The Elderly's Sleepless Nights: Impact And Solutions

Sleep is a pillar of health, and it's common for older adults to develop physical health problems that affect their sleep. These include sleep apnea, gastroesophageal reflux disease, heart failure, untreated pain, and frequent urination. However, even in the absence of health problems, sleep patterns change as we age.

Older adults need the same amount of sleep as younger people to restore their bodies, but sleep patterns tend to change with age. As people grow older, their internal clock tends to advance, causing them to feel tired earlier in the evening and wake up earlier in the morning. Sleep also becomes lighter and more fragmented, with less time spent in REM sleep and a decline in sleep architecture.

Insomnia is one of the most common sleep disorders in seniors, affecting up to 50% of older adults. It can be caused by various factors, including normal changes in sleep patterns, medications, other health conditions, mental illness, lifestyle habits, and chronic stress. If left untreated, insomnia can lead to physical and mental health problems such as diabetes, heart disease, depression, and dementia.

To prevent insomnia, it's important to establish a regular sleep schedule, be active daily, and create a soothing and restful environment. Avoiding caffeine, alcohol, heavy meals, and excessive screen time before bed can also help. If sleep problems persist, it's recommended to seek professional help from a doctor or a sleep specialist.

Medical conditions and medications

Medical Conditions

Chronic pain, arthritis, asthma, diabetes, osteoporosis, heartburn, and Alzheimer's disease are just a few examples of health issues that can make it difficult for older adults to get a good night's sleep. These conditions might require frequent bathroom trips, cause discomfort, or lead to sleep apnea, all of which can fragment sleep.

Neurological conditions, such as Parkinson's disease, multiple sclerosis, and traumatic brain injuries, can also impact sleep. Up to 40% of people with Parkinson's disease experience obstructive sleep apnea, according to the Parkinson's Foundation.

Gastrointestinal issues like gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) can also disturb sleep. Respiratory conditions, including chronic obstructive pulmonary disease (COPD) and asthma, can increase the risk of sleep apnea, further disrupting sleep.

Medications

The use of certain medications can also impact sleep in older adults. Polypharmacy, or the concurrent use of multiple medications, is common in this population. Some medications that may disrupt sleep include:

• Diuretics for high blood pressure or glaucoma
• Inhaled anticholinergics for COPD
• Antihypertensive drugs for high blood pressure
• Oral corticosteroids for rheumatoid arthritis and lupus
• Antidepressants and anti-anxiety medications
• Antihistamines for allergies
• Levodopa for Parkinson's disease
• Donepezil for Alzheimer's disease

Additionally, older adults may be more sensitive to the stimulating effects of caffeine, nicotine, and alcohol, which can interfere with their sleep.

Treatment Options

It is important to note that while sleep patterns may change with age, disturbed sleep and constant tiredness are not normal parts of aging. If you are experiencing sleep difficulties, it is recommended to consult a healthcare professional. They can help identify any underlying medical conditions or sleep disorders and provide appropriate treatment options.

Cognitive-behavioural therapy (CBT) is often recommended as a first-line treatment for insomnia in older adults. This form of psychotherapy addresses the negative thoughts, worries, and behaviours that prevent individuals from sleeping well. It has been found to be more effective than prescription sleep medication in treating chronic insomnia.

In some cases, healthcare professionals may also recommend or adjust medications to improve sleep. However, it is important to remember that medications should not replace good sleeping habits and are typically used as a short-term solution.

Alcohol, caffeine, and nicotine

Alcohol

While alcohol might make one feel sleepy initially, it can disrupt sleep later in the night. Evening alcohol consumption is associated with reduced sleep efficiency, making it difficult to stay asleep. This is true for both small and large amounts of alcohol. It is recommended to limit alcohol consumption to one or two drinks with dinner, at least three to four hours before bedtime, to minimise sleep disruption.

Caffeine

Caffeine is a stimulant that can promote wakefulness and make it challenging to fall asleep. However, recent studies suggest that caffeine intake close to bedtime may not significantly impact sleep for most people. Nevertheless, it is generally advisable to avoid caffeine late in the day and to refrain from consuming caffeinated beverages within three to four hours of bedtime.

