An estimated 35 million Americans report dissatisfaction with the length and quality of their sleep. More than 50 percent of people over the age of 65 who live in the community and nearly two-thirds of seniors living in nursing homes are affected by sleep disturbances.
An understanding of the sleep cycle and age-related changes in sleep patterns partly explains why sleep gets more difficult as we age, says Eran Metzger, M.D., director of Psychiatry at Hebrew SeniorLife.
Humans sleep in five distinct stages: stages 1, 2, 3, 4 and REM (rapid eye movement). These stages progress from 1 through REM and then start over again. The majority of our sleep is spent in stage 2 (50 percent) and REM (20 percent). Stage 1 is when we begin to fall asleep and are easily awakened. Our deepest sleep, when we have no eye movement or muscle activity, occurs in stages 3 and 4. Dreams occur in the REM stage, when our eyes jerk rapidly in various directions, our heart rate increases, and our blood pressure rises.
Another important aspect of sleep biology is the human circadian rhythm. Controlled by a biological "clock," the human circadian rhythm regulates changes in mental and physical characteristics that occur throughout the day, including the sleep/wake cycle, body temperature, hormone secretion, urine production and changes in blood pressure.
In older adults, sleep patterns and stages often change. More time is required to fall asleep. More nighttime arousals and awakenings occur. The overall sleep/wake cycle is more fragmented. The deepest stages of non-REM sleep are frequently reduced or nonexistent. And the normal circadian rhythm is altered, as older people tend to go to sleep earlier in the night and awaken earlier in the morning.
A number of other factors, says Dr. Metzger, can also affect seniors’ quality of sleep, including:
- Medical illnesses - acute and chronic conditions such as arthritis and gastrointestinal, pulmonary and neurodegenerative diseases, as well as pain and discomfort
- Medications - many seniors take medications, including antidepressants, decongestants, diuretics and high blood pressure drugs
- Psychiatric disorders - acute symptoms of psychiatric disorders, including depression
- Lifestyle habits - an inadequate diet, excessive consumption of caffeine or alcohol, and an inconsistent bedtime
Ask a senior if he or she sleeps well, and the answer will most likely be a resounding no. That is no surprise, given the physiological changes that alter sleep in older adults. But, Dr. Metzger says there are ways to help ensure that you'll get a good night’s sleep, including:
- Developing a regular bedtime and wake-up schedule and following it each day
- Making sure your bed and bedroom are quiet and comfortable
- Using your bed only for sleeping or quiet reading
- Establishing quiet before-bed routines
- Developing relaxation techniques, such as yoga, meditation or deep breathing
- Discontinuing caffeine and alcohol consumption at least six hours before bedtime, as they can disrupt sleep later at night
- Exercising regularly (but never just before going to bed)
- Avoiding heavy meals late in the evening
- Reducing stress and worries at bedtime by dealing with them earlier in the evening or the following day
These are things that we all should do to stay healthy, regardless of our age, says Dr. Metzger. A sleep problem that persists after addressing the above issues may indicate the presence of a sleep disorder requiring further medical assessment. For example, obstructive sleep apnea affects up to 20% of adults and impacts both sleep quality and daytime wakefulness. Your doctor can discuss with you whether evaluation for a sleep disorder is warranted.