Sleep Older

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Growing Older

No matter how healthy or fit you are, you can't stop your body from aging. From the day you are born, your body is in a state of constant change. As you grow older, some of these changes may not be so pleasant. Your hair turns gray. Your vision gets blurry. More wrinkles appear on your skin. You feel new aches and pains. You even find that you can't sleep as well as you did years ago. While these changes are all normal, getting used to them is not always easy.

Senior sleeping

I. How Does Your Sleep Change As You Age?

When you were younger, you most likely fell asleep quickly and slept deeply. As you've aged, you may find that it is much harder to get a good night of sleep. You might toss and turn in bed for a long time before you finally drift to sleep. Maybe you wake up more often during the night and can't go back to sleep. The honk of a car horn or the bark of a dog may be enough to disturb your rest. While you used to have energy to go all day long, maybe now you take more naps. You might even find yourself dozing off while watching TV, reading the paper, or just relaxing. These are common changes that you can expect as you age.

But there are some sleep problems that you should not accept as being normal. Sleep disorders can greatly take away from your quality of life. They can cause you to be sleepy all day long. They can make you irritable, grumpy, or depressed. They can even cause or worsen other health problems in your body. This is why it is important for you to know more about your need for sleep and the problems that prevent you from getting it.

At first glance, it can be hard to tell a sleep disorder from a normal change related to aging. Your sleep patterns can change slowly over time. You may not even notice that you're not sleeping well. Medical and mental illnesses make things even more complex. They may be a cause of sleep disorders in older people. Pain, depression, and medications also add to the confusion. It's even hard for a doctor to know which problem may be causing the others.

It doesn't help that many of the things you are told about sleep are not true. For instance, people may tell you that you need more sleep as you age. The truth is that you need about the same amount of sleep for your entire adult life. This amount varies from one person to another. On average, most adults need about seven to eight hours of sleep each night to feel alert and well rested.

The problem is that it is harder to sleep for one long stretch of time when you are older. It is more likely that your sleep will be disturbed during the night. Studies show that young adults wake up briefly about five times a night. Some people over age 60, however, may briefly wake up as many as 150 times each night. Even though you may be unaware of waking up so many times, it keeps you from enjoying as much deep sleep as you did when you were younger. Most people over 65 also wake up at least once a night for a trip to the bathroom. As a result of all these disruptions, you do not feel refreshed when you wake up in the morning. This is why you may begin taking more naps as you age.

It might also be that you nap more often because this is what everyone is supposed to do. Recent research suggests that our bodies are meant to take at least one short nap a day. You have an internal body clock that makes you get sleepy at night. This clock also makes you mildly sleepy in the middle of the afternoon. Younger adults have to suppress this desire to sleep due to busy work schedules. Later in life, you may find that you are free of many of those demands on your time. You are finally able to enjoy the afternoon nap that you were meant to take all along.

II. What Causes Problems With Sleep As You Age?

It is very common for people over the age of 65 to have problems with their sleep. Insomnia is their most common complaint. Insomnia is when you have trouble falling asleep, struggle to stay asleep, or wake up too early. In general, it may result in a quality of sleep that is not as refreshing as it should be. There are a number of causes that may bring it about or make it worse.

Medical illness

As you get older, you are more likely to have a chronic medical illness. This will often interfere with how you sleep. Illnesses that can affect your sleep include the following:

  • Asthma and other respiratory diseases
  • Heart disease
  • Arthritis

Even minor pain, fever, itching, or coughing can cause a mild case of insomnia.

Medications

Many drugs used to treat medical problems can also disrupt your sleep. Discuss with your doctor how the medications you take might keep you from sleeping well. Even a small change in the timing or dose of your medication can bring about a big change in your sleep. This can also affect how you feel during the day.

Some people are able to sleep better by using sleeping pills from time to time. But many older people rely too much upon drugs to help them sleep. Studies show that some common drugs may not even work well in older people. In fact, they may even make sleep problems worse.

Two thirds of people living in nursing homes suffer from sleep problems. Drugs are widely used to treat them. These drugs can cause patients to be confused and to fall more often.

