Being tired doesn’t have to be part of the ageing process
A common myth about sleep and growing older is that we need less of it; while this is untrue, there are age-related issues to consider
Sleep problems in older adults often go undiagnosed and untreated. Photograph: Getty Images
Holly Fawcett: juggling full-time work with student-hood means Holly is struggling to get to bed at a reasonable hour. Photograph: Eric Luke
Our sleep is constantly changing and evolving in complex ways throughout our lives. Newborn babies typically sleep for 15-18 hours every day. School-aged children require 10-11 hours of sleep for optimal development, while teenagers require nine hours each night.
It is a commonly held belief that as we approach old age, our need for sleep decreases. This is in fact a myth, as the amount of sleep that we need remains more or less constant from young adulthood, right through to later life. Every person’s sleep needs are different, but most healthy adults tend to require between seven and a half to nine hours per night to function at their best.
Despite this, there’s no question that a good night’s sleep seems to be tougher to come by as we age.
Research investigating sleep patterns in older adults affirms this supposition, with various studies reporting that as many as 50 per cent of older adults complain about difficulty initiating or maintaining sleep.
So what’s keeping seniors awake?
Rapid eye movement
We know that notable changes occur in our sleep structure and patterns – what experts call “sleep architecture” – as part of the normal ageing process.
Throughout life, the brain’s activity changes in characteristic and predictable ways over the course of the night. Sleep cycles, composed of REM (rapid eye movement, when we’re dreaming) and non-REM sleep, last for about 90 minutes in adults.
Non-REM sleep moves through several, progressively deeper stages: Stage I, Stage II and Stage III (the deepest and most restorative of all).
As we age, our percentage time of REM sleep decreases and our percentage time of Non-REM Stage I and II sleep increases.
Furthermore, the amount of time we spend in Stage III (deep sleep) gradually declines from young adulthood at a rate of approximately 2 per cent per decade, before stabilising again after age 60.
For elderly adults, this results in sleep that is lighter and more fragmented, with brief arousals or longer awakenings throughout the night.
Alterations to the timing of our circadian rhythms, or sleep-wake cycle, can also occur as we age. This can result in advanced timing of the sleep period for some older adults.
This may explain why seniors tend to wake up early in the morning and fall asleep earlier in the evening. Due to societal norms, many older adults resist their fatigue and attempt to stay up later.
Yet these individuals are still likely to wake up early as a result of their biological circadian phase advancement.
This can result in less total time in bed, less sleep time, and increased daytime sleepiness.
However, normal age-related changes in sleep and rhythms alone do not result in a pathological sleep problem.
When older adults begin experiencing difficulty with daytime functioning, it is important to consider whether sleep disorders might be a source of the problems.
Sleep disordered breathing
The prevalence rates of sleep disordered breathing are higher among older adults, than among younger adults.
Sleep disordered breathing refers to a range of respiratory events that occur during sleep, from simple snoring to obstructive sleep apnoea, which is caused by cessation of airflow due to complete or partial upper airway collapse.
These episodes lead to interrupted, poor quality sleep, oxygen desaturation and excessive daytime sleepiness.
Similarly, age-related increases in the incidence of periodic limb movements during sleep have also been noted.
Evidence suggests that about 45 per cent of those independently living over the age of 65 meet an arbitrary criterion (more than five leg movements per hour of sleep) for the presence of leg movements.
These repetitive leg jerks may awaken the person from sleep and usually result in frequent nocturnal arousals and complaints of non-restorative sleep.
There are frequently other factors that may precipitate or perpetuate the problem.
Insomnia and disrupted sleep in elderly people are common side effects of various chronic medical conditions such as arthritis and congestive heart failure.
Sleep difficulties could also be secondary to psychiatric conditions, medication interactions, or life changes, such as the death of a loved one.
Undiagnosed sleep problems
Unfortunately, sleep problems in older adults often go undiagnosed and untreated simply because many people believe that sleep problems are a normal part of ageing, or hold the inaccurate view that nothing can be done to help them sleep better.
While some changes are a normal part of the ageing process, disturbed sleep, waking up tired every day, and other symptoms of insomnia are not.
