Seniors and Sleep: how an Austin sleep specialist can help
Seniors are especially prone to sleep issues. Biological transitions, like the advancing of the circadian rhythm, and social transitions, like retirement, set the stage for disrupted sleep. Reach out today to talk to a sleep specialist in Austin with experience meeting the sleep needs of older adults.
Poor sleep is often thought of as an inevitable part of aging. It doesn’t have to be that way. An Austin sleep specialist can help you improve your sleep regardless of your phase in life. Reach out today to schedule a free 15-minute phone consultation with an Austin sleep specialist.
As an Austin sleep specialist, my insights on sleep in older adults were recently featured in an article on Care.com. You can read the full article here: https://www.care.com/c/why-do-older-people-sleep-so-much/
This post expands on that discussion, providing more detailed information about sleep changes in seniors and how a sleep specialist in Austin can offer support.
How Aging Impacts Sleep: What Seniors Need to Know
As we age, several aspects of our sleep patterns naturally change. These include:
Decreased total sleep time: Older adults often sleep for shorter durations overall.
Reduced sleep efficiency: The percentage of time spent in bed actually sleeping decreases.
Less deep sleep (Stage 3): The restorative deep sleep stage becomes less prominent.
Less REM sleep: The stage where most dreaming occurs also tends to decrease.
Increased sleep-onset latency: It takes longer to fall asleep.
More light sleep (Stages 1 and 2): Time spent in the lighter sleep stages increases.
Many of these shifts become noticeable by around age 60. Older individuals are also more likely to experience frequent and longer awakenings during the night compared to their younger years.
However, it's crucial to understand that poor sleep in seniors shouldn't be dismissed as an inevitable consequence of aging. Sleep duration consistently less than 6 hours and sleep problems that negatively impact quality of life warrant attention from a healthcare professional.
The Evolution of Circadian Rhythms Across the Lifespan
Our circadian rhythm, the internal body clock that regulates sleep and wakefulness, also changes throughout our lives.
Babies: Have very little to no discernible circadian rhythm, leading to highly variable sleep patterns.
First Year: Sleep gradually consolidates into a longer nighttime block with 1-2 daytime naps.
Age 4: The nighttime sleep block lengthens, and naps become shorter.
Age 10: Children typically become monophasic sleepers with long sleep durations.
Adolescence: Sleep duration shortens, and the circadian rhythm shifts later.
Young Adulthood to Middle Age: The circadian rhythm gradually shifts earlier.
Older Adulthood: Seniors tend to fall asleep and wake up earlier than other age groups.
Do Older Adults Sleep More? Debunking the Myth
While nighttime sleep duration may decrease, napping is indeed more common among older adults. However, the impact of napping on this population is still debated. Some research links naps to an increased risk of falls, depression, and lower quality of life, while other studies suggest that naps can improve daytime function and cognitive abilities.
As an Austin sleep specialist, I often explain naps using a "cupcake analogy." A cupcake isn't inherently bad, but it might be problematic for someone with diabetes. Similarly, naps aren't universally harmful, but they can be counterproductive for individuals with sleep disorders like insomnia because they can reduce sleep drive.
Sleep drive is the biological pressure to sleep that builds up throughout the day. It's independent of clock time; what matters is the total amount of drive accumulated. For someone with insomnia, daytime naps can deplete this drive, making nighttime sleep more challenging.
It's also important to differentiate between tired (fatigued, low energy) and sleepy (high likelihood of falling asleep). Napping is more appropriate when someone is genuinely sleepy. In fact, for certain sleep disorders characterized by excessive daytime sleepiness, such as narcolepsy, scheduled naps are often a part of the treatment plan. However, individuals with typical insomnia are often tired but "wired," and naps are generally not effective in alleviating this type of fatigue. Paradoxically, expending energy can sometimes be more helpful in combating fatigue than conserving it.
Good sleep isn’t just a fantasy! An Austin sleep specialist can help you figure out what’s interfering and make recommendations too improve your sleep. Reach out today!
The Crucial Benefits of Sleep for Older Adults
Regardless of age, our bodies perform vital functions during sleep. Research comparing good and poor sleepers in older adults reveals that poor sleepers tend to:
Take more medication
Utilize more healthcare resources
Report feeling worse about their overall health
Here are some key processes that occur during sleep:
Cardiovascular Health: The heart rate and blood pressure decrease, allowing the heart and blood vessels to rest and repair.
Hormonal Balance: Sleep supports the healthy regulation of hormones that control hunger and fullness, increasing leptin (satiety hormone) and decreasing ghrelin (hunger hormone).
