Sleep and Aging
Poor sleep in our elders is caused by very specific problems. Here are some very specific solutions to counter them.
As our aging parents continue to live longer than any other generation, many of us are increasingly involved in their health and well-being, whether they live with us or not.
One woman is roused from sleep every morning at 4:00 A.M. by the sounds of her 80-year-old mother making oatmeal in the kitchen. By the time she hears the clang of the pot going into the sink to be washed, the sound of the stainless-steel spoon scraping round and round and round the pot as her mother stirs the oatmeal has already raised her blood pressure and driven sleep away.
Another eighty-something woman, who lives on her own, has started calling her niece on the phone in the middle of the night. “I have to get to the hospital!” she demands tearfully. “Your uncle needs me!” Her niece gently reminds the elderly woman that her husband died two years ago, then spends an hour consoling the grief-stricken woman.
With help from geriatric doctors, professional caregivers, and therapists who specialize in the challenges of old age, most of us painstakingly work these issues out.
But as we do, we’re torn between the need to help and the need to sleep. Eventually, usually in the middle of a dark, restless night, we begin to realize that if we want to sleep, we need to help them get to sleep as well.
A study at Harvard Medical School reveals that bright-light therapy can reduce “sundowning,” the agitated behavior that frequently occurs in those with Alzheimer’s disease at sundown. The more severe the behavior, the more effective the therapy.
Until recently, most of us simply assumed that getting old meant nodding off in our chair during the day and sleeping less at night. After all, that’s what our aging parents have been complaining about, right?
But scientists have recently begun to question our assumptions about what’s keeping our aging parents up. In fact, they’re beginning to think that insomnia is not a natural consequence of aging but is actually the result of some very specific problems that have very specific solutions.
The problems seem to fall into four areas, says researcher Sonia Ancoli-Israel, Ph.D., a professor of psychiatry at the University of California at San Diego and a recent president of the Sleep Research Society.
For one thing, “the older we get, the more problems we have with our health,” she explains. “Depression, pain from arthritis or from cancer, neurological disorders like Alzheimer’s, and organ system failures that are a result of heart disease, pulmonary disease, and kidney failure—all these things will interrupt sleep.”
Second, “all the medications we give older adults to treat all these medical and psychiatric illnesses can also interfere with sleep—particularly medications that are stimulating or activating when taken in the evening.”
A third cause is the increase in sleep disorders (see page 180) that seems to occur with aging—restless legs syndrome and sleep apnea, in particular—and a fourth is changes in our biological clocks.
ldquo;Changes in our body’s circadian rhythms make the ability to get the sleep we need more difficult,” explains Dr. Ancoli-Israel. “As we get older, our biological rhythm advances such that older people get sleepier earlier in the evening—around 6:00, maybe 7:00 or 8:00 P.M.
ldquo;If they went to bed at that hour, they would sleep their regular amount of time—that is, about seven or eight hours. But do the math: That means that they would wake up at 3, 4, or 5 in the morning, which, of course, is the biggest complaint of older adults: I’m waking up in the middle of the night, and I can’t get back to sleep.
ldquo;The reason that they can’t is that their biological clock is waking up,” says Dr. Ancoli-Israel. “Their physiological night is over.”
In many cases, however, our aging parents are not going to bed at 7:00 or 8:00 P.M., when they first get sleepy. Instead, they try to stay awake until the more acceptable bedtime of 9:00, 10:00, or 11:00 P.M.
What that frequently means, however, is that they sit down after dinner in front of the TV and doze off. “They might sleep for half an hour or hour,” says Dr. Ancoli-Israel. “Then they wake up.”
She chuckles. “But if you ask them if they nap in the evening, they say no, because sleeping in front of the TV doesn’t seem to count.”
Unfortunately, once our elders get into bed, they find that they can’t sleep. Since they’ve just slept for an hour, why should they? The chemical pressure to sleep from your biological clock just isn’t there. So they toss and turn for hours—then wake up at 4:00 A.M. Their nap time, plus the hours in bed, have equaled a full night’s sleep.
