Sleep studies show that with aging, many people have a harder time falling asleep. They also awaken more often during the night, averaging three or four awakenings each night. This may happen because they spend less time in deep (REM) sleep and because they may be awakened by pain from an injury or illness or they may need to get up to urinate.
Because of changes to circadian rhythms, they also may find that they become sleepy earlier in the evening and wake earlier in the morning than when they were younger. Total night time sleep time decreases but some of this may be made up for with increased daytime napping. Some older adults also report being less satisfied with sleep, having more daytime sleepiness, and feeling more tired during the day.
Other causes of sleep disturbances in older adults
In addition to sleep difficulties associated with normal aging, older adults may also have medical or psychiatric illnesses that are associated with poor sleep, including depression, anxiety, chronic pulmonary disease, cardiovascular disease, and dementia. Chronic pain may disturb sleep as will restless legs syndrome and periodic leg movements of sleep. Finally, the prevalence sleep apnea may be increased in older adults and adults with certain chronic conditions that are more common in older individuals. Sleep disturbances related to these types of conditions should be discussed with a physician as special testing and treatments may be required to resolve them.
Tips for dealing with sleep impairment related to aging
Sleep experts recommend you take the following steps to help you sleep better:
- Make your bedroom sleep friendly. Make sure it is pitch dark at night. If you are unable to darken it, try a good quality sleep shade that is comfortable and completely blocks out the light. Figure out the best room temperature for you. Some people sleep better when it is cool and others when it is warmer. If your bedroom environment is too noisy (your night owl neighbor loves rock music and refuses to give it up), try noise canceling headphones or a device that produces soothing white noise. Make sure your bed and pillows are the optimal degree of softness or firmness for you and that your blankets or comforter are neither too light nor too heavy. If you are like the Princess who could feel a pea under a pile of mattresses or even the slightest wrinkling of your sheets drives you crazy, invest in new sheets or buy sheet suspenders or straps that keep the bed surface smooth no matter how much you toss and turn.
- Use the bedroom only for sleep so that you learn to associate the sleep friendly room you have created with getting a good night sleep.
- Establish a regular sleep routine. Try to go to bed and wake up at approximately the same time every day, even weekends and holidays.
- Relax before you go to bed. There are many options that can help you wind down before closing your eyes to go to sleep. Some people like to meditate (with or without meditation tapes); some prefer a warm bath (with or without bubbles); for others, reading a book or listening to soothing music or meditation tapes may do the trick.
- Exercise daily. Exercise should be a part of every senior’s daily routine, but for sleep’s sake, try not to exercise within 3-4 hours of your usual bedtime.
- Check your medications. Do a search online to see if any of the medications that you are taking for a new or chronic condition could be interfering with your sleep. Then ask your doctor if it is possible to change the offending medication for another that is equally effective, but less likely to cause sleep problems.
What you shouldn’t do
- Try not to force sleep. Laying in bed, hoping you will fall asleep when you are actually wide awake, may contribute to any anxiety you have about falling sleep. If you are unable to fall asleep after 20 to 30 minutes, get up and engage in a relaxing activity, such as listening to quiet music or reading or listening to a book in a low light environment, preferably not your bedroom. When you feel sleepy, go back to bed.
- Avoid stimulation 3-4 hours before you go to sleep. This includes things you put into your body (caffeine, tobacco smoke, stimulant drugs) and things you do (watching horror movies on TV or going over pressing to do lists or other topics that may make you anxious).
- No napping. Avoid taking naps during the day, especially in the afternoon, as this may keep you up at night.
- Try not to watch television or use your computer, cell phone, or tablet in the bedroom. The light from these devices, particularly blue light, may make it difficult for you to fall asleep.
- Don’t eat large meals close to bedtime. They can keep you awake particularly if you have gastroesophageal reflux.
- Avoid drinking alcohol close to bedtime. Even though alcohol may help you fall asleep, it disrupts deep (REM) sleep and can make you feel drowsy and groggy in the daytime. Some people have called this “junk sleep.” Alcohol is also associated with sleep apnea (pauses in breathing) and definitely should be avoided if you have this condition.
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What about medications?
There are a wide variety of prescription medications that are used to help with chronic sleep disturbances. These include benzodiazepines, such as lorazepam, temazepam, and many others, as well as nonbenzodiazepine drugs that act on the benzodiazepine receptor. Some drugs in the latter category are zaleplon, zolpidem, and eszopiclone. These drugs are effective but have serious side effects including dependence. They can also interact with other medications you are taking. You should only use these drugs for a short time in consultation with your doctor.
Antidepressant medicines can be very helpful if depression affects your sleep. Antihistamines, such as diphenhydramine, may make you drowsy and facilitate falling asleep. Again, these drugs should be used in consultation with your doctor because drug interactions and adverse side effects may occur.
Melatonin is available over the counter, but here is an important caveat: As is true with all supplements, the quality of the product you buy may vary because the supplement industry is not regulated. Studies of various types of supplements have shown varying amounts of the active ingredients as well as adulteration with other compounds, some of which may be toxic. You should research the quality of any melatonin product before you put it in your mouth.
The bottom line
So, there you have it. Sleeping patterns change as we age, but luckily there are a lot of things that you can do that can help you sleep better even though you no longer sleep like a baby.
Patricia Salber, MD, MBA
Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.
Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.
She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.
She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.
She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.
Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.
Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.