Sleep for Seniors

As we age, good quality sleep can be hard to come by.  Our master clock, the suprachiasmatic nucleus, works less efficiently, and our pineal gland secretes less melatonin.  These biological changes result in a propensity for older adults to both fall asleep earlier and wake up earlier.  None-the-less, seniors need just as much sleep as younger adults - 7 to 8 hours per night is ideal - yet 40 - 70% of them don’t get quality sleep.  

The number one sleep complaint among older adults is waking up too early and not being able to fall back asleep, and the number one reason seniors wake up too early is to use the bathroom. Other common reasons for poorer sleep as we age include chronic pain, medications, obstructive sleep apnea, restless leg syndrome and REM-behavior disorder.  

Sometimes the reason for inadequate sleep is unclear; in these people, daily exercise is the single most effective strategy to improve duration and quality of sleep. Other tips include getting enough daytime light, decreasing caffeine intake and keeping a good sleep routine.  Light is the most powerful cue for maintaining our circadian rhythm, and many seniors don’t get enough daytime light exposure.  Additionally, most people don’t realize that caffeine increases nighttime awakenings, so limiting caffeine is important even if it’s not keeping you from falling asleep.  Retirement brings less structure to our lives and the lack of a routine can easily lead to poor sleep habits.  Avoiding naps and keeping a regular sleep schedule are important; your iPhone can help by sending you daily reminders for bedtime and wakeup time.  

Ambien and other sleep hypnotics should be the last resort for sleep issues and should not be used for more than two weeks.  Hypnotics lose their efficacy after 14 days and can be dangerous in women and the elderly - blood levels are typically 45-50% higher in these groups. Unfortunately, Ambien and other sleep aids are widely prescribed; a recent study estimated that 77% of adults using Ambien are not following FDA safety recommendations.

At BreatheMD Sleep & Wellness, we are passionate about the importance of good sleep for better health. We get to the root cause of sleep issues and offer a wide variety of modalities - from our EmSella chair that decreases nighttime urination to guided meditation classes that ease insomnia -  to help our patients achieve great sleep.    

Keys to Better Sleep

Nothing has more impact on your overall health than the quality of your sleep, yet up to 30% of adults are routinely sleep-deficient and over 50% of adolescents suffer from excess daytime sleepiness.  Inadequate sleep - less than 7 hours a night in adults or 8 hours in teens - has been shown to cause weight gain, impaired executive functioning and attention, changes in memory and emotional dysregulation. People who routinely get less than 7 hours of sleep per night have a significantly higher risk of developing diabetes, hypertension, heart disease, and stroke.  Inadequate sleep decreases immune function, increases sensitivity to pain, and increases risk of alcohol and substance abuse.  

Rather than take a pill, the most important key to better sleep is plenty of physical activity during the day.  If you can’t motivate to exercise, try cleaning out your garage or a cluttered closet; organizing and getting rid of unnecessary things has tremendous mental and physical benefits.  

Here are my favorite sleep tips that anyone can try:

• Aim to get 7 - 8 hours of sleep per night (adolescents need 8 - 10 hours per night.)

• Limit blue light exposure at night - change the settings on your phone and computer to automatically block blue light after 8pm.

• Use a weighted blanket and a weighted eye pillow. The pressure on the skin and eyes activates the parasympathetic nervous system which is conducive to sleep.

• Lower the temperature of your bedroom to 60 - 67 degrees F.

• Use a HEPA filter in your bedroom to keep the bedroom free from allergens and as a white noise device.

Everyone experiences insomnia from time-to time, but if difficulty sleeping persists for 3 months or longer, it’s best to seek professional help - early treatment has been shown to prevent development of long-term sleep problems.  In addition to trouble falling asleep, symptoms such as loud snoring, frequent awakenings during the night, inability to stay awake during the day, and leg discomfort before bed may be signs that an underlying medical problem exists and should be evaluated by a sleep physician.

Insomnia: Tips I give my patients

Most of us are familiar with the basic tenets of sleep hygiene…. keep a regular bed time and wake time, no caffeine after lunch, don’t exercise or use electronics close to bedtime, don’t nap, don’t do anything in your bed besides sleep (and….) These standards have been around for the last few decades but recent advances in sleep medicine have led to better advice and better treatments. I’ve created an updated list of tips to help you fall asleep more easily - without a prescription.

1. Use a weighted blanket. Target sells one for about $40. For a more stylish option, check out Bearaby’s blankets. We use the “Tree Napper” in our clinic.

2. Use a weighted eye pillow. Both the weighted blanket and the weighted eye pillow stimulate the parasympathetic nervous system, and covering your eyes releases melatonin.

3. Eat a small snack (I like Zone Perfect bars) and a glass of milk before bed. This diverts blood flow to the stomach and helps quiet the mind.

4. Learn Transcendental Meditation (TM.) . TM has been in existence for over 5000 years, and the benefits are scientifically-proven to help a variety of medical conditions. TM is easy to learn, easy to maintain, and the most well-studied of all the meditation methods. The Beatles were big believers and today, Jerry Seinfeld, Paul McCartney, Dr Oz and Tom Brady are among the many advocates. A 20 minutes session of TM reduces the body’s oxygen consumption by 16% (compared to 10% during sleep) and dips your brain into alpha 1 activity, lowering cortisol levels and releasing stress from all over your body. To learn how to do TM, find a local TM center near you, or try it at home using this self-help guide.

5. Get an air filter for your bedroom - cleans the air and provides white noise.

6. OTC Medications:

   1. Tylenol PM is just Tylenol + Benadryl. Benadryl is safe and non-habit-forming. I tell my patients to take 2 Benadryl and a melatonin if their insomnia is a moderate to severe problem. When choosing a dose of melatonin, lower is better.. higher doses create an imbalance in the brain’s sleep-wake system.

   2. Magnesium can also be very helpful to take before bed, especially if you’re pregnant. It’s a natural muscle relaxer and what is used to treat pre-term labor. I took it nightly with all my pregnancies - stopped my leg cramps, helped me sleep and kept me regular.

   3. CBD helps with anxiety, is non-habit-forming and has been shown to promote sleep. When buying CBD, look for “THC-free”… the THC is what gives people the high.. and the positive drug test!

7. Prescription Medications:

   1. Avoid benzodiazepines at all cost as they are strongly habit-forming.

   2. If you are struggling with insomnia, in addition to the above measures, exercise more, eat better, get a massage, treat yourself. Only when all else fails, should you think about taking a prescription drug.

   3. There are a slew of prescription sleep medications out there. The newest one, Belsomra, has a unique method of action that sets it apart from the others by targeting orexin receptors in the brain. Orexin is a neuropeptide that increases wakefulness; it was first discovered in narcolepsy patients who have insufficient amounts of it. Belsomra is safe, effective and unlike most other medications for sleep, has no hangover effect. Insurance companies, of course, usually won’t pay for it ($$$$) unless other, less expensive, medications have been tried first.

8. If you wake up and can’t go back to sleep….. the best trick I know, because it happens to me frequently, is to have a small snack and a glass of milk. Blood is immediately diverted to your stomach, the parasympathetic nervous system is stimulated by digestion, and your mind will quiet down.

What have you found helpful for insomnia? Please leave your comments below!