by Ronald M. Hendrickson, MSc.
We never outgrow our need for ample healthy sleep. Ongoing research continues to document that a person's sleep needs do not decline as we age but remain constant throughout adulthood. In fact, sleep becomes even more important as we grow older because it is vital to maintaining concentration and memory formation and allows our bodies to repair any cell damage that occurred during the day. It also is vital to maintaining a healthy immune system which is key to disease prevention. A recent study indicated that getting even a few less hours sleep each night can significantly increase your risk of coming down with the common cold.(1)
Aging does not inherently bring sleep difficulties with it. Too many of our seniors just assume that insomnia, frequently waking up during the night, feeling tired during the day, often in need of a nap, or waking up feeling un-rested are just part of getting old. While those patterns are very common, they are the result of factors most of us are fully able to control and not part of an inevitable or even normal part of the aging process. Research data does show, however I that elderly people have significant sleep problems with one study indicating that (4)4% of elderly persons surveyed in the United States having significant insomnia problems.(2) One scientific paper states that half of all elderly persons suffer from insomnia.(3)
If sleep problems are not normal or inevitable in elderly persons, why is it then so difficult for elderly people to attain regular healthy sleep? There is a long list of items and behaviors that can contribute to problems sleeping, including:
- An inactive, sedentary lifestyle centered indoors, around the television,
- A pattern of daytime napping,
- An unsuitable sleep surface or other environmental issues such as room color, light and clutter,
- Medications for a wide variety of conditions common in the elderly that can have a negative impact on sleep,
- Chronic pain from such conditions as arthritis, heartburn or discomfort from ther health issues or a skin condition,
- Poor diet and eating at times less favorable to healthy sleep,
- Excessive or poorly timed caffeine consumption,
- Emotional and psychological issues such as a feeling of isolation or stress related to separation from or the loss of loved ones and depression,
- Alcohol consumption or even abuse,
- A feeling of a need to frequently use the toilet during the night,
The good news is that while sleep problems are common, relatively few elderly people have genuine, serious sleep disorders and a conscious effort to identify and eliminate as many causes of sleep disruption as possible can have a major impact in the quantity and quality of sleep. Get a healthy sleep program organized for yourself and your spouse, and get your friends and family members involved since they may need help with their sleep problems too.
- Exercise! Get moving because movement supports every aspect of healthy sleep, from respiration and circulation to a feeling of being tired, exercise is sleep's most natural ally. Swim, dance, golf, visit a gym or fitness center, garden or at the very least, walk. Vigorous walking once or more every day will cover the basic needs for movement. Go with a friend or group of friends and make it a social outing.
- Plan and maintain a regular sleep schedule. Unless other opportunities or demands call for variations, which are ok and can even help expedite sleep once you go to bed, set a specific target time to begin sleeping and set a time to wake up every day, even on weekends and when you travel.
- Take conscious steps to ensure you have a sound, sensible sleep environment. Make sure your mattress gives you the support and comfort you need. If it does not, change it. Make sure your room temperature is appropriate; cool but not too cool is best for most people. A dark, quiet room facilitates sleep. Having the television on produces both sound and light and draws your concentration at a time when you want to be letting go of issues and objects that engage your conscious attention.
- Stay mentally active and socially connected. Contact with family members and friends as well as active engagement in groups and church, community or other organizations can keep your mind active, help reduce stress and a sense of isolation and help prepare your mind for a good night's sleep. Write notes or e-mails, use the telephone, read and keep learning:-*AII these activities will help you sleep better.
- Carefully watch your desire to take naps. Watch so that any naps you might take do not interfere with nighttime sleeping. A brief nap early in the day may help you stay active and alert longer and make a good night's sleep easier to attain. Long naps late in the day are not going to help when night time comes.
- Exposure to natural sunlight helps regulate melatonin production, which in turn helps regulate your sleep-wake cycles. A couple of hours in the sunlight, especially if you are walking, gardening or engaging in some physical activity, can really help.
- Work with your spouse if snoring or excessive movements are issues keeping you awake. Do not hesitate to talk openly if such issues are hurting your sleep. Look at all the options, from earplugs and "white noise' devices to seeking professional advice. While sleeping in separate bedrooms is always an option, it doesn't help keep that vital sense of connection couples should enjoy throughout their entire lives.
- Work at relaxing and winding sown with soft music, dim lights, and stretching, breathing or other relaxation exercises. Many people find a bath helps them relax.
- Carefully monitor your medications. Always involve your doctor(s) in making any changes, but always ask if a medication is absolutely necessary. Look for drugless alternatives. Your doctor of chiropractic can help since chiropractic is a drugless science. If medications are absolutely necessary, carefully follow the directions provided by your doctor or pharmacist. Always throw away old prescriptions. Never take old drugs for a new condition or problem.