One other thing that frequently keeps our elders from a restorative sleep are life stressors. Just because our parents are old, it doesn’t mean they don’t have as much stress as we do, says Cathy A. Alessi, M.D., a professor at UCLA and associate director of clinical health services research at the Los Angeles Veterans Administration Healthcare System.
They may not be worrying about childcare or a demanding employer, but they are facing major stressors, such as retirement, trying to make ends meet on Social Security or a retirement plan crafted in World War II, downsizing into smaller homes, transferring to assisted-living facilities, the loss of friends and partners through illness and death, even their own mortality.
In some ways the things our aging parents have to face are the toughest challenges life will ever demand.
7 Sleep Tips for The Elderly
Poor sleep in our elders is caused by very specific problems. Here are some very specific solutions to counter them so everyone in the family can get a good night’s sleep.
strong>1. Reset the clock. Since much of an aging parent’s insomnia may be caused by natural changes in their biological clock as they age, you can help them reset that clock simply by doing two things, says sleep researcher Sonia Ancoli-Israel, Ph.D., a professor of psychiatry at the University of California at San Diego.
One, encourage them to get out into the natural sunshine every day, as late in the day as possible. Light will shoot down the optic nerve into the brain, where it will trigger a cascade of brain chemicals that will help them stay awake in the evening. It’s a good idea to suggest they leave their sunglasses at home to get the maximum effect. On the other hand, if they go out in the morning, they should be encouraged to wear sunglasses, since morning light can actually aggravate their problem.
Two, suggest they use light therapy, particularly during the winter, when late afternoon light is dim. Get them a light box—a device that generates up to 10,000 lux of light—and suggest they sit near it every evening sometime between 7:00 and 9:00 P.M. They don’t need to stare directly at the box but can watch television, read a book, or do any other sedentary activity. If the box emits 10,000 lux, they should sit in front of it for 20 to 30 minutes.
There are two types of light boxes: one that emits blue light and another that emits full-spectrum white light. Although blue light is more effective for younger people, it doesn’t penetrate cataracts effectively. So get them a light box with full-spectrum white light, says Dr. Ancoli-Israel. Check out the list of manufacturers at www.sltbr.org.
2. Change timing or dosage of meds. Have your elders talk with their doctors about whether any of their medications might be disrupting their sleep. In many cases, says Dr. Ancoli-Israel, changing the timing or dosage of a medication can relieve insomnia. For example, a blood pressure pill taken in the morning that makes them drowsy during the day can often be switched to bedtime. And there it does double duty—it not only lowers their blood pressure but also helps them drift into sleep.
3. Watch for sleep disorders. If your parents complain of “twitchy legs” or disruptive snoring, suggest that they ask their doctors to evaluate them for restless legs syndrome or sleep apnea.
4. Treat medical conditions. If arthritis pain, for example, is keeping your elders up, suggest they ask for a pain medication. Treating a medical condition can often have the positive aspect of inducing sleep.
5. Get them moving. Suggest you go for a walk, go line dancing, or spend an afternoon shopping. A Brazilian study recently found that elderly women who stay active sleep an hour longer each night than those who are sedentary. What’s more, they wake up less throughout the night.
6. Pay attention to the basics. Pay attention to sleep basics. Encourage your parents to use the bedroom only for sleeping and keep it dark, quiet, and cool. Suggest they get rid of their bedside clock so they can’t watch it all night. They might also want to avoid alcohol after 6:00 P.M., set aside a “worry time” in the early evening, and take a warm bath before bed.
7. Give crazy socks for gifts. “There’s a study out of Switzerland that shows that wearing socks to bed helps induce sleep,“ says Dr. Ancoli-Israel. Turns out that if you can warm your extremities, it helps drop your core body temperature. And that drop signals your body it’s time for sleep.