Other ways to help patients in nursing homes sleep better include the following:

  • Physical and social activities during the day
  • Limiting naps during the day
  • Exposure to bright lights and sunlight during the day
  • Reducing noise in the nursing home at night

Sleep disorders

There are many sleep disorders that are more common in older people. They are often a factor in the decision to place a loved one in a nursing home. Most caregivers report that their loved one's problems disrupt their own sleep as well. While these problems are common, they often go untreated. Having a medical condition might cause the sleep problem to be overlooked. Not all sleep disorders have obvious signs that can be felt or seen. Detecting and treating a sleep disorder can greatly improve the quality of your sleep.

Alcohol

Alcohol makes you sleepy and might help you fall asleep quickly. But it is also likely to cause you to wake up during the night. Many people wake up too early after drinking alcohol in the evening. This may be a "rebound" from the use of alcohol. It stays in your system for a long time after you have a drink. To improve your sleep, you should not have any alcohol within six hours of your bedtime. You should also limit how much and how often you drink. The heavy use of alcohol can be harmful to your overall health.

Depression

Major life changes are common as your grow older. You might retire from a job you've held for years. Children might move far away from home. Your health might keep you from activities that you enjoy. These changes can cause feelings of depression. For some people, it begins very slowly. Over time, it can progress to the point where "feeling blue" is just a normal part of your life. Depression can greatly disrupt the quality of your sleep. You might lie in bed tossing and turning late into the night. You also might sleep for a long time with no motivation to get out of bed. As poor sleep progresses, some people stop eating regularly. They may also lose their usual interest and pleasure in the normal activities of daily life.

Loss of a loved one

Losing a loved one can make you feel isolated and alone. This often leads to problems with sleep and depression. Surveys show that 75% of recent widows have a hard time sleeping a month after the death of their spouse. One year later, 50% report that their sleep problems still have not gone away.

Other causes

Many other causes of sleep problems are either temporary or easy to correct. You might drink too much caffeine or eat too much at dinner. Perhaps you exercise too close to your bedtime. Sleep problems can also be caused by an operation or a hospital stay. You might lose sleep during a long trip. Times of worry or stress can also cause you to have poor sleep.

III. What Can You Do To Improve Your Sleep?

As you age, your body becomes more sensitive to emotional stress and physical changes around you. These internal and external factors can disrupt your sleep. It is important to be aware of your sleep habits and how they affect your sleep. You can then make sure that what you do and where you are will give you the best chance to get a good night of sleep.

For example, some older people find that their minds race with worry when they lie down to sleep. Just trying to sleep through the worry will often make matters worse. Knowing this, they can set aside a time during the day to focus upon the things that are bothering them. They can make plans, get advice, come up with new solutions, or simply try to understand things better. This will free them up to feel more relaxed at bedtime. The bed should be a place for rest, not worry.

Your internal body clock makes you feel sleepy or alert at regular times every day. Everyone's body has this natural timing system. As you age, your body clock may take longer to adjust to changes. If you still work, it may be hard for you to adapt to a change in shifts. When you fly a long distance, you may also have a hard time getting used to a new time zone.

Your body can also be affected by the following:

  • Temperature
  • Light
  • Noise

You need to make sure that your bed and bedroom are as comfortable as you can make them. You will also want to keep a regular schedule. Try to sleep at times when you will not be disturbed.

An exercise routine can also help you keep a good sleep pattern. It can keep you from sleeping too much during the day. It will also improve the quality of your sleep at night. For the best sleep results, do not exercise within six hours of your bedtime. Talk to your doctor before starting an exercise program.

Forms of exercise that can help you sleep better include the following:

  • Walking
  • Swimming
  • Bike riding
  • Strength training
  • Stretching
  • Yoga
  • Gardening

You might fall asleep too early at night or wake up too early in the morning. If so, try to get some bright sunlight in the afternoon and evening. This will help to keep your body clock set at the right time. The key is for your eyes to see the light. They send the signals to your brain that will be used to set your body clock. Your skin does not need to be exposed to the sunlight.

If you take a nap during the day, try not to sleep for more than an hour. Your naps should also occur early in the afternoon, before 3:00 pm. Napping longer or later may cause you to have a hard time falling asleep that night.

IV. What Sleep Disorders Are Common As You Age?

Talk to your doctor if any of the following disorders seem to fit your sleep problem.

