Around 75% of older adults (aged 65 and up) experience some form of sleep disturbance, including insomnia, according to recent studies.
It has long been established that quality of sleep declines as you get older. Normal biological changes associated with ageing make it harder to fall asleep, sleep deeply, and stay asleep all night.
This isn’t necessarily a cause for concern, but we also know sleep is important for our overall health and wellbeing, so it can have an impact on quality of life.
We spoke to Professor Kevin Morgan, Emeritus Professor of Psychology at the University of Loughborough, who has spent decades researching sleep, to find out why sleep gets trickier as you get older, and the most effective ways to tackle the issue.
How does ageing impact sleep?
‘Ageing can lead to physical and lifestyle changes that detrimentally impact sleep,’ says Professor Morgan.
‘One important change is a flattening of the circadian rhythm.’
The circadian rhythm is a cycle of biological changes that happen over a (roughly) 24 hour period – you may have heard it described as the ‘body clock’. It makes you feel alert in the morning and sleepy at night. It also controls things like your blood pressure, hunger, and even body temperature.
This rhythm is partly controlled by fluctuations in different hormones.
In the case of the sleep/wake cycle, one key hormone is melatonin: it rises in the evening (which makes you feel sleepy) and falls in the morning (to help you wake up). Another important hormone is cortisol, which is released in the morning. It helps you to feel alert.
However, as you get older, your hormones fluctuate less over the course of the day, which can negatively affect your sleep.
Older people tend to release less melatonin in the evening, and release it earlier than younger people. In addition, melatonin release becomes less responsive to external cues, like light.
‘This uncoupling of the circadian rhythm with the typical 24-hour clock can make you feel sleepier in the day, and more awake at night,’ explains Professor Morgan. ‘This can detrimentally impact your sleep.’
These are not the only age-related changes that can disturb your sleep habits.
‘Older adults are more likely to have other health concerns, especially conditions like arthritis, which can cause pain’, says Professor Morgan. ‘You might also become more sensitive to caffeine as you age, or take medications that increase alertness.
‘Altogether, these changes can make it harder to get to sleep well.’
When does poor sleep become a problem?
If you have noticed your quality of sleep has declined, but it isn’t causing you distress or limiting your activity in the day, then it doesn’t necessarily need to be a cause for concern.
Remember also that short-term changes in your sleep are natural. For example, if you catch a cold, you might notice that your sleep is disturbed for a few weeks. You might also start a new medication that makes you feel less sleepy as you adjust to it.
However, if you have persistent sleep issues for more than a few months or you feel that lack of sleep is impacting your daily life, you should speak to your doctor. They can help rule out other health concerns, and recommend solutions for managing your sleep.
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Improving your sleep naturally
Once you have ruled out other health issues that could cause insomnia, there are some simple lifestyle changes you can make to help maintain a healthy sleep schedule.
If you are an older adult, Prof Morgan says the evidence suggests that interventions to support your circadian rhythm can significantly improve sleep quality.
Light exposure
One key change associated with ageing and sleep is a flattening of your sleep/wake control hormone cycle.
One way to manage this change is to control your light exposure through the day.
‘Light suppresses the production of melatonin,’ says Prof Morgan. ‘That means you should try to avoid bright lights in the evening, and expose yourself to bright light in the morning.’
In the evening:
- Swap from overhead lights to lamps, and try to avoid using your phone or tablet devices if possible.
- Consider investing in blackout blinds or curtains in your bedroom, or using a sleep mask.
In the morning:
- Try to expose yourself to as much bright light as possible. A recent meta-analysis found that light therapy can significantly reduce symptoms of insomnia – but this does depend on the amount of light exposure you get, with brighter light having a greater effect.
- Natural light tends to be a lot brighter than artificial lighting, so going outside each morning (eg for a walk) is the most effective way to support better sleep.
- If that isn’t possible, sitting beside a bright window will also help. You can also consider a SAD lamp.
Exercise
Regular exercise has well-documented health benefits, but it can also dramatically improve the quality of your sleep.
‘You don’t need to do vigorous exercise, but a brisk walk, light jog, or lifting some light weights will all help to support good sleep,’ advises Professor Morgan.
A recent review of physical activity and sleep levels in older people found that 150 minutes of exercise per week was associated with significantly reduced symptoms of insomnia in older people. That’s roughly 30 minutes per day, five days a week.
‘Creating a regular routine with exercise will help to regulate your circadian rhythm,’ says Professor Morgan. ‘Try to do it outdoors, so you are exposed to natural light, and in the morning, to help you wake up.’
Physical exercise can also help reduce physical stiffness and pain, as well as symptoms of depression and anxiety – all of which can support better sleep.
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Other tips for improving sleep as you age
Other behavioural changes to support better sleep as you age include:
- Keep a consistent schedule. Waking up and winding down (ie, reducing activity and light exposure) at a similar time every day will help maintain a consistent circadian rhythm.
- Avoiding caffeine after 2pm. As we age, our bodies become more sensitive to caffeine, so caffeine in the afternoon can keep us awake for longer at night.
- Sleeping in a cool, not cold, room. Your body temperature drops as you fall asleep, so keeping your bedroom slightly cooler than the rest of your home can support good rest habits. Aim for between 16 and 18°C. Being too cold can inhibit sleep, too, though, so don’t take it to extremes.
- Keep on top of other physical health conditions. Symptoms of other health conditions, such as chronic pain or breathing difficulties, can all impair sleep. If you have health issues that are impacting your sleep, discuss options for management with your GP.
Additional help if sleep is elusive
If you’re still struggling with sleep, there are other options that may be worth trying, though these should be discussed with your GP.
Cognitive behaviour therapy
Cognitive behavioural therapy for insomnia (CBT-I) is one of the most effective therapies for insomnia, including in older people.
It refers to a range of behavioural and psychological interventions to help improve sleep quality.
If you feel that you have tried multiple behavioural interventions and are still disturbed by the quality of your sleep, speaking to a psychologist can be highly effective. They will help you to work through anxiety and stress around sleeping.
Speak to your NHS GP about your options – you may be able to get access to apps including Sleepstation or Sleepio.
Sleep medication
Medications can help you sleep better, but they are typically a short-term solution and can have negative side effects, so are usually only prescribed when other solutions have failed.
In the UK, they are only available on prescription, so you will need to discuss whether they are suitable with your GP. Options include melatonin, which taken in the evening can help you to feel drowsy.
DORAs, a new type of medication for insomnia, work by blocking a chemical called orexin, which makes you feel awake. This medication is available with a prescription if you have chronic insomnia and CBT has not worked or is not available.
Older sleep aid medications, like benzodiazepines, can help insomnia by making you drowsy. However, they don’t address the root cause of insomnia, and they can have significant side effects, so they are rarely prescribed.
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