Sleep normally occurs in several stages. The sleep cycle includes:
Dreamless periods of light and deep sleep
Some periods of active dreaming (REM sleep)
The sleep cycle is repeated several times during the night.
With aging, sleep patterns tend to change. Most people find that aging causes them to have a harder time falling asleep. They awaken more often during the night and earlier in the morning.
Total sleep time stays the same or is slightly decreased (6.5 to 7 hours per night). It may be harder to fall asleep and you may spend more total time in bed. The transition between sleep and waking up is often abrupt, which makes older people feel like they are a lighter sleeper than when they were younger.
Less time is spent in deep, dreamless sleep. Older people average three or four awakenings each night. They are also more aware of being awake.
Older people wake up more often because they spend less time deep sleep. Other causes include needing to get up and urinate (nocturia), anxiety, and discomfort or pain from chronic illnesses.
EFFECT OF CHANGES
Sleeping difficulty is an annoying problem. Chronic insomnia is a major cause of auto accidents and depression. Because older people sleep more lightly and wake up more often, they may feel deprived of sleep even when their total sleep time has not changed.
Sleep deprivation can eventually cause confusion and other mental changes. It is treatable, though. You can reduce symptoms when you get enough sleep.
Sleep problems are also a common symptom of depression. See a health care provider to find out whether depression or another health condition is affecting your sleep.
Insomnia is one of the more common sleep problems in the elderly.
Sleep apnea, where breathing stops for a time during sleep, can cause severe problems.
The elderly respond differently to medicines than do younger adults. It is very important to talk with a provider before taking sleep medicines. Avoid sleep medicines, if possible. However, antidepressant medicines can be very helpful if depression affects your sleep. Some antidepressants do not cause the same side effects as sleep medicines.
Sometimes, a mild antihistamine works better than a sleeping pill for relieving short-term insomnia. However, most health experts do not recommend these types of medicines for the elderly.
Use sleep medicines (such as benzodiazepines) only as recommended, and only for a short time. Some of these medicines can lead to dependence (needing to take the drug to function) or addiction (compulsive use despite adverse consequences). Some of these drugs build up in your body. You can develop toxic effects such as confusion, delirium, and falls if you take them for a long time.
You can take measures to help you sleep:
A light bedtime snack may be helpful. Many people find that warm milk increases sleepiness, because it contains a natural, sedative-like amino acid.
Avoid stimulants such as caffeine (found in coffee, tea, cola drinks, and chocolate) for at least 3 or 4 hours before bed.
DO NOT take naps during the day.
Exercise (moderately) in the afternoon.
Avoid too much stimulation, such as violent TV shows or computer games, before sleep. Practice relaxation techniques at bedtime.
Try to go to bed at the same time every night and wake at the same time each morning.
Use the bed only for sleep or sexual activity.
Avoid tobacco products, especially before sleep.
Ask your provider if any of the medicines you take may affect your sleep.
If you cannot fall asleep after 20 minutes, get out of bed and do a quiet activity, such as reading or listening to music.
When you feel sleepy, get back in bed and try again. If you still cannot fall asleep in 20 minutes, repeat the process.
Drinking alcohol at bedtime may make you sleepy. However, it is best to avoid alcohol, because it can make you wake up later in the night.
Weilburg JB. Approach to the patient with insomnia. In: Gorell AH, Mulley AG, Jr., eds. Primary Care Medicine: Office Evaluation and Management of the Adult Patient. 6th ed. Philadelphia, PA: Wolters Kluwer; 2009;chap 232.
Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.