Elderly Sleep
How does sleep change as you age?
We all require sleep for optimal health and well-being but our sleep needs, sleep quality, and sleep timing changes after about age 60-65.
Firstly, seniors require slightly less sleep, so between 7-8 hours as opposed to 7-9 hours earlier in adult life.
Second, your sleep-wake cycle and circadian rhythm, which is what controls when you sleep and when you wake, changes and starts losing its strength and consistency. So as you get older, you may begin to feel tired earlier, and wake up earlier in the morning. You also start producing less melatonin, which is a hormone that signals to your body to start the sleep process.
Lastly, your sleep architecture changes, which refers to the amount of time you’re spending in the different stages of sleep. You gradually start spending less time in deep sleep and more time in the earlier lighter stage of sleep, where you’re more likely to be woken up so you may feel like you’re not getting that deep, restorative sleep as your sleep feels more fragmented.
Aging and sleep challenges
Getting older can be a significant time of major hormonal, physical and psychological change and it’s important to acknowledge this. Apart from changes in your actual sleep systems, there are some additional compounding issues that specifically affect seniors and put them more at risk for developing sleep disorders.
As people reach retirement and don’t have the same fixed work schedules and time demands, they may start having more inconsistent bedtimes and wake times. If you don’t have to be up for anything, there’s more fluidity in your schedule. Seniors might start taking more naps during the day or sleeping in and all this can have a big impact on night time sleep.
Furthermore, if you don't have to be up and out for anything, you may be getting a lot less light exposure during the day and light plays a HUGE role in our sleep wake cycle. Simply put - light sends a message to our brain to wake up and our bodies start to release alerting and mood boosting hormones and suppress the release of melatonin. Conversely, darkness sends a message to our brain to release melatonin and start the sleep process. What can happen in the elderly is that they’re not receiving enough bright outdoor light during the day and they’re getting too much artificial light in the evenings, which can cause sleepiness and alertness at the wrong times.
Stress and anxiety can also influence sleep and there are legitimate worries that accompany aging. For example, retirement, empty nesting, caring for a partner - these are all big changes that may affect someone’s psychological well-being. And of course having your own health issues or experiencing loneliness if a loved one has passed are important life stressors that can start to occur around these years. Sleep and stress have an important bidirectional relationship - we need sleep to balance our stress levels but stress can prevent us from falling asleep and it can create a vicious cycle of sleeplessness.
Related to this is what we’re doing or not doing in the minutes and hour before we go to sleep. Sleep does not operate on an on/off switch, it’s like slowly landing a plane and our brains and bodies need signals to help us transition to sleep. If you don't allow yourself time to both process your stress from the day and wind down, it may become difficult to either fall asleep or stay asleep.
And lastly, as you age, medical conditions may interfere with sleep. For example, joint pains, body aches and other illnesses associated with aging can contribute to sleep problems. You lose elasticity in your bladders as you get older, causing more frequent trips to the bathroom, which can interrupt the night. And medications can affect your sleep, causing alertness in the evenings or interfering with your sleep architecture or other systems in your bodies that are connected to sleep. Others can affect your daytime energy levels, creating drowsiness.
So it’s not always immediately clear cut what’s causing what but we do know that this particular period in a person’s life can bring about a lot of change.
Common sleep disorders:
The most prevalent sleep disorders for the elderly include insomnia, sleep apnea, restless leg syndrome, periodic limb movement disorder, REM sleep behaviour disorder, and advanced sleep phase disorder. What’s important to know is that your risk of having one of these sleep disorders increases as you age due to all the previous factors I just mentioned and there can also be a crossover of these disorders, meaning you may have more than one of these at the same time. So it’s important to examine all the various potential factors in a person’s life in order to determine the root cause so you can select the appropriate treatment.
Sleep Tips:
Try to go to bed and wake up at the same time each day 7 days of the week.
Manage your light exposure. Unless you have been diagnosed with Advanced Sleep Phase Disorder, you want to ensure that you’re getting lots of bright light first in the morning and throughout the day (outdoor light best and remove those sunglasses!). And outdoors is a great place to do physical activity if you can do so safely. Remember, you want to move your body during the day if you can to help build up that sleep drive.
In the evening, limit your light exposure as the sun goes down. Turn on lamps and try to put away phones and screens about 30-60 min before bed.
Create a relaxing, repetitive, and consistent bedtime routine approx 30-60 min before bed. Choose activities that are relaxing and not particularly stimulating - this may be folding laundry or tidying, listening to music or a podcast, cooking, reading, stretching, breathing exercises etc. but make sure that you try and do the same activities at the same time each day. Manage your stress levels during the day or in the evening hours before bed by engaging in activities such as deep breathing, meditation, mindfulness, guided imagery, talking to a loved one, taking a bath or journalling.
Watch your nutrition and intake of substances. Eat your lightest meals in the evenings a few hours before you go to bed and avoid inflammatory foods (eg sugar, spices) late at night. Reduce or eliminate caffeine, nicotine or alcohol in the hours before bed because they can interfere with your sleep. You may also want to consider reducing your fluid intake in the evenings to minimize bathroom trips in the middle of the night.
Make your bedroom dark, cool, quiet, well-ventilated, and tidy while keeping it safe to prevent any trips or injury if you are up in the middle of the night. You may want to consider:
having a side lamp within reach that you can switch on easily
using dim or motion activated night lights in the bathrooms and hallways to illuminate your path
removing obstacles or rugs on the way to the bathroom
keeping a phone by your bed with emergency numbers on speed dial
