Sleep Tips for Older Adults
Sleep is essential to overall mental and physical health and well-being. Sleep is vital for brain health and cognitive function. In fact, people with chronic inadequate sleep are at higher risk for dementia, depression, heart disease, obesity, diabetes, fall-related injuries, and cancer. This guide will review sleep information.
- How Much Sleep Do Older Adults Need?
- What are symptoms of sleep problems in older adults?
- What are common sleep disorders in older adults?
- Insomnia Diagnosis and Treatment in Older Adults
- Why are older adults more likely to experience insomnia?
- Why Is It Important to Treat Insomnia?
- How is insomnia treated?
How Much Sleep Do Older Adults Need?
There’s an erroneous belief that older adults don’t need as much sleep. Experts agree that sleeping on average 7-8 hours each day is related to better brain and physical health in older adults.
How Does Sleep Change with Age?
As we age, it’s common for sleep to become less deep, for example, and we may experience more awakenings. Sleep also becomes more vulnerable to disturbances, like pain, health issues, stress, mental health conditions, changes in our environment, etc.
Sleep Hygiene Tips for Older Adults
When I think of hygiene, I think of grooming, don’t you? Well that’s essentially what this is, you’re cleaning up and grooming your sleep rituals and routines. The idea with sleep hygiene is that you set yourself up for healthy sleep and a non-disruptive sleep environment. There are ways to promote good sleep just by making a few changes to behavior.
What to do to get a good night’s sleep?
- Maintain a regular sleep schedule: go to sleep and wake up around the same time every day
- Expose yourself to light and fresh air during the daytime.
- Exercise: regular physical activity promotes good sleep.
- Maintain a regular routine in preparation for bedtime
- Keep the bedroom quiet and dark at night. If you have to get up in the night, use a soft amber-colored night light rather than turning on overhead lights.
- Maintain a bedroom temperature that is comfortable to you to promote falling and staying asleep
What to avoid to help you get a good night’s sleep?
- Avoid caffeine after lunch time
- Limit nicotine and alcohol (they negatively affect sleep)
- Avoid daytime naps
- Avoid exercise at least 6 hours before bedtime
- Keep pets that disturb sleep out of the bedroom.
- Keep smartphones, TVs, electronics, out of the bedroom.
What about prescription sleeping pills and supplements?
- Dietary supplements for sleep such as melatonin may have benefits for some but the scientific evidence on its effectiveness is inconclusive.
- If you are using prescription medications to help you sleep, be aware that habitual use can limit their effectiveness. Consider limiting their use to 3 nights during the week, unless your health provider says otherwise.
- Avoid using over-the-counter medications (e.g., Tylenol PM, Benadryl, Nyquil, etc) for sleep as they can have negative side-effects, particularly as we get older.
Excessive daytime sleepiness is not a normal part of aging
source: Global Council on Brain Health
What are symptoms of sleep problems in older adults?
Having disturbed sleep on a regular basis is not a normal part of aging. Here is a list of symptoms of sleep problems in older adults provided by the Global Council on Brain Health. If you experience these symptoms on a regular basis, you may have a sleep disorder that could benefit from treatment and you should be evaluated for a sleep disorder by a healthcare provider. Symptoms include:
- Persistent difficulties falling or staying asleep, which results in impaired daytime functioning or well-being
- Daytime drowsiness
- Fatigue or low energy
- Difficulty paying attention and concentrating
- Declining memory
- Mood disturbance (irritability, depression)
- Behavioral problems (impulsivity, aggression)
- Impaired occupational or social functioning
- Abnormal behaviors during sleep (e.g., kicking, calling out or shouting, nightmares, snoring, acting out dreams
- Uncontrolled snacking during the night
- Unusually prone to errors/accidents
- Awakening short of breath, snoring, or witnessed apneas
- Uncomfortable sensations in the legs at bedtime
- Witnessed teeth grinding
- Waking up with a headache or aching jaws or ears
What are common sleep disorders in older adults?
- Sleep-related breathing disorders (such as sleep apnea)
- Sleep-related movement disorders (such as restless leg syndrome and periodic limb movement disorder)
- Hypersomnia (e.g., excessive daytime sleepiness, or excessively long sleep periods usually greater than 10 hours)
- Parasomnias [such as acting out dreams, sometimes called Rapid Eye Movement (REM) sleep behavior disorder]
- Circadian rhythm sleep disorders
- Bruxism (grinding or clenching teeth during sleep)
Insomnia Diagnosis and Treatment in Older Adults
What is Insomnia?
Insomnia is defined as dissatisfaction with sleep, and is usually associated with one or more of the following:
- Difficulty falling asleep
- Difficulty staying asleep (waking up frequently, or having problems returning to sleep after you wake up)
- Waking too early and not being able to return to sleep
The fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) says that a sleep disturbance causes clinically significant distress or functional impairment, and occurs at least 3 nights a week for at least 3 months.
The International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) requires at least 1 month of symptoms not explained by another sleep-wake disorder, illicit substance use, or coexisting medical and psychiatric disorders.
Why are older adults more likely to experience insomnia?
Researchers found that 93% of older adults who experience insomnia, also experience other conditions at the same time, like:
- Chronic pain
- Chronic obstructive pulmonary disease (COPD)
- Cardiovascular diseases
- Medication use, and
- Factors associated with aging (like retirement)
- Losing mobility and becoming more inactive
- Limited social interactions
Here are a couple of ways that caregiving affects sleep:
- At times in the dementia process, the person with dementia will wake at night and pace, rummage through drawers, or get dressed thinking it’s daytime and they have to go to work. This, naturally, wakes up the caregiver, who has to redirect the person living with dementia to keep them safe and assist them with returning to sleep.
- Caregivers often assist older loved ones in the night with various tasks, like helping their loved one to take medications, drink water, or help a loved one to the bathroom safely and free of falling.
Sleep disorders become more common with age, but they can often be successfully treated
source: Global Council on Brain Health
Why Is It Important to Treat Insomnia?
Large studies suggest insomnia can harm brain function. Older adults who have fragmented sleep have increased risks of heart disease as well as of poor cognitive and emotional functioning. Older adults with fragmented sleep are at greater risk for faster cognitive decline and have a higher risk of Alzheimer’s disease than older adults without fragmented sleep.
Insomnia is also a risk factor for stroke and the primary risk factor for the development of depression
Source: Global Council on Brain Health.
How is insomnia treated?
If your healthcare provider diagnoses you with Insomnia Disorder, there is effective treatment. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the front line treatment for insomnia in older adults. The American College of Physicians recommends CBT-I as first-line management for insomnia in adults. CBT-I has also been shown to be more effective and safe than the use of sleeping pills.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I typically includes 6 to 10 sessions with a trained therapist that focus on cognitive beliefs and counterproductive behaviors that interfere with sleep.CBT-I has been shown to improve sleep and daytime well-being and to improve mood in people with depressive symptoms.
Ready to find a therapist who can help you get a good night’s sleep? Our directory of mental health providers can help.
- Global Council on Brain Health (2016) The Brain–Sleep Connection: GCBH Recommendations on Sleep and Brain Health
- Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the Elderly: A Review. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1017–1024. https://doi.org/10.5664/jcsm.7172
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