SLEEP BETTER - How to Sleep Well Over 50

How to Sleep Well Over 50

Tips for Overcoming Insomnia and Sleeping Better as You Age

As we age we often experience normal changes in our sleeping patterns. We may become sleepy earlier, wake up earlier, or enjoy less deep sleep. Although these changes are a normal part of aging, disturbed sleep, waking up tired every day, and other symptoms of insomnia are not a normal part of aging. Sleep is just as important to our physical and emotional health over the age of 50 as it was when we were younger. These tips can help you overcome age-related sleep problems and get a good night’s rest.

The importance of sleep for older adults

No matter what your age, sleeping well is essential to your physical health and emotional well-being. For older adults, a good night’s sleep is especially important because it helps improve concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system, which in turn helps to prevent disease.

Many physicians consider sleep to be a barometer of a person’s health, like taking his or her temperature. Older adults who don’t sleep well are more likely to suffer from depression, attention and memory problems, and excessive daytime sleepiness. They are likely to suffer more nighttime falls, have increased sensitivity to pain, and use more prescription or over-the-counter sleep aids. Insufficient sleep can also lead to many serious health problems in older adults, including an increased risk of cardiovascular disease, diabetes, weight problems, and breast cancer in women.

How many hours of sleep do older adults need?

While sleep requirements vary from person to person, most healthy adults tend to require between seven and a half to nine hours of sleep per night to function at his or her best. A recent study by the National Institutes of Health suggests that healthy older people may require about one and a half hours less sleep than younger adults, or an average of seven and a half hours per night. The study indicates that older adults sleep less even when given the opportunity for more sleep because of age-related changes in the ability to fall asleep or remain asleep.

While the results of the study may not be conclusive, it’s important to focus more on how you feel following a night’s sleep rather than the specific number of hours you spend asleep. Quality is as important as quantity. Some older adults mistakenly believe they have a sleeping problem because they go to bed expecting to be asleep for eight or nine hours of sleep a night, and may even needlessly start using medications to help them sleep more. Frequently waking up not feeling rested or feeling tired during the day are better indications that you’re not getting enough sleep at night and may have a sleep problem that needs to be addressed.

Insomnia & Aging tip 1: Understand how sleep changes as you age

As you age your body produces lower levels of growth hormone, so you'll likely experience a decrease in slow wave or deep sleep. When this happens you produce less melatonin, meaning you'll often experience more fragmented sleep (more rapid sleep cycles) and more awakenings between sleep cycles. As your circadian rhythm (the internal clock that tells you when to sleep and when to wake up) changes, you may also find yourself wanting to go to sleep earlier in the evening and waking up earlier in the morning. If you don't adjust your bedtimes to these changes, you may find that you have difficulty falling and staying asleep.

It should be noted that older adults tend to wake up more often during the night. Consequently, you may have to spend longer in bed at night to get the hours of sleep you need, or you may have to make up the shortfall by taking a nap during the day. In most cases, such sleep changes are normal and don't indicate a sleep problem.

Sleep problems not related to age

At any age, it’s common to experience occasional sleep problems. However, if you experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder:

• Have trouble falling asleep even though you feel tired
• Have trouble getting back to sleep when awakened
• Don’t feel refreshed after a night’s sleep
• Feel irritable or sleepy during the day
• Have difficulty staying awake when sitting still, watching television, or driving
• Have difficulty concentrating during the day
• Rely on sleeping pills or alcohol to fall asleep
• Have trouble controlling your emotions

Insomnia & Aging tip 2: Identify underlying problems

Many cases of insomnia are caused by underlying but very treatable causes. While emotional issues such as stress, anxiety, and depression can cause insomnia, the most common causes in adults over 50 are a poor sleep environment and poor sleep and daytime habits. Try to identify all possible causes of your insomnia; once you figure out the root cause, you can tailor treatment accordingly.

• Are you under a lot of stress?
• Are you depressed? Do you feel emotionally flat or hopeless?
• Do you struggle with chronic feelings of anxiety or worry?
• Have you recently gone through a traumatic experience?
• Are you taking any medications that might be affecting your sleep?
• Do you have any health problems that may be interfering with sleep?

Common causes of insomnia and sleep problems in older adults

The most common causes of insomnia and sleep problems in older adults include:

• Poor sleep habits and sleep environment. Examples of poor sleep habits are irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on.
• 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. Older adults tend to take more medications than younger people and the 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 aerobic exercise during the day, at least three hours before bedtime, 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) and sleep-disordered breathing—such as snoring and sleep apnea—occur more frequently in older adults.
• Learned response. People with a legitimate cause for having trouble sleeping—after suffering a loss, for example—may lie in bed and try to force themselves to sleep. Eventually their bodies learn not to sleep. Even after your original reason for sleep disruption has passed, the learned response of not sleeping can remain.

Insomnia & Aging tip 3: Improve sleep habits

Poor sleep habits, including a poor sleep environment and poor daytime habits, can be the main causes of sleep problems and low-quality sleep. In many cases, older adults develop these poor sleep habits over a lifetime but find they create more and more problems as they age. Fortunately, these habits are easy to improve.

Improve daytime habits for better sleep

• Be engaged. Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep. If you’re retired, try volunteering, joining a seniors’ group, or taking an adult education class.
• Improve your mood. A more positive mood and outlook can reduce sleep problems. Find someone you can talk to, preferably face-to-face, about your problems and worries.
• Exercise regularly. Exercise releases endorphins that can boost your mood and reduce stress, depression, and anxiety.
• Expose yourself to sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to get at least two hours of sunlight a day. Keep curtains and shades open during the day, move your favorite chair to a sunny spot, or consider using a light therapy box to simulate daylight.
• Limit caffeine, alcohol, and nicotine. All are stimulants and interfere with the quality of your sleep.

