Sleep for Seniors

I recently gave a talk to a group of seniors at the Memory Cafe chapter where my dad and stepmom are members. In speaking to that group (and in working with several of my coaching patients), I realized the need for more information specifically on how sleep changes as we age. I hope this entry will help dispel some myths as well as call attention to some other major factors which are specific confounders for sleep in many seniors- including comorbid medical and mental disorders.

I find my sleep coaching clients have two beliefs about sleep which are often counterproductive and worsen their anxiety around sleep.

Myth #1: The first is that we “need” eight hours a night. The literature is quite clear that our need for sleep declines through the decades after reaching adulthood. As you can see from the chart below, when we reach adulthood, 7-8 hours is the “normal” average amount of sleep. But as we reach our 70s and 80’s, normal can drop to around 5-6 hours a night. Even by our 50’s, “normal” can be under six hours. Why do kids need so much more? Because they are building new bones and growing, and learning tons of new things each day. If we think of the purpose of sleep as consolidating new learning and tissue growth/restoration, both of those processes naturally reduce with age. On the other hand, seniors who are still keeping active and learning new things often have fewer sleep complaints (we’ll learn more later how that can relate to depression).

Myth #2: The second is that if you’re not sleeping perfectly throughout the night without interruption, there is something wrong. In truth, sleeping like that would be quite the rarity and if we use that as the goal, it’s frankly unrealistic. We all have bladders, ambient noise, bad dreams, and a range of other thing which can wake us up. We also can briefly wake up for no reason as we transition between sleep stages. It’s quite common for everyone to wake up a few times each night, but this frequency increases with age. It’s part of a normal aging process (not pathological).  So too, is the tendency to wake up early in the morning. This article explains a bit more about some of the natural changes in the relative breakdown of light and deep sleep as we age. Simply put, we have more light sleep, we will be prone to more awakenings. The bigger question is- how easy is it to get back to sleep? And if it’s not easy, what are we doing about it?

Ultimately, the true test of whether you are getting enough sleep is how do you feel in the morning and throughout the day? Do you have the energy to do the things you’d like to do? If you’re only getting say 5 hours and waking up a few times, but you’re living an active life and have energy, you are still within the normal range for your age if you’re 50 plus.

An important footnote on “do you have the energy you need”- some people can sleep for 8+ hours and still not feel like they have energy. There could be a few factors here. One would be an undiagnosed/untreated sleep disorder such as sleep apnea. This could prevent you from getting good, restful sleep. Other medical disorders can also reduce sleep quality (in the senior population, chronic pain could be a major factor). Specific to the dementia population, damage to the brain’s circadian regulators (which set our night/day behaviors) can lead to “sundowning,” in which patients can want to sleep in the day and be active at night, or to be all over the place with sleep/wake patterns.

Another thing I see commonly in my patient population is undiagnosed or suboptimally treated depression. I am not a therapist, but I often refer my patients out to qualified mental health resources in partnership with their referring physician. Depression in the senior population can often come as a result of increased social isolation and loneliness, especially in these pandemic times in which it can feel unsafe to leave the house. A good screening tool to check for depression is the PHQ9. If I am concerned about this, I’ll have patients take this self-assessment online and consider based on their score whether they should talk with their physician more or directly seek a therapist.

While there are definitely headwinds in getting enough good quality sleep as we age, the good news in some ways is that we need less than we did in early adulthood. Fixating on the numbers can produce a counter-productive anxiety spiral in which you don’t sleep enough because you’re worried about how you don’t sleep enough. In some cases, the development of sleep tracking wearables and apps has worsened this anxiety in my patients. I keep bringing them back to “how are you feeling/functioning in the daytime” as a measure of how they’re doing.

I also try to make sure we’re looking at the answer to that in a whole-person way: do they have purpose/joy/meaningful relationships? Are they exercising? This can be a good way to naturally fatigue the body (along with its many other health benefits). Oftentimes people focus on sleep as a fixation because it’s an easier thing to name than depression or general anxiety.

An integrative approach looks at the whole picture of wellness and doesn’t use the reported hours of sleep as the end-all be all determinant of how someone is doing. The more we can make space for positive relationships and meaning, often the better we will sleep. An integrative approach may also look towards non-pharmacologic options such as meditation or progressive relaxation to try and support restful sleep.

I find hope in the literature on normal sleep as we age. It can take some pressure off the need to hit certain numbers or do it perfectly. What if we didn’t need as much sleep in our later years? What could we do with that extra time that would add purpose, meaning, and connection to our days? That’s where the true opportunity is. If we live well, it makes it easier to sleep well.


Sleep and Mental Health

The Brain Cleanses Itself

Sleep from a Chinese Medicine Perspective

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