As we age, sleep quality can decrease, partly because of normal changes and partly as a consequence of disease, poor habits, and medications.
That's not to say disrupted sleep or insomnia is OK; any problem sleeping should be discussed with your physician or a sleep specialist.
But there are differences between the natural changes we have in our sleep patterns as we age and changes caused by underlying issues that need to be addressed.
It is a normal part of aging, for example, to have an earlier bedtime and have difficulty staying asleep as long as we used to. It also may be normal to have less deep sleep and more awakenings toward the end of sleep. In addition, the diseases we accumulate as we age affect the quality of sleep. And pain from these illnesses and the medications we're taking for them can affect sleep significantly.
But it is not necessarily normal to snore, have pauses in your breathing (apnea), wake up with a headache, sleep fewer than six to seven hours, or have dream-related behaviors (movements that act out your dream). And excessive sleepiness during the daytime, increased irritability, worsened memory, and frequent awakenings or fragmented sleep may all be signs of a sleep disorder and should not be ignored.
In the case of obstructive sleep apnea, which occurs as frequently in the elderly as in the general population, signs may be different and snoring may be less pronounced. Snoring is rarely benign, and when coupled with increased sleepiness during the day or fragmented sleep, may indicate sleep disordered breathing.
In addition, the presence of dream enactment behaviors may increase with aging and can be associated with neurological disease and dementia, such as Parkinson's disease. The movements may seem small and infrequent but they can increase in frequency and may cause injury to you or your bed partner. The emergence of movement during dream sleep, and particularly mimicking the dream, should also be evaluated by your primary physician or a specialist.
Disordered sleeping of any kind, especially in the elderly, can lead to a worsened quality of life, impaired thinking, and exacerbate depression and anxiety.
Of all sleeping problems, insomnia is by far the most common complaint and it is typically not difficulty falling asleep but staying asleep. Changes in the body's natural clock and rhythm tend to cause this and include dampening of the signal and advancing phase, which helps keep us asleep. The result is typically an earlier bedtime with an earlier wake-up time and increasing difficulty staying asleep in the early morning hours.
As with all age groups, there are steps you can take to help make falling asleep and staying asleep easier:
Maintain a regular bedtime and wake time.
Remain active and get exercise every day.
Do not lie in bed trying to fall asleep; if you aren't asleep within 15 minutes, get out of bed and do something quiet and relaxing and try again when sleepy.
Avoid napping during the day.
Limit alcohol and caffeine late in the day.
Limit fluid intake before bedtime.
Keep the bedroom cool, dark, and quiet.
Know how your medications affect sleep.
Seek care if warning signs are present or sleep disturbance persists
Dr. Geck is an assistant professor in the USF Division of Pulmonary, Critical Care; associate program director for USF Sleep Medicine; co-medical director of the Sleep Lab at Florida Hospital Tampa; and Pulmonary, Critical Care and sleep specialist at Tampa General Hospital