Sleep and Aging
Frequently Asked Questions
1. Does your need for sleep change as you get older?
Sleep needs change over a person's lifetime. Children and adolescents need more sleep than adults. Interestingly, older adults need about the same amount of sleep as younger adults -- seven to nine hours of sleep per night.
Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep. A study of adults over 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep.
Also, older people often sleep less deeply and wake up more often throughout the night, which may be why they may nap more often during the daytime. Nighttime sleep schedules may change with age too. Many older adults tend to get sleepier earlier in the evening and awaken earlier in the morning.
2. What are the consequences of poor sleep for older adults?
Older adults who have poor nighttime sleep are more likely to have attention and memory problems, a depressed mood, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life.
3. I have trouble falling asleep at night. Is that just a normal part of aging?
Many people believe that poor sleep is a normal part of aging, but it is not. In fact, many healthy older adults report few or no sleep problems. Sleep patterns change as we age, but disturbed sleep and waking up tired every day are not part of normal aging.
4. What is the most common reason older adults wake up at night?
The most common reason older adults wake up at night is to go to the bathroom. Prostate enlargement in men and continence problems in women are often the cause. Unfortunately, waking up to go to the bathroom at night also places older adults at greater risk for falling.
5. As I get older, why do I tend to become tired earlier in the evening?
As people age, their sleeping and waking patterns tend to change. Older adults usually become sleepier earlier in the evening and wake up earlier in the morning. If they don't adjust their bedtimes to these changes, they may have difficulty falling and staying asleep.
6. Do older adults get enough sleep?
Unfortunately, many older adults often get less sleep then they need. One reason is that they often have more trouble falling asleep. A study of adults over 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep.
7. How many types of sleep are there?
There are two types of sleep: non-rapid eye movement -- or NREM sleep -- and rapid eye movement -- or REM sleep. NREM sleep has four stages ranging from light to deep sleep. Then we go into REM sleep, the most active stage of sleep when dreaming often occurs. During REM sleep, the eyes move back and forth beneath the eyelids and muscles become immobile. We cycle through these stages of NREM-REM sleep approximately every 90 minutes.
8. What are the most common sleep disorders among older adults?
The most common sleep disorders among older adults are insomnia, sleep-disordered breathing, such as sleep apnea, as well as movement disorders like restless legs syndrome.
9. What are the symptoms of insomnia?
If you have insomnia, you may experience any one or any combination of the following symptoms.
- taking a long time -- more than 30 to 45 minutes -- to fall asleep
- waking up many times each night
- waking up early and being unable to get back to sleep
- waking up feeling tired and unable to function well during the day
10. What can be done to relieve insomnia?
Ways to relieve insomnia include lifestyle changes, counseling and medications.
Making these lifestyle changes often can help relieve short-term insomnia.
- Avoid substances that make insomnia worse. These include caffeine, alcohol, and certain over-the-counter and prescription medicines.
- Try to adopt bedtime habits that make it easier to fall asleep and stay asleep. Some people watch the evening news, read a book, or soak in a warm bath.
- Make your bedroom sleep-friendly. The room should be dark, well ventilated, and as quiet as possible.
- Go to sleep around the same time each night and wake up around the same time each morning.
Cognitive behavioral therapy, a type of counseling, can help relieve chronic (ongoing) insomnia. This therapy encourages good sleep habits and uses several methods such as relaxation and biofeedback to relieve sleep anxiety.
Many prescription medicines are used to treat insomnia. They can help relieve insomnia and re-establish a regular sleep schedule. Some are meant for short-term use, while others are meant for longer use. Talk to your doctor about the benefits and side effects of insomnia medicines. For example, insomnia medicines can help you fall asleep, but you may feel groggy in the morning after taking them.
Some over-the-counter products claim to treat insomnia. Although these products may make you sleepy, talk to your doctor before taking them.
If your insomnia is the symptom or side effect of another problem, it's important to treat the underlying cause if possible.
11. What are some suggestions for getting a good night's sleep?
A good night's sleep can make a big difference in how you feel. Here are some suggestions to help you.
- Follow a regular schedule -- go to sleep and wake up at the same time, even on weekends.
- Try not to nap too much during the day -- you might be less sleepy at night.
- Try to exercise at regular times each day. If possible, finish your workout at least three hours before bedtime.
- Try to get some natural light in the afternoon each day.
