Sleep in later life

How big a problem is this? 

Nearly 50% of older adults complain of sleeping problems. These include difficulties in getting to sleep, waking up at different times during the night and waking up too early in the morning. Over 5 million prescriptions for sleeping tablets are issued each year in the UK to the over 65's! 

What are the consequences of not getting enough sleep? 

Without adequate sleep - and most particularly quality restorative sleep - we may be victim to a number of health issues.These include: 

  • Irritability, inability to concentrate, poor mental reasoning and memory recall coupled with daytime sleepiness and napping.
  • An increased risk of falls and hip and other bone fractures - and the risk of traffic accidents due to lapses in concentration whilst driving. 

Sadly daytime napping may not help. It can further disrupt the normal sleep pattern. 

What can we do if we experience sleep problems as we get older? 

Tackle the cause not the symptoms 

Sleep problems in later life tend to have three main causes: 

  • Biological changes in our body, in particular a declining level of the sleep hormone, melatonin or changes in our body clock.
  • Pain and discomfort due to physical illness, including night-time bladder problems.
  • Disturbance to our sleep patterns due to neurological disorders (such as Alzheimer’s) or mental illness (such as depression).

 To get a good night’s sleep we therefore need to identify the underlying cause.

 Managing biological changes in our body

 A melatonin supplement can help compensate if we have a declining natural level of melatonin.

 We can reinforce our body’s natural clock by: 

  • Getting exposure to bright light during the day, if possible.
  • Then avoiding ‘blue light’ (from lap tops, tablets and computers) while we’re in bed and just before we go to bed.
  • Investing in black out curtains and avoiding background lights while in bed at night. 

Avoiding ‘blue light’ while in bed is important. That’s because photoreceptors in the eye are sensitive to blue light and this stops the formation of the all important sleep hormone melatonin. 

Managing pain and discomfort due to physical illness 

This is often from age related diseases such as osteoarthritis, gastrointestinal problems and night time bladder issues. 

The best way to deal with poor sleep resulting from these problems is to see your doctor and get proper medication to treat the underlying disease and try to ensure adequate nightlong relief. 

Managing neurological disorders and mental illness 

Neurological disorders and diseases such as depression, Alzheimer's andParkinson's can result in major disturbances in sleep patterns. 

Again the best way to deal with this is to seek treatment for the underlying disorder or disease. 

Managing some specific night time conditions

Nocturia - getting up to go to the bathroom too many times. This could be due to drinking too much before you go to bed (in particular drinks with a diuretic effect, like coffee or alcohol). If so, you just need to drink less in the evening. Other causes include diabetes, polyuria (where there are unusually large amounts of urine, sometimes a symptom of diabetes) and (in men) an enlarged prostate - in each of these cases seek medical advice.

Restless legs syndrome (RLS)This condition may sometimes be due to iron deficiency. If so, take more iron rich foods such as sea food, liver or dark chocolate or even supplementary iron 

Night cramps. Stretching exercises before sleep can significantly reduce the frequency and severity of these nocturnal leg cramps  

Sleep hypopnea and apnoea. If you have serious breathing problems at night you may need assisted or positive night time breathing apparatus.  

What about the use of sleeping tablets?  

If best efforts to treat the causes fail then sleeping tablets may need to be considered. The choice here is best left to your doctor. There can be side effects, so please discuss this with your doctor too. 

There are limitations to long term use of sleeping tablets, so other approaches may have value. 

Cognitive Behavioural Therapy (CBT) can bring about a more realistic expectation of sleep pattern norms in older people. 

Meditation: Well practiced meditation techniques may help empty the mind of distracting or worrying thoughts, especially during night time waking. This includes mindfulness meditation, according to a clinical trial reported in 2015.

Exercise: Even moderate exercise such as that from dancing or walking may help promote more restorative and relaxing sleep. Some research suggests that Tai Chi can also help, although more good quality research is needed to confirm this.

Herbal and other "over the counter" remedies: Herbal remedies include camomile and valerian. There is some anecdotal evidence for their effectiveness – but their safety in long term use has not been formally assessed and a 2015 review of research into herbal remedies (including camomile and valerian) found insufficient evidence to support their use to counter insomnia. 

Conclusions  

To improve our prospects of a good night’s sleep we should 

  • Reinforce our natural body clock by getting enough light during the day and then avoiding light (especially ‘blue light’) at night.
  • Make sure any medical condition that keeps us awake at night is treated and that the drug effects last all night long.
  • Make only sparing use of sleeping tablets if these prove necessary
  • Consider alternative self-help options, including CBT and meditation
  • Take some form of exercise every day 

Richard Franklin December 2013   Reviewed and updated December 2016. Next review date November 2019.