Getting a good night's sleep

The importance of quality sleep for seniors

No matter what your age, sleeping well is essential to your physical health and emotional well-being. As we age, a good night’s sleep is especially important because it improves concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system which helps to prevent disease. Many seniors complain about sleep problems such as:

• difficulty falling asleep
• frequent waking during the night, and lighter sleep
• waking up early and not feeling rested
• a urge to go to bed in early evening
• being tired in the daytime
• needing naps during the day

To feel your best, you need a good night’s sleep, and you may be surprised that keeping yourself active and engaged, eating a healthy diet and exercising regularly can improve how well you sleep.

How is sleep related to an active, healthy lifestyle?

A National Sleep Foundation poll of older adults found a close relationship between the health and quality of life of older adults, and their sleep quantity and quality. “The NSF poll found that the better the health of older adults, the more likely they are to sleep well. Conversely, the greater the number of diagnosed medical conditions, the more likely they are to report sleep problems. Additionally, among older adults, more positive moods and outlooks as well as having more active and “engaged” lifestyles (having someone to speak with about a problem, exercise, volunteer activity, etc.) are associated with sleeping 7–9 hours and fewer sleep complaints.”

Causes of sleep changes as we age

Aging may bring unwelcome changes in your sleep, such as more fragmented sleep (more rapid sleep cycles), a decrease in deep sleep, and more awakenings between sleep cycles. You may also find yourself wanting to go to sleep earlier in the evening and then waking up very early in the morning unable to go back to sleep (a change caused by a decrease in certain sleep regulating hormones).

Consider some common causes of sleep problems in the elderly:

• Poor sleep hygiene – The most common cause of insomnia in the elderly is poor sleep habits or a poor sleep environment. Examples of poor sleep hygiene are irregular sleep hours, consumption of alcohol before bedtime, and too much daytime napping.
• Pain or medical illness – Pain can keep you from sleeping well. In addition, many health conditions such as, a frequent need to urinate, arthritis, asthma, diabetes mellitus, osteoporosis, nighttime heartburn, menopause, and Alzheimer’s can interfere with sleep.
• Medications – Seniors tend to take more medications than younger people. Combinations of drugs, as well as the side-effects of individual drugs, can impair sleep or even stimulate wakefulness.
• Lack of exercise – If you are too sedentary, you may not feel sleepy or feel sleepy all of the time. Regular exercise early in the day can promote good sleep.
• Psychological stress or psychological disorders –Significant life changes like the death of a loved one or moving from a family home can cause stress. Anxiety or sadness can also keep you awake, which can, in turn, cause more anxiety or depression.
• Sleep disorders - Restless Legs Syndrome (RLS),insomnia, and sleep-disordered breathing such as snoring and sleep apnea occur more frequently in older adults.

To learn more about sleep hygiene, see Sleep Tips in Related Links below

Pain and medications can interfere with quality sleep

Pain and health issues are often obstacles to sleep for seniors. A frequent need to go to the bathroom, arthritis, asthma, diabetes mellitus, osteoporosis, nighttime heartburn, menopause, and Alzheimer’s can cause frequent awakenings. Discomfort may also prevent an easy return to sleep.

Additionally, the medications you take for pain or medical conditions can get in the way of sleeping well. While it may be difficult to pinpoint which medication could be causing sleep problems, your doctor should be able to help. The solution may be as simple as switching the time of day you take your medication; changing to another medication; or lowering the dosage.

Sleep tips for the elderly

Aging alone is unlikely to be the cause of your sleep problems. Poor sleep hygiene (your sleep habits and your sleep environment) can be the main cause of low-quality sleep. Fortunately, sleep hygiene is easy to improve.

Sleep Tips for the Elderly

• Keep a regular sleep schedule – Go to bed and wake up at the same times every day, even on weekends.
• Be engaged – Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep.
• Experiment with napping Although napping too close to bedtime can interfere with nighttime sleeping, short naps early in the day can improve overall restfulness.
• Expose yourself to sunlight – Bright sunlight increases melatonin, which regulates your sleep-wake cycles. Try to get at least two hours of sunlight a day.
• Block out snoring – If snoring is keeping you up, try ear plugs, a white-noise machine, or separate bedrooms.
• Go to bed early – Adjust your bedtime earlier, to match when you feel like going to bed.
• Quit smoking – Nicotine is a stimulant and can keep you awake. If you can’t quit, avoid smoking within three hours of bedtime.
• Develop bedtime rituals – A soothing ritual, like taking a bath or playing music will help you wind down.
• Limit your use of sleeping aids and sleeping pills – Many sleep aids have side-effects and are not meant for long-term use.
• Combine sex and sleep – Sex and physical intimacy, such as hugging and massage, can lead to restful sleep.

For additional sleep tips, see Tips for a Good Night’s Sleep and Coping with Stress..

To nap or not to nap – what is the right answer for me?

If you don’t feel fully alert during the day, a nap may be just what you need. For many people, taking a brief nap can provide the needed energy to perform fully for the rest of the day. Experiment with napping to see if it helps you.