- Don't drink beverages with caffeine late in the day. Caffeine is a stimulant and can keep you awake.
- Don't drink alcohol to help you sleep. Even small amounts of alcohol can make it harder to stay asleep.
- Don't smoke to help you sleep. Smoking is dangerous for many reasons, including the hazard of falling asleep with a lit cigarette. Also, the nicotine in cigarettes is a stimulant.
- Create a safe and comfortable place to sleep. The room should be dark, well ventilated, and as quiet as possible.
- Develop a bedtime routine. Do the same things each night to tell your body that it's time to wind down. Some people watch the evening news, read a book, or soak in a warm bath.
- After turning off the light, give yourself about 15 minutes to fall asleep. If you are still awake and not drowsy, get out of bed. When you get sleepy, go back to bed.
12. What causes a person to snore?
Snoring is caused by a partial obstruction, or blockage, of the airway passage from the nose and mouth to the lungs. The blockage causes the tissues in these passages to vibrate, leading to the noise produced when someone snores.
13. What can be done about snoring?
If you are among approximately 40% of adults who snore, you can try these lifestyle changes, which may help you stop snoring.
- Change your sleep position.
- Lose weight. Weight loss helps some people but not everyone -- thin people snore, too.
- Limit alcohol intake and avoid taking sedative medications.
Use caution before you self-treat with over-the-counter sprays and pills until you talk with your doctor.
14. What is obstructive sleep apnea?
Obstructive sleep apnea occurs when air entering from the nose or mouth is either partially or completely blocked, usually because of obesity or extra tissue in the back of the throat and mouth. If these episodes occur frequently or are severe, they may cause a person to wake up frequently throughout the night. This may disrupt their sleep and make them sleepy during the day.
Obstructive sleep apnea is more common among older adults and among people who are significantly overweight. Obstructive sleep apnea can increase a person's risk for high blood pressure, strokes, heart disease, and cognitive problems. However, more research is needed to understand the long-term consequences of obstructive sleep apnea in older adults.
15. What is central sleep apnea?
Central sleep apnea occurs when the brain doesn't send the right signals to start the breathing process. It is less common than obstructive sleep apnea. Often, both types of sleep apnea occur in the same person.
16. What causes sleep apnea?
Obstructive sleep apnea is caused by a narrowing or blockage of the upper airway, usually when the soft tissue in the rear of the throat collapses during sleep. In central sleep apnea, the airway is not blocked, but the brain fails to signal the muscles that control breathing. Central sleep apnea is a less common type of sleep apnea. Often, both types of sleep apnea occur in the same person.
17. What are the symptoms of sleep apnea?
Symptoms of sleep apnea include
- loud and chronic snoring
- choking, snorting, or gasping during sleep
- long pauses in breathing
- daytime sleepiness, no matter how much time you spend in bed.
18. What are the risk factors for sleep apnea?
Obstructive sleep apnea can affect anyone, but certain factors can put one at increased risk. Risk factors for sleep apnea include
- being overweight
- being male
- being over age 40
- having a large neck size
- having large tonsils, a large tongue, or a small jaw bone
- having a family history of sleep apnea
- gastroesophageal reflux
- nasal obstruction due to a deviated septum, allergies, or sinus problems.
19. How can you reduce your risk for sleep apnea?
Obesity is the number one risk factor for sleep apnea, and you may be able to reduce your risk for sleep apnea by maintaining an appropriate weight. If you are not overweight, try to maintain an appropriate weight through proper diet and exercise. Limit alcohol intake and avoid taking sedative medications that can increase the number of sleep apnea episodes you have each night and can make sleep apnea worse. Heavy smokers are more likely to develop sleep apnea than nonsmokers. If you smoke, quit.
20. How is sleep apnea usually treated?
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The most effective and popular treatment for sleep apnea is nasal continuous positive airway pressure or CPAP. This device creates airway pressure that keeps the airway passages open.
To use the CPAP, the patient puts on a small mask that fits around the nose. Air pressure is delivered to the mask from a small, quiet air pump that sits at the bedside. The patient not only wears the mask at night but also during naps, since obstructions can occur during these times as well.
21. Are there other treatments for sleep apnea?
People who are diagnosed with sleep apnea should try to lose weight if possible. Also, adjusting your body position during the night may benefit you if you experience sleep apnea more often when you lie on your back.