Nicotine

Nicotine is a stimulant that can disrupt sleep through its impact on sleep-involved neurotransmitters and withdrawal effects during sleep. Evening nicotine use is associated with reduced sleep efficiency and increased wakefulness after sleep onset. It can also worsen insomnia, with one study finding that nightly nicotine use resulted in a more than 40-minute reduction in overall sleep for individuals with insomnia. Given the detrimental effects of nicotine on sleep, it is recommended to avoid smoking or vaping at least two hours before bedtime and to refrain from nicotine use if one wakes up during the night.

Lack of physical activity

Sleep is essential for both physical and emotional health, helping to improve concentration and memory formation, allowing the body to repair any cell damage from the previous day, and boosting the immune system. However, a lack of physical activity can negatively impact sleep patterns in older adults.

A study of older Singaporeans reported that those who had trouble sleeping were more likely to be less physically active. Additionally, Yale Medicine geriatric and sleep medicine specialist Brienne Miner, MD, MHS, explains that a lack of physical activity during the day can disrupt the normal sleep/wake cycle.

Regular exercise, especially aerobic activity, can help older adults fall asleep more easily and improve their overall sleep quality. A study at Northwestern University found that participants who engaged in aerobic exercise reported improved sleep quality, including longer sleep duration. The exercises included two 20-minute sessions or one 30-to-40-minute session of walking or stationary cycling four times a week. As a result, participants reported fewer depressive symptoms, increased vitality, and reduced daytime sleepiness.

Older adults with mobility issues can also benefit from physical activity. Swimming, water exercises, dancing, lawn bowling, and cycling are some examples of low-impact exercises that can promote better sleep.

It is important to consult with a doctor before starting any new fitness program. Additionally, older adults should aim to exercise regularly but not within three hours of bedtime, as this can also impact sleep.

Sleep disorders

Causes of Sleep Disorders in Older Adults

Poor sleep in older adults can be caused by a variety of factors, including:

• Sleep disorders such as insomnia, restless leg syndrome, sleep apnea, and REM sleep behaviour disorder.
• Health conditions such as Parkinson's disease, Alzheimer's disease, chronic pain, cardiovascular disease, neurological conditions, gastrointestinal conditions, lung or respiratory conditions, and poor bladder control.
• Medication, including diuretics, antihypertensives, oral corticosteroids, antidepressants, anti-anxiety medication, and antihistamines.
• Lifestyle factors such as caffeine, alcohol, and smoking.
• Ageing itself: as people age, their internal clocks become less efficient, resulting in falling asleep and waking up earlier.

Symptoms of Sleep Disorders

• Difficulty falling asleep.
• Waking up frequently during the night or early in the morning.
• Feeling very sleepy during the day.
• Memory problems or forgetfulness.
• Increased risk of falls or accidents.
• Daytime fatigue.
• Irritability or difficulty controlling emotions.
• Difficulty staying awake when sitting still, watching TV, or driving.
• Difficulty concentrating during the day.

Treatment of Sleep Disorders

Treatment of sleep disorders in older adults may include:

• Non-pharmaceutical treatments such as cognitive behavioural therapy (CBT).
• Improving sleep habits, such as maintaining a regular sleep schedule, avoiding naps in the late afternoon or evening, developing a bedtime routine, and keeping the bedroom comfortable and quiet.
• Addressing lifestyle factors, such as reducing caffeine, alcohol, and smoking intake, improving diet, and getting regular exercise.
• Medication, such as sleeping pills, antidepressants, or other treatments depending on the underlying cause.

Emotional issues

Older adults experiencing insomnia may benefit from reducing mental stress. Keeping a journal to record worries before bedtime, listening to calming music, reading a relaxing book, or practising relaxation techniques such as deep breathing or meditation can help prepare the mind for sleep. Seeking social support from friends, family, or a therapist to discuss troubling thoughts during the day can also alleviate sleep disturbances.

Additionally, cognitive-behavioural therapy (CBT) has been found to be an effective treatment for chronic insomnia in older adults. This form of psychotherapy addresses the negative thoughts, worries, and behaviours that prevent individuals from sleeping well. By modifying these thought patterns and behaviours, older adults can improve their sleep quality and duration.

It is important to note that while sleep patterns may change with age, disturbed sleep and constant fatigue are not typical signs of ageing. If emotional issues are affecting sleep, it is recommended to consult a healthcare professional for guidance and support.

Frequently asked questions