- Avoid sleep medications, especially self-administered substances. Sleep medications often have the opposite effect intended since they can both create dependency and at the same time make deep, healthy sleep more difficult to achieve and maintain. As well, the levels and quality of sleep can be negatively impacted.
Diet and sleep deserve a special discussion because of how important such inputs are to the sleep process. One sleep expert made the comment, "We sleep what we eat," because nutritional inputs, good or bad, can have a major impact on our sleeping habits. Some basic guidelines for senior citizens include the following:
- Avoid caffeine from coffee, tea, cola drinks and chocolate, especially late in the day. lt takes the body at least six hours to process half the caffeine in a large cup of coffee and caffeine is a proven barrier to easy and uninterrupted sleep.
- Alcohol is a bad and perhaps even a dangerous choice as a sleeping aid. It might seem to make you sleepy, but will disrupt your sleep. If you do drink alcohol, do so with a meal and make sure you have three or four hours to process it through your system before trying to sleep.
- Never go to bed hungry. Regular meals are an essential element for our general health and should be a priority for everyone. Sometimes, a light snack an hour or so before bed time can eliminate any hunger edge that might keep you awake or wake you up after you have fallen asleep. Remember; avoid alcohol and foods with high-sugar, sodium or caffeine contents.
- Watch out for foods that you know are going to be a problem. This might include hot or spicy foods, certain kinds of meats or vegetables that you have difficulty digesting, and watch the quantities of everything you eat. To overeat almost always means discomfort on some level. Also, timing can make a big difference in how food impacts sleep. Try to eat your evening meal, especially if it is a big one, at least three hours before you try to go to sleep.
- Finally, watch your intake of liquids before bedtime. It is important that you drink plenty of water and fruit or vegetable juices as part of a healthy diet. In fact, dehydration among the elderly is important to watch out for. However, remember that drinking lots of liquids right before bedtime will have consequences on the other end and will most certainly require one or more trips to the bathroom during the night, further disrupting your sleep patterns.
Perhaps the most difficult dimensions of sleep problems are those that stem from emotional or psychological stresses and problems. Worrying about family, health or money issues can easily escalate into serious stressors, especially for someone living alone. A sense of isolation and deep feelings of loneliness or abandonment can wreck havoc with healthy sleep. Sometimes professional help is needed, but family support and family attention and concern are always important. Family members need to make a special effort to be in both physical as well as emotional touch with aging relatives and to understand their deeper, more personal feelings and needs and respond accordingly, A loving message or telephone call from a family member can be a highly effective sedative.
Serious illness and chronic pain are real threats to healthy sleep and it is important to involve your health care professionals in a sleep discussion when treatment options are considered and decided upon. If certain medications have serious sleep side-effects, perhaps alternatives can be explored. In fact, the need for any medication and all its side-effects should be a central part of every doctor visit.
Serious sleep deprivation or sleeping for excessive periods of time may indicate problems with medications, illness or infection or serious emotional or psychological issues family members may not be otherwise aware of. Families need to learn to talk about sleep and sleep problems and also be on the lookout for danger signals that might indicate the need to consult a health care professional. Do not be afraid to err on the side of caution and seek help. It is always better to hear that your elderly family member is ok that to learn that early intervention could have prevented or mitigated a serious problem.4
In so many aspects of life it is commonly said that attitude is everything. This applies to healthy sleep as well. You can work to attain a healthy, restorative sleeping pattern, but it takes awareness, follow-up and support from friends and family. Consciously adopt a positive, can-do attitude towards healthy sleep.^ Since sleep is so vital, like good nutrition and healthy exercise, it can add years to your life and life to your years so it is really worth it.
1. Cohen, Sheldon, PhD; Doyle, William J. PhD; Alper, Cuneyt, M., MD; Janicki-Deverts, Denise, PhD; Turner, Ronald B., MD, "Sleep Habits and Susceptibility to the Common Cold," Archives of Internal Medicine, 2009; 169(1 ):62-67.
2. "Aging and Sleep," National Sleep Foundation, http://www.sleepfoundation.org
3. Kamel, NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006; 119(6):463-9.
4. "Sleep Disorder, Geriatric: Follow-up," Brannon, Guy E., MD, Coauthor(s): Vij, Subir, MD, MPH, Gentili, Angela MD, WebMD, http://emedicine.medscape.com/article/292498-followup, Updated: Aug 3,2009
The International Chiropractors Association is presently engaged in a comprehensive review of sleep research with the aim of making those findings available to chiropractic practitioners worldwide. We also believe that this review of the current state of sleep research will point to areas where additional study is needed and, in cooperation with our affiliated educational institutions and with the support of our sleep products partner King Koil Indonesia, we hope to help fill such gaps in the understanding of healthy sleep. For more information contact International Chiropractors Association at firstname.lastname@example.org, 01-703-528-5000 or contact King Koil Indonesia.