December 30, 2011
Dear Mayo Clinic:
Does getting older mean that you won't sleep as well? Why does it seem like older people like me can't sleep like we used to?
Although sleep patterns change somewhat as you age, that doesn't mean you have to live with restless nights and the persistent feeling of insufficient sleep. The underlying causes are usually treatable.
Many brain activities contribute to sleep and wakefulness. Chemicals in your brain called neurotransmitters help control whether you're awake or asleep. Some of these chemicals help keep parts of your brain active while others encourage sleep.
Other forces, such as the amount of light you're exposed to and the medications you take, also influence your sleep patterns. Diet also can be a factor — for instance, caffeine and alcohol can have a significant effect.
Generally, sleeping seven to eight hours a night is considered optimal. Some adults need less. But if you're getting too little sleep, you're amassing a sleep debt.
Regularly sleeping less than five hours a night is associated with poor physical health, although there's debate whether poor health causes lost sleep or lost sleep results in poor health.
In older adults, sleeping less than five hours a night is associated with a more than 50 percent increased risk of falls. Getting less than seven hours of sleep on a regular basis may cut into your ability to concentrate, make decisions and remember things. Adding to that, ongoing sleep deprivation may actually interfere with your ability to recognize how tired you are.
But simply focusing your attention on getting a certain amount of sleep may not be helpful. Sleep difficulties can often be traced to treatable health issues. Talk to your care provider if you think your sleep problems are related to other medical conditions. For example, chronic health problems such as arthritis, kidney disease, Parkinson's disease and depression can cause difficulty sleeping.
Some of the other factors that could cause sleep difficulties include:
Sleep disorders — Sleep-related leg cramps, obstructive sleep apnea, periodic leg and arm movements, and restless legs syndrome can jeopardize sleep. A Mayo Clinic study of aging adults found that more than half of the 892 participants had signs of at least one sleep disorder other than insomnia.
Pain — Conditions that cause chronic pain, including heartburn, arthritis, back pain, cancer pain and headaches, can take a toll on sleep. In turn, poor sleep can increase the perception of pain intensity. Difficulties such as falling asleep or frequent nighttime wakening often are related to poor pain control.
Nighttime urination (nocturia) — Trips to the bathroom area common reason older adultswake at night. This also increases the risk of nighttime falls.
Illness — Coughing, shortness of breath, chronic pain and even itching can disrupt your sleep. Mental health conditions, such as depression, often are associated with sleep difficulties.
Medications — Drugs that disrupt sleep range from nonprescription decongestants to commonly prescribed drugs such as bronchodilators, some antidepressants and corticosteroids. Other medications such as beta blockers, varenicline (Chantix), some antidepressants and narcotics can cause vivid dreams or nightmares, contributing to sleep difficulty. Some pain relievers contain caffeine.
Menopause — Up to half of women in menopause report sleep difficulties. Hormone changes may be a factor and result in hot flashes, night sweats and disrupted sleep.
Providing care to family members is another factor that can reduce sleep.
Some sleep habits that everyone can adopt that may make a difference include going to bed at the same time each day; exercising before the evening hours; avoiding caffeine, nicotine and alcohol; and relaxing before bed with a warm bath or by reading something enjoyable. Try to keep your bedroom quiet, dark and at a comfortable sleeping temperature, and use your bedroom only for sleep or intimacy.
As a general rule, if you can't sleep, don't lie in bed. Leave your bedroom and do a quiet activity — such as read, watch TV or listen to music — until you feel tired.
If you're having sleep difficulties, consider whether a particular stress may be the cause. Once the stress is relieved, the sleep issue may resolve. But if you can't identify a reason for ongoing sleep loss, talk with your doctor. Determining and addressing its cause can make your nighttime sleep more restful.
— Jarrett Richardson, M.D., Psychiatry, Mayo Clinic, Rochester, Minn.