Sleeping Well As We Age:

The importance of quality sleep for seniors

No matter what your age, getting the proper amount of sleep is essential to your physical health and emotional well-being. Experts disagree about whether you need less sleep as you age, or if it is just more difficult to get the sleep you need. Either way, many seniors complain about sleep problems such as:

• a desire to go to bed earlier
• difficulty falling asleep
• frequent waking during the night, and lighter sleep
• waking up early and not feeling rested
• being tired in the daytime
• needing naps during the day

To feel your best, you need a restful night of sleep, good nutrition, and exercise. You may be surprised at how good you feel when you get enough sleep.

As we age, a good night’s sleep is especially important because it improves concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system which helps to prevent disease.

Causes of sleep changes as we age

As you age, you may perceive unwelcome changes in your sleep patterns, such as more fragmented sleep (more rapid sleep cycles), a decrease in deep sleep, and more awakening between sleep cycles. These changes are in the quality of sleep, rather than in the quantity of sleep. In addition, certain hormones decrease as you get older and may alter your former sleep/wake timeframe so that you feel like going to bed earlier and waking up earlier.

If you or a senior you care for is having trouble sleeping well, consider some common causes of sleep problems in the elderly:

• Poor sleep hygiene – The most common cause of insomnia in the elderly is poor sleep habits or a poor sleep environment. Examples of poor sleep hygiene are irregular sleep hours, consumption of alcohol before bedtime, and too much daytime napping.
• Pain or medical illness – Pain can keep you from sleeping well. In addition, many common health conditions can interfere with sleep: a frequent need to urinate, arthritis, asthma, diabetes mellitus, osteoporosis, nighttime heartburn, menopause, and Alzheimer's.
• Medications – Seniors tend to take more medications than do younger people. Combinations of drugs, as well as the side-effects of individual drugs, can impair sleep or even stimulate wakefulness.
• Lack of exercise – If you are too sedentary, you may not feel sleepy. Alternatively, you may feel sleepy all of the time.
• Psychological stress or psychological disorders –Significant life changes like the death of a loved one or moving from a family home can cause stress. Anxiety or sadness can also keep you awake, and sleeplessness can, in turn, cause more anxiety or depression.
• Sleep disorders - Restless Legs Syndrome (RLS),insomnia, and sleep-disordered breathing such as snoring and sleep apnea occur more frequently in older adults.

Medications can interfere with quality sleep

If you are like older adults, you take medications for one or more ongoing conditions. You may take heart medications, diabetes medications, or something for congestion. Any of these medications may have the side-effect of keeping you awake. In addition, a combination of medications can also cause sleep trouble.

While it may be difficult to pinpoint which medication could be causing sleep problems, your doctor should be able to help. Take a list of your medications to your physician and discuss your sleep problems. The solution may be as simple as switching the time of day you take your medication; changing to another medication; or lowering the dosage.

Sleep tips for the elderly

Aging alone is unlikely to be the cause of your sleep problems. Poor sleep hygiene (your sleep habits and your sleep environment) is often the main cause of low-quality sleep, and is often responsible for sleep problems in aging people.

Fortunately, sleep hygiene is easy to improve. Start by improving your sleep habits and sleep environment; then consider the other possible causes for your sleep problems.

Following are some ideas on how to tune up your sleep hygiene.

Sleep Tips for the Elderly

Keep a regular sleep schedule – Go to bed and wake up at the same time every day, even on weekends. Experiment with napping – Although napping too close to bedtime, or long naps, can interfere with nighttime sleeping, some people find that short naps early in the day improve their overall feeling of being rested. Expose yourself to sunlight - Get at least two hours of bright sunlight each day. Exposure to sunlight increases your body’s production of melatonin, which regulates your sleep-wake cycles. Separate yourself from a snoring sleep partner - If your sleep partner snores, consider ear plugs or a white-noise machine, or sleep in separate bedrooms. Go to bed early - Adjust your bedtime earlier, to concur with when you feel like going to bed. Limit smoking - Nicotine is a stimulant and can keep you awake. If you can’t quit smoking, avoid smoking within three hours of bedtime. Develop bedtime rituals - Create soothing bedtime rituals, such as taking a hot bath or playing calm music. Monitor your medications – Drugs you take for your medical conditions may be interfering with your sleep. Take care of your psychological health – Stress and anxiety can keep you awake. Limit your use of sleeping aids and sleeping pills - Some over-the-counter sleep aids and prescription sleeping pills have harmful side-effects, and most are not designed to be used long-term. Combine sex and sleep – Sex and physical intimacy, such as hugging and massage, can provide relaxation and the physical release that lead to restful sleep. If sex makes you feel more awake, however, don’t have sex right before you want to sleep

To nap or not to nap – what is the right answer for me?

For many people, taking a brief nap during the day perks them up to perform fully for the rest of the day. Experiment with napping to see if it helps you. If you don’t feel fully alert during the day, a nap may be just what you need.

Take only a brief nap (15 to 30 minutes). Napping longer than this puts you into deeper sleep, and you will feel groggy for a while afterwards. And take your nap in the early afternoon, not the late afternoon - if you nap too late, you won’t be able to fall asleep at night.

Using diet and exercise to reduce senior sleep problems

How can the foods you eat close to bedtime disturb your sleep?

To promote good sleep, pay particular attention to the foods you eat in the evening. Following are some ways to alter your pre-bedtime diet to improve your sleep.

