Maintaining Proper Sleep Hygiene

by Richard O’Boyle, Publisher
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Getting a good night’s sleep is not only satisfying and invigorating, but also the foundation for a healthy and productive day. Yet up to a third of older individuals report difficulty maintaining sleep on a recurring basis and more than half report occasional problems with their sleep. Identifying and correcting poor sleeping habits can help older adults to improve their well-being and quality of life.

It is generally believed that older people require the same amount of sleep as younger adults – seven to nine hours each night. But they then to become lighter sleepers and may wake three or four times throughout the course of the night. They may have to go the bathroom frequently or find their sleep disturbed by the discomfort of a chronic illness. Some of these disturbances may be correctable with lifestyle and nutrition changes, but others may be symptoms of more serious medical conditions.

A recent study suggests that poor sleep habits may not only make you tired and irritable in the morning, but may also weaken your immune system and cause depression. Researchers at the University of Pittsburgh Medical Center Health Systems (UPMC) Western Psychiatric Institute and Clinic in Pittsburgh found that patients in their study whose sleep had been disrupted had decreased levels of natural killer cells (NKCs). A decreased NKC count indicates a weakened immune system and a body more vulnerable to illness. Sleep deprivation may lead to irritability, decreased concentration, and a greater risk for accidents and falls.

According to the National Sleep Foundation, many of the medical conditions that interrupt the sleep of older people are treatable. Medical problems such as arthritis, heartburn, osteoporosis, and heart and lung disease may interrupt, delay or abbreviate sleep, as may some of the drugs used to treat these conditions. There are many medical disorders more common among older people. “Middle-aged and elderly people suffer from at least four sleep disorders in numbers far greater than younger people: sleep apnea, restless legs syndrome, periodic limb movements disorder, and advanced sleep phase syndrome,” the Foundation says. In addition, depression, bereavement, and anxiety also impact the sleep of older adults.

In men, frequent trips to the bathroom to urinate may be a sign that the prostate gland is enlarged. Your doctor can screen you for prostate cancer. Other medical conditions mentioned about may also be treated effectively after consultation with the appropriate medical professionals.

What is a “Good Night’s Sleep?”

Scientists are not sure exactly why people need to sleep. But in animal studies, sleep is essential for survival. For example, rats deprived of sleep tend to live a small fraction of their expected lifespan. The rats have abnormally low body temperatures and seriously weakened immune systems. Some experts believe that sleep gives the brain time to repair cell damage and to restore energy levels within cells. In children and young adults sleep coincides with the release of growth hormones. REM sleep stimulates the brain regions used in learning, which is one reason that infants spend almost half of their sleep time in REM sleep.

Normal sleep usually consists of five consecutive stages that progress cyclically. The total time for each cycle of Stage 1 through Stage 5 averages 90 to 110 minutes:

  • Stage 1: Light Sleep: We drift in and out of sleep and can be woken easily. Slow eye movements and muscle activity.
  • Stage 2: Light Sleep: Eye movements stop and brain waves slow. About 50% of total sleep time.
  • Stage 3: Deep Sleep: Difficult to waken someone. Appearance of extremely slow “delta waves” within the brain. No eye movements or muscle activity.
  • Stage 4: Deep Sleep: Brain produces “delta waves” almost exclusively. Groggy or disoriented when awoken.
  • Stage 5: REM Sleep: Breathing becomes rapid, irregular, and shallow. Eyes jerk rapidly and limbs become partially paralyzed. Dreaming occurs. About 20% of total sleep time.

As we age, our need for sleep remains constant, but the amount of time we spend in the various stages changes. The percentage of time spent in REM sleep remains relatively stable although the first period of REM sleep comes faster and lasts for less time, according to the American Federation for Aging Research. The sleep of older adults is more fragmented with periods of wakefulness and less time is spent in deep, dreamless sleep. In particular, the amount of sleep in Stage 4 may be much less or absent in older adults. Older adults spend less time in Stage 3 sleep and there may be an absence of Stage 4 sleep.