Obstructive sleep apnea (OSA)

Obstructive sleep apnea (OSA) occurs when the tissue in the back of the throat collapses during sleep. This keeps air from getting in to the lungs. This is very common, because the muscles inside the throat relax as you sleep. Gravity then causes the tongue to fall back and block the airway. It can happen a few times a night or several hundred times per night. These pauses in breathing briefly wake you up and disturb your sleep. This can cause you to be very tired the next day. It affects an estimated one in four people over the age of 60. Men who are overweight are at a higher risk of having OSA.

The primary signs of OSA are daytime sleepiness and loud snoring. Snoring is due to a partial blockage of the airway during sleep. It tends to increase as you age. There is a range of snoring from simple to severe. Simple, primary snoring is "normal" and is mostly harmless. But loud, severe snoring with gasps and snorts is a cause for concern. Many people do not even know that they snore. It is often a spouse or bed partner who detects the loud snoring problem.

Sleep apnea may make it hard for you to think or concentrate during the day. If left untreated, it may also put you at risk of heart or lung disease, high blood pressure or diabetes.

Talk to your doctor if you snore loudly and are often tired during the day. He may refer you to a sleep specialist to find out if you have sleep apnea. Losing weight and sleeping on one's side may help in some mild cases of OSA. Severe sleep apnea requires medical treatment. Positive airway pressure (PAP) is the most common way to treat OSA in adults. PAP provides a gentle and steady flow of air through a mask that is worn over the nose. This keeps the airway open and prevents pauses in breathing as you sleep. Surgery or the use of an oral appliance may be a better option for some people.

Central sleep apnea (CSA)

In contrast to OSA, people with central sleep apnea (CSA) are often thin and may not snore at all. CSA occurs when the brain fails to tell the lungs to breathe. As this signal is lost, the lungs do not take in the oxygen that your body needs. People with CSA may sigh frequently or appear to have shallow breathing as they sleep. In the morning, they may remember waking up many times and complain of light and broken sleep. CSA is most common in older people and in patients with heart disease. It can also occur as a result of a stroke.

CSA is first treated by dealing with the other medical problem that is causing it. For example, CSA caused by heart failure may go away when the heart failure is treated. Other treatment options for CSA include oxygen and positive air pressure (PAP).

Advanced sleep phase syndrome (ASPS)

The tendency to be "early to bed and early to rise" increases as we grow older. Many people adapt well to this pattern of sleep. Others find that their bodies are ready for bed much earlier than they desire. They often fall asleep well before 9:00 pm. This causes them to wake up earlier than they would like. They may be alert and unable to go back to sleep as early as 3:00 or 4:00 am. This pattern of going to bed and waking up too early is called advanced sleep phase syndrome (ASPS).

ASPS can disrupt your social life. It is very frustrating to be awake early in the morning while others are still sleeping. It is also hard to stay awake later in the evening to spend time with friends or family. You may try various methods to stay up later. But staying up later does not always mean that you will be able to sleep later in the morning. Your body clock is still set for you to wake up early.

One thing you can do to help is to get plenty of sunlight late in the afternoon until dark. This will help delay your body clock from starting to make you sleepy. Even if you are inside, open the curtains or blinds to let in a lot of light. When you go to bed at night, make sure that your room is very dark.

Periodic limb movement disorder (PLMD)

Periodic limb movement disorder (PLMD) is very common in people age 60 and over. PLMD is when you have episodes of simple, repetitive muscle movements. You are unable to control them. They tend to involve the tightening or flexing of a muscle. A typical movement is for the big toe to extend. Often the ankle, knee or hip will also bend slightly. Though it is less common, this can also happen in your upper arms. An episode will normally last from a few minutes to an hour. Within that time, movements tend to occur every 20 to 40 seconds. They may affect only one of the legs. More often, they will affect both legs in a random pattern. They usually do not keep you from falling asleep. Instead, they can disrupt your sleep during the night.

When PLMD is mild, you may be unaware of any impact on your sleep. If it is moderate, you may complain of restless nights and waking to find the sheets in a tangle. When it is more severe, you will still be very tired even after a full night of sleep.

