This post continues the Aging Educated series. Each post takes one system of the body and addresses some common changes that occur with aging, diseases relevant to that body system, and how prevention is so important. Please check out the other posts in the series available so far: muscle health, bone health, joint health, and brain health.
Alertness, sleepiness, insomnia, sleep apnea. All terms that are related to sleep and sleep health. Sleep is an important and yet often overlooked aspect of your personal health. Let’s discuss why sleep is so important, how older adults can get better sleep, and some common sleep disorders.
Sleep: What it Does for Your Body
How well did you sleep? Do you sleep well? These are some of the questions I frequently ask my physical therapy patients. Why do I care? I care because I care about my patients and their overall wellness. I also care because I know that sleep is important to their overall health and it can potentially affect their performance in our session that day. Also, I know their health history and I know the factors that can affect sleep such as pain, bladder control, or their history of insomnia or sleep apnea. If they are not sleeping well this may lead to poor alertness, decreased endurance, increased pain reported, and lower motivation or engagement with their daily activities and specifically in this example my therapy session with them. I may modify activities or shorten exercise intervals to accommodate for their reported fatigue.
Think about sleep for a little bit. Did you sleep well last night? If so, what made it a good night’s sleep? Was it the hours of sleep you were able to have in a row, was it going to bed at an earlier time, was it less interruptions from your bladder? If you did not sleep well, consider what may have contributed to that as well. Did pain interrupt your sleep, did you wake up anxious for some reason, did you have a hard time relaxing enough to fall asleep? There are many factors that can lead to a good night’s sleep or bad.
Why is sleep so important? What does it do for us? Sleep’s role physiologically is to help remove toxins in your brain, consolidate information for learning, and rest our bodies and minds to improve alertness, concentration, and overall performance when we are awake. Sleep has different stages and you go through sleep cycles when you sleep. Sleepiness is regulated by our body’s desire to be in homeostasis and is impacted by how much time we have been awake, hormones, and our circadian rhythm. Our bodies need sleep although all of the roles sleep plays are still being researched in depth.
Age Related Changes
As you age your sleep patterns will likely change. Think about your daily routine when you were raising kids and working outside the home full time. You had external demands that influenced your sleep/awake times and daily schedule. Aside from just practical routine and change in daily demands on your time older adults tend to sleep less in deep, dreamless sleep. They also tend to wake up overnight more often whether for urination, pain, or other reasons.
Sleep is an important part of your overall health. Healthy older adults tend to sleep better than those with medical or psychiatric diseases. Waking up tired everyday is not normal and should be addressed by your primary care provider for further advice. There are many treatable conditions that impact sleep quality which then carries over into how you are feeling in general and poor sleep can contribute to decreased activity participation, social isolation, and worsening of chronic conditions due to low mood and poor quality of life.
Think about your own health and what may be impacting your sleep that could be improved? Bladder health, chronic pain conditions, erratic bedtime and wake up time, anxiety, acid reflux-just a few examples of conditions that could be improved with lifestyle changes and contribute to improved rest and feeling less tired.
Common Sleep Disorders
Although none of these conditions we are going to briefly discuss below are exclusive to older adults, they are impactful and may explain why your sleep is poor. All of these should be discussed with your primary care or sleep medicine physician to see if you can improve their management. Maintaining a healthy weight and exercising regularly can contribute to improvement in these conditions as well.
Sleep Apnea
Sleep apnea is when your breathing stops and starts during sleep. There can by anatomical causes for this such as airway blockage, obesity contributes to the likelihood of sleep apnea as well or it could be an issue with the signals from the brain to your respiratory centers causing a breathing problem and this is called central sleep apnea and is less common. Obstructive sleep apea is fairly common in older adults and requires a diagnosis through a sleep study and then the appropriate therapy can be decided upon.
