The brain's ability to carry out sleep-related duties declines over time.(GETTY IMAGES)
Dozing through prime-time television shows. Waking before sunrise, unable to fall back asleep. Getting up several times during the night. For many adults over the age of 50, sleep issues such as these can disrupt everyday life and leave them wondering, “Is this a normal part of getting older?”
Theres no question that once we reach middle age, we begin to face obstacles to a good nights sleep. The older we get, the more prominent sleep problems can become. In a 2005 Gallup study of Americans aged 50 and older, 24% of subjects believed they had a sleep problem. In a 2003 National Sleep Foundation poll, 67% of adults aged 55 to 84 reported frequent sleep problems; in the findings, poor sleep in the elderly was associated with other health, weight, or mobility problems.
Experts tend to agree that some sleep changes are normal as we age, but that doesn't mean you should chalk up all sleep problems to growing older. If you or your loved ones aren't resting as easily as in previous years, here are a few points to consider.
Sleep patterns do change as we get older
As with other normal bodily functions, the efficiency of the brain in carrying out its sleep-related duties begins to decline over time, and this may lead to sleep problems. Such a decline in normal sleep probably begins in our 40s, though it may not be until years later, when we reach our 50s or 60s, that we finally become aware of a problem.
The brain produces less and less melatonin, a hormone that regulates sleep at night and alertness during the day. As adults enter their senior years, sleep patterns may naturally shift to earlier in the day.
For example, seniors may normally begin to fall asleep earlier in the night—at 8 p.m. on the couch after dinner, for example. Because of this, they may begin to wake up earlier, at 3 or 4 a.m. It may seem like a logical step to take over-the-counter melatonin to help correct such a shift, but experts have mixed opinions about how safe this approach is for older people. (Read more about sleep medication and older adults.)
Ronald Kramer, MD, a neurologist and the medical director at the Colorado Neurological Institute's Sleep Disorders Center in Denver, and a spokesperson for the American Academy of Sleep Medicine, sees these advanced sleep cycles in many of his elderly patients.
"They come in and say, 'I'm sleepy all the time; I go out at night and I fall asleep at the movies.'" A big part of counseling these patients, says Dr. Kramer, is educating them about the changes their bodies are going through. "They may have to make some adjustments—get used to going to bed earlier and getting up earlier, or taking a nap in the afternoon. In a way, it's payback for what we all used to do as adolescents, delaying our natural sleep patterns by staying up late so often."
Nighttime sleep also becomes more fragmented after age 50, and most seniors have difficulty sleeping through the night without waking several times. Because of constant interruption in the natural sleep cycle, some older adults get less deep, restorative REM sleep.
Chronic health conditions can play a role…
“Fragmented sleep is tricky as we get older,” says Dr. Kramer. “Some of it is natural, but a lot also has to do with other medical issues. Some of it we cant help, but a lot can be improved by taking care of the underlying medical condition that contributes to poor sleep.”
Men can experience prostate issues that may keep them running to the bathroom; women going through menopause may experience hot flashes and night sweats. For the elderly, depression and physical pain, such as arthritis, are both conditions that can disrupt sleep. Older adults are also more susceptible to other sleep problems, such as sleep apnea and periodic limb movements, which may interfere with their sleep. By talking to your doctor and finding treatment for these potential causes, you may find that your sleep—and how you feel during the day—improves a great deal.
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…as can lifestyle and medications
Older adults may be facing other health conditions that require medication, and it's important to consider whether that medication may affect sleep quality—especially for elderly people, who have more difficulty metabolizing drugs and may be sensitive to even small doses of common drugs.
Elderly people may also get less exposure to bright light than they need to set their internal body clocks for daytime alertness and nighttime sleep. Dr. Kramer cites research showing that people in nursing homes often get as little as one to two hours of exposure to the lowest level of light intensity necessary to signal to a person's brain that it is daytime. "Such a small amount of daytime light exposure, presumably with an associated lack of physical activity, is a formula for nighttime sleep disruption in most nursing home patients," says Dr. Kramer.
This is why good sleep hygiene is still so important, even as people get older, retire, enter assisted living, or develop other health problems. Caregivers tending to an elderly adult can help make sure he or she gets some type of exercise during the day, sees at least a few hours of daylight, and maintains a regular sleep schedule.
Bottom line: How you feel during the day
Although it's generally believed that older adults should get just as much sleep as younger adults, a 2008 study suggests that we actually may not need as much sleep as we get older. When researchers asked participants to stay in bed for 16 hours a day, those aged 60 to 72 slept only 7.5 hours on average, compared to the participants aged 18 to 32, who slept an average of 9. The study authors suggest that seniors who report having insomnia may actually not need the sleep they're missing.
If you or an older loved one is suddenly losing sleep, the first thing to consider is whether it's affecting daytime function. Do you feel tired during the day? Are you losing concentration or constantly fighting off sleep? If so, talk to your doctor about possible solutions.
"No matter how much sleep you need—whether it's more or less than when you were younger, whether 7 hours or 10 hours—you should still feel pretty good the other 17 or 14 hours a day that you spend awake," says Dr. Kramer. "You may have to accept some normal changes in your sleep pattern to feel better, but you should never accept not feeling good day in and day out." If you think a sleep problem may be adversely affecting your daily life, your primary care doctor, a certified sleep doctor, or an evaluation at a sleep center may be able help.