Bedtime Diet Tips to Improve Sleep
Limit caffeine late in the day	Coffee, tea, caffeinated soft drinks, and chocolate can all keep you awake. Depending upon your sensitivity, avoid caffeine in the late afternoon and evening. Some people are still affected by caffeine eight hours after ingesting it.
Avoid alcohol before bedtime	A nightcap of alcohol may make you feel sleepy, but your sleep will be disrupted later in the night. Don’t use alcohol as a sleeping aid.
Satisfy your hunger prior to bed	Have a light snack such as crackers, cereal and milk, or yogurt. Some people find that warm milk helps them to sleep because it contains an amino acid that acts as a natural sedative.
Avoid big meals or spicy foods just before bedtime	You can get heartburn or aggravate a hiatal hernia with large or spicy meals. Try to eat dinner at least three hours before bedtime, and don’t consume too many calories.
Minimize liquid intake before sleep	Limit what you drink within the hour and a half before bedtime so that your sleep is not interrupted by needing to get up to go to the bathroom.

Can a lack of exercise affect my sleep?

A sedentary existence can make you feel sleepy all of the time, or else not very sleepy any of the time. You can develop an exercise plan that helps to regulate your sleepiness. However, you should always consult a doctor for exercise recommendations that suit your physical health.

Build up your exercise program slowly. Ask your doctor to supervise your exercise plan, and very slowly increase speed and vigor. Even something as simple as a daily walk can do wonders for your sleep regularity. And make sure to exercise early in the day – exercise releases certain chemicals in your body that lead to sleep, but exercise too late in the day can be stimulating – so do your exercise at least six hours before retiring.

Exercise suggestions for older individuals

The following are suggestions for incorporating physical activity in your life. No matter what form of exercise you choose, include stretching and strengthening as part of your routine – flexibility and strength are a major part of physical health. If you have mobility issues, you can exercise from one position, either standing, sitting, or lying down.

• Swim – If your joints are sore and your muscles weak, swimming is a gentle way to build up fitness. Many community and YMCA pools have swim programs just for older adults.
• Dance – If you love to move to music, go dancing or take a dance class. Dance classes are also a great way to extend your social network!
• Take up lawn bowling, bocce, or pétanque – Variations on throwing a ball on an earthen or grassy court are gentle ways to exercise.
• Golf – Golf is a form of exercise that requires precise, strong movement of particular parts of your body, but which doesn’t require vigorous locomotion. If you wish, you also can include walking in this sport.
• Garden – Gardening is a gentle way to increase your flexibility and range of motion.
• Cycle or run – If you are in good enough shape, you can run and bicycle until late in life.

Reducing mental stress to improve your sleep

Your thoughts can keep you from falling asleep or can wake you up in the middle of the night. Everyone has worries and lists of things to do, but it is important to teach yourself to let go of these thoughts when it’s time to sleep.

Tips for Reducing Mental Stress to Improve Your Sleep
Keep a journal to record worries and concerns before you retire. On your to-do list, check off tasks accomplished for the day and list what you need to do tomorrow, then let go! Listen to calming music. Read a book that makes you feel relaxed. Get a massage from a friend or partner. Use a relaxation technique to prepare your body for sleep. Talk about what is troubling you.

Talking to your doctor about senior sleep problems

The next time you see your doctor for a routine physical, mention any sleep problems that you have. If your own attempts to solve your sleep problems are unsuccessful, your doctor can probably help solve sleep problems due to:

• A sleep disorder
• Medication side-effects or interactions
• Medical conditions or illnesses
• Pain

Bring with you a sleep diary that you have recorded for a couple of weeks  Include when you use alcohol, caffeine, and nicotine. Keep track of your medications, exercise, lifestyle changes and recent stresses.

Above all, don’t just expect to sleep poorly as you age. Just as younger adults can solve their sleep problems, so can you.

Related links for sleeping well as we age

General information about sleep and aging

Sleep and Aging – An easy-to-understand guide to sleep for seniors. Includes ample illustrations and video clips. Displays information in easy-to-read chunks, and then offers optional quizzes on each section. (NIH Senior Health)

Older Adults and Sleep – Comprehensive series of articles covering various topics related to sleep and aging. Includes specific medical problems affecting sleep; dementia-related sleep problems; menopause and sleep; snoring; and sleep apnea. (National Sleep Foundation)

A Good Night’s Sleep – An overview of sleep changes in older adults, common problems, and things you can do to alleviate sleep problems. (National Institute on Aging)

Sleep Problems in the Elderly – Journal article that provides a wealth of information on seniors and sleep problems. (American Family Physician)

Diet, exercise and sleep

Foods for Sleep – Foods recommended to help you sleep, and others that keep you awake. (AskDrSears.com – commercial site)

Caffeine Calculator (PDF) – A handy list of how much caffeine is in common drinks and foods. (SleepFoundation.org)

Diet, Exercise, Sleep! The Path to a Healthier Lifestyle – Little-known facts about the interrelationships between sleep, nutrition, and exercise. (SleepFoundation.org)

Napping

New Respect for the Nap, a Pause That Refreshes – Encouraging words for taking a nap in the middle of the day to improve performance for the rest of the day. (Jane E. Brody, Science Times)

The Short Story on Napping – Key facts about napping and guidelines for how and when to nap. (National Sleep Foundation)

Relaxation

Relaxation Techniques – Learn about several types of relaxation including progressive relaxation, toe tensing, deep breathing, guided imagery, and quiet ears. (University of Maryland Medical Center)

Tina de Benedictis, Ph.D., Heather Larson, Gina Kemp, M.A., Suzanne Barston, and Robert Segal, M.A., contributed to this article