If you have a mild case of sleep apnea, sometimes a dental device or appliance can be helpful. If your condition is more severe and you don't tolerate other treatments, your doctor may suggest surgery to increase the airway size in the mouth and throat. One common surgical method removes excess tissue from the back of the throat.
22. What are movement disorders and how do they affect sleep?
Movement disorders cause people to move their limbs when they sleep, leading to poor sleep and daytime drowsiness. These disorders include restless legs syndrome, or RLS, periodic limb movement disorder, or PLMD, and REM sleep behavior disorder. Often, restless legs syndrome and periodic limb movement disorder occur in the same person.
23. What are the symptoms of periodic limb movement disorder?
Periodic limb movement disorder, or PLMD, is a condition that causes people to jerk and kick their legs every 20 to 40 seconds during sleep. PLMD often disrupts sleep -- not only for the patient but the bed partner as well. One study found that roughly 40 percent of older adults have at least a mild form of PLMD.
24. What are the symptoms of restless legs syndrome?
People with RLS experience uncomfortable feelings in their legs such as tingling, crawling, or pins and needles. It’s worse at night. This often makes it hard for them to fall asleep or stay asleep, and causes them to be sleepy during the day.
25. How is restless legs syndrome treated?
If you have mild to moderate symptoms of restless legs syndrome, your doctor may suggest certain lifestyle changes. Reducing the use of caffeine, alcohol, and tobacco may provide some relief. People with restless legs syndrome often have low levels of iron in their blood. In such cases doctors often prescribe supplements. Your doctor may also suggest taking supplements to correct low levels of folate and magnesium. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients.
Very often, people who suffer from movement disorders during sleep such as restless legs syndrome or periodic limb movement disorder are successfully treated with the same medications used for Parkinson's disease.
26. What is REM sleep behavior disorder?
Another condition that may make it harder to get a good night's sleep is rapid eye movement sleep behavior disorder, also known as REM sleep behavior disorder. It is somewhat more common in men over the age of 50.
REM sleep, or rapid eye movement sleep, is the most active stage of sleep when dreaming often occurs. During normal REM sleep, the eyes move back and forth beneath the eyelids, and muscles cannot move. In more severe forms of REM sleep behavior disorder, the muscles become quite mobile and sufferers often act out their dreams.
27. How are movement disorders treated?
Very often, people who suffer from movement disorders during sleep such as restless legs syndrome or periodic limb movement disorder are successfully treated with the same medications used for Parkinson's disease. People with restless legs syndrome often have low levels of iron in their blood. In such cases doctors often prescribe supplements.
Medications can also treat people with REM sleep behavior disorder. If there are reports of dangerous activities such as hitting or running during these episodes, it may be necessary to make changes to the person's sleeping area to protect sufferers and their bed partners from injury.
28. At what point should I see a doctor about a sleeping problem?
If you are often tired during the day and don't feel that you sleep well, you should discuss this with your doctor or healthcare provider. Many primary care providers can diagnose sleep disorders and offer suggestions and treatments that can improve your sleep.
29. What can I expect during my visit to the doctor?
During your appointment, your doctor will ask you about your symptoms and may have you fill out questionnaires that measure the severity of your sleep problem. It is also helpful to have your bed partner come with you to your appointment since he or she may be able to report symptoms unknown to you like loud snoring, breathing pauses, or movements during sleep.
Since older people are more likely to take medications and to have medical problems that may affect sleep, it is important for your doctor to know about all of your health conditions and medicines. Don't forget to mention over-the-counter medications, coffee or caffeine use, and alcohol since these may also have an impact on your sleep.
The doctor will then perform a physical examination. During the exam the doctor will look for signs of other diseases that may affect sleep, such as Parkinson's disease, stroke, heart disease, or obesity. If your doctor feels more information is needed, he or she may refer you to a sleep center for more testing.
30. How does a sleep center diagnose sleep problems?
Sleep centers employ physicians and others who are experts in problems that affect sleep. If the sleep specialist needs more information, he or she may ask you to undergo an overnight sleep study, also called a polysomnogram, and/or a sleepiness, or a nap test. A polysomnogram measures brain waves, heart rate, breathing patterns, and body movements.
A common sleepiness test is the multiple sleep latency test. During this test, the person has an opportunity to nap every 2 hours during the daytime. If the person falls asleep too quickly it may mean that he or she has too much daytime sleepiness.