I'm in my sixties.
Thirty years ago I certainly could get up at four or five o'clock in the morning on a heavy work day, and most of the time I did just that five or six days a week, but my natural wake up time was about nine in the morning. Then about twenty years ago I started waking up naturally about eight in the morning. Ten years ago my preferred wake up time was about seven o'clock in the morning. Now I wake up about 5:30 or six.
I'm relatively lucky as an aging person. If I wake up early on a day I don't have something planned to do, I can roll over and go back to sleep for a while. However, many older persons not only wake up too early, they can't go back to sleep. That's true even after nights they couldn't sleep well.
Insomnia Isn't Always Taken Seriously by Doctors
One study of insomnia in the elderly found that 69 percent of people over the age 60 mentioned that they had problems sleeping, but only 81 percent of their doctors bothered to make a note in their charts. There are a number of reasons insomnia in the elderly isn't taken seriously.
- Elderly people are assumed to take naps during the day.
- Feeling groggy during the daytime, or nodding off while sitting too long, are accepted as normal in older people.
- Retired people don't have to rush off to work, so it's not considered to be as important for them to get good sleep.
The fact is, elderly people have sleep patterns very different from younger people. They spend more time in light sleep than younger people, and they spend less time in rapid eye movement or deep sleep. Seniors have shorter dream time than their younger counterparts. On average, people in their seventies get 90 minutes less sleep every night than people in their twenties. But does that mean that older people need less sleep?
Older People Need as Much Sleep as Anyone Else
According to Clifford Saper, M.D., Ph.D., chairman of neurology at the Beth Israel Deaconess Medical Center in Boston, older people don't need less sleep. They just get less sleep. Hundreds of millions of people over the age of 60 are in a constant state of insomnia, awake at night, tired during the day. Some are able to take naps, but many are not.
Why do people lose their ability to get good sleep as they get older? There are two main reasons:
- A cluster of neurons in the brain known as the ventrolateral preoptic nucleus dies off as people get older. The fewer nerve cells there are in this part of the brain, the less GABA and gabalin are made by the brain, and the shorter the time that people spend in deep sleep.
- The brain's biological clock seems to shift as we get older. We get sleepier earlier in the evening, and begin to wake up earlier in the morning.
People who have Alzheimer's disease lose especially large numbers of cells in the ventrolateral preoptic nucleus, and tend to to be active in the middle of the night as a result. Because they have greater risk of falling and other kinds of injuries, as a result many people have to be confined to nursing homes.
What Can Be Done About Insomnia in the Elderly?
The kind of insomnia most common in the elderly is a problem with the biological clock known as advanced sleep phase syndrome. There are some common characteristics to this condition:
- Sleepiness sets in between six and nine o'clock in the evening.
- Wake-up time shifts to between three and five o'clock in the morning.
- People who have advanced sleep phase syndrome feel alert in the morning, but are really tired in the late afternoon.
- If it is possible actually to go to bed between six and nine p.m., people can get a normal night's sleep, but if it is not possible to go to bed early, people who have this condition still wake up early.
Some of the same sleep remedies that work for younger people also work in older people. Snoring is no less a problem for the elderly and their bed partners than it is for younger people. Whether snoring is due to allergies, overweight, infections of the sinuses or adenoids or tonsils, or obstructive sleep apnea, it needs to be treated. Common sleep remedies like melatonin are also helpful as people get older and the brain's ventrolateral preoptic nucleus can make less of its own. Not every commonly prescribed remedy for sleep problems, however, is uniformly helpful.
- Antipsychotic drugs like Seroquel (quetiapine fumarate) sometimes help elderly people who have dementia sleep better at first, but they almost always result in serious long-term complications. If the primary symptom is insomnia. antipsychotic drugs are a bad choice. Canadian doctors are more likely to prescribe antipsychotic medications for insomnia than doctors in most other countries.
- Belsamra (suvorexant) works by helping people stay asleep in the morning, not by helping them fall asleep at night. As a result, doctors usually recommend not driving or doing tasks that require concentration the day after taking the medication. This makes the medication impractical for many seniors who are still working.
- Tasimelteon (Hetlioz) is a medication for people who are totally blind. It is not likely to be helpful for treating insomnia in the elderly who are not totally blind.
Rather than drugs, there are other interventions that can help reset the body's biological clock:
- Intense light therapy in the early evening can signal the brain that it is not yet time for bed. Similar to the way the device used to treat seasonal affective disorder that is used in the morning to help people wake, the same device is used to help people stay up longer in the evening.
- Keeping the bedroom dark is essential for sleep. It's especially important to avoid blue light; blue light tells the brain is time to get up. You can see blue light even through your eyelids when your eyes are shut, so any blue light has to be completely blocked out. People who live in northerly or southerly places closer to the poles where the sun rises very early during the summer may need blackout curtains or sleeping masks.
- Eating dinner at a normal hour helps you stay awake longer in the evening and sleep longer in the morning. Avoid "four o'clock specials" common in many American cities where older people are a large part of the population.
- Going to bed later in the evening often leads to waking up later in the morning, at least in the earlier stages of the condition. Going to bed two or three hours after you begin to yawn and feel sleepy may help you sleep until it is a normal hour for getting up the next morning.
- Taking one nap in the afternoon can be helpful in establishing a routine, but taking multiple naps throughout the day does not help regulate sleep at night.
- Melatonin can aid normal sleep, but be sure not to take until about an hour before your intended bedtime. Taking it earlier will cause you to fall asleep earlier.
These measures go a long way toward normalizing sleep. Some elderly people will still need medications, but it is simpler and often effective to try non-drug natural sleep remedies first.