Finding that a good night’s rest has become more elusive over the years?
Older people need about the same amount of sleep as younger ones — generally, seven to eight hours, says Rosanne M. Leipzig, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York.
But about 30 percent of older people get less than seven hours of sleep daily, and almost 20 percent report either frequent insomnia or poor sleep quality, according to a 2022 study published in the journal BMC Public Health. If you have been struggling with sleep, consider the following.
How your sleep cycle changes
Older adults tend to have less deep (what’s called non-REM) sleep, says Ronald Chervin, chief of the Division of Sleep Medicine at University of Michigan Health in Ann Arbor.
So “you may find that you’re woken more by things that would not have disturbed you before,” Leipzig says.
You may also notice that you become sleepy earlier in the evening. “As we get older, our circadian rhythm — the body’s internal clock — changes,” Chervin says. This may lead you to head off to sleep earlier at night and wake up earlier in the morning.
In addition, at night, older people tend to produce less antidiuretic hormone — which “instructs” the kidneys to cut back on creating fluid — than they once did, Leipzig says. As a result, you may wake up more often at night with the need to urinate. Other medical conditions, such as prostate problems or diabetes, can also contribute to those middle-of-the-night bathroom visits.
Four ways to get your ZZZ’s
You may already know the basics of what’s called good sleep hygiene — all of which can help: Go to bed and wake up at the same time each day, use your bedroom for only sleep and sex, and wind down about an hour or two before bed with relaxing activities such as stretching, a warm shower and calming music, says Kathleen Rogers, a geriatrician at the Cleveland Clinic.
Several other lifestyle steps can also help, some of them a bit unexpected.
Reset your body clock. If you find that you often nod off at 8 or 9 p.m., then wake up for the day far too early, you may want to rejigger your internal clock so that you fall asleep — and wake up — later.
One way to do so is to move your exercise and other energizing activities to later in the day, which may seem counterintuitive because we’ve long been told this interferes with sleep.
“It may be a negative for a younger person to exercise right before bed, but for a senior, an evening workout may allow them to stay up later so that they’re not up at 3 a.m.,” says Chris Winter, a neurologist and author of “The Sleep Solution.” A small study published in the Journal of Geriatric Psychiatry and Neurology in 2021 found that older people who exercised at low intensity for 30 minutes at home in the evening reported sleeping better than those who did morning workouts.
And while sleep experts usually recommend avoiding electronics before bed, “this is the one time where I would tell patients to turn on their computer in the early evening, to wake them up a bit,” says Beth Malow, director of the Vanderbilt Sleep Division at the Vanderbilt University Medical Center in Nashville. “This way, they can hopefully stretch out their evening so that they’ll go to bed later.”
Strive for enough — but not too much — sleep. Spending too much time in bed may also lead to too-early wake-ups as well as difficulty falling or staying asleep, Winter says. Unsure of how much time you’re spending in bed or how much sleep you’re actually getting? It may be useful to track this with an app or on paper and adjust your schedule accordingly.
“If you are awake every night for an hour or so, it’s often a sign that you should spend an hour less in bed each night,” says Lynelle Schneeberg, a behavioral sleep specialist at the Yale School of Medicine in New Haven, Conn.
And if you can’t fall asleep (or fall back to sleep) within about 20 minutes, get up and go to another room to read or do something else that relaxes you until you feel sleepy again.
Nap strategically. If you like a daytime nap, go ahead and take one. Contrary to popular belief, napping won’t necessarily get in the way of your nighttime sleep, according to a review published in the journal Frontiers in Aging Neuroscience in 2022.
The key is to snooze after lunch, and to keep your nap to an hour or less, Schneeberg says. A brief siesta may also offer brain benefits. A study of 2,200 adults 60 and older published in the journal General Psychiatry in 2021 found that those who took naps of 30 minutes or less four times a week scored higher on cognitive tests than never-nappers.
Focus on a whole-foods diet. A host of studies suggest that avoiding processed foods and embracing a diet rich in produce, nuts, beans and lean protein is heart-healthy. But this style of eating also appears to be good for sleep, according to a study of postmenopausal women published in the American Journal of Clinical Nutrition in 2020.
It’s also wise to avoid alcohol several hours before you go to sleep. And it’s a good idea to put the kibosh on eating and drinking an hour before bed. A study published in the British Journal of Nutrition in 2021 found an association between such nighttime noshing and poor sleep.
When to see your doctor
It’s reasonable to let your doctor know about any sleep problems that are getting in the way of daily life. But it’s important to schedule an appointment if you think you meet the criteria for chronic insomnia: sleep troubles at least three nights a week for more than three months, Malow says.
A medical issue that your doctor can help with, such as an enlarged prostate or pain from arthritis, may be the reason. But if an exam doesn’t reveal a clear cause, ask to see a sleep specialist to be checked for a sleep disorder, such as restless leg syndrome or obstructive sleep apnea (OSA). Research suggests that more than half of adults 65 and older are at risk for OSA, but many may not know it. The condition often goes undiagnosed, particularly in women, Malow says.
Many people can now be diagnosed with an at-home sleep apnea test. You wear a monitor that typically tracks your breathing and oxygen levels as you sleep. A positive test is reliable, Chervin says. But if it’s negative, you’ll need to go to a sleep center for an overnight sleep study, which can pick up milder OSA cases and some other sleep disorders.
Should you ever use sleep meds?
Many older people turn to over-the-counter or prescription sleep medications to help them nod off. But sleep experts and geriatricians don’t usually recommend them. “There’s a pretty scary association between sleeping pill use and risk of falls for older adults,” Chervin says.
A study published in 2019 in the Journal of Contemporary Pharmacy Practice, for example, found that older people who reported taking sleep drugs nightly were 1.5 times more likely to experience a fall than those who didn’t use those drugs. “These can happen when people get up at night to go to the bathroom,” Chervin says.
Instead, consider cognitive behavioral therapy for insomnia (CBT-I). It’s recommended by the American College of Physicians and the American Academy of Sleep Medicine as a first-line treatment for chronic insomnia.
If you want to take something in the short term while you work on your sleep habits, a small dose of the dietary supplement melatonin might make it easier to fall asleep, Rogers says. A review published in the journal the Senior Care Pharmacist in 2021 concluded that melatonin improved sleep time and quality in older adults, with minimal side effects. But it’s unwise to take it regularly, so first talk to your doctor about how to use it and what to look for in a supplement.