When sleep needs change
There have been several periods in my life where sleep was short, disrupted, and fitful: during medical residency or with a new baby in the house. During those times, I never had trouble falling asleep and always seemed to feel not just tired, but drowsy. Even today, I look forward to rare occasions that I don’t set an alarm clock, or I have a few hours to spare on a rainy afternoon to curl up and grab 40 winks.
All of this to indicate that I really do appreciate how lovely it is to sleep, and a small part of me feels like a heel when I advise a patient to cut out afternoon naps, or limit nighttime rest to under 8 hours. The hard truth is that as we age, many of our core beliefs about sleep and rest are simply not true and can be harmful. Below are some common perceptions:
Perception: Rest is healing.
Fact: Sleep can be healing and restorative, and adequate rest is a part of a healthy lifestyle. But for seniors, when recovering from an acute illness, movement and activity can be the key to getting better. Prolonged bedrest can promote numerous complications in seniors, like skin ulcers, delirium, depression, muscle weakness, incontinence, pneumonia, and deep vein thrombosis. Some seniors who spend even several days in bed after an illness will never return to their prior level of activity.
Perception: We need more sleep as we get older.
Fact: Recommended optimal sleep duration goes down with age, not up. We need 14-17 hours of sleep a day – when we are under the age of 12 months! After that, sleep requirements go down, such that in those aged 65 years and over, 7- 8 hours is recommended, and those who sleep longer than 9 or 10 hours per night can have an increased risk of diabetes, hypertension, and cardiovascular mortality.
Perception: Sleeping pills work and are safe.
Fact: No sleeping pill is completely effective and safe. Prescription sleeping pills like benzodiazepines have been implicated in increased risk of dementia, falls, delirium, car accidents, withdrawal and dependence, and can increase insomnia. Other sleep aids like zopiclone can impair driving performance and can be addictive. Even “natural” sleep aids like valerian root and melatonin can have residual sedating effects. Over the counter sleeping pills are no safer than prescriptions in terms of side effects on mental alertness, and can contribute to constipation, dry mouth and urinary retention.
Perception: Naps are normal and harmless.
Fact: We are still learning about how naps affect seniors, but we know that up to half of older adults report taking daily naps. Whether this affects nighttime sleep or contributes to diminished cognitive performance is under debate, but there does seem to be some indication that nappers are less likely to participate in daytime social activities, and reduced socialization is a risk for isolation and cognitive impairment.
Where to start
In general, if you have no difficulty falling asleep, wake feeling rested, and enjoy a lifestyle that involves being active and getting out of the house, then you can do what you like with your sleep habits. But many seniors come to me complaining of sleep problems and looking for help. Often, the first step in sleeping better includes re-examining some of our beliefs and perceptions about sleep.