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  • Dr Rahuls Elder Care

GUIDE TO GOOD SLEEP


Refreshing sleep requires both sufficient total sleep time as well as sleep that is in synchrony with the individual's circadian rhythm. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening, and less total sleep time. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Caffeine, alcohol, and some medications can also interfere with sleep. Primary sleep disorders are more common in the elderly than in younger persons.


How much sleep do older adults need?


While sleep requirements vary from person to person, most healthy adults require seven to nine hours of sleep per night. However, how you feel in the morning is more important than a specific number of hours. Frequently waking up not feeling rested or feeling tired during the day are the best indications that you’re not getting enough sleep.


Ageing Body and Sleep


As you age your body produces lower levels of growth hormone, so you’ll likely experience a decrease in slow-wave or deep sleep (an especially refreshing part of the sleep cycle). When this happens you produce less melatonin, meaning you’ll often experience more fragmented sleep and wake up more often during the night. That’s why many of us consider ourselves “light sleepers” as we age.





Sleep and normal ageing


Elders would want to go to sleep earlier in the evening and wake up earlier in the morning. Have to spend longer in bed at night to get the hours of sleep you need, or make up the shortfall by taking a nap during the day. In most cases, such sleep changes are normal and don’t indicate a sleep problem.


Sleep problems not related to age


At any age, it’s common to experience occasional sleep problems. However, if you experience any of the following symptoms regularly, you may be dealing with sleep disorder:





  • Have trouble falling asleep even though you feel tired.

  • Have trouble getting back to sleep when awakened.

  • Don’t feel refreshed after a night’s sleep.

  • Feel irritable or sleepy during the day.

  • Have difficulty staying awake when sitting still, watching television, or driving.

  • Have difficulty concentrating during the day.

  • Rely on sleeping pills or alcohol to fall asleep.

  • Have trouble controlling your emotions.


Identify underlying causes for your insomnia


Many cases of insomnia or sleep difficulties are caused by underlying but very treatable causes. By identifying all possible causes, you can tailor treatment accordingly.

  • Are you under a lot of stress?

  • Are you depressed?

  • Do you feel emotionally flat or hopeless?

  • Do you struggle with chronic anxiety or worry?

  • Have you recently gone through a traumatic experience?

  • Are you taking any medications that might be affecting your sleep?

  • Do you have any health problems that may interfere with sleep?


Common causes of insomnia and sleep problems in older adults


Poor sleep habits and sleep environment.

These include irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on. Make sure your room is comfortable, dark and quiet, and your bedtime rituals conducive to sleep.


Pain or medical conditions.

Health conditions such as a frequent need to urinate, pain, arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, and Alzheimer’s disease can interfere with sleep. Talk to your doctor to address any medical issues.


Menopause and post menopause.

During menopause, many women find that hot flashes and night sweats can interrupt sleep. Even post menopause, sleep problems can continue. Improving your daytime habits, especially diet and exercise, can help.


Medications.

Older adults tend to take more medications than younger people and the combination of drugs, as well as their side-effects, can impair sleep. Your doctor may be able to make changes to your medications to improve sleep.


Lack of exercise.

If you are too sedentary, you may never feel sleepy or feel sleepy all the time. Regular aerobic exercise during the day can promote good sleep.


Stress.

Significant life changes like retirement, the death of a loved one, or moving from a family home can cause stress. Nothing improves your mood better than finding someone you can talk to face-to-face.


Lack of social engagement.

Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep. If you’re retired, try volunteering, joining a seniors’ group, or taking an adult education class.


Sleep disorders.

Restless Legs Syndrome (RLS) and sleep-disordered breathing—such as snoring and sleep apnea—occur more frequently in older adults.


Lack of sunlight.

Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to get at least two hours of sunlight a day. Keep shades open during the day or use a light therapy box.


Improve sleep habits



In many cases, you can improve your sleep by addressing emotional issues, improving your sleep environment, and choosing healthier daytime habits. Since everyone is different, though, it may take some experimentation to find the specific changes that work best to improve your sleep.


Encourage better sleep at night


Naturally boost your melatonin levels.

Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy. Use low-wattage bulbs where safe to do so, and turn off the TV and computer at least one hour before bed.


Don’t read from a backlit device at night (such as an iPad).

If like to read from a tablet or other electronic device, switch to an eReader that requires an additional light source.


Make sure your bedroom is quiet, dark, and cool, and your bed is comfortable.

We often become more sensitive to noise as we age, and light and heat can also cause sleep problems. Using a sound machine, ear plugs, or a sleep mask can help.


