Enhancing Rem Sleep For Older Adults: Effective Strategies

Sleep patterns tend to change as people age. Older adults experience shorter total sleep time than younger adults, with total sleep time decreasing until about age 60, then stabilizing through the later decades of life. Older adults spend a lower percentage of their sleep time in both slow-wave (deep) sleep and REM sleep compared to younger adults. The time it takes to fall asleep increases slightly as well. The number of arousals and total time awake after falling asleep also increases with age. Older adults do not experience increased difficulty in their ability to return to sleep following arousals compared to younger adults. Additionally, older adults spend more time napping during the day.

REM sleep is part of the body's normal sleep cycle. Each sleep cycle lasts about 80 to 100 minutes, and most people experience four to six sleep cycles per night. The first REM episode usually lasts just a few minutes, lengthening during each subsequent sleep cycle. Toward the end of the night, people may spend up to half an hour in REM sleep.

Just like overall sleep patterns, REM sleep needs shift as people age. Newborns spend about half their sleep time in REM sleep. This starts to decrease by about six months and continues to decline throughout childhood and the teen years. By age 20, most people spend just over 20% of their total sleep time in REM sleep. In older adults, time spent in REM sleep decreases slightly, to about 17% by age 80.

Increased exposure to daylight

Older adults often experience changes in their sleep patterns, and one of the main reasons for this is reduced exposure to daylight. Research shows that older people average around one hour less of daylight exposure per day, and this can have a significant impact on their sleep.

The body's internal clock, or circadian rhythms, are largely influenced by light, which is one of the most powerful cues for maintaining these rhythms. The body's sleep-wake cycles are regulated by the suprachiasmatic nucleus (SCN), which is located in the hypothalamus and is made up of around 20,000 cells. The SCN controls 24-hour daily cycles, and as people age, the function of the SCN deteriorates, disrupting these cycles and influencing when they feel tired and alert.

Older adults with insufficient exposure to daylight tend to experience a phase advance in their circadian rhythm, which means they get tired earlier in the afternoon and wake up earlier in the morning. This shift can contribute to more fragmented sleep and a greater number of awakenings during the night.

To counteract this, older adults can aim for more daylight exposure. Getting outdoors in natural light, especially in the morning, can help set the body's sleep-wake cycle. Additionally, bright light therapy, either through light boxes or outdoor exposure, can help delay sleepiness and shift the sleep schedule later.

By increasing their exposure to daylight, older adults may be able to improve their sleep patterns, promoting better sleep quality and overall well-being.

Exercise

Exercising outdoors in the morning is ideal, as natural light helps to set the body's sleep/wake cycle. Morning exercise is also preferable to afternoon or evening exercise, as exercising too close to bedtime can make it challenging to fall asleep.

Avoid substances that disrupt sleep

As we age, our bodies undergo various physiological changes, and our sleep patterns are no exception. Older adults may experience shorter total sleep time, with sleep duration decreasing until about 60 years of age and then stabilising. Older adults also tend to spend a lower percentage of their sleep time in deep sleep and REM sleep compared to younger adults. Additionally, the time it takes to fall asleep may increase slightly, and older adults may experience more arousals and wake up more frequently during the night.

To improve sleep quality and duration, it is essential to avoid substances that can disrupt sleep. Here are some tips for older adults to avoid substances that may interfere with their sleep:

• Alcohol: While a nightcap may help you fall asleep initially, it suppresses REM sleep. Alcohol can disrupt your sleep architecture and reduce the quality of your rest. It is best to avoid alcohol close to bedtime or limit your intake to improve sleep quality.
• Caffeine: Caffeine is a stimulant that can interfere with your sleep. It blocks brain chemicals that promote sleep and can make it challenging to fall and stay asleep. Avoid consuming caffeine late in the day, and limit your overall intake if you struggle with sleep.
• Tobacco: Tobacco products, especially close to bedtime, can negatively impact your sleep. Nicotine is a stimulant that can make it harder to fall asleep and increase sleep disruptions. Quitting smoking can improve your sleep quality and overall health.
• Heavy meals: Eating a large meal close to bedtime can affect your sleep. It is advisable to finish dinner at least four hours before bedtime. This gives your body time to digest the meal and prepares you for a more restful sleep.
• Medications: Certain medications can interfere with sleep. If you are taking multiple medications, consult your healthcare provider to review your prescriptions and discuss any potential side effects that may impact your sleep.

