Grandpa sits on a chair, head bowed. He has already fallen asleep, lulled by the comedic banter coming from the television. It’s only ten in the morning and he’ll take another nap after lunchtime. He would also excuse himself from the dinner table before the clock hits 8 pm, shuffling back to his room and saying his goodnights.
Is it just me, or do elderly people spend an excessive amount of time sleeping?
Or, at least, it’s not that simple. In fact, the total amount of time spent sleeping decreases typically once one hits the 60’s. This is one of the age-related changes in the sleep-wake physiology of elderly people. But just because they’re normal doesn’t mean that it’s ideal. The National Sleep Foundation still recommends 7-8 hours of sleep for better cognitive and mental health. Thus, the need for sleep is not reduced. Instead, the ability to attain the same amount and quality of sleep dips over time.
So, what’s it like as an older person trying to sleep?
The day often starts early for elderly people. They also feel the sleepiness weighs on their eyes before the younger folks do. They go up to their rooms and move through their evening routines. When they do settle in for bed, it will take them longer to fall into a restful sleep. Once there, they end up spending less time on the REM (rapid eye movement) stage of sleep-- the one associated with learning and memory. Later in the evening, they may wake up several times. However, most healthy seniors would fall back to sleep without too much fuss. Overall, they may spend more time awake in bed compared to their younger selves.
And these are the normal sleep-related changes that come with age. What happens when grandpa isn’t a perfectly healthy senior?
The term “multimorbidity” means having two or more different and usually chronic diseases. Older people are more likely to be multimorbid simply because living longer means more time to acquire these diseases. Sadly, multimorbidity is also associated with poor sleep.[1,2]
Certain chronic conditions are more likely to result in poor sleep. Among these are chronic pain, depression, and neurologic conditions. Difficulty sleeping may also herald subclinical inflammation brought about by inflammatory bowel disease.
There are also specific disease symptoms that contribute to decreased sleeping time. I’m talking about nocturia, a symptom of diabetes and prostate enlargement. This is a fancy medical word for waking up in the middle of the night to urinate. But this doesn’t just happen once every evening-- sometimes as much as five times.[5,6] These small moments of disturbed sleep can accumulate throughout the night.
In most cases, giving medicine to treat these disorders or symptoms would help. But this could also open the pandora’s box to another problem.
Taking five or more medications on a daily basis can lead to poor quality sleep. There are also certain medications that can cause insomnia. Among these are medications for hypertension, depression, asthma, and even the common cold.[1,8]
Other substances we don’t usually conflate with medicine can also affect sleep. While having a glass of wine before bed can make sleep come faster, alcohol can cause more night awakenings-- often, to rush to the bathroom. Smoking tobacco has also been associated with insomnia and difficulty sleeping.
Then, there are the sleep disorders.
The most common among the sleep disorders in elderly individuals is still insomnia. It’s common because it covers a broad range of sleeping problems-- from having trouble falling asleep, trouble maintaining sleep, and trouble going back to sleep once you’ve woken up. These symptoms and even the prevalence of insomnia are known to increase with age.
Obstructive sleep apnea (OSA) is another disorder that cuts what should be a continuous and restful sleep into small interrupted chunks. You’ll know when someone has OSA because they usually snore when they sleep. They could sound like a quiet whistle or a sonorous grumble. But whatever it sounds like, this is usually caused by an obstruction in the pathway for breathing--- often, the obstruction is the tongue that falls to the back of the mouth. This happens more often in older people because of certain physiologic changes that come with age.
The individual would first be snoring, unaware that they’re keeping someone awake. Suddenly, the snoring might stop. But that’s not all that stops. For a few seconds, when the pathway has been fully obstructed, breathing stops too. Of course, your body won’t let you get away with this. So, it interrupts your sleep, wakes you up-- then you, half-asleep, adjust your position and go back to dreamland. Except that these small bouts of interruption, like those five trips to the bathroom by my diabetic grandmother, pile up into the logical conclusion of all these sleep disturbances.
So the truth is that elderly people don’t sleep so much at all. Grandpa’s afternoon naps aren’t actually the issue. They are, instead, a symptom of a problem that’s hidden behind the bedroom door after our elders go to bed. Or, at least, try to. The question then becomes, “what can we do about these problems?”
With multimorbidity, polypharmacy, and sleep disorders being common in older adults, asking your healthcare provider about these might be the best place to start. They may be able to uncover an underlying reason for these sleep difficulties. Or they could switch the type, dosage, and when a medicine is taken to help with sleep. They may also advise the patient about sleep hygiene. These are small behavioral changes that could be made to better associate the bed with restful sleep.
Some parts of aging, like sleep disturbances, go under or unreported because they are accepted consequences of aging. But there are still things we can do to help our older loved ones sleep easily.
- Miner B, Kryger MH. Sleep in the Aging Population. Sleep Med Clin. 2017;12(1):31-38. doi:10.1016/j.jsmc.2016.10.008
- He L, Biddle SJH, Lee JT, et al. The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China. Int J BehavNutr Phys Act. 2021;18(1):77. Published 2021 Jun 10. doi:10.1186/s12966-021-01150-7
- McCrae CS. Late-life comorbid insomnia: diagnosis and treatment. Am J Manag Care. 2009;15 Suppl:S14-S23.
- Qazi T, Farraye FA. Sleep Disturbances in the Elderly Patient with Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2019;17(4):470-491. doi:10.1007/s11938-019-00258-x
- Chiang GSH, Sim BLH, Lee JJM, Quah JHM. Determinants of poor sleep quality in elderly patients with diabetes mellitus, hyperlipidemia and hypertension in Singapore. Prim Health Care Res Dev. 2018;19(6):610-615. doi:10.1017/S146342361800018X
- Chartier-Kastler E, Leger D, Montauban V, Comet D, Haab F. Etude observationnellenationale (Association françaised'urologie) de l'impact de la nycturie sur le sommeil des patients porteursd'unehyperplasiebénigne de la prostate [Impact of nocturia on sleep efficiency in patients with benign prostatic hypertrophy]. Prog Urol. 2009;19(5):333-340. doi:10.1016/j.purol.2008.10.013
- Campanini MZ, González AD, de Andrade SM, et al. The association of continuous-use medications and sleep parameters in a sample of working adults [published online ahead of print, 2021 Mar 13]. Sleep Breath. 2021;10.1007/s11325-021-02343-x. doi:10.1007/s11325-021-02343-x
- Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019;18(3):337-352. doi:10.1002/wps.20674