If you’re an older American, chances are you have problems sleeping. Whether it’s difficulty getting to sleep, waking up in the middle of the night or having trouble going back to sleep once you’re awake, getting enough sleep is a luxury many people don’t have.
A 2015 paper cited estimates that 65%–about two out of three–of older adults report at least one sleep-related problem. They include insomnia, nocturnal urination, sleep apnea and other conditions.
But it’s not benign; the same study reported that roughly seven of eight older adults “who report sleep disturbances report at least one other major mental/psychological disorder, particularly depression, heart disease, pain, and memory problems.” The connection between chronic sleep problems and dementia is well established. More than 30% of older individuals who experience insomnia have a psychological condition such as depression and anxiety.
Of course, underlying medical conditions can cause problems sleeping, too, and one in four Americans between 65 and 84 have been diagnosed with four or more conditions. So can taking medications—almost two out of every five adults over 65 take five or more medications. All of these together can combine to prevent older people from getting a good night’s sleep.
What constitutes a good night’s sleep? One of the biggest myths is that people need less sleep when they age. Actually, older people need the same amount of sleep as younger people do—seven to eight hours a night, the National Sleep Foundation recommends.
But the pattern of sleep changes, says Dr. David Neubauer, a psychiatrist and professor at Johns Hopkins Medicine who has treated patients for over 35 years in the medical center’s sleep clinic. It’s all based on shifts in circadian rhythms, the way our bodies respond to light, which is why our distant ancestors who didn’t have alarm clocks awakened or went to sleep when the light or darkness told them to.
In older adults, the circadian clock advances, Neubauer explains. “People as they age tend to become more early birds, being sleepier earlier in the evening and having their sleep turned off earlier in the mornings,” he tells me in an interview. “Someone who might’ve been able to sleep until 7:00 or 8:00 several decades later in their life may find that they’re waking up at 6:00 or maybe 5:00 in the morning spontaneously and not being able to sleep anymore.”
But old habits die hard. “People are set in their ways. They’re accustomed to watching particular programs and staying up for the news and finally going to bed after they figure out what the weather’s going to be for the next day–not that it makes any difference,” Neubauer says.
Instead, he suggests, go to bed when you’re tired. “People are not going to bed as early as they could fall asleep, which is earlier than it would have been a few decades earlier in their lives,” he tells me. “When you feel tired, don’t fight it–just go to sleep, even if it’s earlier than you used to go to sleep. Don’t stay up until 11:00; go to bed at 10:00.”
That’s getting even more difficult these days with the widespread use of notebook computers, tablets and phones, which not only keep people too preoccupied to fall asleep but emit light that disrupts the body’s rhythms. “I strongly encourage people to minimize light exposure,” Neubauer says. “Avoid having all of the electronic screens close to you, avoid that stimulation. Don’t have such bright lights on.” He recommends separating from electronic screens one to two hours before bedtime. Remember when people used to take a good book to bed?
It is a battle between 21st century technology and tens of thousands of years of evolution hard-wired into our brains. “It goes back way earlier than humans, the circadian system and the sleep/wake cycle, phylogenetically goes way, way, way, way back,” he says, “It is burned in to our physiology, that we have all sorts of different processes that are driven by our circadian clock.”
Of course, if your sleep problems are worse or last longer, consult your physician. Twenty-five percent of older males have sleep apnea and it’s an underdiagnosed condition.
But for the rest of us, just as the old saying in stock investing goes “don’t fight the tape,” when it comes to sleep, don’t fight the circadian clock. Go to bed when you’re tired and get at least seven hours of sleep a night, if you can.
The three pillars of healthy aging are diet, exercise and sleep, Dr. Neubauer says. And sleep is probably the one you can most easily control.
Sweet dreams, everyone.