CPAP machines are commonly used and require compliance with their use to help with this condition. As a physical therapist that visits people’s homes I can attest to how many people discontinue their CPAP use due to discomfort of the mask, sleeping position it requires, etc. Make sure you discuss these concerns with your provider because there may be ways to improve your comfort and be able to use your machine as it is intended to be used. Sleep apnea can be a very serious condition and not allowing your body to get enough oxygen as you sleep has high costs especially over time that exceed “just” daily fatigue.
Studies have shown an association between untreated sleep apnea and increased risk of diabetes, stroke, and heart attack. Many people with sleep apnea are also obese which increases risks of these conditions as well so it is hard to fully isolate the effects of untreated sleep apnea. Just know that if you are prescribed breathing support during sleep it is very important to use it as indicated and discuss any barriers with your provider.
Insomnia
Insomnia is defined as trouble falling asleep or staying asleep. Sometimes insomnia can be short term due to an acute injury, stress, lifestyle change, etc. and may resolve on its own. For others insomnia is chronic and can require more formal intervention to be resolved. Improving your bedtime routine and habits can help with insomnia; but, potentially medication or other therapies will be required to fully resolve this issue.
Restless Legs
Restless leg syndrome (RLS) is characterized by an uncontrollable urge to move your legs. This condition is more common in older adults, likely due to the increased prevalence of risk factors for restless legs including peripheral neuropathy, anemia, and kidney failure. Restless legs can impact sleep quality by disrupting sleep and can lead to fatigue, low mood, and energy level. Treating any underlying cause, exercise, warm baths, and potentially medications specifically for restless legs can all be part of a treatment plan.
Healthy Sleep Habits
Regular Exercise
Of course as a physical therapist we are going to talk about exercise with most topics on this site. Exercise is so important to overall health and when it comes to sleep it is no different. Exercise improves mental and physical health and as part of other lifestyle choices can help a person maintain a healthy weight. Including exercise as part of your routine helps with your energy and even temperature regulation which can contribute to healthier sleep as well. Ability to fall asleep can also be improved by exercise. Consider your current exercise habits and consult with a physical therapist for an individualized exercise plan that could lead to better sleep quality and overall health improvement as well.
Screens and Sleep
Light influences your body’s natural sleep awake patterns. It even impacts your body’s production of melatonin which is a hormone that promotes sleep. Natural and artificial light exposure impact our sleep cycles. This is why shift work, jet lag, and lack of time in natural light daily impacts quality sleep and awake cycles so much. Think about our screen use in the current age as well. Blue light is emitted which impacts melatonin and sleep rhythm. A common piece of advice for implementing healthy sleep habits is to keep screens out of your bedroom such as not watching TV or looking at a phone or tablet before bed for at least an hour. You can also change settings on your phone to use night mode which lessens the impact of the blue light on your eye health as well as sleep health.
Bedtime Routine
How much do you think about your bedtime routine? Are you really consistent on what time you go to bed and wake up or take each day as it comes? Our bodies like to be in a good rhythm. Having a consistent bedtime and wake up time can help our hormones be more stable and improve our sleep quality. Taking some time to consider your bedtime routine can help you improve your sleep. Consider the tip above about screen use and try to set a cut off time for turning off the TV and other devices. Think about having a darker bedroom environment to promote melatonin production. As a physical therapist I will caveat this statement with advice to consider what lights will need to be turned on for overnight bathroom visits to maintain falls safety though. Think about including a relaxing activity into your evening routine. Also, think about your fluid intake. Setting a cut off time for having liquids for an hour or so before your desired bedtime may allow you to sleep for a longer period of time when you first go to bed. Try adding exercise, especially outdoors if possible, into your day and see how that changes your routine and sleep quality. Download the handout below for a few quick tips and a reminder of the topics we have covered today and see how your sleep can improve.
Check out the free printable below for a take away tip list that you can implement to improve your sleep. You will also then be on my email list and receive updates about new posts on the blog and other helpful information to help you age well!