Some tips for good napping:

• Short – Make sure your nap is only 15-30 minutes. You may feel groggy and unable to concentrate after a longer nap.
• Early – Nap early in the afternoon. Napping too late in the day may disrupt your nighttime sleep.
• Comfortable – Try to nap in a comfortable environment preferably with limited light and noise.

Using diet and exercise to reduce senior sleep problems How can the foods you eat close to bedtime disturb your sleep?

To promote good sleep, pay particular attention to your pre-bedtime diet.

Bedtime Diet Tips to Improve Sleep

Limit caffeine late in the day

Avoid caffeine (from coffee, tea, soft drinks and chocolate) late in the day.

Avoid alcohol before bedtime

Don’t use alcohol as a sleeping aid. It might seem to make you sleepy, but will disrupt your sleep.

Satisfy your hunger prior to bed

Have a light snack such as crackers, cereal and milk, or yogurt or warm milk.

Avoid big meals or spicy foods just before bedtime

Large or spicy meals may lead to indigestion or discomfort. Try to eat a modest-size dinner at least three hours before bedtime.

Minimize liquid intake before sleep

Limit what you drink within the hour and a half before bedtime.

Can a lack of exercise affect my sleep?

A life without exercise can make you feel sleepy all of the time, or not tired at all. Exercise releases chemicals in your body that promote more restful sleep. Even something as simple as a daily walk can do wonders for your sleep regularity.

Be sure to exercise early in the day

Exercise too late in the day can be stimulating – so plan to be active at least six hours before retiring.

Adding exercise to your life does not necessarily mean signing up for a gym membership. There are countless activities you can do to increase strength, burn calories and prepare yourself for a good night’s sleep at the end of the day.

• Swim – Swimming is a gentle way to build up fitness and it is great for sore joints or weak muscles. Many community and YMCA pools have swim programs just for older adults.
• Dance – If you love to move to music, go dancing or take a dance class. Dance classes are also a great way to extend your social network!
• Take up lawn bowling, bocce, or pétanque – Variations on throwing a ball on an earthen or grassy court are gentle ways to exercise.
• Golf – Golf is a form of exercise that requires precise, strong movement of particular parts of your body, but which doesn’t require vigorous movement. Walking can be an added bonus to your game.
• Garden – Gardening is a great way to increase your flexibility and range of motion.
• Cycle or run – If you are in good shape, you can run and bicycle until late in life.

If you have mobility issues, you can exercise from one position, either standing, sitting, or lying down.

Reducing mental stress to improve your sleep

Stress and anxiety can easily get in the way of a good night’s sleep. Everyone has worries and lists of things to do, but it is important to teach yourself to let go of these thoughts when it’s time to sleep.

See Stress Relief for more ideas on reducing stress and anxiety

Talking to your doctor about senior sleep problems

If your own attempts to solve your sleep problems are unsuccessful, your doctor may be able to help with sleep problems due to:

• A sleep disorder
• Medication side-effects or interactions
• Medical conditions or illnesses
• Pain

Bring with you a sleep diary (see Helpguide’s sample sleep diary). Include when you use alcohol, caffeine, and nicotine, and keep track of your medications, exercise, lifestyle changes and recent stresses. Above all, don’t expect to sleep poorly as you age. Just as younger adults can solve their sleep problems, so can you.

Related articles Related links for sleeping well as we age General information about sleep and aging

Sleep and Aging – An easy-to-understand guide to sleep for seniors. Includes illustrations and video clips. Displays information in easy-to-read chunks, and then offers optional quizzes on each section. (NIH Senior Health)

Older Adults and Sleep – Comprehensive series of articles covering sleep and aging topics including specific medical problems affecting sleep; dementia-related sleep problems; menopause and sleep; snoring; and sleep apnea. (National Sleep Foundation)

A Good Night’s Sleep – An overview of sleep changes in older adults, common problems, and things you can do to alleviate sleep problems. (National Institute on Aging)

Sleep Problems in the Elderly – Journal article that provides a wealth of information on seniors and sleep problems. (American Family Physician)

Diet, exercise and sleep

Foods for Sleep – Foods recommended to help you sleep, and others that keep you awake. (AskDrSears.com – commercial site)

Caffeine Calculator (PDF) – A handy list of how much caffeine is in common drinks and foods. (SleepFoundation.org)

Diet, Exercise, Sleep! The Path to a Healthier Lifestyle – Little-known facts about the interrelationships between sleep, nutrition, and exercise. (SleepFoundation.org)

Napping

New Respect for the Nap, a Pause That Refreshes – Encouraging words for taking a nap in the middle of the day to improve performance for the rest of the day. (Jane E. Brody, Science Times)

The Short Story on Napping – Key facts about napping and guidelines for how and when to nap. (National Sleep Foundation)

Relaxation

Relaxation Techniques – Learn about several types of relaxation including progressive relaxation, toe tensing, deep breathing, guided imagery, and quiet ears. (University of Maryland Medical Center)

Tina de Benedictis, Ph.D., Heather Larson, Gina Kemp, M.A., Suzanne Barston, and Robert Segal, M.A., contributed to this article. Last modified: November 08.

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