Sleep and Aging: Improving Sleep Quality in the Elderly

Good quality sleep is essential for older adults' well-being.

As one gets older, not sleeping enough or poor sleep quality becomes an issue. Other sleep problems that come with age include sleep apnea, excessive sleepiness, and daytime drowsiness.

Sleep problems and disorders in older adults can lead to severe repercussions on their physical and mental health. Recent studies have linked poor sleep quality in older adults to increased risk for accidents, heart disease, kidney problems, Alzheimer's disease, depression, suicide, and risk-taking behavior.

In this guide, we'll take a closer look at why sleep gets more elusive as you get older and the steps you can take to finally drift off to a night of deep, restorative sleep.

Why sleep is crucial as you age

According to the Centers for Disease Control (CDC), getting a good night’s sleep is not a luxury —it’s something people of all ages should regularly get for good health.

In his TED talk “Sleep is a Superpower”, neuroscientist Matthew Walker shares why sleep is our “life-support system” as humans and how sleep impacts our immune system, learning, memory recall, and even genetic expression.

• Good sleep can improve your mood and problem-solving skills. It makes you feel better. When you feel better, you have good relationships with your family, spouse, coworkers, and friends.
• Sleep deprivation can even potentially hurt your love life. For example, research evidence shows that spouses with fewer sleep problems also tend to be happier¹. A later study supports these findings too. Relationships tend to have worse conflicts when one partner is sleep-deprived.²
• Finally, researchers are also beginning to understand and recognize the neuroprotective aspects of sleep. They discovered that deep sleep is critical to the function of the brain’s glymphatic system (or waste removal system).³ The deeper you sleep, the greater your brain’s ability to efficiently flush away waste and toxic proteins.
  
  While omega-3 fatty acids and exercise have the same waste-flushing capabilities, slow-wave sleep or deep NREM (non-rapid eye movement) sleep plays a more critical role in the elimination of potentially neurotoxic waste products.⁴ Accumulation of these waste products significantly predicts the degree and extent of cognitive decline associated with Alzheimer’s Disease.⁵

In a nutshell, a good sleep makes your life remarkably better.

How much sleep do older adults need?

"The National Sleep Foundation recommends that people over 65 should get 7 to 8 hours of deep, refreshing sleep."

The National Sleep Foundation recommends that people over 65 should get 7 to 8 hours of deep, refreshing sleep. Sleeping for less than 5 hours and more than 9 hours aren’t also recommended for this age group. ⁶

It may come as a surprise but older people need about the same amount and quality of sleep as younger adults.

However, getting enough sleep may be a challenge for older adults because of altered sleeping patterns. These changes are often a result of stress, medical conditions, medications, pain, depression, and anxiety.

Why sleep quality grows more elusive as you get older

There are two opposing camps as to why sleep quality grows more elusive as you age. First, researchers theorized that the need for sleep is innately reduced in older adults. Meanwhile, the other side of the debate explains that many older people have trouble sleeping due to age-related physiological changes.

A 2017 paper presented by researchers at the University of California, Berkeley supports the second hypothesis — it appears that older adults do not have a reduced need for sleep but rather an impaired ability to meet their sleep requirements. ⁷

Aging and the circadian rhythm

The circadian rhythm acts as your internal body clock and controls your sleep-wake cycles. ⁸ This 24/7 internal clock gets its clues from exposure to light in the morning and dark in the evening. It tells your body when it's time for bed and when to wake up.

Later in life, your circadian rhythm will start to lose its consistency. You may feel tired earlier than you're used to in the evening. You may wake up earlier in the morning than when you're in your 20s or 30s.⁹

Reduction in melatonin levels among the elderly is another factor that impacts an older adult's impaired ability to a restful night. ¹¹ Melatonin is produced by the pineal gland in your brain. Natural levels of melatonin in the blood tend to be highest during the evenings.

Circadian Rhythm Comparison between Younger and Older Adults  

Health conditions in older adults

Physical and mental health conditions such as depression, anxiety, diabetes, arthritis, and other conditions that involve chronic pain are typically linked to sleep issues in older adults.

