Does sleep change as we age?June 20, 2018 0 Comments
[by Tamara Sellman RPSGT CCSH for Advanced Cardiovascular Sleep Disorders Center]
It would seem that senior citizens are a sleepy bunch and their need for naps automatically presumes that older people simply need more sleep.
However, aging itself does not determine how much we sleep as adults. In fact, a healthy 80 year old will probably need the same amount of sleep (about 7 to 9 hours a night) as someone 50 years their junior.
Adults of all ages experience multiple stages and periods of sleep at night, including light sleep, deep sleep, regular sleep and dream sleep.
With aging, sleep patterns can change. Most notably, the transition between sleep and waking up can be abrupt. Older people spend less time dreaming as well. It’s no wonder they don’t feel as young as they used to. But it doesn’t have to be this way. So why is it that our seniors seem to be so sleepy all the time?
Senior Sleep: The challenges
Changes in sleep phasing
You may have heard about how teenagers tend to stay up far later than the rest of us, and that it’s related to their brain development. That’s a physiological, circadian reality in adolescence otherwise referred to as delayed sleep phase. Most young people outgrow this delay in their sleep phase by their mid 20s.
Older people experience a different kind of circadian shift. Advanced sleep phase refers to the drive to go to bed far earlier than is common (and the result is that rise times are earlier, as well.) This is likely one of the reasons why skilled nursing facilities and supervised senior homes have meals at 5pm: their residents are usually turning out the lights by 7pm!
Just as there’s nothing particularly wrong with teenagers going to bed late, so it goes for our seniors preferring an earlier bedtime. It’s just part of our circadian rhythms. Only when the shifts run to extremes (teenagers going to bed at 3am? Or seniors going to bed at 3pm?) that these shifts become a cause for concern).
Insomnia is a pretty common sleep disorder among the elderly. (In fact, it’s pretty common no matter how old you are.) As we age, other aspects of the aging process may interfere with our ability to fall asleep.
Take menopause, for example. Women going through “the change of life” experience disruptions to sleep that are directly related to hormone changes (such as hot flashes and other symptoms that lead to sleeplessness). Another example might be someone, male or female, who suffers from arthritis. Degenerative joint disease leads to pain that can make it hard to fall asleep at night because there’s no good position for sleeping and the joints may be stiff or throb at night. In either of these cases, medications for relief may help tone down the discomfort, but may also make it hard to sleep at night because of side effects.
Sleep architecture changes
It’s true that the older we get, the less likely we’re going to get the deepest sleep. Our deepest sleep stage, stage 3 (also known as delta sleep, slow-wave-sleep, or N3) is best enjoyed in our youth as this is the time when the body releases human growth hormone (HGH) into the bloodstream. HGH is a kind of internal “fountain of youth” that helps the body recovery from damage caused by injuries or illness or stress during the day. As we age, our bodies generate less of it because we are simply no longer developing like children are.
Those who snore (both male and female) are likely candidates for a sleep breathing disorder known as sleep apnea.
In obstructive sleep apnea, the mechanics of breathing are disrupted during sleep, usually by a collapse of the tissues of the upper airway or a blockage caused by overlarge tonsils or swelling in the neck. This leads to frequent periods all night long when breathing stops taking place. Sleep apnea can make it hard to fall asleep and to stay asleep. When it’s untreated, it can accelerate many chronic age-related conditions as well.
In central sleep apnea, breathing while asleep is dysfunctional due to signaling problems between the brain and the respiratory system. It’s as if the brain forgets to tell the diaphragm and the lungs to continue breathing as you sleep. This also makes it hard to fall asleep or stay asleep and it another reason why people suffer from certain kinds of health problems common in the elderly.
Many people (of all ages) struggle with discomfort in their legs at bedtime. They experience unpleasant sensations in the muscles of the legs that seem only to be relieved by getting up and moving around. Restless legs syndrome is a sleep disorder because of its tendency to force a delay of sleep onset. People lose sleep at the beginning of the night simply trying to overcome the discomfort in their legs. However, once they fall asleep, they can usually remain asleep.
A related problem is periodic limb movement disorder (PLMD). This movement disorder of sleep occurs only after the sufferer falls asleep; it occurs in periodic patterns which involve activity usually in the legs (though it can happen in the arms as well). Toe pointing or flexing, knee bending, and other movements occur in a repetitive fashion all night. Though a person with PLMD may not notice they have this condition, they’ll feel it later as persisting daytime fatigue, as sleep can become fragmented as a result of this condition. They also might be told they move their legs at night by their loved ones, who may be losing sleep because of it!
Most older people rise 3 or 4 times a night to use the bathroom. This may be due to problems with the bladder and kidneys (and prostate, in men), an undiagnosed case of sleep apnea, or metabolic problems caused by diabetes. The frequent nocturnal visits break up sleep even further, making it even less refreshing.
Does sleep help keep us young?
In a sense, sleep is one of the main ways we can best invest in our own mental, emotional, and physical health. If we don’t get enough of it, eventually that sleep deficit catches up with us in the shape of depression, cognitive dysfunction, heart disease, obesity, diabetes, stroke, kidney disease and other chronic illnesses that can happen at any time during adulthood.
In addition, more research continues to show a relationship between poor sleep and the development of Parkinson’s disease, Alzheimer’s disease, and other neurological disorders that are typically related to aging. When you lose sleep on a regular basis, it leads to problems with memory, clear thinking, decision making, and learning, problems we normally associate only with aging. However, these are problems that happen to anyone who doesn’t get adequate sleep, including young children.
It’s also worth adding: If you have experienced poor sleep and/or sleep deprivation throughout your life, you’re more likely going to feel the brunt of it the older you get. This is because of changes in sleep architecture that don’t allow for the deep restorative sleep of younger days; add that to a growing list of aches and pains that come with aging and sleep loss is sure to only enhance your discomfort and other symptoms of aging.
Not only is losing sleep or having fragmented or unrefreshing sleep a nuisance, it can lead to car accidents, bad falls, and mood changes that can really make it hard to enjoy the golden years.
What can our elderly loved ones to do to improve their sleep?
Good sleep hygiene is something we should all be practicing, no matter what our age. Here are some prime examples of sleep hygiene best practices:
- Go to bed at the same time every night.
- Arise from bed at the same time every morning.
- Put away handheld electronic devices an hour before bedtime.
- Avoid caffeine after lunch.
- Avoid alcohol at bedtime.
- Avoid smoking at bedtime.
- Make sure the medications you take aren’t causing daytime sleepiness or insomnia; ask your doctor or pharmacist for tips on when to best take them, or seek alternatives if the ones you’re taking now are interfering with sleep.
- Keep naps short, if you need them.
- Take a walk in the morning, weather and access permitting.
- Manage pain conditions properly so you can get enough sleep. Stretching, massage, and pain relief through topical medications or electrostimulation can be as helpful as some medications, but without the side effects.
- It’s okay to enjoy a light bedtime snack if that might help promote sleep, such as warm milk, herbal tea, a banana, or crackers.
- Practice relaxation techniques at bedtime. Breathing exercises, yoga, relaxing music, visualization, light reading, or other types of sleep-inducing rituals at bedtime are known to make it easier to fall asleep.