Your body clock shifts
The quality and duration of your sleep tends to change when you get older, through changes in the 24-hour daily cycles of your circadian rhythms due to a drop in the amount of melatonin secreted by your pineal gland. These rhythms influence the release of certain hormones, and feelings of hunger, alertness, and sleepiness.
The cycles are controlled by a master clock in your brain, the suprachiasmatic nucleus, which can deteriorate with age. It receives information through your eyes and light is the most important for maintaining circadian rhythms. According to the US National Sleep Foundation, research has shown many older people don’t have enough exposure to daylight as they go out less or are in nursing homes.
Your health changes
Sleep can also be negatively suprachiasmatic by an increasing number of medical conditions, says Dr Alison Bentley, a Joburg-based sleep disorders clinician and researcher. Heart and lung conditions that affect breathing (such as heart failure and chronic obstructive pulmonary disease), diabetes, arthritis, reflux (causing heartburn), depression and anxiety tend to develop with age, and can affect your ability to sleep.
“Grief, redundancy and loneliness are also big factors,” says Michelle Baker, a Durban clinical psychologist with a special interest in sleep.
Your lifestyle changes
After retirement, you’re likely to spend much of your time at home, and to take naps and follow a less structured sleep schedule. Life changes, such as loss of independence and greater social isolation, can increase stress and anxiety, contributing to sleep problems.
“There’s also less exercise and structure to the day,” Bentley says. “Older people tend to go to bed earlier, and this causes fragmentation of sleep and very early rising (3-4am).”
Your sleep quality changes
You also tend to tire and wake earlier because your circadian rhythms tend to drift forward with age. What’s called your ‘sleep architecture’ changes, too – the way you cycle through the stages of sleep. You tend to spend longer in the earlier, lighter stages, and less in the later, deeper stages, waking more often and getting less restful sleep.
In a study, about 25% of older adults took naps, against 8% of younger adults. And while a short afternoon nap can be beneficial, says Bentley, "later or longer naps can make it harder to get to sleep at bedtime and lead to disrupted sleep".
You’re more likely to have chronic sleep issues
Research published in Sleep Medicine Clinics found 40% to 70% of older adults have chronic sleep problems, though nearly half may go undiagnosed
These can affect your daily activities and quality of life:
Pain: Caused by osteoarthritis, back pain or other age-related conditions, this can prevent or interrupt sleep, leading to non-restorative sleep, says Bentley. “Then sleeplessness contributes to increased sensitivity to pain, in a vicious cycle.”
Neurological illness: Parkinson’s, for instance, can cause movements that break your sleep
Insomnia: Ongoing difficulty falling or staying asleep is common in older adults, she says. It can result from not only stress and anxiety, but consuming alcohol or caffeine after 2pm or taking medications that inhibit sleep (including some cold remedies).
Waking to go to the bathroom: The need to urinate at night increases with age through changes in your urinary system and other factors, interrupting sleep.
Excessive daytime sleepiness: This can signal sleep disorders such as sleep apnea and snoring (where obstruction causes pauses in your breathing), restless leg syndrome (the urge to move your limbs while sleeping) and REM sleep behaviour disorder (where you act out dreams, thrashing around). “The result is fragmented sleep that leaves you tired, as well as at increased risk of future heart disease,” Bentley says.
If you experience these sleep problems, don’t ignore them or self-medicate – speak to your healthcare provider. They can address the underlying cause and prescribe treatment. Prescription medicine may be advised (such as replacing melatonin), cognitive behavioural therapy (for the more chronic anxiety-driven insomnia), or just better sleep hygiene (such as limiting naps, alcohol and caffeine), says Bentley.
“Occasionally surgery or weight loss or use of a mini-ventilator called a CPAP machine may help to keep you breathing and sleeping at night when you have sleep apnoea,” Bentley says.
Sleep is more important than ever as you age, and Sleep Foundation guidelines advise that people over 65 should still aim to get enough sleep at night (on average seven to eight hours) to be able to stay alert the next day.
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