Seniors and Sleep: how an Austin sleep specialist can help

Seniors are especially prone to sleep issues. Biological transitions, like the advancing of the circadian rhythm, and social transitions, like retirement, set the stage for disrupted sleep. Reach out today to talk to a sleep specialist in Austin with experience meeting the sleep needs of older adults.

I was quoted as a sleep specialist in Austin in an article on care.com about sleep in senior adults. Go here to read the article: https://www.care.com/c/why-do-older-people-sleep-so-much/

Here is some expanded information about sleep in older adults based off the article.

How does aging affect sleep?

With age, total sleep time, sleep efficiency (percentage of time in bed spent actually sleeping), stage 3 sleep (deepest stage) and REM sleep (where most dreaming occurs) will decrease while sleep-onset latency (amount of time it takes to fall asleep), stage 1 and stage 2 sleep (lighter stages) will increase. Many of these changes will happen by age 60. 

Older people will usually experience more frequent and longer awakenings over the course of the night as well as shorter total sleep time compared to when they were younger. That said, the attitude shouldn’t just be “well you’re old so you’re just going to sleep poorly. Such is life.” Sleep duration less than 6 hours and sleep problems that interfere with quality of life should be attended to. 

Circadian rhythm changes over the lifespan. Babies have effectively no circadian rhythm; their sleep and wake times are highly variable. By the first year of life, sleep consolidates more to be one longish block at night plus 1-2 naps during the day. By age 4, the night block is longer and naps are shorter. By age 10 the child is generally a monophasic (and very long) sleeper. Young adolescents won’t sleep as long as 10-year-olds and their circadian rhythm will delay as they become older teens. Then as they transition into young adulthood the rhythm will advance and continue advancing through middle age and into older adulthood. Older adults will tend to fall asleep earlier and wake up earlier than any other age group.

Do older people sleep more?

Poor sleep is often thought of as an inevitable part of aging. It doesn’t have to be that way. An Austin sleep specialist can help you improve your sleep regardless of your phase in life. Reach out today to schedule a free 15-minute phone consultation with an Austin sleep specialist.

They’re not generally sleeping more at night but napping is certainty more common is older people. It’s unclear whether naps are helpful or harmful to this population as there is evidence on both sides. There is research that associates naps with falls, depression, and lower quality of life and then there is other research that concluded that naps improve daytime function and cognition.

In my training, I was told to think of naps like a cupcake. Is it bad to eat a cupcake? Not necessarily. Is it bad to eat a cupcake if you’re diabetic? That’s a different calculus. Are naps bad? Not necessarily. If you have a sleep disorder like insomnia, naps could be counterproductive. But if you have narcolepsy, scheduled naps are often part of the treatment.

In a person with insomnia, the recommendation tends to be no naps during the day because naps spend sleep drive. Sleep drive influences the quality and quantity of your sleep. It’s unrelated to clock time. It only matters how much drive is built up in the system. So you have to consider whether a nap is in the overall sleep drive budget. Also there are good and bad naps. A good nap is 15-20 minutes and timed to coincide with your circadian dip. Your circadian dip is that time of day you get tired which is usually 7-9 hours after your wake time. 

There is a difference between tired and sleepy. Sleepy is a high likelihood of falling asleep. Tired is fatigued, low energy, dragging, cranky, etc. but not sleepy. It’s okay to nap if you are sleepy. As mentioned above, prescribed naps are even part of the treatment for some sleep disorders characterized by excessive daytime sleepiness, like narcolepsy. But your typical insomnia sufferer is not sleepy, they are tired but wired. And naps aren’t very effective for alleviating tiredness. Paradoxically, fatigue can often be mitigated by expending energy rather than conserving energy. 

How does sleep benefit older adults?

Research in older adults that compares good sleepers to poor sleepers finds that poor sleepers take more medication, use more healthcare, and feel worse about their health. 

Our bodies perform an array of important functions while sleeping (regardless of age.)

• Heals and repairs heart and blood vessels. Heart rate and blood pressure decrease so these systems can rest.

• Supports a healthy balance of hormones regulating hunger and fullness. Increased production of leptin (helps you feel full) and decreased production of ghrelin (makes you fell hungry). 

• Affects how body reacts to insulin. Insulin helps glucose enter cells to be used as energy. Decreased sleep leads to increased insulin resistance.

• Supports healthy growth and development. Highest production of growth hormones (repair tissue, muscle growth) is while sleeping.

• Impacts body’s ability to fight infection. Body produces cytokines (fight infection) during sleep.

What are the common sleep conditions that affect older people?

Poor sleep has ripple effects throughout your life. Get the sleep you want and need. Reach out to an Austin sleep specialist today!

