Elderly need to adapt their sleep patterns

You're not sleeping well. You're taking longer to drift off, snapping awake at 2 a.m., then finding it harder to sink back into slumber.

If you think this is normal when you're older, you're mistaken.

A decade's worth of scientific research shows that, yes, sleep changes in older adults. We get less deep sleep and less dream-filled shut-eye. Our biological clocks reset, leading us to bed earlier and to awake with the birds.

Aches and pains can keep us tossing and turning, as can medications we're taking. If we're women of a certain age, hot flashes and bathroom runs can be nightly annoyances. So it goes, also, for men with enlarged prostates.

But these sleep disturbances are treatable, experts say.

Most of the time, a change in sleep habits will do the trick. Drugs that help people sleep are recommended only if other strategies fail and only on a short-term basis.

"Growing older doesn't mean sleeping poorly, and sleep disturbances shouldn't be considered part and parcel of aging," says Michael Vitiello, a professor of psychiatry at the University of Washington.

Evidence-based recommendations for addressing sleep disorders in older adults, published late last year in the Journal of the American Geriatrics Society, are the latest significant contribution to the science of sleep in seniors.

The guidelines encourage doctors to routinely ask older men and women about sleep problems. Patients should take responsibility, also, and bring up any complaints.

Research reports indicate that 57 percent of older adults experience sleep disruptions such as unsettling periodic limb movements (45 percent), insomnia (29 percent), obstructive sleep apnea (24 percent) and early-morning awakening (19 percent). Last year, a Gallup survey of more than 1,000 Americans age 50 or older found that 25 percent believed they had a "sleep problem."

A common cause of difficulties can be medications taken for other illnesses. Some of these drugs act as stimulants, making it difficult for a person to get shut-eye at night; some act as sedatives, causing excessive tiredness during the day.

People can minimize the impact by switching to another drug, changing the dose or simply shifting their medication schedule.

For instance, it's probably better to take a diuretic for high blood pressure in the morning so you're not running to the bathroom at night, says Dr. Harrison Bloom, an author of the new recommendations and an associate clinical professor at Mount Sinai Medical School in New York City. Similarly, it may be advisable to take a narcotic for chronic pain at day's end so you can turn in as you start becoming drowsy.

Other common causes of sleep disturbances include too much caffeine or alcohol, too little exercise or exposure to bright light, and untreated medical conditions such as arthritis or depression. How old your mattress is, how warm your room is at night, how much light comes in through your window - these can make a difference too.

Try changing sleep habits and conditions before taking sleep medications, which can be habit-forming and have other unwanted side effects such as excessive grogginess the next day, experts advise. But realize you may need short-term assistance from a counselor.

"Implementing behavioral changes is very difficult for people to do without help," said Dr. Cathy Alessi, a sleep expert at the Veterans Administration Greater Los Angeles Healthcare System.

Whether the need for sleep diminishes with age is a topic of ongoing debate. Educational materials from the National Institutes of Health suggest that seniors need seven to nine hours of sleep a night, about the same as younger adults. But Scott Campbell, director of the laboratory of human chronobiology at Weill Cornell Medical College in New York, says some research suggests otherwise.

In a small experiment involving 50 people observed in a sleep laboratory, Campbell found that older adults slept about two hours less than people 30 or younger and almost a full hour less than people in middle age. The study was published in 2007 in the Journal of Sleep Research. Similarly, a 2008 report in Current Biology found that older adults (age 60 to 72) slept 7.5 hours a night on average, compared with nine hours a night for people age 18 to 32.

What's increasingly clear is that for the elderly, insufficient sleep is linked with medical concerns such as hypertension, depression, diabetes, heart disease and stroke. "If you have a sleep disorder, the chances of developing one of these conditions is heightened," Bloom said. "And conversely, if you have one of these diseases, the chances of developing a sleep disorder are higher."

Many U.S. sleep experts frown on naps, arguing that they can compromise nighttime slumber. But several small studies suggest that napping adds to the total amount of sleep older people get during a 24-hour period, potentially improving their alertness during the day and early evening.

If you do nap, practice good habits: "Go to bed, close the curtains, turn off the ringer on the telephone, set an alarm so you sleep for 1.5 hours at most, and make sure you get up by about 4 p.m.," said Timothy Monk, a professor of psychiatry at the University of Pittsburgh Medical Center. "If you (do this), your nap shouldn't interfere with your sleep at night."

TIPS FOR SLEEPING WELL

Develop a sleep ritual. Take a hot bath 90 minutes before bedtime or concentrate on relaxing 30 minutes before you get into bed.

Try to go to bed and awaken at the same time every day.

Make your bedroom restful and comfortable. Limit noise and light.

Go to bed only if you feel sleepy.

Try to exercise every day. Exercise helps many people sleep better. But avoid heavy exercise within two hours of bedtime.

Cut down on substances such as caffeine, nicotine and alcohol, which can interfere with sleep, especially later in the day.

Use your bedroom only for sleep and sex.

Sleep only in your bedroom. Avoid napping or sleeping on couches or chairs.

If you nap, do so in the early afternoon for a limited time. Some experts suggest 30 to 45 minutes; others say an hour or a bit longer is fine.

If you can't fall asleep, leave your bedroom. Return only when you feel ready to go to sleep.

Ask your doctor if any of your medications could be keeping you awake at night.

Sources: Evidence-based recommendations for assessment and management of sleep disorders in older persons, Journal of the American Geriatrics Society, 2009; FamilyDoctor.org