A National Sleep Foundation survey revealed that sleep problems in older adults are more often associated with comorbidities or existing health conditions rather than a result of normal aging. ¹¹ For example, two-thirds of older adults in assisted living facilities suffer from poor sleep quality. ¹²

The elderly are also more likely to experience insomnia and impaired sleep due to medications for their existing health conditions. For instance, antihistamines may cause daytime drowsiness, while diuretics and calcium-channel blockers can increase nighttime urination, resulting in frequent sleep interruptions. Certain medications for hypertension and asthma can also contribute to insomnia.

What sleep problems do older people experience more often?

Sleeping problems are perfectly normal if they happen rarely. Life isn’t perfect, and the occasional stress can lead to altered sleeping patterns. However, sleeping difficulties and disorders can be a serious health issue if you’ve been experiencing it consistently, and it has affected your quality of life.

In older adults, the most common sleeping problems and changes include the following:

• Change in sleeping schedules. Older people tend to get tired earlier in the afternoon and take naps. It’s also not uncommon for older adults to sleep early at night and wake up early in the morning.
• Insomnia. Older adults tend to have trouble sleeping, getting back to sleep, and/or waking up too early and unable to go back to sleep.
• Sleep disturbances due to altered sleeping architecture. Sleep architecture refers to the stages and cycles that you go through when you sleep. The stages of sleep include NREM and REM sleep. A typical sleep structure includes one REM and 3 NREM sleep, and a person usually goes through four to six sleep cycles. ¹³
  
  
• Nighttime urination due to changes in the urinary system or other health conditions can interrupt sleep at night in older adults. It affects at least 80 percent of adults in their 60s. ¹⁴
• Daytime drowsiness or sleepiness. While daytime sleeping during the day is normal among seniors, it can be a problem when older adults spend most of their time napping instead of performing daily living activities.
• Restless leg syndrome. In older adults, this can cause unpleasant sensations in the legs and an overwhelming urge to move them during sleep. It is estimated to occur in 10 to 35 percent of individuals that are over 65 years old.¹⁵
• Sleep apnea or brief pauses in breathing during sleep. It can interrupt sleep and alter oxygen levels in the body, resulting in daytime sleepiness and cognitive problems.

Overall, researchers estimate that 40 to 70 percent of older adults experience chronic sleep problems, and up to 50 percent of these cases remain undiagnosed. ¹⁶

Consequences of lack of sleep in the elderly

Older adults who don't sleep well for an extended period may suffer from the following physical and mental problems:

15 steps to improve sleep quality as you age

If you’re waking up every day feeling tired, a closer look at your sleeping patterns and developing better sleeping habits might help.

The good news is you can take simple steps to improve your sleep quality as you age.

1 Determine the underlying cause of your sleeping issues.

Besides the normal aging process, identify health issues or medications that can negatively impact your sleep quality.

Health conditions can make it harder to doze off at night such as heart disease, lung conditions, indigestion, incontinence, menopause, and osteoporosis.

Meanwhile, medications that can disrupt sleeping patterns ¹⁷ include the following:

Talk to your primary health care provider about your underlying conditions and their potential role in your struggle to have a sound, comfortable sleep.

Next, review your medications and supplements with your health care team and ask them if it’s possible to explore alternatives that don’t impact sleep quality.

2Have a consistent sleep schedule.

A consistent sleep schedule tells your body when it’s time to rest and when it’s time to wake up. Go to bed and wake up at the same time each day, including weekends.

3Limit daytime naps to up to 20 minutes each day.

If you’re having trouble sleeping at night after napping at day, avoid daytime naps altogether.

4Unplug before bedtime.

It’s tempting to watch one more episode of your favorite TV show online or check your work inbox before bedtime. However, staring at your computer or phone before bedtime suppresses melatonin production¹⁸, the hormone that helps regulate your sleep-wake cycle.

Disrupting your body clock in the evening with screen time also keeps your mind active, keeping your body awake than it should be. Listen to your natural body clock.

5Develop a relaxing bedtime routine.