Insulin Sensitivity: Adequate sleep helps maintain the body's response to insulin, which is crucial for energy utilization. Reduced sleep can lead to increased insulin resistance.
Growth and Repair: The highest production of growth hormones, essential for tissue repair and muscle growth, occurs during sleep.
Immune Function: The body produces cytokines, which help fight infection, during sleep.
Common Sleep Conditions Affecting Older People
Sleep in older adults is often influenced by existing medical conditions and the medications they take. Seniors tend to have more comorbidities and are prescribed a greater number of medications, both of which can impact sleep.
Retirement can also be a significant factor contributing to insomnia. The loss of a structured work schedule can lead to highly variable bedtimes and wake times, disrupting the circadian rhythm. Our circadian rhythm relies on external cues called zeitgebers (German for "time givers") to stay synchronized with the outside world. The most powerful zeitgeber for humans is light.
Poor sleep has ripple effects throughout your life. Get the sleep you want and need. Reach out to an Austin sleep specialist today!
Inconsistent bedtimes and, particularly, wake times lead to variability in other important zeitgebers like meals, social interactions, and physical activity. This dysregulation of the circadian rhythm results in less predictable sleep and wake patterns, increased daytime fatigue, and sleepiness. Simply regularizing bedtimes and wake times can often significantly improve sleep.
Nocturia, the need to urinate frequently during the night, is a very common sleep complaint among older adults. Increasing the time between falling asleep and the first time needing to urinate is associated with better overall sleep.
The two most prevalent sleep disorders across all age groups are sleep apnea and insomnia. The risk of sleep apnea increases with age and is more common in men, although this gender difference tends to disappear after menopause in women. It's also possible to have both sleep apnea and insomnia concurrently. Sleep apnea is typically treated with PAP therapy, while insomnia is addressed through behavioral changes.
Sleep disturbance is also common in long-term care settings. Factors like noise, light, room temperature, roommates, and incontinence care can all interfere with sleep, leading to highly irregular sleep-wake patterns that can resemble those of infants.
Tips for Better Sleep in Older Adults: Guidance from an Austin Sleep Specialist
Occasional nights of poor sleep are a normal human experience at any age. Sometimes, people have unrealistic expectations about their sleep, believing they should fall asleep instantly, sleep deeply for eight uninterrupted hours, and wake up feeling completely refreshed. Dispelling these myths and normalizing occasional sleep disturbances can reduce the pressure to perform, which often contributes to and worsens sleep problems.
If you are experiencing persistent sleep difficulties, it's essential to rule out any underlying medical conditions or medications that might be contributing to the problem. A sleep specialist (which could be a sleep medicine physician or a psychotherapist with specialized training in sleep), like myself here in Austin, can help diagnose the specific sleep issue. A sleep study is often recommended if sleep apnea is suspected.
Insomnia is often a learned behavior that has become a habit, characterized by difficulty falling asleep, staying asleep, or waking up too early. The diagnostic criteria include taking longer than 30 minutes to fall asleep, being awake for more than 30 minutes during the night, and/or waking up at least 30 minutes earlier than desired, occurring at least three nights per week for at least three months, and causing distress or daytime impairment. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard treatment for insomnia.
While sleep hygiene practices are beneficial for good sleepers and can help prevent insomnia, they are usually insufficient to resolve established insomnia. Again, CBT-I is the most effective approach. As an Austin sleep specialist, I offer CBT-I to help individuals overcome insomnia. I also provide treatment for nightmares and circadian rhythm disorders.
Here are some general tips that can benefit anyone seeking better sleep:
Maintain a consistent sleep schedule: Go to bed and, more importantly, wake up around the same time each day, even on weekends (within an hour of your weekday schedule).
Don't force sleep: It's okay to go to bed a little later if you're not feeling sleepy. There's an unwarranted stigma against "night owls." If you're not tired, lying in bed won't make you sleepy. Spending excessive time in bed without sleeping can actually harm your sleep drive.
Reserve your bed for sleep and sex: This helps your brain associate your bed with these activities. Avoid working, reading, or watching television in bed.
Engage in a longer and more active day: Increased physical activity can build a stronger sleep drive.
If you have a bad night of sleep, stick to your regular wake-up time: Avoid the temptation to sleep in excessively. Don't dwell on the poor sleep or catastrophize it. Trust that your sleep will likely regulate itself. This is a common behavior among good sleepers.
Limit alcohol, caffeine, and nicotine, especially close to bedtime: These substances can negatively impact your sleep drive.
Don't aggressively pursue sleep: The more you try to force sleep, the more elusive it can become. Actively trying to achieve a goal requires focus and effort, while sleep requires disengagement. You can't consciously focus and disengage simultaneously.