Encourage better sleep at night

• Naturally boost your melatonin levels. Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy. Use low-wattage bulbs where safe to do so, and turn off the TV and computer at least one hour before bed.  
• Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a soft bedside lamp.
• Make sure your bedroom is quiet, dark, and cool, and your bed is comfortable. Noise, light, and heat can cause sleep problems. Try using a sleep mask to help block out light.
• Use your bedroom only for sleep and sex. By not working, watching TV, or using your computer in bed, you’ll come to associate the bedroom with sleep and sex, so when you get into bed your brain and body get a strong signal that it’s time to nod off or be romantic.
• Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep is a surefire recipe for insomnia. Light emitted from a clock, telephone or other device can also disrupt your sleep.

Keep a regular bedtime routine for better sleep

• Maintain a consistent sleep schedule. Go to bed and wake up at the same times every day, even on weekends.
• Block out snoring. If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.
• Go to bed earlier. Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.
• Develop bedtime rituals. A soothing ritual, like taking a bath or playing music will help you wind down. Relaxation and stress management techniques, such as deep breathing and progressive muscle relaxation, take some practice but their benefits can be substantial. 
• Limit your use of sleeping aids and sleeping pills. Many sleep aids have side effects and are not meant for long-term use. Although it may be tempting to continue using them, they are crutches that only address the symptoms and not the causes of insomnia. In fact, sleeping pills can often make insomnia worse in the long run. Therefore, it’s best to limit sleeping pills to situations where a person’s health or safety is threatened.
• Combine sex and sleep. Sex and physical intimacy, such as hugging and massage, can lead to restful sleep.

Can napping help with sleep problems?

People are biologically programmed to sleep not only for a long period in the middle of the night but also for a short period in the middle of the day. Naps can enhance visual, motor, and spatial skills, and have even been shown to decrease the risk of coronary heart disease. So, 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 – Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 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.

Insomnia & Aging tip 4: Use diet and exercise to improve 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 actually disrupt your sleep.
Satisfy your hunger prior to bed	Have a light snack such as crackers, cereal and milk, 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.

The importance of regular exercise in overcoming sleep problems

Exercise releases chemicals in your body that promote more restful sleep. There are four main types of exercise:

• Aerobic activities, such as walking, swimming, or riding a bike, increase your heart rate and breathing to improve the health of your heart and circulatory system
• Strength exercises build muscle tissue and reduce age-related muscle loss
• Stretching exercises keep your body limber and flexible, allowing a greater range of motion as you age
• Balance exercises build leg muscles to reduce the chances of a fall

While adults need some of each type of exercise, studies have shown that participating in moderate aerobic activity can have the greatest impact on improving sleep.

Aerobic exercise helps older adults sleep better

A recent study by Feinberg School of Medicine at Northwestern University found that aerobic exercise resulted in the most dramatic improvement in patients' reported quality of sleep, including sleep duration, on middle-aged and older adults with a diagnosis of insomnia.

The participants, aged 55 and up, exercised for two 20-minute sessions four times per week or one 30-to-40-minute session four times per week. Participants worked at 75 percent of their maximum heart rate on at least two activities including walking or using a stationary bicycle or treadmill. The regular aerobic exercise improved the participants' sleep quality from a diagnosis of poor sleeper to good sleeper. They also reported fewer depressive symptoms, more vitality, and less daytime sleepiness.

Source: National Sleep Foundation

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, improve aerobic capacity, burn calories, and prepare yourself for a good night’s sleep at the end of the day. Always consult your doctor before embarking on any new fitness program.

• Swim/Water exercises – Swimming laps is a gentle way to build up fitness and is great for sore joints or weak muscles. Many community and YMCA pools have swim programs just for older adults, as well as water-based exercise classes such as water aerobics.
• 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. The more you walk, and the brisker the pace, the more aerobic benefit you’ll experience.
• 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 aerobic bonus to your game.
• Cycle or run – If you are in good shape, you can run and bicycle until late in life. Both can be done outdoors or on a stationary bike or treadmill.

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

Insomnia & Aging tip 5: Reduce mental stress

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.

• Keep a journal to record worries and concerns before you retire
• On your to-do list, check off tasks accomplished for the day, list your goals for tomorrow, and then let go
• Listen to calming music
• Read a book that makes you feel relaxed
• Get a massage from a friend or partner
• Use a relaxation technique to prepare your body for sleep
• Seek opportunities to talk with a friend or therapist about what is troubling you

Getting back to sleep at night

It’s normal to wake briefly during the night but if you’re having trouble falling back asleep, the following tips may help:

• Don’t stress. Try not to stress over the fact that you can’t get back to sleep, because that very stress encourages your body to stay awake. Focus on the feelings and sensations in your body instead.
• Make relaxation your goal, not sleep. Try a relaxation technique such as deep breathing or meditation, which can be done without getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.
• Do a quiet, non-stimulating activity. If you’ve been awake for more than 15 minutes, try getting out of bed and doing a non-stimulating activity, such as reading a book. Keep the lights dim so as not to cue your body clock that it’s time to wake up, and avoid TV and computer screens.
• Postpone worrying. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve.

Insomnia & Aging tip 6: Talk to your doctor about 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 a sleep diary with you. Write down 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 due to your increasing age. Just as younger adults can solve their sleep problems, so can you.