Harvard Health Letter

Restructure your day to get a better night's sleep

Wake up at the same time every day. Waking time is the anchor for your circadian sleep rhythm.
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Consistency in your schedule may help restore patterns of sleep and waking so you can get needed rest.

The free time that accompanies your older years may allow you to keep any schedule you like: sleep late one day or wake up early the next. But that lack of structure can have a negative impact on your sleep. "I see a fair number of people who say their sleep was better when they were working, but after retirement it becomes more disrupted," says sleep specialist Dr. Cynthia Dorsey, assistant professor of psychology in Harvard Medical School's psychiatry department.

Risks of inconsistent sleep

Even though it may feel like a luxury, an inconsistent sleep schedule can throw off your circadian rhythm, the body's way of regulating sleep and waking. "That can lead to insomnia," warns Dr. Dorsey, "but people don't realize that their schedule is causing the problem."

Let sleep problems go on too long, and you may experience the effects of sleep deprivation, such as changes in mood, thinking skills, and judgment. A lack of sleep can also lead to many health problems, such as heart disease, obesity, and diabetes.

Getting help

Rather than suffer with sleeping difficulties, talk to your doctor or go to a sleep specialist for help. Get a physical exam to make sure there isn't an underlying cause for your sleep problems.

If the cause is unclear, a sleep diary can help. Dr. Dorsey recommends recording the details of your sleep for two weeks. "Each morning, write down when you went to bed, estimate how long it took to fall asleep, count how many times you woke up in the night, and record when you finally woke in the morning. That baseline data will help you see patterns that may need to be changed," says Dr. Dorsey. But keep the diary out of the bedroom and just estimate the values the next morning. Try not to look at a clock if you are awake during the night. That can create anxiety that makes sleeping more difficult.

Get back on schedule

To get your circadian rhythm back on track, start by waking up at the same time every day. The wake time is most important to getting on a schedule again. "It's the anchor of your circadian sleep rhythm," says Dr. Dorsey. She recommends using an alarm clock, since it sets a boundary for you.

Make your bedtime about seven or eight hours before the alarm will sound. "But don't get into bed until your sleep time, and only if you're sleepy. Trying too hard to fall asleep will wake you up," says Dr. Dorsey. It helps to make a wind-down period part of your bedtime routine. That means stopping the use of all electronics an hour and a half before bed, keeping the lights low, and doing relaxing yet nonstimulating activities such as reading. "It's worth it to wind down before bed because physical, emotional, and cognitive relaxation helps you to fall asleep faster," says Dr. Dorsey.

Filling your day with more structure will also reinforce your circadian rhythm. Keep a regular schedule for meals, exercise, and activities such as grocery shopping, socializing, or housework. "Maintaining structure throughout your day can help you stick to your sleep schedule. Plus, routines are good for mood and can make you feel productive and vital," says Dr. Dorsey. "You don't have to be rigid about it. It's fine if you occasionally stay up late. Just try to get up at close to the same time every day."

The physical challenges of sleep in older years

An inconsistent sleep schedule isn't the only sleep challenge older adults face. "As we age, we lose our slow-wave, or deep, sleep," says Dr. Cynthia Dorsey, assistant professor of psychology in Harvard Medical School's psychiatry department. As a result, you may wake up feeling unrested.

On top of that, older adults may wake more in the night be-cause of discomfort from chronic illness, frequent trips to the bathroom, medication side effects, or sleep disorders such as obstructive sleep apnea (OSA) or periodic limb movement disorder.

Treating the physical problems that are keeping you awake may be simple, such as switching medications if a drug side effect is causing sleep disturbances. If symptoms indicate that there's an underlying physical ailment—such as high blood pressure, an enlarged prostate (in men), or OSA—treatment may be more complicated, but will go a long way toward improving your sleep.