As we age, our ability to get a deep, continuous night’s sleep decreases due to the brain’s reduced production of human growth hormone and melatonin and changes in our circadian rhythm (the body’s “internal clock”). These changes, combined with more frequent trips to the bathroom due to an enlarged prostate in men or decline in antidiuretic hormones in women, can be frustrating and lead to a fitful, unsatisfying night’s sleep.
Research shows that among older adults, interrupted sleep, rather than total amount of sleep, most negatively affects the brain’s ability to think clearly and learn efficiently. Cognitive symptoms due to chronically poor sleep can include a decreased ability to concentrate, multi-task, learn new information, reason, process complex information and engage in critical thinking and decision-making. Interrupted sleep in older adults usually occurs in two different phases: sleep maintenance problems (awakening several times throughout the night) or sleep termination problems (waking up before you have slept enough to feel rested while being unable to get back to sleep).
Beyond the age-related changes that affect sleep, poor quality sleep can be caused by other modifiable factors that can be improved, including a high level of stress (excessive worrying), lack of a routine sleep-wake schedule, medication side effects, lack of exercise, chronic pain or caffeine intake after 3 p.m. Experts say that there is no universal “magic number” for how many hours of sleep older adults should get.
Sleep need is an individual matter that varies from person to person. Your magic number is the amount of sleep that leaves you feeling rested and “clear-headed” when you wake up in the morning. Research suggests regularly getting seven to eight hours of uninterrupted sleep is optimal, and following these ten rules of sleep hygiene may help you achieve this goal:
1. Keep a regular sleep schedule by going to sleep and waking up around the same time every day.
2. Reduce caffeine intake, especially after lunch, and limit liquid intake two hours before sleep.
3. Avoid sugar after dinner. Spikes in our blood sugar due to sweets or simple carbohydrates can reduce the amount of time you spend in the deeper, restorative stages of sleep.
4. Try to get at least one to two hours of sunlight each day to help regulate circadian rhythms.
5. Use of the bed should primarily be restricted to sleeping and physical intimacy. Reading, watching TV and other activities in bed can make it harder for the brain to transition to sleep.
6. Develop a pre-sleep ritual. Listening to soothing music, practicing deep breathing, doing gentle yoga or watching a fire in the fireplace are ways to give your body and brain the message that it is time to wind down and stop “doing.”
7. If you do not fall asleep within 30 minutes of going to bed, get out of bed and do something that may increase sleepiness, such as reading a book, and then return to bed. However, do not use devices or watch TV.
8. Avoid over-the-counter medications for sleep with PM in the title (remember the PM part has anti-cholinergic properties known to have a negative effect on memory in older adults).
9. Keep a worry journal to write down and let go of nagging anxieties before bedtime. The key is to face stressors directly in our waking hours with assertive communication and action steps.
10. If none of these recommendations work, discuss your sleep concerns with your primary care physician to see if you should undergo a sleep study. Many sleep problems are caused by underlying but treatable issues. By identifying the root cause of your sleep problem, your care can be personalized.
Dr. Karen Sullivan, a board-certified clinical neuropsychologist, owner of Pinehurst Neuropsychology Brain & Memory Clinic and creator of the I CARE FOR YOUR BRAIN program, can be reached at 910-420-8041 or by visiting www.pinehurstneuropsychology.com or www.icfyb.com.
Additional Sleep Tips
by Rachel Stewart
Sleep needs change with age, as the American Academy of Sleep Medicine found that 13 percent of men and 36 percent of women over the age of 65 had issues falling asleep at night. For a restful night, consider these sleep hygiene highlights.
Make your space more sleep-friendly. Comfort is key when you’re getting ready to fall asleep. Keep your room cool and dark. This also means keeping it free of distractions like television, smartphones, tablets or other gadgets. Research suggests that just the light from your phone screen could interrupt your sleep patterns, so consider putting it out of reach and out of your line of sight if scrolling has you staying up. Consider changing the bedding as well so you’re as cool or as warm as you prefer to be. Adding a foam mattress pad can also provide extra comfort for achy joints, while heavy sound-cancelling curtains can keep the room extra quiet and dark.
Seek out supplements. Looking for a little extra help to get settled for the night? You’re on the right track, as we age, we experience hormone changes that make it harder to get to sleep. Natural supplements like melatonin – a hormone the body produces to make you sleep – are available over the counter. Just be sure to discuss any supplements with your primary care physician or pharmacist before you start taking it in case of interactions with other medications or vitamins you may be taking.
Tackle your triggers. Other times, daytime food and drink can be what’s wreaking havoc on your sleep schedule. Craving a warm drink before bed? Stick to decaf coffee or an herbal tea like mint or chamomile, which may help you wind down. Also nix heavy or spicy meals before bed, as these can lead to acid reflux or upset stomach. Sipping wine or something stronger right before bed? It’s true that alcohol can provide relaxation, but over-imbibing can actually lead to disrupted sleep in the long run, so it’s best to skip the nightcap.
Speak with a specialist. If you’re experiencing consistent problems falling or staying asleep, it’s time for a medical consultation. Your primary care physician can refer you to a sleep specialist. This provider will discuss any issues you’ve been having as well as your medical history and recommend a sleep study. During a sleep study, you’ll stay overnight at a facility where technicians will monitor your sleep patterns. Once the sleep study is complete, the sleep specialist will recommend care based on your condition, whether it’s insomnia or something more complex,
like sleep apnea.
To learn more about sleep hygiene or sleep disorders, visit sleepeducation.com.