How to sleep through the night

Your sleeping cycle changes as you age, but there are ways to ensure you get a good night's rest.

Published: August, 2018

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Most men experience bouts of sleeplessness as they age. They have trouble going to sleep, wake up in the night, and then have trouble falling back to sleep.

Most of this has to do with normal aging, but don't think you need less sleep because you are older. "Research has shown that your sleep needs stay constant throughout adulthood," says Dr. Lawrence Epstein, associate physician with the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women's Hospital. "Instead, it's your sleep patterns that change, and that is what can interfere with sleep quality."

The role of sleep aids

Some older adults reach for over-the-counter sleep aids when they have trouble falling and staying asleep, but these remedies should be used only for a short period. "These medications use antihistamines to make you sleepy," says Dr. Lawrence Epstein, associate physician with the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women's Hospital. "They can reduce the time it takes to fall asleep, but they tend to lose their effectiveness quickly if used regularly." Since sleep aids don't address any underlying problems that interfere with your sleep, he recommends that you speak with your doctor.

What's keeping you up

Sleep is more important as you age. Healthy sleep has been linked to better cognitive function, lower rates of inflammation and heart disease, and improved resistance against viruses like influenza and the common cold.

On the other hand, people who sleep poorly have a higher risk of dementia, depression, memory loss, confusion, and anxiety. "It's simple: people who sleep better tend to be healthier and live longer," says Dr. Epstein.

Sleep occurs in a sequence of stages, including dreamless periods of light and deep sleep, plus occasional periods of active dreaming, known as REM (rapid eye movement) sleep. This cycle is repeated several times during the night. However, older people spend more time in the lighter stages of sleep than in deep sleep. "When you are in the lighter stages, it's easier to be aroused, which then can make it difficult to fall back to sleep," says Dr. Epstein.

Unfortunately, you can't change this new sleeping cycle, so the goal is to address issues that make you wake up from a lighter sleep. The most common ones are sleep disorders, such as sleep apnea, needing to urinate at during the night, and restless leg syndrome.

Sleep apnea. Sleep apnea occurs when soft tissue in the back of the throat collapses and blocks the upper airway during sleep. This causes people to experience short pauses in their breathing many times during the night. Your bed partner often can help identify sleep apnea. If you live alone, look for signs like morning headaches, daytime sleepiness, and problems with concentration.

If you think you have sleep apnea, see your doctor. You may need to learn to sleep in a position that keeps your airway open. Another option is to use a continuous positive airway pressure device, which consists of a mask connected to a bedside machine by a tube. The machine blows air through the tube and mask into your air passages to keep your airways open while you sleep.

Nocturia. Nocturia (waking up to use the bathroom) tends to disrupt the first three to four hours of sleep, which are considered the most important for restoration. "Don't drink any water or other beverages close to bedtime, as this could increase the need to urinate in the night," says Dr. Epstein.

Also, if you take diuretics ("water pills") to control high blood pressure, consult your doctor about possibly adjusting your dosage. If you still have problems with nocturia, it could be related to other conditions that need medical attention, like a bladder or urinary tract infection or an enlarged prostate.

Restless leg syndrome (RLS). People with RLS feel sensations of tingling, crawling, or pins and needles in one or both legs that creates a continuous urge to move the legs. This feeling is often worse at night. See your doctor for more information about medicines and exercises used to treat RLS.

How much sleep do you need?

Most older adults still need seven to nine hours of sleep each night, according to Dr. Lawrence Epstein, associate physician with the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women's Hospital. "Health problems tend to arise when people sleep fewer than seven hours per night," he says. The guideline is to stick with the number of hours you have slept in the past. If you feel you need more sleep, then look closer at what issues might be affecting your sleep quality.

Get some rest

There are other problems that can disrupt sleep too, like depression, arthritis, and lack of exercise, so speak with your doctor if you feel any of these might be an issue. You also can improve your sleep quality by practicing good sleep habits, according to Dr. Epstein. For example:

Maintain a regular sleep schedule. Approach sleep like any other structured part of your life. Go to bed at the same time each night, and give yourself about an hour beforehand to relax, bathe, and brush your teeth.

"The ritual tells your body and mind that it's time to slow down, which can make falling asleep easier," says Dr. Epstein. Also, don't have anything distracting or stimulating in the bedroom like a TV, computer, or phone. Make sure the bedroom is dark and quiet, and listen to a white-noise machine, if needed, to help you relax.

Watch the caffeine and alcohol. Caffeine is a stimulant that can make it harder to fall asleep; alcohol makes you sleepy, but can cause fragmented sleep. Refrain from drinking or eating anything that contains them for at least two hours before bedtime, or earlier if that makes a difference for you.

Be careful with naps. Naps can have either good or bad effects on sleep quality, says Dr. Epstein. "If you nap too long during the day or too close to your normal bedtime, like after 5 p.m., it might disrupt your normal sleep cycle," he says. Yet, if you constantly feel sleepy during the day, a 20- to 30-minute nap can be reinvigorating. Set a timer, so you don't sleep too long, and try to schedule naps during a specific time of day, like early or late afternoon.

Sleep is a necessary part of a healthy life, so make every effort to ensure your sleep quality remains sound. "Often being unable to sleep becomes a habit, and people begin to worry about not sleeping even before they get into bed, which makes it even harder to fall asleep and stay asleep," says Dr. Epstein. "But with the right approach, poor sleep is something anyone can eventually overcome."

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