Seniors' Sleep: Understanding The Challenges Of Aging And Sleep

Sleep is essential for physical and emotional health, but it's common for older people to experience changes in their sleep quality and duration. This can be attributed to various factors, including the body's internal clock, known as the suprachiasmatic nucleus (SCN), which controls our 24-hour circadian rhythms. As the SCN deteriorates with age, it can disrupt these rhythms, affecting when we feel tired and alert. Additionally, older adults may experience a decrease in melatonin production, further contributing to sleep disturbances.

Other factors that can impact sleep in seniors include lifestyle choices, such as alcohol and caffeine consumption, as well as medical conditions like depression, anxiety, heart disease, and diabetes. The use of certain medications and supplements can also interfere with sleep. It's important to note that sleep problems are not an inevitable part of ageing, and addressing the root causes can help improve sleep quality.

Circadian rhythm changes

The body's internal clock is located in the hypothalamus, a part of the brain. This internal clock is made up of around 20,000 cells that form the suprachiasmatic nucleus (SCN). The SCN controls our circadian rhythms, and as we age, its function deteriorates, directly influencing when we feel tired and alert.

Research shows that older people often have insufficient exposure to daylight, which is one of the most powerful cues for maintaining circadian rhythms. This lack of daylight exposure can be more restricted for those living in nursing homes or with Alzheimer's disease. As a result, older adults may experience a phase advance, feeling tired earlier in the afternoon and waking up earlier in the morning.

In addition to changes in the SCN, hormone production also changes with age. The body secretes less melatonin as we get older. Melatonin is normally produced in response to darkness and helps promote sleep by coordinating circadian rhythms. This decrease in melatonin levels can further disrupt sleep patterns in older adults.

Health conditions

The side effects of medications taken to manage these health conditions can also disrupt sleep. Polypharmacy, or the use of multiple medications, is common among older adults, and the interactions of these medications can have unanticipated effects on sleep. It is important for older adults to discuss their medication regimens with their doctors to identify any sleep-disrupting side effects and explore alternative treatments if necessary.

Chronic pain is a significant contributor to sleep disturbances in older adults. Conditions such as arthritis and osteoporosis can cause discomfort and pain, making it difficult to fall asleep and maintain restful sleep throughout the night. Addressing chronic pain through medical treatments and pain management strategies can help improve sleep quality in this population.

Additionally, brain and nervous system conditions, such as Alzheimer's disease, can also impact sleep patterns in older adults. Alzheimer's patients may experience changes in their sleeping habits, sleeping too much or too little, and waking up multiple times during the night. Caregivers of individuals with Alzheimer's disease may also experience sleep disturbances due to the challenges of caring for someone with this condition.

Urinary issues, such as nocturia, or the frequent need to urinate at night, are also common in older adults and can disrupt sleep. This issue is often related to physical changes in the urinary system that occur with ageing.

Overall, addressing health conditions and their associated symptoms and side effects is crucial for improving sleep in older adults. This may involve working with healthcare providers to manage medications, treat chronic pain, and address mental health concerns.

Medication side effects

Seniors may experience sleep disturbances due to various factors, including changes in their body's internal clock, chronic diseases, certain medications, mental health conditions, and lifestyle factors. While there are many reasons why older adults may not get sufficient sleep, medication side effects are a significant contributor.

Medications and Their Effects:

• Central Nervous System (CNS) Stimulants: Diet pills or amphetamines can cause insomnia in older adults by stimulating the central nervous system.
• Antidepressants: While they can improve sleep in people with depression, they may disrupt sleep in others. Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine (Prozac) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine (Effexor) can worsen sleep continuity and delay REM sleep. Bupropion (Wellbutrin) is particularly stimulating and may cause insomnia.
• Corticosteroids: These medications can decrease natural melatonin levels and disrupt sleep cycles, making it harder to fall and stay asleep.
• Diuretics: Diuretics, commonly used to treat high blood pressure, can cause nocturnal hypoglycemia, leading to restless and irritable sleep, night sweats, and a racing heartbeat.
• Anticonvulsants: These medications can alter sleep cycles and even cause sleep apnea, resulting in disrupted sleep.
• Certain Anti-hypertensives: Beta-blockers, such as metoprolol (Lopressor) and propranolol (Inderal XL), can cross the blood-brain barrier, reducing sleep quality and causing frequent awakenings. They are also linked to nightmares and daytime sleepiness.
• Pain Medications: Opioid pain medications can contribute to sleep issues by altering sleep cycles and causing sleep apnea.
• Prostate Medications: Alpha-blockers, used to treat prostate symptoms, can reduce REM sleep, which is crucial for memory, emotional processing, and brain development.
• Stimulants: Stimulants like amphetamine-dextroamphetamine (Adderall) and methylphenidate (Ritalin) can make it harder to fall asleep and disrupt the internal sleep clock.
• Steroids: Glucocorticoids used as anti-inflammatory medications can cause restlessness, decrease melatonin levels, and disrupt sleep cycles.