Any relaxing activity at least an hour or two before bedtime helps you transition from wakefulness to a good night’s sleep. Consider reading a book, having a warm bath, listening to relaxing music like nature sounds, or listening to sleepcasts (audio designed to help you relax before bedtime).

6Use dim lights at night.

Bright lights from lamps or other lighting fixtures in the house can disrupt your body clock. Consider using dim lights after dark or right after dinner.

7Wash your pillows and sheets at least once a week.

According to a Sleep Foundation poll, people are more likely to get a comfortable night’s sleep with newly-washed, fresh bed sheets.

Apart from clean, crisp sheets, ensure that your pillows, blankets, and mattress are clean and comfortable.

8Use slide sheets if you’re having trouble moving around in bed at night.

A slide sheet is a slippery sheet that you can put on top of your bed sheet. Slide sheets help you sleep better by helping you toss and turn in bed smoothly.

Older adults with conditions involving chronic pain and limited mobility benefit the most from slide sheets. You can easily switch sides and turn into your most comfortable sleeping position without even disturbing your partner.

9Steer clear of caffeine, alcohol, and other stimulants at least 6 hours before bedtime.

Stimulants like coffee, tea, chocolate, and alcohol are substances that stimulate the brain and the rest of the central nervous system, leading to increased alertness and trouble getting to sleep. Explore alternatives such as warm milk, golden milk ( made of turmeric and ginger), and chamomile tea.

10Create a dark, relaxed, and comfortable environment where you sleep.

Warmer room temperatures can cause restlessness and discomfort, leading to fatigue and inability to sleep.

Consider the National Sleep Foundation’s recommendations for the best bedroom temperature — approximately 65 degrees Fahrenheit (18.3 degrees Celsius). While it varies for each person, you can keep the room temperature between 60 to 67 degrees Fahrenheit for a relaxing, comfortable good night’s rest.

11Check your regular diet for food that can interrupt sleep.

Limit your intake of fried and spicy food in the evening. Avoid heavy meals before bedtime to prevent indigestion. If you’re prone to experiencing heartburn, try to have dinner 4 hours before you sleep. It takes 3 to 4 hours for the stomach to empty, and lying down after a meal can exacerbate heartburn.

12Engage in moderate exercise or physical activity regularly.

Exercising during the day can help you drift off to sleep quickly as it makes you more tired at night. ¹⁹ While more research is needed, it seems like the effect of aerobic exercise on sleep appears to be comparable to sleeping pills.

Walk around the block once or twice a day, go for a swim, or do some gardening. It’s worth noting that it’s best to avoid exercising late in the evening as it can keep you awake for the rest of the night.

13Seek natural light during the day time.

Spend time outdoors for at least half an hour during the day or sit by a bright window. This helps regulate your body clock.

14Avoid doing other activities in your bed

Working or scrolling on your phone in bed can cause your brain to associate sleeping with these activities. As a result, your mind ends up more alert and awake. Use your bed for sleep and sex only.

Meanwhile, avoid lying in bed for a long time when you're trying to go to sleep. If you haven't slept after 30 minutes of lying in bed, get up, and do something relaxing. You can read fiction, listen to music, meditate, or write in your journal. Do not do anything that will excite or stimulate your brain. After 20-30 minutes, go back to bed, and try to fall asleep.

15Try not to worry too much if you’re starting to have trouble drifting off to sleep.

Sleep scientist Dr. Jason Ong refers to it as relaxing your grip on sleep. According to Dr. Ong, getting very attached to getting a good night’s sleep leads to sleeplessness and inflexible expectations. Both of which can get in the way of your unwinding at night.

When to seek help

Questions to ask your healthcare provider:

• How many hours of sleep at night is ideal for my age?
• What other signs of sleep deprivation should I look out for?
• Could my medications hurt my sleep quality and quantity?
• Do I have a health issue that could affect my sleep?
• Can I take daytime naps if I want to during the day?
• I seem to sleep fine, but I still feel tired during the day? Is this normal?
• What specific interventions can I do to improve my sleep quality and quantity?

With proper guidance from your health care team and better sleep hygiene habits on your end, you’ll discover that aging isn’t necessarily a life sentence to restless sleep and wakeful nights.

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