Move bedroom clocks out of view.

The light can disrupt your sleep and anxiously watching the minutes tick by is a surefire recipe for insomnia.


Keep a regular bedtime routine for better sleep


Maintain a consistent sleep schedule.

Go to bed and wake up at the same time every day, even on weekends.


Block out snoring.

If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.


Go to bed earlier.

Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.


Develop soothing bedtime rituals.

Taking a bath, playing music, or practicing a relaxation technique such as progressive muscle relaxation, mindfulness meditation, or deep breathing can help you wind down before bed.


Limit sleep aids and sleeping pills.

Many sleep aids have side effects and are not meant for long-term use. Sleeping pills don’t address the causes of insomnia and can even make it worse in the long run.


Combine sex and sleep.

Sex and physical intimacy, such as hugging, can lead to restful sleep.


How to nap


If you don’t feel fully alert during the day, a nap may provide the energy you need to perform fully for the rest of the day. Experiment to see if it helps you.

Some tips for napping:

  • Keep it short. Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 minutes. You may feel groggy and unable to concentrate after a longer nap.

  • Nap early. Nap early in the afternoon. Napping too late in the day may disrupt your nighttime sleep.

  • Be comfortable. Try to nap in a comfortable environment preferably with limited light and noise.

Use diet and exercise to improve sleep





Two of the daytime habits that most affect sleep are diet and exercise. As well as eating a sleep-friendly diet during the day, it’s particularly important to watch what you put in your body in the hours before bedtime.


Diet tips to improve sleep


Limit caffeine late in the day.

Avoid coffee, tea, soda, and chocolate late in the day.


Avoid alcohol before bedtime.

It might seem that alcohol makes you sleepy, but it will actually disrupt your sleep.


Satisfy your hunger prior to bed.

Have a light snack such as low-sugar cereal, yogurt, or warm milk.


Cut down on sugary foods.

Eating a diet high in sugar and refined carbs such as sweets, candy bars, French fries, or too much rice can cause wakefulness at night and pull you out of the deep, restorative stages of sleep.


Avoid big meals or spicy foods just before bedtime.

Large or spicy meals may lead to indigestion or discomfort. Try to eat a modest-size dinner at least 3 hours before bedtime.


Minimize liquid intake before sleep.

Limit what you drink within the hour and a half before bedtime to limit how often you wake up to use the bathroom at night.


Reduce mental stress


Stress and anxiety built up during the day can also interfere with sleep at night. It’s important to learn how to let go of thoughts and worries when it’s time to sleep.

  • Keep a journal to record worries before you retire.

  • On your to-do list, check off tasks completed, list your goals for tomorrow, and then let them go.

  • Listen to calming music.

  • Read a book that makes you feel relaxed.

  • Use a relaxation technique to prepare your body for sleep.

  • Seek opportunities during the day to talk face to face with a friend about what’s troubling you.

Getting back to sleep at night


As you get older, it’s normal to wake up more often during the night. However, if you’re having trouble falling back asleep, the following tips may help:


Don’t stress.

Stressing over the fact that you can’t get back to sleep only encourages your body to stay awake. Try to stay out of your head and focus on the feelings and sensations in your body instead.


Make relaxation your goal, not sleep.

Try a relaxation technique such as deep breathing or meditation, without getting out of bed. Although not a replacement for sleep, relaxation can still help rejuvenate your body.


Do a quiet, non-stimulating activity.

If you’ve been awake for more than 20 minutes, get out of bed and do a non-stimulating activity, such as reading a book. But keep the lights dim and avoid screens.


Postpone worrying.

If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when it will be easier to resolve.


When to talk to a doctor about sleep problems


If your own attempts to solve your sleep problems are unsuccessful, keep a sleep diary and take it to your doctor. Write down when you use alcohol, caffeine, and nicotine, and keep track of your medications, exercise, lifestyle changes, and recent stresses.


Therapy vs. sleeping pills for insomnia in seniors


While sleeping pills and sleep aids can be effective when used sparingly for short-term situations, such as recovery from a medical procedure, they won’t cure your insomnia. In fact, they can actually make insomnia worse in the long-term.

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that treats sleep problems by addressing the negative thoughts, worries, and behavior that prevent you from sleeping well at night.


1.Melinda. (n.d.). Sleep Tips for Older Adults. Retrieved October 24, 2020, from https://www.helpguide.org/articles/sleep/how-to-sleep-well-as-you-age.htm

2.National Sleep Foundation