Restful sleep: There’s more to it than counting sheep

It’s often assumed that the elderly have different sleep needs than younger adults. But experts say regardless of age in adulthood, seven to nine hours per night are still what’s required to be rested and ready for the day.

Just because older adults need the same amount of sleep doesn’t mean that they don’t face unique challenges in getting it. A study by the National Sleep Foundation found that 44 percent of older people have symptoms of insomnia more than once per week.

As people age, their sleep patterns change. Deep sleep becomes less common, and the variety and severity of sleep interruptions often increases.

As we progress from infancy to childhood and through adolescence and young adulthood, our sleep needs are regularly changing and evolving. At these earlier stages of development, there’s no doubt that these needs are markedly different than what’s required later in life.

However, it’s common for people to assume that these sleep needs continue to change during adulthood. Experts say, though, that getting 7-9 hours of sleep remains important for adults of any age. For all adults, sleep is vital to physical and cognitive function and plays a multifaceted role in our overall health.

The issue that older adults face is that with age it gets harder and harder to get high-quality sleep. One of the main reasons is that older people experience changes to what experts call sleep architecture. This relates to the sleep cycle and how much time we spend in a deep sleep. When older people sleep, they spend more time in light sleep that is not as restorative for the body and that is more easily interrupted.

As lifespans have increased and a new wave of the population enters old age, there has been a growing focus on understanding the sleep difficulties faced by this demographic group. Research has shown that insomnia — which can be understood as regularly having difficulty getting to sleep or staying asleep — is a major issue among the U.S. population over the age of 60 as nearly half of people of this group reported having experienced this problem.

While sleep is important at any age, health professionals and researchers are also gaining an understanding of the relationships between sleep and aging. For older people, many of the effects of insomnia are similar to those that can occur in younger adults, but they may be exacerbated by other coexisting medical conditions. Some of the symptoms and consequences of insomnia and sleep deprivation in older people include:

  • Daytime drowsiness. A lack of sleep overnight can cause physical tiredness and a tendency to doze off during the day. This and a related lack of alertness heightens the risk of falls and automotive accidents.
  • Cognitive issues. Insomnia in older people has been linked to higher levels of memory loss and confusion that can complicate many aspects of daily life.
  • Insufficient sleep can affect mood, triggering a propensity to be easily frustrated or irritated.
  • Persistent sleep deprivation can play a role in causing or worsening depression among the elderly.
  • Cardiovascular problem and chronic diseases. Studies have shown a relationship between insomnia and cardiovascular conditions like hypertension (high blood pressure) and the risk of stroke. These risks are greater in people who suffer from untreated sleep apnea. Studies also continue to show that lack of sleep can contribute to chronic health problems related to weight, as well as immune function, metabolism, and the endocrine system.

Many of the health and body-related issues that affect insomnia in older people have overlapping effects. The body is a system, after all, and sleep is affected by and affects many other issues.

There are two main types of insomnia. One type relates to not being able to fall asleep. A number of issues can contribute to this, and many of these are more common in the elderly. For example, chronic pain may interfere with finding a comfortable sleeping position, and older adults are more likely to have the type of health conditions — such as arthritis — that cause chronic pain. Restless Leg Syndrome (RLS), a condition more common in older people who report tingling or itching in the legs, can also be a barrier to falling asleep. Furthermore, older adults often take many prescription medications, and some of these can make it harder to fall asleep.

A second type of insomnia relates to staying asleep. Because older adults spend less time in deep sleep, they are more prone to interruptions and waking in the night. These interruptions may be more numerous for older people for several reasons, such as:

  • Health conditions that affect urinary control and frequency and cause older people to to go to the bathroom more frequently.
  • Obstructive sleep apnea, characterized by periods of halted breathing in the night, is more common in older people and can cause someone to wake up. It’s also related to cardiovascular concerns.
  • Snoring, including snoring caused by sleep apnea, can cause sleep disruptions. Snoring is more common because of age-associated atrophy of the muscles that control breathing and the airways.
  • Involuntary movements or REM (rapid eye movement).

Problems with thermoregulation (the body’s processing of maintaining a stable core temperature) can throw off the body’s typical sleep cycles. The natural rhythms of sleep typically line up with changes to our body temperature, so a decrease in thermoregulation can interfere with these cycles and make it more likely for a person to be awoken prematurely. Many other medical conditions ranging from cancer to cardiovascular conditions to depression can cause sleep disruptions, and many of these conditions are more common in the elderly.


Treating Sleep Problems

For all adults, dealing with persistent sleeping problems can be frustrating, confusing, and literally tiresome. There aren’t always simple or fast-acting solutions to getting more sleep, and sometimes many factors are at work in causing insomnia. The good news is that in many cases, there are steps to help older people fall asleep and stay asleep.