Sleep is impacted by any other medical diagnoses you have as well as the medications you take. Older people tend to have more medical diagnoses and are prescribed more medication. 

Retirement is a common precipitating factor for insomnia because people lose the structure of their work schedule and their bedtime and rise times become highly variable. Your circadian rhythm determines the timing of sleep and wakefulness. There is a German word zeitgebers which means time givers. These are external cues that help to sync your endogenous circadian rhythm with the outside world. The most impactful zeitgeber for humans is light. 

Varying bedtimes and especially varying waketimes also mean variability in all of the things that let our brain know what time it is: meals, social interactions, light exposure, physical activity. This dysregulates the circadian rhythm which means less predictability in timing of sleep and wakefulness and more daytime fatigue and sleepiness. Just regularizing your bedtimes and waketimes can do wonders for your sleep.

Nocturia (having to pee a lot at night) may be the most common sleep complaint in older adults. Lengthening the amount of time between sleep onset and what’s called first void is associated with better sleep overall. 

The two most common sleep disorders across the age span are sleep apnea and insomnia. 

Risk for sleep apnea increases with age. It’s more common in men but that means it gets missed in women, and this sex difference disappears once women are in menopause. 

It’s possible to have both sleep apnea and insomnia. Sleep apnea is generally treated with PAP. Insomnia is treated with behavior changes. 

Sleep disturbance is common in long-term care settings. Things like noise, light, room temperature, roommates and incontinence care all interfere with sleep. Sleep patterns can become highly irregular with no real pattern to sleep and wakefulness, similar to babies.

Any tips to help older adults sleep better?

Everyone will have a night of poor sleep here or there. Sometimes people have unrealistic expectations for their sleep, like that they should fall asleep as soon as their head hits the pillow, sleep deeply for 8 hours with absolutely no awakenings, bounce right of bed full of energy, and have no fatigue all day long. Dispelling these myths and normalizing the occasional sleep disturbance helps reduce that pressure to perform that actually creates and exacerbates sleep problems. 

If you’re having difficulty sleeping, it’s helpful to rule out any medical condition or medication that could be causing the sleep disturbance. A sleep specialist (which could be a sleep medicine physician or a psychotherapist with specialized training in sleep) can help diagnose the sleep problem. A sleep study is useful if you suspect sleep apnea. 

Insomnia is a learned behavior that’s become a habit. It’s characterized by an inability to fall asleep or stay asleep. This is defined as taking longer than 30 minutes to fall asleep, spending more than 30 minutes awake over the course of the night, and/or waking earlier than you’d like by 30 minutes or more. The pattern needs to be present at least 3 nights per week for at least 3 months to call it insomnia. There also needs to be distress about the sleep problem or interference with your daytime functioning. CBT for Insomnia is the gold standard treatment for insomnia.

Good sleep isn’t just a fantasy! An Austin sleep specialist can help you figure out what’s interfering and make recommendations too improve your sleep. Reach out today!

Sleep hygiene is useful for good sleepers and is good preventive care for insomnia but if you have insomnia, sleep hygiene isn’t going to fix your problem. Again, CBT for Insomnia is your best bet. As a sleep specialist in Austin, I offer CBT for Insomnia. Go here to learn more about how I help insomnia. I also can treat nightmares and circadian rhythm disorders.

Here are some tips that could apply to anybody:

• Be consistent in the time you get into bed and especially the time you get out of bed each day. Keep it within an hour.

• It’s okay to go to bed late. There is a societal stigma against night owls. Most older adults aren’t night owls but some are. If you’re not sleepy, lying in bed isn’t going to make you sleepy. Excessive time in bed relative to sleeping is detrimental to your sleep drive.

• Limit activities done in your bed to sleep and sex. Our brains like to pair things that co-occur and you can create a situation where your brain is uncertain what it should be doing while you are in bed. 

• A longer and more active day = more sleep drive.

• If you have a poor night of sleep, get up at your usual time anyway. Don’t make it a thing. Don’t catastrophize it. Go about your business as usual. Trust that it will sort itself out. This is what good sleepers do.

• Alcohol, caffeine, and nicotine all have adverse effects on sleep drive. Limit these close to bedtime. 

• Sleep will evade you the more aggressively you pursue it. That’s because actively pursuing a goal requires paying attention and exerting effort. Sleep is about disengaging. You can’t pay attention and disengage at the same time.

If you are struggling to get good sleep, go here to contact a sleep specialist in Austin. We’ll do a brief phone consultation and I’ll offer some guidance. If I can help you, we’ll schedule your first appointment on the phone.