Sleep is as vital to your health as the air you breathe, the food you eat, and the water you drink.1 Nor does this basic human need change with age; in fact, research suggests older adults are especially prone to sleeping problems.2-4 The good news? You have more control than you think. By making a few changes to your lifestyle and pre-bedtime routine, you can foster healthier sleep habits no matter what your age.

How sleep affects your health

A lack of sleep can impact nearly every part of your body.

  • Brain function and cognition. You can feel irritable or drowsy, have brain fog with trouble focusing, and struggle to complete daily tasks.1,4
  • Mental health. Insufficient sleep increases your risk for anxiety and depression.1,3,4
  • Physical health. Chronic sleep deficiency increases your risk for health conditions like high blood pressure, cardiovascular disease, obesity, and diabetes.1,3,4 

Sleep changes in older adults

Older adults need just as much sleep as younger adults – 7 to 9 hours a night. But sleep patterns commonly change as you age.2,3 You can have trouble falling asleep or staying asleep. You go to bed earlier than you used to and wake up earlier in the morning. You might need to nap during the day.

Sleep changes that accompany aging are only a concern if they're problematic for you. If the changes aren't distressing or disruptive, then you probably don't need to adjust your sleep routine.5 However, if your ability to function during the day or your quality of life is diminishing because of insufficient sleep, then you can take steps to find more rest.

Set yourself up for a better night's sleep

Start by examining the lifestyle habits that might be contributing to your sleep problems. Consider implementing the following changes:

  • Create a sleep schedule. Go to bed and wake up at the same time every day. Tailor your sleep schedule to your specific needs. For example, if you're consistently waking up way too early in the morning, try moving your bedtime to an hour later.2,4,6 
  • Nap strategically. Some people find their nighttime sleep improves when they eliminate daytime naps entirely. But for others, naps are beneficial, so don't feel like you have to skip naps altogether. Limit naps to 20 minutes and don’t nap in the late afternoon or early evening, which can disrupt your nighttime sleep.2,4,6
  • Establish a pre-bedtime quiet time. Limit your exposure to television, tablet, and phone screens, because the light from these devices can disrupt your sleep cycles. Instead, use the hour or so before bed to relax:  take a warm bath, read a book, listen to soothing music, do some gentle stretching.1-3,6 
  • Consider your sleep environment. Set the thermostat to a cool, comfortable temperature. Wear comfortable clothing. Use low lighting. Keep the bedroom quiet or use a fan or white noise machine to mask obtrusive sounds.1-4,6
  • Stay active. Work with your health professional to establish an exercise routine. Try to spend some time every day outdoors, in natural light. Don't exercise during the four hours before bedtime.1-4,6
  • Limit fluids before bed. This will reduce the number of times you wake in the night to empty your bladder.4,5
  • Limit or avoid caffeine, nicotine, and alcohol. These substances can affect your sleep cycles.1-4,6

When you can't fall asleep – or fall back to sleep 

 Don't make a habit of lying in bed, awake, for hours at a time, which can perpetuate your sleep problems. Instead:

  • Get out of bed. When you've been awake for more than 20 minutes, get up and do something. When you feel sleepy again, return to bed.3,4,6
  • Avoid middle-of-the-night screen time. Don't reach for your smart phone, tablet, or the TV remote. The artificial light from these screens can keep you awake. Instead, get out of bed and read a book, or listen to calming music, or write in a journal until you feel sleepy.4,6
  • Don't change your morning alarm. Set your alarm and wake up at the same time each morning, even if you lose some nighttime sleep. This will help your body stay on a regular sleep schedule.4,6

Other causes of poor sleep in older adults

For some individuals, lifestyle changes won't resolve sleep issues. The following health conditions – many of them treatable – can cause or contribute to poor sleep in older adults:

  • Sleep disorders, like insomnia and sleep apnea2,4
  • Movement disorders, including restless legs syndrome, periodic limb movement disorder, and REM sleep behavior disorder2
  • Certain medications, including those used to treat colds (over-the-counter cough and cold medicines), depression (antidepressants), high blood pressure (anti-hypertensives and calcium channel blockers), fluid retention (diuretics), and asthma and COPD (beta agonists)4
  • Mental health issues like stress, anxiety, and depression4
  • Neurological disorders like dementia, Alzheimer's disease, and Parkinson's disease2-4
  • Chronic pain, from arthritis, back pain, injury, or a chronic illness4-5
  • Obesity, cardiovascular disease, breathing problems, diabetes, and some cancers3-5

When sleep problems persist

Talk to a health-care professional about your sleep problems. A health-care professional can help determine if medications are causing sleep problems or if a health condition is interfering with your sleep. You may need to switch medications or be evaluated for a sleep or movement disorder.

Older adults often benefit from cognitive behavioral therapy for insomnia (CBT-I).4,6,7 A CBT-I program offers sleep coaching and education, training in relaxation techniques, and counseling. Often, CBT-I takes place in one-on-one sessions with a trained professional, although group classes and online courses are also effective. Research suggests that CBT-I is more successful at treating insomnia in older adults than prescription medications.4

Will medicine help me sleep?

 Be cautious about using over-the-counter and prescription sleep aids.6-8 Many of these drugs can’t be used by individuals who have a chronic health condition. Sleep aids can also interact with other medications, causing serious side effects.

Melatonin appears to be the safest option for many older adults.8,9 Melatonin is a hormone that plays a role in sleep and is naturally produced by your body. As you age, your body produces less melatonin, which can contribute to sleep problems.8,9 A melatonin supplement taken an hour before bedtime can help you fall asleep quicker and stay asleep longer.*8,9 

But like any medication or supplement, melatonin might cause a side effect such as daytime drowsiness, which can increase your risk for falls.8 Melatonin might also interact with other drugs, including medications for diabetes and high blood pressure.9 Consult with your health-care professional about taking melatonin.

Prescription sleep aids are more likely to cause negative side effects in older adults. Although these drugs improve nighttime sleep, this benefit is often outweighed by the risk of side effects like cognitive impairment, delirium, night wandering, trouble functioning the next day, and balance problems and falls.6,7 Consult with your health-care professional before taking a prescription sleep aid.

References

  1. Sleep deprivation and deficiency. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency. [Accessed Aug. 28, 2019]
  2. A good night's sleep. National Institute on Aging. https://www.nia.nih.gov/health/good-nights-sleep. [Accessed Aug. 28, 2019]
  3. Brain basics: Understanding sleep. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep. [Accessed Aug. 28, 2019]
  4. Maness D, Khan M. Nonpharmacologic management of chronic insomnia. Am Fam Physician 2015;92:1058-1064.
  5. Kryger M, Roth T, William D. Principles and Practice of Sleep Medicine. 6th ed. Elsevier Saunders; 2017:25,31-33.
  6. Bonnet M, Arand D. Behavioral and pharmacologic therapies for chronic insomnia in adults. https://www.uptodate.com/contents/search. [Accessed Sept. 4, 2019]
  7. Rodriguez J, Dzierzewski J, Alessi C. Sleep problems in the elderly. Med Clin North America 2015;99:431-439.
  8. Schroeck J, Ford J, Conway E, et al. Review of safety and efficacy of sleep medicines in older adults. Clin Ther 2016;38:2340-2372.
  9. Melatonin. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/drugs-supplements-melatonin/art-20363071. [Accessed Sept. 3, 2019]