Our brain chemistry subtly changes as we age. Production of melatonin, the hormone that regulates our sleep-wake cycle, decreases. Many people take over-the-counter dietary supplements that contain melatonin to aide in sleep. Martha McKittrick, RD, a registered dietician at New York Presbyterian Hospital - Weill Cornell Medical College, warns, “At this time, there have been no conclusive, well-designed studies examining the effects of melatonin on sleep.” She notes that researchers are unclear as to what the therapeutic effects of melatonin are or what dosage should be used. In addition, it is unknown if there are any significant side effects of melatonin, if there are any interactions between melatonin and other drugs, or if it should not be used by people with certain medical conditions.

An Avoidable Culprit: “Sleep-Unfriendly” Habits 

For many seniors, the underlying cause of poor sleep hygiene tends to be caused by dietary choices and sleeping habits. The leading lifestyle cause of poor sleep are the use of stimulants before bedtime, such as caffeine (found in coffee, tea, and colas), alcohol, and nicotine (found in cigarettes and cigars). These habits have often been ingrained over decades of life and only present a serious problem later in life.

Although alcohol may initially induce sleep, once it wears off, the sleep tends to be fragmented,” says McKittrick. She also suggests that caffeine be limited during the 4 to 6 hours before bedtime. “Approximately 50% of the caffeine consumed at 7 PM remains in the body at 11 PM,” she says. “Remember that caffeine is present in many different foods, beverages and medications.

Eating spicy or heavy foods before bedtime can cause heartburn and disrupt sleep. Furthermore, she says that a light snack before bedtime can alleviate hunger pangs that can keep you awake. Avoid liquids 90 minutes before bedtime to minimize nighttime trips to the bathroom.

While regular exercise can increase your chances of getting a good night’s sleep, exercise within three hours before bedtime can make you more alert and delay sleep. According to McKittrick, studies have shown that exercising more than three to six hours before going to bed has the most positive effect on falling asleep and staying asleep.

“Triple A” Tips for Getting a Good Night’s Sleep

Follow these tips to improve your sleep hygiene:

Avoid

- Avoid alcohol: Alcohol can initially cause drowsiness, but may exacerbate heartburn and cause nighttime wakings.
 - Avoid caffeine: This powerful stimulant is present in coffee, tea, cola, and chocolate.
 - Avoid nicotine: Cigarettes are another power stimulant and should be avoided before bedtime.
 - Avoid sleeping pills: Sleeping pills and some medications may be habit-forming or cause drowsiness during the day.

Adjust

 - Sleep at night: Keep a regular sleep schedule and minimize daytime naps that may disrupt your wake-sleep cycle.
 - Get enough sleep: People typically need from six to nine hours of sleep each night. 

Add

 - Create a “sleep-friendly” environment: Reduce outside light and noise; make sure that your bed and pillows are comfortable; don’t let the room get too warm.
- Exercise: Add an exercise program – even a nice long walk or visit to the gym – during the day, but not too close to bedtime.
 - Relax before bedtime: Don’t relive the day and don’t worry about tomorrow; take a warm bath, read a book, or take extra time to meditate and wind down.
 - Enjoy a light snack: Have a class of milk or carbohydrate-rich snack (low in sugar).

Sources:

 - “Good Nights,” by Jay Gordon, M.D. and Maria Goodavage, St. Martin’s Griffin, New York 2002.
 - “Sleep Information Center” from the American Federation for Aging Research at http://www.infoaging.org/l-sleep-home.html
 - Symptoms of Stress and Depression as Correlates of Sleep in Primary Insomnia,” Martica Hall, et al., Psychosomatic Medicine 2000 62: 227-230.
 - “Sleep and Aging” The National Sleep Foundation http://www.sleepfoundation.org/publications/sleepage.html#1
 - “The Principles of Sleep Hygiene,” by Loren Broch, Ph.D. and Rochelle Zak, M.D., New York Presbyterian Hospital at http://talkaboutsleep.healthology.com/focus_article.asp?f=sleep_disorders&b=talkaboutsleep&c=sleephygiene
 - “How Your Diet Affects Your Sleep” by Martha McKittrick, RD at http://talkaboutsleep.healthology.com/focus_article.asp?f=sleep_disorders&c=dietandsleep
 - “Simple Steps Can Combat Sleep Problems in the Elderly” by Theresa Defino, WebMD http://my.webmd.com/content/article/1728.53258
 - “Brain Basics: Understanding Sleep,” National Institute of Neurological Disorders and Stroke, July 1, 2001 http://www.ninds.nih.gov/health_and_medical/pubs/understanding_sleep_brain_basic_.htm

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