Remember that everyone's sleep needs are unique, and it is essential to listen to your body. If you have concerns about your sleep or experience persistent sleep difficulties, consult your healthcare provider for personalised advice and guidance.

Keep a regular sleep schedule

Keeping a regular sleep schedule is one of the most important things older adults can do to improve their sleep. Here are some tips to help you establish and maintain a consistent sleep schedule:

• Set a bedtime and wake-up time: Choose a bedtime and wake-up time that allows you to get enough sleep, typically seven to eight hours for older adults. Stick to this schedule, even on weekends and holidays. Consistency is key to regulating your body's sleep-wake cycle.
• Avoid sudden changes: Try to avoid making sudden changes to your sleep schedule. If you need to adjust your sleep schedule, do it gradually, shifting your bedtime and wake-up time by 15-30 minutes at a time.
• Avoid napping: While a short nap can be refreshing, long or frequent napping can disrupt your nighttime sleep. If you must nap, try to limit it to 20-30 minutes and avoid napping too close to bedtime.
• Be careful with naps if you have insomnia: If you have insomnia, napping may make it harder to fall asleep at night. Limit naps to 20-30 minutes in the early afternoon, and avoid napping after 3 pm.
• Create a bedtime routine: Develop a calming bedtime routine to signal to your body that it's time to wind down. This could include reading, listening to soothing music, or taking a warm bath. Start your routine at the same time every night to reinforce your body's sleep schedule.
• Get up at the same time every day: Even if you've had a poor night's sleep, try to get up at your usual time. This will help reinforce your sleep schedule and improve your chances of a good night's sleep the next night.
• Avoid staying in bed if you can't sleep: If you can't fall asleep within 20-30 minutes, get up and do something relaxing in another room. Return to bed when you feel sleepy. This will help reinforce the association between your bed and sleep.

Develop a bedtime routine

Developing a bedtime routine is a great way to improve sleep quality and duration. Here are some tips to help older adults establish a bedtime routine and get a good night's rest:

• Stick to a sleep schedule: Maintaining a consistent sleep schedule is crucial for regulating your body's sleep/wake cycle. Go to bed and wake up at the same time each day, even on weekends and during vacations. If you struggle with falling asleep, avoid staying in bed. Instead, leave the bedroom and engage in a relaxing activity until you feel sleepy again.
• Create a relaxing bedtime routine: Incorporate calming rituals into your bedtime routine to signal to your body that it's time to wind down. This could include listening to soft music, taking a warm bath or shower, or reading a book. However, avoid reading on your phone or tablet, as the blue light emitted by these devices can interfere with your sleep.
• Limit alcohol and caffeine intake: While a nightcap may help you fall asleep initially, it suppresses REM sleep. Caffeine, too, can disrupt your sleep as it blocks brain chemicals that promote sleep. Try to avoid consuming caffeine late in the day, as its effects can linger and impact your sleep quality.
• Exercise regularly: Regular physical activity can improve your sleep quality and duration. Aim to exercise outdoors in the morning, as natural light exposure helps regulate your body's sleep/wake cycle.
• Reduce bedroom distractions: Televisions, smartphones, and bright lights can make it harder to fall asleep. Remove electronic devices from your bedroom and reserve this space solely for sleeping and sexual activity.
• Keep the bedroom safe and comfortable: Ensure your bedroom is set up to promote a good night's sleep. Keep a phone by your bed for emergencies, but avoid the temptation of a smartphone, as notifications and bright screens can disrupt your sleep. Make sure a light is within reach to reduce the risk of tripping or falling in the dark, and reduce hazards by removing rugs, cords, and other potential obstacles.

By implementing these strategies and developing a consistent bedtime routine, older adults can improve their sleep quality and overall well-being.

Frequently asked questions