Aging And Sleep: Strategies To Keep Elders Awake And Active

As people age, their sleep patterns change due to shifts in their body's internal clock, which is known as the circadian rhythm. This can result in older adults taking more naps during the day and experiencing fragmented sleep at night. While napping can compensate for shorter nighttime sleep, excessive napping can interfere with sleep quality and duration.

There are several factors that can contribute to excessive sleepiness in older adults, including:

- Health conditions such as arthritis, neurological disorders, diabetes, and heart disease, which can cause pain and discomfort, making it difficult to fall asleep or stay asleep.

- Recovery from surgery or other medical treatments, which can disrupt sleep patterns due to post-operative pain, environmental factors, and changes in the normal sleep-wake cycle.

- Dementia, which can cause fatigue and sleep deprivation, aggravating symptoms.

- Sleep disorders such as sleep apnea, restless leg syndrome, and narcolepsy, which can impact overall health and quality of life.

- Medications and medical treatments, which can have fatigue as a side effect.

- Infections and nutrient deficiencies, which can result in feelings of fatigue and weakness.

- Mental health conditions such as anxiety and depression, which can manifest as physical symptoms like extreme fatigue.

- Lifestyle factors such as boredom, lack of engagement, and social isolation, which can contribute to napping during the day.

To help improve sleep patterns in older adults, it is recommended to:

- Establish a regular sleep routine to regulate the body's internal clock.

- Encourage time outdoors and exposure to sunlight, especially in the morning and afternoon.

- Create a comfortable and relaxing sleep environment that is cool, dark, and quiet.

- Allow for short naps in the afternoon, lasting 20-90 minutes, to prevent interference with nighttime sleep.

- Engage in regular exercise to improve sleep quality and help tire the body for bedtime.

- Reduce mental stress through activities such as meditation, deep breathing, or gentle stretches.

- Monitor diet and fluid intake, avoiding large meals, caffeine, and fluids close to bedtime to reduce nighttime trips to the bathroom.

- Establish a calming pre-sleep routine, such as reading or listening to soft music.

- Review medications with a healthcare provider to ensure they are not impacting sleep.

- Consult a healthcare professional if sleep problems persist to rule out any underlying sleep disorders or health issues.

Establish a bedtime routine

Establishing a bedtime routine can be a great way to help older adults get a good night's rest and improve their overall quality of life. Here are some tips to help you get started:

• Maintain a consistent sleep schedule: Try to go to bed and wake up at the same time every day, even on weekends. This will help regulate your body's internal clock and make it easier to fall asleep and wake up feeling refreshed.
• Create a soothing bedtime routine: Engage in activities that help you relax before bed. This could include taking a warm bath, playing soft music, practising meditation, or deep breathing exercises.
• Make the bedroom sleep-friendly: Ensure the bedroom is quiet, cool, and dark. Consider using earplugs, a white noise machine, blackout curtains, or a sleep mask to create a comfortable and relaxing environment.
• Limit screen time before bed: Avoid watching TV, using electronic devices, or bright lights at least one hour before bedtime. Blue light from screens can interfere with the production of melatonin, the hormone that makes you sleepy.
• Engage in light physical activity during the day: Regular physical activity can help improve sleep quality. However, avoid strenuous exercise close to bedtime as it may interfere with falling asleep.
• Monitor diet and fluid intake: Avoid large meals, caffeine, and alcohol close to bedtime. Eat a light snack before bed to satisfy hunger and prevent hunger pangs from disturbing sleep. Limit fluid intake 1-2 hours before bed to reduce the need for nighttime bathroom trips.
• Manage stress: Stress and anxiety can interfere with sleep. Establish a calming pre-sleep routine and consider activities such as meditation, reading, or listening to soft music to help wind down.
• Review medications: Certain medications can interfere with sleep. Consult a healthcare provider to review prescriptions and discuss any concerns.

Improve their sleep environment

The bedroom should be used only for sleep and sex. By not working, watching TV, or using a computer in bed, the brain will associate the bedroom with just sleep and sex.

Keep the bedroom quiet, dark, and cool. As people age, they often become more sensitive to noise, and light and heat can also cause sleep problems. Using a sound machine, earplugs, or a sleep mask can help.

Make sure the bed is comfortable. Try out different pillows and toppers, or consider a new mattress that better suits their sleeping position. Using an adjustable base can benefit both the upper and lower body, provide sleep apnea relief, and reduce back pain as they age.

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

General Tips

• Set a regular routine to help regulate their body’s internal clock, making it easier for them to fall asleep and wake up feeling refreshed.
• Encourage them to spend time outside during the day to help improve their sleep. Make sure they get some sunlight in the morning, take a walk in the afternoon, and avoid blue light from screens at least three hours before bed.
• Allow short naps of about 20-90 minutes in the afternoon, as this can interfere with nighttime sleep.
• Encourage them to exercise regularly to improve sleep quality. From walking and gentle yoga to swimming or Tai Chi, these exercises can help naturally tire them out by bedtime.
• Reduce mental stress. Stress and anxiety accumulated throughout the day can make it difficult to relax at bedtime. To combat this, help them establish a calming pre-sleep routine. This might involve activities such as meditation, deep breathing exercises, or gentle yoga stretches.
• Monitor their diet and fluid intake. For example, avoid large meals, fluid intake and caffeine close to bedtime to help reduce nighttime trips to the bathroom.
• Satisfy their hunger before bed. Eating a light snack before bed can prevent hunger pangs from disturbing their sleep. Opt for snacks that are easy on the stomach and low in sugar to avoid spikes in blood sugar levels. Some good options include a glass of warm milk or a small bowl of low-sugar cereal with milk.
• Establish a relaxing pre-sleep routine to help them wind down. This can include activities, such as reading, gentle stretching, or listening to soft music.
• Review medications with their healthcare provider to ensure they are not interfering with sleep. Some medications, such as diuretics or “water pills”, can have stimulating effects or increase the need to use the bathroom during the night.