Talk to your doctor if you’re having trouble sleeping.
They can help make sure that any conditions you have are being managed appropriately, adjust medications that may be affecting you, and offer suggestions or referrals to people who can help you deal with life’s changes.
Don’t accept that being tired is simply a part of getting older.
Regardless of age, good restorative sleep is essential to physical health and emotional wellbeing, so make sure to get the sleep you deserve.
Olga Lee is a research assistant working in Trinity College Institute of Neuroscience and with Health Founders
Sleep champions: week three update
It has been a week of ups and downs for our sleep champions . Student Laura Gaynor appears to have cracked it. It has taken a fair bit of discipline but she has cut back on her tea addiction, upped her exercise and, most importantly, started going to bed and rising earlier. “I’ve been getting up at 6.30am,” she says. “Before, the temptation would have been to work late into the night, but instead I’m working early in the morning and it’s way more productive.” The result is better sleep and more of it. “I think that I took sleep for granted before,” she says. “I didn’t realise that you actually have to work at it if you want to sleep well.”
For Holly Fawcett and Lisa Walsh, however, life is getting in the way of their eight hours.
Holly is juggling full-time work with student-hood and the result is long hours with very little wind-down time. She is trying to make mealtimes more regular and she has been keeping the iPad out of the bedroom but she is struggling to get to bed at a reasonable hour.
Dr John Faul says, “Holly has a hectic, crazy lifestyle at the moment. The balancing act of trying to achieve two tasks simultaneously, or to try to combine a job with study will cause fatigue, diminished performance, and shortened sleep hours, not least because it is harder to wind down at night.” It is difficult to see how Holly can make space in her life for the measures that are needed to optimise sleep.
Dr Faul says, “Ensuring that meals are taken at regular times and sleep times are generous, particularly during holidays and weekends, can allow most people to regain refreshing sleep after a period of sleep deprivation. For many there is a short period of sleep deprivation that accompanies many projects, exams and events, but the trick is to catch up on sleep after these events.”
Lisa, meanwhile, has spent the week recovering from shift work. She was working nights last Saturday and Sunday – the first time she has done so since the challenge started. While she tried to combat the effect by getting up at midday on Monday after going to bed at 7.30am after her shift, she was still recovering from the effect of the nights by Thursday.
Unfortunately for Lisa, doing occasional shift work, according to Dr Faul, is the worst possible thing when it comes to sleep routines. Regular shift workers can establish some semblance of a routine within their week of nights where they can eat their meals at regular times and wind down to sleep as they would if it were evening time. “It will never be normal,” he says. “But pretending you’re on a schedule, and remembering to wind down before you go to sleep is a way of minimising the effects.”
Both Lisa and Holly are finding the recommended bedtime of 10 or 10.30pm next to impossible. “This is a real cultural problem we have,” says Dr Faul. “I’m in California at the moment and everybody is in bed by 9.30. In Switzerland, you have to minimise noise after 9pm because people are sleeping. It’s a different world outside of Ireland.”
I suffered a serious setback in the second week of my sleep challenge when I contracted a severe dose of man flu and the resulting complaining, coughing and wheezing and other near-death experiences made normal sleep almost impossible.
On the plus side, my illness made alcohol unpalatable for the entire week so that was one not-entirely-good-for-me habit broken handily enough. While falling asleep after a couple of glasses of wine is pretty easy, staying asleep is much harder. I found that by knocking the booze on the head, I was able to stretch out my sleep for as long as six hours at a time.
Once the worst of the hacking cough subsided, I found I was sleeping better than I had been for weeks, although the fact that my illness meant I missed two work-related early-morning starts early in the week probably helped that no end.
Technology continues to be a problem. There was probably a time when I did not bring my phone to bed but it is so long ago , I don’t remember it. I have done my level best not to check my bank balance or the Irish Times website or my Twitter stream after I have got into bed or when I wake up in the middle of the night. And I have tried not to look at my phone until at least after I have brushed my teeth.
I am not going to lie. I have fallen off the virtual wagon a couple of times, and almost as soon as I pick up the phone I can feel myself properly waking up. Next week, I will be better. I promise.