Here are some common questions I have been asked when speaking on this topic:
Q: “I am 80 and I take a one-hour nap after lunch. Is this
why I can’t sleep at night?”
A: YES! A nap of more than 20
minutes will interfere with your sleep at night.
Q: “I am a senior. I never nap and I don’t believe in naps. I
doze off several times daily while watching television. Why can’t I sleep at
night?”
A: You can’t sleep at night because
you are sleeping during the day. Dozing is sleeping!!
Q: “I heard that seniors should get a good night’s sleep and
that red wine is good for health. If I drink a glass of wine before bed, will
that help me?”
A: Yes, it will help you fall
asleep. BUT you will reawaken and have trouble getting to sleep again. Also,
alcohol is dangerous if mixed with certain medications. One 6 oz. glass is the
maximum amount of wine for an older adult per day. According to the latest
research, there is no medical benefit to drinking alcohol at any age.
Do older adults get enough sleep? The public’s awareness of quality sleep is improving, but still not as stressed as it should be. Less than five hours per night raises the risk of death. According to a study of nearly 800 older adults aged 62-90 who reported insomnia and sleep deprivation, their perception of their sleep habits and their actual sleep did not match. They completed self-reports and then wore an electronic device [like a Fitbit] to measure length and type of sleep. The study findings showed that their average sleep time was 7.3-7.9 hours.
The myth that older adults need less sleep as they age is not grounded in science. According to the NIH, older adults need the same amount of sleep as other adults, about 7-9 hours.
Researchers are finding an
association between sleep deprivation and chronic diseases. I attended a
webinar on May 12 featuring Dr. Richard Bogan. Poor sleep and duration are
associated with high blood pressure, elevated cholesterol, stroke, heart
attack. The American Heart Association added SLEEP to its checklist for measuring
cardiovascular health, as sleep quality is an essential component for heart and
brain health.
In a study of 100 participants in Pennsylvania,
sleep deprived older adults:
· Ate 500 calories more per day (about
10 pounds yearly weight gain)
· Slow reaction time
· Poor attention span
· Bad mood, negative facial expression
· Low energy
· Brain fog and forgetting
WHY were they sleep deprived? Frequent urination, pain,
effects of medication, restless leg syndrome, napping, caregiving, computer
screens, caffeine, worry, etc.
Sleep and chronic conditions –
Disturbed sleep is associated with inflammation which is associated with
biomarkers related to diabetes and cardiovascular disease. Treating insomnia
can reduce inflammation, as shown in numerous studies. Modifiable risk factors
are high fat diets and sedentary lifestyle.
Glymphatic Clearance is a term new to
most people. What happens if your washing machine skipped the rinse cycle?
Clothes would have suds and leave a soapy, sticky film. Recent studies have
shown that during sleep, waste clearance occurs in the brain. It works like the
rinse cycle of the washing machine. The glymphatic system is a fluid transport
system and can be described as a rinsing network distributed throughout the
brain. Although some glymphatic clearance occurs during waking hours, the vast
majority of glymphatic clearance occurs during sleep while the brain is idle.
It cleanses the brain during sleep, removing toxins, including Amyloid B
associated with Alzheimer’s Disease. Researchers have found that sleeping on
the right side of the body optimizes glymphatic clearance. These studies impact
healthy brain aging and Alzheimer’s Disease research. In the References and
Resources section below, access Dr. Collins’ video of glymphatic rinsing!
Does poor sleep cause depression in
old age? Disturbed sleep is associated with depression, a treatable medical condition
not to be confused with “mental illness.” People with depression have a higher
number of chronic diseases including high blood pressure, diabetes, chronic
lung disease, cardiovascular disease, cancer, arthritis. Does poor sleep cause
depression? That is debatable but the most recent research suggests that depression
is attributed to having chronic conditions.
Napping among older adults is quite
common, especially if they are retired and have napping opportunities. People
nap for a variety of reasons:
a. Poor nighttime sleep
b. Chronic conditions
c. Sedating medications
d. A boost in late-day fun
e. A boost in later day functioning
f. Less social engagement
g. boredom
Short naps of under 90 minutes may be beneficial. Older
adults taking longer naps (over 90 minutes) are more likely to restrict their
participation in one or more valued activities.
Caregiving takes a toll on sleep, especially dementia
caregiving. The more aid caregivers provide, the more they are sleep deprived. Sometimes,
extended family relationships impact sleep quality. Participants describe
causes as stress, conflict, supportiveness, demands, concerns, and criticism. Likewise,
family relationships may be beneficial or harmful to sleep.
Ethnicity and socioeconomic factors
also impact sleep. Numerous studies show that African Americans who report high
levels of discrimination also tend to sleep poorly. Participants reported they
are treated with less respect, assumed to be dishonest or not smart, and people
afraid of them because they are black. Researchers concluded that
discrimination explains some of the sleep differences between African Americans
and Whites. Living in a disadvantaged neighborhood contributes to less sleep. African
Americans slept for less time, took longer to fall asleep, and woke after
falling asleep more than other White Americans. Less sleep contributes to
racial disparities in health.
The Sleep Foundation is an
informative and practical website for developing strategies for getting more
quality sleep, a term known as sleep hygiene. What you do during the day
impacts how you sleep at night. Some sleep hygiene recommendations are:
a.
Wake up and go to bed at the same time every
day including weekends.
b.
Limit
naps.
c.
Ingest
caffeine early in the day. The effects of caffeine stay in the body for twelve
hours.
d.
Avoid
alcohol, as it interrupts restorative sleep.
e.
Darkness
promotes sleep. Therefore, keeping the room dark and wearing an eye mask
secretes more melatonin, a hormone that induces sleepiness.
References and Resources:
The Sleep Foundation: https://www.sleepfoundation.org/aging-and-sleep
Collins, F. (March 5, 2020). Discovering
the brain’s nightly rinse cycle. https://directorsblog.nih.gov/2020/03/05/discovering-the-brains-nightly-rinse-cycle/
Gulia, K.K. and Kumar, V.M. (2018).
Sleep disorders in the elderly: a growing challenge. Psychogeriatrics, 18:
155-165. https://doi.org/10.1111/psyg.12319
Reddy OC, van der Werf YD. The
sleeping brain: harnessing the power of the glymphatic system through lifestyle
choices. Brain Sci. 2020 Nov 17;10(11):868. doi:
10.3390/brainsci10110868. PMID: 33212927; PMCID: PMC7698404
Improvements in knowledge of sleep
and heart health. Richard Bogan, MD (May 11, 2023). Video. https://www.neurologylive.com/view/improvements-in-knowledge-sleep-and-heart-health-richard-bogan?utm_source=sfmc&utm_medium=email&utm_campaign=05172023_NRL_HAR-23-NRD0223_Narc%20MMCC_eNL%205-12&eKey=Z2V0ZHJqYW5AZ21haWwuY29t
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