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Later Life Guide

Health issues and concerns of older adults: solutions, strategies, and support

Sleep Patterns of Older Adults

Human sleep cycles through initial stages of falling asleep, into slow-wave (non-REM) stages, down into REM (active dreaming) stage, then back up through these stages. That cycle repeats several times through the night. Usually the period of the first cycle is the longest. Later cycles take shorter periods of time, and may cycle all the way back to waking up before falling back asleep.

The patterns of those cycles change as we grow from babies to children to adults. Generally, healthy adults get 7-9 hours of sleep - fewer than 5 hours a night, or more than 9, is not recommended. Timing for those hours may shift in older adults, though. It's not unusual for seniors to fall asleep earlier (and wake up earlier).

by Sun Ladder, own work CC-BY SA 3.0
Our sleep cycles are linked to other body processes, including building memory  and strengthening cognition, releasing hormones that support the immune and endocrine systems. Studies of people who have gone without sleep (from jet lag, working swing shifts, etc.) found that lack of sleep often leads to poor coordination, inattention, making incorrect decisions, irritability, and much higher risk of accidents. Newer research is finding links between sleep disorders and our mental states, our physical coordination, our emotions and our metabolism (even appetite and weight gain). All good reasons to maximize our chances of getting a good night's sleep regularly. 
Some factors that get in the way of sleeping well are: physical discomfort, exposure to light at night (especially blue light from electronic devices), unpredictable sleep schedules, hormonal changes (menopause), not enough exercise or exercise too close to bedtime, smoking or nicotine, caffeine or alcohol consumption, depression and stress in general. Lack of sunlight in the winter (SAD) can also make us want to sleep more. For advice to help you sleep better, see:

Trouble Falling Asleep or Staying Asleep

Insomnia - difficulty falling asleep, difficulty staying asleep, or both - is not unusual. It's estimated at least half of seniors experience this at least sometime). Sometimes it is a direct reaction to a crisis or to a difficult situation.

But if insomnia doesn't resolve, either by practicing healthy sleep habits or as the difficult situation improves, then it would be wise to talk with the health care team to see if this is a symptom of a larger problem. Consult your health care team if insomnia lasts for several days a week, or for months.

Some common possibilities to consider are: 

  • physical problems like sleep apnea, noctiuria, restless leg syndrome; 
  • medication side effects; 
  • depression or anxiety. 

Insomnia is also a known side effect of many medications. If your sleep is troubled, ask your health care team to do a review of all the medications you are taking (not just prescriptions, but also over-the-counter medications too).

It is also possible that worrying over insomnia makes it even harder to sleep, as explained in this video. Meditation or mindfulness practices can help, or psychotherapy to cope with anxiety.

Traditional Chinese medicine, especially acupuncture, has been proven effective in some people - and may be even more effective in combination with making changes to sleep habits.

Excessive Daytime Sleepiness

Being too sleepy during the day, when we're expected to function, can be a serious problem. Nodding off or drowsiness are the cause of far too many car accidents, for example. In older adults, sleepiness is implicated in many falls or injuries. It is also connected in some way to Alzheimer's: some studies found an increased risk of dementia in people who take long daytime naps, and changing sleep patterns (daytime sleep but nighttime alertness) is one of the signs of dementia. Daytime sleepiness can also be a symptom of poorly-controlled diabetes or COPD.

All the more reason to pay attention to our sleep patterns, and talk with our health care team about them!

Sleep Disorders

Here are some useful overviews of the more common sleep disorders:

If a sleep disorder is suspected, the health care team may ask you to do a sleep study.

Sleep apnea is one of the most common sleep disorders (estimates range from 10% to nearly one-third of all older adults). While it can have serious effects if untreated, the good news is that it is very treatable.

If the diagnosis is sleep apnea, the team might prescribe using a CPAP (Continuous Positive Airway Pressure) machine while sleeping.

If you're uncomfortable trying to lie still, and/or in the evenings, there's a name for that - restless legs syndrome - and ways to keep it from interrupting sleep.

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