Unlike some things that improve with age – wine, whiskey and a good cheddar, for instance – our quality of sleep does not. From infancy to old age, marked changes occur in our sleep patterns. How you fall asleep, how long you stay asleep, and the amount of time spent in each sleep stage changes, especially after the age of 60.
“Those over 65 tend to complain that it takes ages to fall asleep, that they wake up frequently during the night and that they get very light sleep,” explains Dr Irshaad Ebrahim, medical director of the London Sleep Centre and consulting doctor at the Constantia Sleep Centre in Cape Town.
For some, this normal physiological change to their sleep patterns isn’t a problem. But others find the loss of sleep quality impacts their daily lives. In such cases, insomnia could be a possible diagnosis – in fact, several studies show that insomnia is more prevalent in the elderly.
Could you have age-related insomnia?
Insomnia symptoms vary from person to person. Some people toss and turn, taking a long time to fall asleep. Others may wake frequently and struggle to fall asleep again. Some complain of waking up too early or that they don’t feel well rested in the morning.
What tips these symptoms into the territory of insomnia is when the lack of a good night’s rest affects day-time functioning and causes distress.
If, for a period of three months or longer, you’ve experienced difficulty falling asleep, staying asleep or “non-restorative” sleep combined with tiredness, lethargy and poor concentration during the day, clinicians will likely offer a diagnosis of chronic insomnia.
What else is keeping seniors awake?
But insomnia can also be caused, and compounded, by factors other than the normal physiological changes to sleep patterns that come with age.
Many chronic conditions, such as hypertension, diabetes and pain syndromes such as arthritis, can interfere with sleep directly, while in other cases the medication used to treat these conditions can disrupt sleep, explains Dr Karine Scheuermaier, head of the Wits Sleep Laboratory.
Steroids, for instance, a medication more likely to be used by people over 65, is known to disrupt sleep. Likewise, lipid-lowering drugs – used to treat cholesterol – can also cause insomnia. Definitive sleep disorders such as obstructive sleep apnoea and restless legs syndrome are also common in this age group, explains Dr Alison Bentley, who has been involved in sleep medicine and research since 1987.
And retired adults also have a tendency to nap, to have a slower lifestyle, and to go to bed earlier.
“So there is a greater sleep opportunity paired with an age-related reduced sleep need. Consequently more hours are spent lying awake in bed. You either view this as normal or panic that your ability to sleep is disappearing. If you do the second, you create an insomnia out of something which was quite natural,” quips Bentley.
Nonetheless, anxiety over your ability to sleep – as well as other psychological factors that disturb the mind – can be as disruptive as physical conditions to your sleep.
Lifestyle changes such as retirement, losing a loved one, or experiencing feelings of inadequacy, rejection, loneliness and fear for one’s personal safety, as well as psychiatric illness such as depression and anxiety, can also be factors in insomnia, explains Michelle Baker, a clinical psychologist with a special interest in sleep disorders.
So you have insomnia – what’s next?
“Sometimes being effectively treated by a psychologist for anxiety and depression can resolve your sleep issues,” Baker explains.
And Ebrahim sees no reason why sleep-pattern changes need rob anyone of a good night’s rest or impact the quality of their work and social life – especially given today’s large, and growing, silver-haired working force.
Therapies such as melatonin agonists, which regulate the sleep-wake cycle and readjust circadian rhythms, are now considered a safer and more effective way of treating insomnia than traditional sedative hypnotics, he explains.
Cognitive behavioural therapy for insomnia – which includes regular visits to a clinician who will work with you to help you change the way you sleep – is also effective,” suggests Baker.