Aging, anxiety can take a toll on your sleep quality
Behavioural changes help, but experts urge caution on meds
Many older adults have sleep problems that can be caused by aging. But other issues also contribute to the prevalence of sleep complaints, and they should be discussed and investigated, experts say.
A U.S. poll conducted by the University of Michigan and released in October found that almost half of those 65 and older have trouble getting to sleep, and more than a third are taking prescription or over-the-counter sleep aids.
Older adults also have problems staying asleep, said Adam Spira, a sleep researcher at the Johns Hopkins Bloomberg School of Public Health. “Good sleep protects against negative outcomes, and those who sleep poorly are at higher risk of functional decline and depression,” he said.
The American College of Physicians (ACP) defines chronic insomnia as the presence of symptoms of distress and impairment that last for at least three nights a week for at least three months and are not linked to medical or mental problems or other sleep disorders, such as obstructive sleep apnea and restless legs syndrome.
The National Sleep Foundation says older adults need about seven to eight hours a night.
Changes in sleep occur throughout life, Spira said.
In later years, there are decreases in total sleep time, increases in sleep fragmentation and decreases in deep sleep.
Many people experience a circadian rhythm shift as they age, such that they awaken earlier in the morning and do not feel they are able to get enough sleep, said David N. Neubauer, a clinical faculty member in the Johns Hopkins Sleep Disorders Center.
Later in life, there also tend to be other factors that undermine good sleep quality, he said, adding that older adults may have suffered personal losses or have worries about the future.
As a group, older adults also have more health problems, which, along with the medications they take, can be major drivers of sleep problems, Spira said.
However, both older adults who are healthy and those with chronic medical conditions should use caution in taking over-the-counter and prescription sleeping aids, experts said.
Studies show that older people who take sleeping pills, also called sedative-hypnotics and tranquillizers, sleep only a little longer and a little better than those who don’t take them, according to Choosing Wisely, an initiative of the American Board of Internal Medicine.
The ACP also says that over-thecounter drugs — diphenhydramine (Benadryl Allergy, Nytol, Sominex and generic), doxylamine (Unisom tablets and generic), Advil PM and Tylenol PM — carry risks for older adults. Next-day side effects include drowsiness, confusion, constipation, dry mouth and difficulty urinating.
The ACP recommends that medications, when used, be taken for only a short time (four to five weeks).
Dietary supplements that are used as sleep aids and contain plant products, vitamins and minerals — for instance, valerian — appear to be generally safe, although there is little evidence they work, Neubauer said. Another common compound used in dietary supplements, melatonin — a naturally occurring hormone that is typically released in the evening and remains elevated until morning — does little to help people fall asleep quicker when taken at bedtime and is more likely to help people when taken a few hours before, studies suggest, Neubauer said.
Behavioural changes can also be effective in tackling sleep issues.
In 2016, the ACP recommended that cognitive behavioural therapy for insomnia (CBT-I) be the first-line treatment for adults with chronic insomnia. CBT-I is a combination of treatments including cognitive therapy, behavioural interventions such as sleep restriction and stimulus control, and helping develop habits conducive to a good night’s sleep.