Sleep in Seniors

The phrase “sleep like a baby” exists for good reason. When we’re young, sleep often comes easily. Generally, children and younger adults sleep more soundly, experience fewer awakenings, and spend more time in deep sleep. With age, adults spend gradually less time in slow-wave sleep and in REM sleep, in favor of more time spent in the lighter stages of sleep.

Older adults are more likely to experience sleep disorders, including insomnia, obstructive sleep apnea, and restless leg syndrome. Frequently, older adults will experience declines to their total sleep time, and may find it increasingly difficult to sleep through the night.

In many cases, sleep problems in seniors can be traced to other medical conditions, or to the side effects of medications used to treat health problems. Physical pain and discomfort can be significant barriers to sleep. In addition to minor, everyday physical discomfort that becomes more likely with age, conditions such as arthritis are often accompanied by sleep problems. Other medical conditions that lead to sleep disruptions include:

• Depression
• Gastroesophageal reflux disease (GERD)
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Autoimmune diseases such as fibromyalgia and thyroid disorders

Common medications, including antidepressants, high-blood-pressure medications, statins, and drugs used to treat rheumatoid arthritis and other inflammatory conditions can cause disrupted sleep.

There are physiological changes that occur with age that appear to increase the likelihood of sleep problems in older adults:

• With age, hormone levels in both men and women decline, and these hormonal changes — including the hormones cortisol, melatonin, and growth hormone — are associated with diminished sleep, according to studies.
• Changes to circadian rhythms, the 24-hour rhythms that help regulate sleep as well as many other biological processes, occur with age. Age-related alterations to circadian function appear to compromise sleep quality and sleep quantity.
• Genetics may play a role in sleep declines that come with age. Research indicates genes may influence deterioration to sleep and circadian rhythms that occur with age.
• As they age, adults spend more time in the lighter stages of sleep. In light sleep, older adults are more vulnerable to disruption from environmental stimuli: bursts of noise, intrusions of light, and changes in temperature.
• Older adults are more likely to need to use the bathroom throughout the course of a night, which can result in more frequent awakenings.

Older adults can help to diminish sleep problems by maintaining a consistent sleep-wake schedule. Sticking to regular bedtimes and wake times reinforces circadian rhythms and helps to regulate the body’s sleep drive. Other strategies for protecting sleep with age include:

• Regular exercise.
  Exercise provides a significant boost to sleep. Studies show that regular, moderate exercise in older adults can help improve sleep quality. The form of exercise appears to be less important than making exercise a habit. Aerobic exercise, resistance training, and mind-body exercises such as tai chi have all demonstrated benefits to sleep. To avoid disrupting sleep, don’t exercise within three hours of bedtime.
• Naps.
  If a full night’s sleep isn’t happening on a regular basis, older adults can benefit from daytime naps. The timing and duration of naps are important. Late afternoon and early evening naps may interfere with nighttime sleep. Finishing naps by mid-afternoon can help avoid this interference. Even a short nap, as little as 10-15 minutes, may make a significant difference in feeling refreshed and energized. Longer naps may be necessary, but shouldn’t exceed 90 minutes, the length of a full sleep cycle, to avoid inhibiting nighttime sleep.

Couple in bed photo available from Shutterstock