Restless Legs Syndrome (RLS)

Most people who have restless legs syndrome (RLS) also have periodic limb movements in their sleep. RLS causes a weird, prickling urge to move your legs. It is made worse by rest. Lying or sitting still can be very hard. Temporary relief is found when you walk or move the legs. RLS makes it very hard for you to rest or go to sleep. People with severe RLS may get less than five hours of sleep each night. The use of medications can ease this problem.

Rapid eye movement sleep behavior disorder (RBD)

Most dreams occur during the rapid eye movement (REM) stage of sleep. The body is virtually paralyzed during this dream sleep. This normal muscle paralysis does not occur in people with REM sleep behavior disorder (RBD). As a result, they literally act out their dreams. They may crash into furniture, break windows, or fall down stairs. They may injure themselves and sometimes their bed partners. Their bedroom should be made safer by removing sharp objects or furniture. RBD tends to occur in men who are over 50 years old. It is also common in people with Parkinson's disease. The use of medications can ease this problem.

V. When Should I Get Help For My Sleep?

You should talk to your doctor if you have not been able to sleep well for a month or longer. You may have a sleep disorder if your problem has a negative effect on your daily life. Use the tools in the Evaluate Your Sleep section of this site to assess the quality of your sleep. Then share your findings with your doctor. Be sure to fill out the daily sleep diary for two weeks. The sleep diary will help a doctor see your sleeping patterns. This information gives him or her clues about what is causing your problem and how to correct it.

Your doctor may decide that you need to see a sleep specialist. A specialist who is board certified in Sleep Medicine will have the expertise to find the cause of your sleep problem. If he or she suspects that you have a sleep disorder, then the specialist may ask you to do an overnight sleep study. This is called a polysomnogram. It charts your brain waves, heart beat, and breathing as you sleep. It will also record how your eyes, arms and legs move.

Sensors are put on your head, face, chest and legs. The sensors are gently placed on the skin and do not cause any pain. They send tiny electrical signals to a computer. The cables are long enough for you to move around and turn over in bed. There is no risk or danger related to the sleep study.

The data from this study is very helpful in finding out if you have a sleep disorder. It will also show how severe the problem is. This will help determine the level of treatment that will be needed to help you.

You may also be asked to do a nap study during the day. This is called a multiple sleep latency test (MSLT). It helps show how tired you are and how quickly you fall asleep during the day.

VI. Should I Use Medications To Help Me Sleep Better?

Sleeping pills

As you grow older, your body does not break down drugs as well as when you were younger. Drugs stay in your system longer as you age. This means that their effects may last longer.

Ideally, a sleeping pill should be used for only a short period of time. A sleeping pill should help you fall asleep faster and wake up less often at night. It also should not cause a "hangover" the next day. Short-acting drugs help you fall asleep, but their effects may wear off quickly. They may not help you stay asleep through the night. Long-acting drugs help you stay asleep through the night, but they may cause you to be sleepy during the day. This can put you in danger of falling asleep when you get behind the wheel of a car.

Always talk to your doctor before using drugs to improve your sleep. He will prescribe the type of drug and the dosage that is just right for you. Some drugs have proven to be especially useful in helping older people fall asleep. But they still may not help you stay asleep during the middle and late parts of the night.

Sleeping pills can also be found on the shelves of your local drugstore. The most common ingredient in these sleep aids is antihistamine. These drugs can also make you very sleepy the next day. They should be used with caution.

Warning: A complaint of insomnia can be a sign of a breathing disorder. It may be a mistake to use sleeping pills. They tend to make pauses in breathing occur more often and last longer. If you have a regular problem sleeping, be sure to discuss it with your doctor first.

Melatonin

Melatonin is a hormone that is released by the brain at night. It seems to play a role in making your body sleepy. Its primary use is to help people suffering from jet lag. It may also help people who are blind to have a more stable sleep pattern. Melatonin has not proven to be a big help for people with routine insomnia. Consult a doctor to make sure that it is safe and proper for your use.

Medication interactions

Even a drug that is safe for your use may harm you if it interacts with another drug that you are taking. Make sure that all of your doctors are aware of any medications that you are taking.

VII. How To Sleep Well

You can often sleep better by simply following the practices of good sleep hygiene. Sleep hygiene consists of basic habits and tips that help you develop a pattern of healthy sleep. See the Resources section of this site to find out how you can start down the path to better sleep.

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