An important first step can be to talk with their doctor. Often, insomnia is caused by an underlying health condition or by a medication. Doctors can review health histories and lists of current medications and address whether there are any other treatments that may be available to try to manage insomnia. If you haven’t been diagnosed with any health issues that might be causing insomnia, your doctor can begin an appropriate diagnostic process to try to bring you relief. In most cases, resolving or mitigating a coexisting health problem can stop or substantially reduce insomnia.

Talking with your doctor is especially important if you have experienced any symptoms of sleep apnea. Because this condition can be related to a number of serious medical problems, diagnosing and managing it can improve your sleep and your overall health. Sleep apnea can usually be resolved by wearing a positive airway pressure (PAP) device at night. The most common of these is a continuous positive airway pressure device (CPAP). The CPAP maintains a flow of air through a mask that prevents the obstruction of the airway. It can take some time to adjust to wearing the mask, but today’s masks are lighter and better cushioned than in the past. People with sleep apnea typically adjust to using the CPAP within a few days and find that they get dramatically better sleep.

Another way that your doctor can help is by offering a referral to a mental health counselor. Or if you already have a counselor that you work with, be sure to let them know about your sleep problems.

In some cases, the underlying conditions that are affecting sleep are psychological. Issues like depression and anxiety, even if they are mild, can play a role in sleeplessness. A type of talk therapy called cognitive behavioral therapy for insomnia can involve a number of types of discussion and reflection.


Be Wary of Sleep Medications

Many people suffering from sleep difficulties immediately think about medications as a way to help them sleep. Taking drugs to help with sleep problems is referred to as pharmacotherapy, and this includes prescription and over-the-counter sleep aids. Remember that medications like these, even when they bring some relief, are not a cure for insomnia. First, even though drugs may have strong effects at the outset, they usually become less and less effective over time. The amount of time this may take can vary based on the person and the medication, but diminishing returns are common. Second, sleep medications can be habit-forming. Relying on a medication to get to sleep can create dependencies that make it harder to ever get back to falling asleep naturally. Third, as with most medications, there are side-effects, some of which can be serious. One of the most common is a grogginess or fogginess that can persist after having woken up. This can slow reaction times and raise the risk of falls or car accidents. Fourth, detailed research studies aren’t available for many pharmacotherapies. While broad studies may have been conducted, those studies usually do not provide specific guidance about the drug in terms of its interactions with other drugs, about its effects on people with coexisting medical conditions, about how it influences sleep architecture, or about its safety and efficacy in this particular demographic group.

If you do decide to use a sleep medication, whether it be prescription or over-the-counter, talk to your doctor first. Your doctor is in the best position to address any potential concerns or instructions for using these medications in your situation.


Improving Your Sleep Without Medications

Besides treating any underlying medical issues that can contribute to insomnia, there are a handful of other steps that you can take to improve your ability to get good sleep.

  • Physical activity. Studies have indicated that adding regular exercise to your day may help with sleep problems. Exercise at least three hours before bedtime, and consult with a health professional before beginning a new exercise routine. This can help ensure that your exercises are appropriate given your overall health and any co-existing medical conditions.
  • Light therapy. This approach, also known as bright light therapy or phototherapy, exposes you to what is usually a bright light tinged with blue. This can help to modify and improve circadian rhythms in ways that may decrease insomnia.
  • Watch when you eat. Having a late, heavy dinner can make it harder to fall asleep. Try to avoid eating anything heavy for at least a few hours before you plan to go to bed.
  • Go easy on alcohol. Though some people think alcohol makes them sleepy, it disturbs sleep architecture and can make it harder to get a truly restful night’s sleep. Being mindful and moderate in alcohol consumption can help avoid this.
  • Don’t overdo caffeine. Caffeine is a stimulant that is well-known for its ability to help people stay awake. It can take many hours for caffeine to be fully metabolized, so avoid drinking caffeinated drinks after the morning as they can contribute to sleeping problems in the evening.
  • Have a regular sleep schedule. Try to go to bed and wake up at the same time each day, even on weekends. This can help your body get acclimated to a specific timeline that promotes a full night’s rest.
  • Avoid afternoon naps. They may seem refreshing, but they often make it more challenging to fall asleep at night.
  • Avoid screen time in bed. The light from electronics like mobile phones, laptops, and tablets all stimulate the brain in a way that has been found to make it harder to fall asleep. Try to only use these devices in other rooms of your home.
  • Follow a bedtime routine. It helps to have consistency in the lead-up to going to bed. This routine can include the basics like brushing your teeth as well as other things like stretching or deep breathing for relaxation.

Source: The Sleep Help Institute (, an independently owned and operated resource for sleep problems.

Insomnia commonly keeps older adults awake more than once a week, according to the National Sleep Foundation.