Aging and Sleep - How Seniors Can Get Better Sleep

While the golden years may usher in plenty of good surprises, they also come with a few curveballs. Even if you were a previously perfect sleeper, you may find that you are now waking earlier, getting up more frequently during the night, or may be having a harder time falling asleep. Are your days of getting a good night’s sleep over? No! Let’s talk about aging and sleep, and how you can get your sleeping routine back in check.

The average adult needs approximately 7-9 hours of sleep per night – and this doesn’t change the older you get. It’s a common misconception that seniors need less sleep, however their needs are the same as anyone else’s. Despite needing the same amount of sleep, 44% of older Americans are suffering from some sort of sleep issue.

Sleep is an incredibly important process that keeps our bodies functioning at optimal levels, something that becomes even more important as we get older. To understand sleep issues as we age, we must first understand how sleep works and why we need it. A normal sleep cycle lasts about 90 minutes and can be broken down into two different types: Rapid eye movement (REM) sleep and non-REM (NREM) sleep. Within those two different types, there are 4 stages of sleep – here’s a breakdown:

Stage 1: This first stage of NREM sleep is a light sleep, lasting only a few minutes or so. Here, your body is preparing to fall into a deeper sleep, your eye movements slow down, and your brain activity begins to increase. During this stage, you can be awoken easily since you’re only lightly sleeping.

Stage 2: During this NREM stage, your heart rate begins to slow down, your muscles relax, and your body temperature decreases slightly. Eye movements will slow down during this stage, and your brain waves slow down with occasional increases in activity.

Stage 3: This NREM stage is restorative sleep, the kind that makes you feel refreshed. If someone were to wake you up during this stage, you would likely feel disoriented for a few minutes before realizing your surroundings. Our eye movements slow down or stop, and it’s very difficult to wake us up. This stage is an important one – it’s where your body starts repairing muscle, strengthening your immune system, and other vital processes. It’s also during this stage that growth hormones are released, which are essential for muscle development and overall growth and development.

REM sleep stage: During REM sleep, our eye movements increase dramatically, as the name suggests. REM sleep is the stage where you dream the most, and it’s thought that the eye movements are related to the dreaming that you’re doing. During this stage, most of your muscles are in a paralyzed state, to keep you from acting out your dreams. Don’t worry though, the important muscles like your heart and diaphragm aren’t paralyzed and are working like they’re supposed to! REM sleep gives your brain the energy it needs to keep you alert during the day, which makes it an ultra-important component to the sleep cycle.

While the average sleep cycle lasts 90 minutes, you will go through several cycles of varying lengths over the course of a night. During your first few sleep cycles, you’ll go through longer cycles of NREM sleep, followed by a few cycles of REM sleep. As if that doesn’t complicate things enough, there has been research that shows that the time of day can affect what type of sleep you get. For example, it is thought that most NREM sleep happens between the hours of 11pm and 3am, and REM sleep more often happens between 3am and 7am.

Late to bed, early to rise. Seniors may notice that their bedtimes are later and later, and they may find themselves waking before the sun rises! It’s okay that your times are shifting, it just means that your internal clock is changing. Try to accommodate your body’s needs by shifting your bedtime and wake routines slightly until you find one that works for you.

Restless leg syndrome. One of the most annoying reasons older adults can’t sleep is restless leg syndrome. You may feel as though you need to constantly move your legs and cannot get into a comfortable position. Talk to your doctor about medications that may be able to get these symptoms under control and to make sure that they aren’t a symptom of an underlying condition.

Temperature regulation. Older adults can have a harder time regulating their body temperature, and that can be made worse at night. Make sure that your room is at a comfortable temperature for you – an optimal temperature is 60-68 degrees Fahrenheit. If you tend to be cold often, have an extra blanket on hand to snuggle up with.

