“The best cure for insomnia is to get a lot of sleep.” – W.C. Fields

“A ruffled mind makes a restless pillow.” – Charlotte Bronte

As many of us know, either from direct experience or from relationships with relatives, aging brings a host of changes. They can be uncomfortable for the individual and a challenge for care givers. Some may be of concern medically, while others are more of an irritant.

Sleep fits that profile perfectly. It’s something that shifts as we get older. Many seniors find it hard to experience the deep, restorative sleep they remember from earlier years. Those changes can be addressed through medication if severe enough or through some pretty simple lifestyle adjustments. In fact, a consensus has been built that medication can and should be viewed as a last resort.

The repeating phases of sleep include periods of no dreaming (both light and deep sleep) as well as the dreaming periods found in REM sleep. The elderly may experience an increase in the time needed to fall asleep and tend to stay more in the lighter stages.

Is There a Problem?

As one of the body’s fundamental processes, a good sleep can have a range of positive effects from enhanced mood to overall brain health. Moreover, there appear to be connections between sleep, dementia and memory loss. A basic rule of thumb is that the quality of one’s sleep is more important the quantity.

Here are some typical symptoms of sleep problems in the elderly:

• Nodding off a little earlier in the evening
• Sleep that doesn’t feel as deep as it used to
• Light sleeping and frequent waking
• Fatigue in the daytime

It’s important to know exactly what is going on, why it’s happening and how to address any concerns. That typically calls for a thorough medical exam, which may include a conversation with a spouse.

An integrated approach to healthcare should always include consideration of any other illnesses or conditions that may be contributing to sleep disruption as well as significant life events such as retirement or a death in the family.

What’s often referred to as “sleep fragmentation” can be caused by underlying health issues like heart and lung conditions, reflux disease, chronic pain, urinary problems, Alzheimer’s disease, mood disorders and the side effects of medications.

What Are Some Common Conditions?

Let’s take a look at a few common disorders:

Restless leg syndrome is an unpleasant sensation of itching, crawling or an urge to move.

Its cause is not fully understood and may be based on changes in brain chemistry and low iron levels.

A related condition is called periodic limb movement disorder. It’s described as intermittent movement of toes, ankles, knees or hip. While it reportedly affects nearly 50% of people, it’s ultimately more frustrating than problematic.

Breathing disorders like snoring and apnea can certainly be frustrating. And even drive your significant other to sleep in the spare bedroom or on the couch. But they can also have more serious negative impacts on other problems like overall mortality and the possibility of stroke, coronary artery disease or heart failure. These conditions often arise from obstructed breathing passageways. They tend to increase with age, seem to be more common with men and are often associated with obesity. Luckily, easy testing can be done at home or in a sleep lab. Ways to deal with these situations can include sleeping less on the back, using appliances that help open the airway, diet and weight loss, and not using of medications that may depress breathing

Here’s the big one: insomnia. An unfortunately very common condition, it simply means having a hard time falling or staying asleep which can also cause functional issues in the daytime. Insomnia can have a broad range of effects from depression and anxiety to an overall poor quality of life and even cognitive decline. One of the first things to consider is avoiding alcohol as well as medication that may deter brain function. There can be an initial adjustment period by the body, but it’s well worth it in the long term. Alternative substances that may be approved by one’s physician include melatonin, ramelteon and trazodone. Substance-free approaches include cognitive behavior therapy, mindfulness meditation and relaxation techniques.

Other conditions include circadian rhythm disorders which cause problems with the sleeping and waking cycle, as well as REM behavior disorder which involves unusually vivid acting of dreams when asleep.

What Is Sleep Hygiene?

“Sleep hygiene” is a concept that encompasses several habits and routines that can help improve sleep. Getting a good night’s sleep on a regular basis has strong benefits, not matter our age.

These sleep tips for the elderly may help set up positive behaviors with benefits when young as well as processes to address sleep problems later in life:

• Shut off the computer or TV televisions at least an hour before going to bed. Blue light from these screens makes it physiologically hard to fall asleep and suppresses production of melatonin.
• Cut back caffeine overall and as early in the day as possible. Gradually eliminate one cup per day, or switch to green or herbal tea in the afternoon.
• Maintain a regular bedtime, at least for most days of the week. Seven hours of sleep is a pretty common benchmark. Some folks me need a little more or less, but it’s the consistency that matters.
• Don’t eat a big meal within 2-3 hours before hitting the hay. Digestive system makes it harder to sleep better. Alcohol is no friend of sleep, either.
• A way to help keep your mind from racing is to keep a journal next to your bed and jot down tasks and ideas for next day, then more peacefully fall asleep.
• Use an activity tracker to monitor your sleep throughout the week and draw correlations between good sleep and activities like exercise, alcohol and stress.
• Make sure to experience adequate daylight to support body’s circadian rhythms.

Reaching a mature stage in life, or the “golden years,” can bring new opportunities and joys like the change to pursue interests like hobbies and travel as well as wonderful experiences with grandchildren. It’s also a time of inevitable physical and mental changes that everyone addresses in one form or another.

Sleep is no exception. With knowledge, patience and the support of the family physician, it too can be managed to optimize quality of life.