Perhaps if the residents of Miami-Dade County had been better rested last
November, the citizens of the United States would have decided the election
2000 outcome instead of the TV networks and lawyers.
Could it be that many of our most serious national problems spring from the
fact that our leaders and voters are just plain sleepy? There is an old
often-repeated myth that says you need less sleep as you grow older. Well,
that old “myth” is wrong!
The need for sleep does not change with age, but sleep patterns may change
with age, according to Sonia Ancoli-Israel, Ph.D., Professor of Psychiatry
at The University of California, San Diego, and Director of the Sleep
Disorders Clinic, V.A. San Diego Health Care System.
The truth is that while the need for sleep does not decrease with age,
sleep problems do, indeed, become more prevalent. Various studies show that
about one-third of seniors report symptoms of insomnia, and problems are
more prevalent in women.
Unfortunately, when sleep disturbances occur, they may result in behaviors
that can be associated with signs of normal aging. These include attention
difficulty, slowed response time, difficulty with memory and decreased
performance — all of which may be misinterpreted as dementia. The elderly
note that their time in bed increases, the number of awakenings increase,
total night sleep time decreases, time to fall asleep increases, sleep is
less satisfying, they are more tired during the day and they nap more
Insomnia and daytime sleepiness can occur at any age, and the resulting
symptoms should not be presumed to be a factor of age. But it is true that
seniors are more at risk to insomnia because of lifestyle changes, illness
and use of medications.
Studies show that retirement, isolation, loneliness, bereavement, and lack
of physical activity have profound effects on sleep in the elderly. All of
these issues can contribute to mood disorders such as major depression and
generalized anxiety — with insomnia being a major symptom.
Medical conditions that have a direct link to insomnia are hyperthyroidism,
arthritis, chronic renal failure, chronic lung disease, heart failure,
neurological disorders, restless legs syndrome, Dementia/Alzheimer’s,
Parkinson’s disease and primary sleep disorders.
Drugs that cause insomnia are alcohol, CNS stimulants, beta-blockers,
bronchodilators, calcium channel blockers, corticosteroids, decongestants,
stimulating antidepressants, thyroid hormone and nicotine.
The role of melatonin to combat insomnia remains under discussion. The best
dose is not well defined, and the over-the-counter preparations are not FDA
controlled and may not be pure. Melatonin can induce sleep but the timing
is extremely crucial and beyond the scope of this column.
So what to do to combat insomnia, especially in seniors? Dr. Ancoli-Israel offers these
1. Exercise every day. Lack of physical activity is one of the most
prevalent reasons for insomnia.
2. Curtail daytime naps. Limit naps to one per day for less than 30
minutes. While catnaps can rejuvenate, longer naps and more of them will only make insomnia worse.
3. Check medications. Make sure you aren’t overmedicating.
4. Avoid alcohol, caffeine and nicotine. Yeah, we know a glass of red wine may help you feel sleepy. But common sense tells us to avoid these in the evening.
5. Limit liquids. Take that last glass of milk or juice at least 3 hours
6. Keep regular hours. The circadian rhythm is a powerful force and more
sensitive to interruptions in seniors.
Sleeplessness causes daytime drowsiness and less than optimal daytime
functioning. Circadian rhythms naturally advance a few hours with age, so
older people may feel sleepy earlier and wake up earlier in contrast to
teen-agers who, as we know, are just getting started when the rest of us
want to go to sleep. Physical activity and natural light exposure can
promote better sleep. Natural light helps reset the circadian clock and a
regular schedule stabilizes the circadian rhythm. Try taking that walk late
in the afternoon.
If you’re a senior experiencing a sleep disturbance, don’t assume that’s the
best you can do. Instead, address the primary cause, whether it’s
medication, physical ailments, depression or emotional problems. Just
because you are a little older, the extra wisdom in itself does not cause
sleep problems. Although sleep patterns do change, the need for sleep does
not change with age.
Remember that when the best years of your life are ahead, approaching, or
here, you don’t want to spend them sacked out or making bad decisions.
And in the meantime, maybe we can all take a cue from Presidents Reagan and
Kennedy, who were both notorious for their afternoon catnaps. Maybe our
current leaders would make better future decisions if better rested!
Our thanks again to Dr. Sonia Ancoli-Israel for providing us with sound sleep
advice so these AARP-eligible authors of this article could stay awake long
enough to write this one.
For more information write the National Sleep Foundation.