General Recommendations:

• Consult a doctor: Before adjusting or discontinuing any medication, it is crucial to consult a healthcare provider to assess the risks and benefits.
• Medication adjustments: A doctor may adjust the dosage or timing of medications or recommend alternative treatments to improve sleep.
• Sleep hygiene: Improving sleep hygiene practices, such as maintaining a consistent sleep schedule, avoiding daytime napping, and creating a relaxing bedtime routine, can enhance sleep quality.
• Lifestyle changes: Regular exercise, limiting caffeine and alcohol intake, and avoiding stimulating activities before bed can promote better sleep.
• Cognitive Behavioral Therapy (CBT): CBT is a first-line treatment for insomnia and can help address underlying factors contributing to sleep disturbances.

Lifestyle changes

Improve Your Sleep Environment

Make your bedroom quiet, dark, and cool. Use low-wattage bulbs, turn off electronics at least an hour before bed, and ensure your room is at a comfortable temperature. You can also use a sound machine, earplugs, or a sleep mask to enhance your sleep environment.

Keep a Regular Bedtime Routine

Maintain a consistent sleep schedule by going to bed and waking up at the same times every day, even on weekends. Develop soothing bedtime rituals such as taking a bath, playing music, or practicing relaxation techniques like deep breathing or meditation.

Learn the Best Ways to Nap

Keep naps short, preferably around 5-15 minutes, and in the early afternoon. Limiting the duration and timing of your naps can help improve your nighttime sleep quality.

Use Diet to Improve Sleep

Limit caffeine, alcohol, and sugary foods, especially later in the day. Eat a light snack before bed, such as low-sugar cereal, yogurt, or warm milk, and avoid large or spicy meals within 3-4 hours of bedtime.

Exercise for Better Sleep

Engage in regular aerobic exercise, such as swimming, dancing, or cycling, which has been shown to improve sleep quality. Consult your doctor to determine the best type of activity for you, and try to get some sunlight during the day, as this can also enhance your sleep.

Reduce Mental Stress

Keep a journal, listen to calming music, read a relaxing book, or practice relaxation techniques. Address any underlying stress factors by talking to a friend, family member, or therapist.

Sleep disorders

Insomnia

Insomnia is the most common sleep problem in adults over 60. People with insomnia have trouble falling asleep and staying asleep. It can last for days, months, or even years. Insomnia can be caused by a variety of factors, including:

• Poor sleep habits, such as irregular sleep hours, daytime napping, and a poor sleeping environment.
• Medical problems, such as anxiety disorders, bipolar disorder, thyroid disease, depression, and chronic pain.
• Lifestyle choices, such as alcohol or recreational drug use, heavy smoking, and high caffeine consumption.
• Medication, including over-the-counter sleep aids and prescription medicines.
• Ageing, as the body's internal clock changes, causing people to fall asleep earlier in the evening.

Sleep-disordered breathing

Sleep-disordered breathing, such as snoring and sleep apnea, is more common in older adults. Sleep apnea causes short pauses in breathing during sleep, which can lead to fragmented sleep and affect oxygen levels in the body.

Restless Legs Syndrome (RLS)

RLS affects 9-20% of older people and causes an urge to move the legs while resting or sleeping. It can be treated with medication, warm baths, exercise, and relaxation exercises.

Periodic Limb Movement Disorder (PLMD)

PLMD causes people to jerk and kick their legs every 20 to 40 seconds during sleep. It can be treated with medication, warm baths, exercise, and relaxation exercises.

REM Sleep Behaviour Disorder

During normal REM sleep, the body remains still. However, this disorder causes people to physically act out their dreams, disrupting their sleep.

Advanced Sleep Phase Syndrome

This syndrome causes the body's internal clock to adjust to earlier bed and wake-up times. If seniors continue to stay up late, they may experience sleep deprivation.

Alzheimer's Disease

Alzheimer's disease often changes a person's sleeping habits. Some people with the disease sleep too much, while others don't sleep enough. Some wake up many times during the night, while others wander or yell. Caregivers of people with Alzheimer's may also experience sleep disturbances.

Medication

Older adults tend to take more medications, and the combination of drugs and their side effects can impair sleep.

Pain and Medical Conditions

Health conditions such as arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, and frequent urination can interfere with sleep.

Menopause and Postmenopause

During menopause, hot flashes and night sweats can interrupt sleep. Sleep problems can continue even after menopause.

Lack of Exercise

Being too sedentary can lead to feeling sleepy all the time or never feeling sleepy at all. Regular aerobic exercise can promote good sleep.

Stress

Significant life changes, such as retirement, the death of a loved one, or moving from a family home, can cause stress and disrupt sleep.

Lack of Sunlight

Bright sunlight helps regulate melatonin and sleep-wake cycles. Getting at least two hours of sunlight a day can improve sleep.

Frequently asked questions