Sleep apnea. Sleep apnea is a disorder during which a person may stop breathing for several seconds while asleep, causing a brief drop in oxygen levels and resulting in fatigue, headaches, inability to fall or stay asleep, and other unpleasant side effects. It’s caused by a variety of factors, including large tonsils and/or adenoids, obesity, or even genetics. It can affect people of all ages, but its effects can be harder to manage as we age. Sleep apnea is diagnosed by a medical professional, usually through a sleep study during which the person is observed for several hours while sleeping. Once diagnosed, sleep apnea can be treated in a few different ways. Surgery to remove tonsils and/or adenoids can sometimes be an effective option, but often, it is not advised for elderly people to go under anesthesia. A common, non-invasive treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine. These machines force air into your lungs at preset intervals, making sure that you are breathing regularly and deeply enough. This is accomplished by wearing a mask either over your nose or over your mouth and nose. Options for these machines include humidified air, which will cut down on the amount of irritation your nose may experience.

Frequent bathroom trips. The need for frequent urination increases as we age, for a variety of reasons. An overactive bladder is a common complaint among the elderly and can be attributed to a few different medical conditions. As men get older, their prostates may enlarge, placing pressure on the bladder and increasing the frequency of bathroom trips. Medications are also a big-time culprit, especially those that are used to treat high blood pressure and congestive heart failure. These medications are called diuretics, commonly known as “water pills.” Some examples of diuretics include Lasix (furosemide), hydrochlorothiazide (HCTZ), and Bumex (bumetonide). 

Talk to your doctor. If you suspect that your water pills may be the reason you aren’t sleeping well, talk to your doctor about changing the times at which you take them. While it isn’t always possible to adjust medication times, you can never be sure unless you ask. Remember, do not adjust your medication schedule without consulting your healthcare team first, as this may cause them to not work like they’re supposed to.

Your doctor can also recommend medications to manage other conditions that may be affecting your sleep quality, like restless leg syndrome. If other methods to get quality sleep have failed, your doctor may also recommend a sleep medication. It’s important to talk to your doctor before starting a sleep medication, since sleep aids can often mask an underlying issue. Your doctor will be able to look at all your medications and choose a sleep aid that won’t interfere with your other meds or affect your liver or kidneys negatively.

Limit liquids. It’s important to stay hydrated, but you should also plan out your liquid intake. Try to have your last sip of liquids about an hour before you plan to head to bed. This will hopefully head off any extra trips to the bathroom.

Avoid caffeine. Did you know that caffeinated beverages have a diuretic effect? Coffee and tea can make you have to go to the bathroom more! It’s a bummer since these are traditional before-bed drinks, but that doesn’t mean you have to avoid them completely. Choose a decaffeinated option for your nightcap, and make sure that your last caffeine-containing drink is consumed at least 6 hours before you plan to head to bed. Not only will you avoid the frequent bathroom trips, but you may also have an easier time falling asleep.

Have a sleep routine. There’s no doubt that having a bedtime routine and regular sleep schedule can help your body adjust to whatever changes it is going through. While we know that a routine is impossible to stick to 100% of the time, try to have a regular bedtime and wake time to keep your body’s clock running smoothly and regularly. Many people find it helpful to set an alarm for both bedtime and awakening and stick to those times even on the weekends. If you feel as though you need to “sleep in” on the weekends, you may not be getting enough sleep during the week and you should reevaluate your routines.

Turn off the TV. This really applies to all electronic devices, including cell phones and tablets. Switch them off between 30 minutes to an hour before you plan to go to sleep. Screens can emit blue light, which research has shown can affect your ability to fall and stay asleep. Instead, read a book before bed or listen to a meditation tape to relax. If you have a smartphone, use a meditation app to help guide you to relaxation.

The bottom line is this – just because you’re getting older doesn’t mean you can’t get a good night’s sleep. Keep an open line of communication with your healthcare provider to figure out what’s keeping you up and how to fix it. Happy sleeping!

Mary Sweeney, RN, BSN, CEN, ONN-CG, is an oncology nurse navigator and medical writer, currently writing for StartSleeping.org. Before working in nurse navigation and patient education, Mary was an emergency nurse at a level 1 trauma center, followed by active duty time as an officer in the Navy Nurse Corps. In the military, she worked in several areas including emergency/trauma, post-anesthesia, and deployment medicine. In her career, she has picked up on the important value sleep plays to health both in and outside of the military.  

https://www.sleepfoundation.org/articles/aging-and-sleep

https://www.webmd.com/sleep-disorders/features/do-seniors-need-less-sleep#1

https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174