Encourage exercise

Exercise is one of the most important things older adults can do to maintain their health and independence. However, older adults often do not get the recommended amount of exercise. Here are some tips to encourage exercise in the elderly:

• Make it fun: Doing activities that are enjoyable is a big part of sticking to an exercise regimen. Variety also helps to keep things interesting, so it's important to change up the routine regularly and aim for a new adventure or experience every week. Some ideas include walking instead of taking a golf cart when playing golf, taking a Zumba class, going for a swim, or riding a bike.
• Make it social: According to a 2018 study, people who walk with companions are more likely to stick with it compared to those who walk alone. Exercising with a partner or group makes it more enjoyable and can help keep you accountable. You can also try live-streaming or on-demand virtual classes if you're homebound or the weather is bad.
• Set attainable goals: Going from no exercise to 30 minutes a day can be overwhelming. It's better to create smaller, realistic goals. For example, pledge to take the stairs instead of the elevator or pick the furthest parking spot at the store. Start small and then expand your goals as your confidence and fitness level grow.
• Track your progress: Logging your exercise activity can help you monitor your progress and see how far you've come. You can use a journal, a fitness tracking app, or a pedometer/steps tracker. Building in rewards for milestones achieved can also help keep you motivated.
• Combine physical activity with daily tasks: Try to fit exercise into your daily routine by combining it with tasks you already do. For example, walk the dog, do household chores, or take a walk with coworkers during your lunch break. If you don't have 30 minutes to exercise, look for three 10-minute periods instead. As you progress, gradually add more 10-minute sessions until you reach your goal.
• Start slowly and increase intensity: For older adults who are new to structured exercise programs, it's best to start with light activity and focus on consistency before moving on to more vigorous activities. This helps to build good exercise habits and makes it easier to stick with it.
• Engage in pleasant activities: Walking is a practical and beneficial form of exercise, but it doesn't provide the same strength, coordination, and balance benefits as other activities. It's important to find activities that challenge these areas as well, such as sports like tennis or swimming, or group activities like Tai Chi or yoga.

Reduce mental stress

Reducing mental stress is an important part of improving sleep quality in older adults. Here are some tips to reduce mental stress in older adults:

• Keep a journal: Writing down your worries before going to bed can help you offload your thoughts and concerns, making it easier to let go of them when it's time to sleep.
• Create a to-do list: Checking off completed tasks and listing tomorrow's goals can help you feel more organized and less stressed.
• Listen to calming music: Soothing music can help relax your mind and body, reducing mental stress.
• Read a relaxing book: Reading something that makes you feel calm and relaxed can help ease tension and mental stress.
• Get a massage: A massage from a friend or partner can help relieve physical and mental tension, promoting relaxation.
• Practice relaxation techniques: Techniques such as deep breathing or meditation can prepare your body for sleep and reduce mental stress.
• Talk about your concerns: Sharing your worries with a friend, family member, or therapist during the day can help you process difficult emotions and reduce stress.
• Exercise regularly: Physical activity, especially aerobic exercise, releases chemicals in the body that promote more restful sleep. It also helps to improve overall cognitive health and can reduce stress.
• Improve your sleep environment: Reducing distractions and creating a comfortable, quiet, dark, and cool bedroom can improve sleep quality and reduce mental stress.
• Establish a bedtime routine: Developing a consistent sleep schedule, including soothing bedtime rituals like taking a warm bath or playing music, can help you wind down and reduce stress before bed.
• Limit screen time: Reducing exposure to artificial light from electronic devices and screens before bed can improve melatonin levels and reduce mental stress, leading to better sleep.
• Address emotional issues: Unresolved emotional issues can contribute to mental stress and sleep disturbances. Addressing these issues, whether through therapy or other means, can help improve sleep quality.

Review their diet and fluid intake

Diet and fluid intake can have a significant impact on the sleep quality of elderly individuals. Here are some tips to help improve sleep through diet and fluid intake:

• Satisfy hunger before bed: Eating a light snack before bed can prevent hunger pangs from disturbing sleep. Opt for snacks that are easy on the stomach and low in sugar to avoid spikes in blood sugar levels. Some good options include a glass of warm milk or a small bowl of low-sugar cereal with milk.
• Avoid large meals, caffeine, and fluid intake close to bedtime: Eating large meals or drinking fluids within an hour and a half of bedtime can lead to indigestion, discomfort, and frequent trips to the bathroom during the night.
• Reduce caffeine intake: Avoid coffee, tea, soda, and chocolate late in the day. Caffeine can disrupt sleep and cause insomnia.
• Avoid alcohol before bedtime: Alcohol might make one feel sleepy, but it will disrupt sleep and cause fragmented sleep.
• Monitor fluid intake: While staying hydrated is important, excessive fluid intake can lead to frequent trips to the bathroom, disrupting sleep.
• Review medications: Certain medications can impact sleep. For example, diuretics or "water pills" can increase the need to use the bathroom during the night. Review medications with a healthcare provider to ensure they are not interfering with sleep.
• Address nutrient deficiencies: Nutrient deficiencies, such as iron, vitamin B12, or vitamin D deficiencies, can result in feelings of sluggishness and fatigue. Addressing these deficiencies can help improve energy levels and sleep quality.

Frequently asked questions