Chasing Sleep

Getting sufficient sleep is important at any age, but doing so can become tougher as you get older. According to the National Sleep Foundation, older adults often find it harder to fall and remain asleep, experience higher rates of sleep disorders than younger adults and suffer higher rates of insomnia.

Research suggests that this is in large part due to the prevalence of chronic physical and psychiatric ailments older adults experience and side effects from the medications used to treat them.

But there can be other causes, as well. Older adults tend to be lighter sleepers and more sensitive to noises and changes in their environment. Women going through menopause may wake during the night due to night sweats.

“There are lots of reasons why older adults have problems with sleep,” says Michael V. Vitiello, PhD, a professor of Psychiatry and Behavioral Science, Gerontology and Geriatrics at the University of Washington and Co-Director of the Northwest Geriatrics Workforce Enhancement Center. “The important thing is to parse out the causes and treat them.”

Sleep Disorders
“If you’re having chronic difficulty sleeping, the first thing to do is discuss it with a physician,” says Dr. Vitiello. “If it’s the result of a sleep disorder, you need to get that diagnosed and treated. All sleep disorders are treatable.”

Sleep apnea — a sleep disorder in which breathing is disrupted during sleep, often associated with loud snoring — can be treated with a face or nasal mask worn during the night known as a CPAP (Continuous Positive Airway Pressure) machine. The mask is connected to a pump, which sends a flow of air into the nasal passages to keep airways open as you sleep.

Restless leg syndrome, another common sleep disorder, causes an irresistible urge to move the legs during sleep. It can be treated with medication, says Dr. Vitiello.

Patterns and Changes
What’s not treatable, he says, are age-related changes to the body’s sleep regulatory drive and circadian rhythms that cause older adults to sleep more lightly and want to go to sleep earlier and wake earlier than they did when they were younger.

“There are changes occurring in the brain that change how you sleep. Nobody should expect the sleep you have at 75 to be the same sleep you had when you were 18. But the vast majority of older adults — if they’re healthy — find even with these changes in sleep they are still functional during the day and can go about their daily routine just fine.”

The doesn’t mean that older adults need less sleep than younger ones, says Lawerence J. Epstein, MD, Assistant Clinical Director of the Sleep Clinic, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. “It’s a myth that older people need less sleep,” he says. “They still need at least seven hours of sleep every night. It’s just harder for them to get it in a single block.”

Some people use daytime naps to meet part of their daily sleep requirement as they get older, says Dr. Epstein, which is fine as long as those naps are part of a regular routine. “You have to set aside that time every day to get it — otherwise you’ll be sleep deprived,” he says.

“Napping can also be a double-edged sword,” Dr. Epstein says. “It will restore your alertness, but the more you sleep during the day, the less you sleep at night.”

When You Don’t Get Sufficient ZZZs
Not getting enough sleep can be harmful. Lack of sleep can cause difficulty concentrating and memory loss, may make people more accident prone and more susceptible to illness. Poor sleep has been associated with health problems such as cardiovascular disease, diabetes, depression, arthritis, acid reflux, renal failure and immune disorders.

“We are learning more and more that long-term sleep issues contribute to major illnesses,” says Dr. Vitiello. “If you’re experiencing long-term problems with sleep, the best thing to do is get some help — sooner rather than later.”

Dos & Don’ts
Fortunately there are steps you can take to improve your chances of getting a good night’s rest. Suggestions from the Division of Sleep Medicine at Harvard Medical School follow.

* Avoid caffeine, alcohol, nicotine and other chemicals that interfere with sleep.

* Make your bedroom conducive to sleep by keeping it quiet, dark and cool in the evening and restricting activities in this room to sex and sleep (no computers, TVs or work materials).

* Establish a pre-sleep routine such as taking a bath, reading a book or practicing relaxation techniques.

* Keep a consistent sleep schedule. Going to bed and waking up at the same time each day helps to set your “internal clock.”

* Nap early or not at all. Napping late in the afternoon can make it more difficult to fall asleep at night.

* Exercise early in the day. Exercising releases the hormone cortisol, which keeps the brain alert.

* Don’t eat anything heavy before bed, as this may cause indigestion.

* Balance fluid intake. Stay hydrated but don’t drink so much before bedtime that you have to get up during the night to use the bathroom.