A clinical psychologist describes how a few pieces of practical advice can help seniors get the best possible sleep.
By Kristin L. Daley, PhD, FSBSM
For many aging adults, a message that they hear repeated at their physician’s visits is to get more sleep, but these generalized messages aren’t always effective and may even fuel an unhealthy obsession with sleep. A realistic goal is to ensure that sleep is as well-regulated and protected as possible, without creating a fixation on sleep that can actually worsen it. By following a few simple steps, seniors can improve their shuteye so they can focus on the things in life that they find the most meaningful.
Here are a few specific pieces of advice that can help almost any senior optimize their sleep.
Step 1: Estimate Total Sleep Time
The best way to estimate a person’s amount of total sleep time is the old-fashioned way: a paper record of how much they sleep over a two-week period. (Make sure daytime naps are included.)
Add up all the hours of sleep, then divide by the 14 days. This daily sleep time estimate is a good snapshot of how much sleep a person is getting during their normal routine and will be the starting point.
The goal is to get this amount of sleep in a consistent schedule, which will aid the capacity to have consistent sleep and will also support other bodily systems like glucose (blood sugar) regulation.
Step 2: Establish Preferred Time for Sleep
The next step is for an individual to determine when they would like to sleep. Most older adults have a tendency toward becoming larks, meaning their circadian rhythm is more sensitive to signals to wake them in the morning, and wake time tends to creep earlier when those signals are present.
There is a reason the “senior dinner special” tends to mean dinner at 5 pm; it is not uncommon for seniors to develop a pattern of early sleep onset (prior to 9 pm) and early awakening (prior to 5 am).
If a senior is happy with being an early riser, then they can keep the pattern they have. If they would like to shift sleep later, then they can start to move some of the cues for wakefulness later in the day and avoid those cues until they want to be awake.
The strongest signal for wakefulness is light exposure. Movement and food consumption are also cues for wakefulness. If a senior wants to learn to stay up later, staying active, in the light, and pushing dinner later will support this schedule. An alarm can help support this process—even though retirement ads promise they could throw alarm clocks away! The alarm can be used as a signal to stay in bed, in the dark, without movement or food consumption, until after the clock says the time is right.
Step 3: Address Naps
Another common pattern that affects total sleep quality in the elderly is shorter nocturnal sleep and an added nap period, either in the mid-morning or in the afternoon. Naps are controversial. There is evidence naps can be healthy because they create more total daily sleep, but naps also are related to increased mortality and social challenges.
I also see naps turning into an expected daily activity, which can then limit some of seniors’ other activities and restrict the flexibility otherwise available in the day. If a senior loves to nap, and it fits their schedule, they can continue napping, but the amount they can expect to sleep at night will be reduced.
If seniors would like to eliminate the nap, they can try adding more activity and light exposure (such as going for a walk outside) during the time they would typically take a nap. Eventually, over a few weeks, the daytime sleep will be added to their nocturnal sleep.
Step 4: Create the Ideal Sleep Environment
Sleep also becomes slightly less efficient with age, meaning it is easier to wake up. So it can be even more important to make sure an older person’s environment is protective of sleep.
Recent research has demonstrated that light in a sleep environment affects sleep quality, even when people feel that they sleep well. If someone finds that light is needed to guide them to the bathroom at night, they can keep a flashlight handy rather than using a continuous nightlight.
Also, seniors may consider using white noise to mask any sounds that can interrupt sleep (even if they are unaware of these interruptions) but know that most people can require 3 to 4 days to adjust to white noise. Lastly, caffeine sensitivity increases with age, so seniors should avoid caffeine a full 12 hours before they plan to sleep.
Step 5: Plan for Stressors
The last factor I encourage in my “set it and forget it” plan would be to consider what happens with the stressors that arise.
Many people develop insomnia after they have experienced a significant stressor in their lives and find they cannot escape racing thoughts at night. We need better strategies than just distracting from those thoughts because there often aren’t a lot of distractions available in the middle of the night.
My favorite intervention is to have some time toward the end of the day where a person can engage in a “brain dump” in which they spend 5 to 10 minutes listening to their thoughts and making a list of all their worries, tasks, and challenges, which they tuck away to reflect on the next day. When their brain tries to revisit these during the night, they can gently remind it that this has already been managed.
Step 6: Enjoy Better Sleep
The goal with sleep is to make sure that the body’s needs are met without making sleep something that rules a person’s day or night. People should be advised to focus on having time in bed that matches their sleep need, time sleep to the pattern that fits them the best, optimize the bed environment, and manage stressful thoughts. Seniors, set sleep, then forget all about it.
Clinical psychologist Kristin L. Daley, PhD, FSBSM, is a founding partner at BASE Cognitive Behavioral in Charlotte, NC, and fellow of the Society of Behavioral Sleep Medicine.
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