequently during the night.
These changes in sleep patterns are often due to the body's internal clock, located in the hypothalamus, which controls our 24-hour daily cycles, or circadian rhythms. As the body ages, the function of this internal clock deteriorates, disrupting circadian rhythms and influencing when we feel tired and alert.
Hormones such as melatonin and cortisol play a crucial role in regulating sleep. Melatonin is a hormone produced by the body that regulates the body's sleep-wake cycle. When it gets dark, melatonin levels rise, making us feel sleepy, and during daylight hours, melatonin levels drop, and we feel more alert. However, as we age, the body secretes less melatonin. Exposure to blue light from electronic devices can also suppress melatonin production and reduce sleep quality.
Cortisol, on the other hand, is a hormone produced in the adrenal glands that helps our body cope with stress, regulate blood pressure and sugar levels, and control inflammation. Cortisol levels typically rise early in the morning and decrease throughout the day. Stress and caffeine consumption can cause cortisol levels to spike, leading to disturbances in sleep patterns.
The balance between cortisol and melatonin is essential for optimal sleep. When one is high, the other is low, and vice versa. By understanding this relationship and making lifestyle changes, we can improve our sleep quality. For example, getting plenty of natural light during the day and reducing stress can help regulate cortisol and melatonin levels. Additionally, avoiding caffeine and blue light from electronic devices before bed can positively impact these hormone levels and improve sleep.
Furthermore, addressing emotional issues, improving the sleep environment, and choosing healthier daytime habits can also help regulate melatonin and cortisol levels. For instance, regular aerobic exercise can promote good sleep by releasing chemicals that promote restfulness. Additionally, keeping a sleep diary can help identify patterns and make informed decisions to improve sleep quality.
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Sleep environment: light, sound, temperature
As people age, their sleep patterns change. Older adults tend to go to bed earlier and wake up earlier, and the amount of time spent in each type of sleep decreases. Sleep tends to be shorter and lighter, and older adults may wake up more often during the night.
Light
Sunlight helps regulate melatonin, a hormone that makes you sleepy. Older people tend to have insufficient exposure to daylight, averaging about one hour per day. Daylight exposure may be even more restricted for those living in nursing homes or those with Alzheimer's disease.
To improve your sleep, try to get at least two hours of sunlight per day. Keep shades open during the day or use a light therapy box. Artificial lights at night can suppress your body's production of melatonin, so use low-wattage bulbs where possible and turn off the TV and computer at least one hour before bed.
Sound
Noise can be a distraction when trying to sleep. Keep your bedroom quiet. Find ways to relax before bedtime, such as reading a book or listening to soothing music.
Temperature
Temperature has a direct correlation with our circadian rhythm. Sleep quality is optimal between 20°C and 25°C (68°F–77°F) and drops at higher and lower levels. Hot and humid sleeping environments can result in insomnia due to increased core temperature.
Working out two to three hours before bedtime can help you relax. Taking a warm bath or shower one to two hours before bed can also decrease the time it takes to fall asleep.
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Frequently asked questions
Older adults need around seven to nine hours of sleep each night, which is the same amount of sleep recommended for all adults.
Older people may experience changes in the quality and duration of their sleep due to changes in their body's internal clock. Other reasons include physical conditions like sleep apnea, restless leg syndrome, and nocturia, as well as poor sleep habits such as drinking caffeinated beverages in the late afternoon.
Here are some tips to improve sleep for older adults:
- Establish a regular sleep schedule by going to bed and waking up at the same time each day.
- Develop a bedtime routine and find ways to relax before bedtime, such as reading a book or listening to soothing music.
- Make your bedroom comfortable and conducive to sleep by maintaining a suitable temperature and minimising distractions like electronic devices and bright lights.
- Avoid heavy meals, caffeine, and alcohol close to bedtime, as they can disrupt sleep.
- Get regular exercise, but avoid exercising within three hours of bedtime.
- Address emotional issues and improve your sleep environment by getting enough sunlight during the day and minimising artificial light at night.
If you continue to experience sleep difficulties, consider keeping a sleep diary to track your sleep patterns. Identify and address any underlying causes of your sleep problems, such as stress or medical conditions. Consult your doctor for advice, as they may recommend lifestyle changes, cognitive behavioural therapy, or short-term sleep medications.
