Introduction

Many people envision the "golden years" not only as a time to reap the rewards of life's labors but also as a time to catch up on years of missed sleep. However, for many older people, labor's rewards come more easily than does sleep: Up to half say that they do not sleep as well as they would like.

Sleep is important for health and a long life, but why sleep is necessary and what benefits it provides are not known.

Two of the main disturbances of sleep experienced by older people are insomnia during the night and excessive daytime sleepiness. These disturbances often result from poor sleep habits (for example, going to bed at different times on different nights) or changes in the brain that occur with aging. Insomnia and daytime sleepiness can also be symptoms of specific sleep disorders or other physical or mental health disorders. Sleep disorders that can cause insomnia or daytime sleepiness include limb movement disorders (which involve leg symptoms and movements while sleeping or trying to sleep), sleep apnea, circadian rhythm disorders, and REM sleep behavior disorder (which involves REM sleep, a deep stage of sleep characterized by dreams and rapid eye movements). In addition, physical dependence on others, lack of social stimulation, and loss of control over physical surroundings, as can occur with a move to a nursing home, can all affect the quality of sleep.

For older people who sleep together, sleep problems can be extremely "catching"; one sleepless person can quickly turn a restful night into a sleepless one for the other person.

Changes in Sleep Patterns With Aging

As people age, their sleep patterns almost always change. Older people tend to get sleepy earlier in the evening and wake up earlier in the morning. They may take a bit longer to get to sleep once they are in bed. Additionally, the brain changes the way it "organizes" sleep. Older people seem to spend less time in the deep sleep stages (which help the body recover from daytime activities) and more time in light sleep stages. Once asleep, they then wake up easily and frequently. As a result, they feel less rested and less alert than they might expect after a full night's sleep. The bottom line is that older people spend more time in bed getting less sleep than they did when they were younger.

For additional detail on this topic, see Stages of Sleep.

Physical and Mental Health Disorders Affecting Sleep

Dementia can cause confusion, paranoia, agitation, wandering, and disruptive behavior. For unknown reasons, these symptoms are often more intense in the evening and at night (an effect called "sun-downing"). People with dementia spend less time in deep and REM sleep, but whether this change explains why they become restless at night is unclear. Often, the effects of sleep disruptions on households compel family members to move their relatives to assisted living facilities or nursing homes. However, sleep problems may worsen in a nursing home, where residents have little control over noise, light, temperature, privacy, use of certain drugs, and nighttime interruptions.

Diagnosis of sleep disturbance in a person with dementia is usually obvious from family or caregiver reports. Behavioral strategies, such as encouraging daytime exercise and discouraging napping, are the safest and usually the most effective treatment. But drugs are sometimes needed temporarily. Benzodiazepines may help nighttime sleep and reduce anxiety. Certain antidepressants that cause sleepiness, such as trazodone or mirtazapine, may help, especially when dementia is accompanied by symptoms of depression.

Sensory loss, particularly vision and hearing loss, causes some older people to become confused at bedtime. No one knows why, but one possibility is that hearing or vision loss makes people feel disoriented in the dark and quiet of nighttime. Some people who have lost their vision fall asleep and wake up on an unpredictable cycle independent of night and day. Low nighttime doses of melatonin may help such people resume a normal day-night schedule.

Other physical disorders (such as arthritis and gastroesophageal reflux disease) can keep people from falling asleep or cause them to wake up several hours into their sleep. Sleep may also be disrupted by nocturia (excessive urination during nighttime). Nocturia can be caused by a variety of disorders (such as benign prostatic hyperplasia, diabetes, and heart failure), or it can be a side effect of certain drugs (such as diuretics). Many other drugs can interfere with sleep or cause excessive daytime sleepiness.

Mental health disorders, such as anxiety, posttraumatic stress disorder, and depression, can have a severe impact on sleep. Bereavement also affects sleep.

See the sidebar Some Strategies For Improving Sleep.

See the sidebar Napping.

See the table Disorders and Situations That Disturb Sleep.