JT Lewis

How our sleep changes with age & tips to fix it

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How our sleep changes with age & tips to fix it

How our sleep changes with age & tips to fix it.

It’s a cold hard fact: we sleep a third of our life away. That’s right, most of us can expect to spend 25 plus years of our life in unfettered slumber. But when was the last time you had a solid eight hours? The length, timing and quality of our sleep changes with age.

Have you ever carried a sleeping child from the car to the house? Did they waken? Probably not. Slumped, unmindful, they doze solidly as you clamber up the stairs. The expression ‘sleep like a child’ conveys this deep, untroubled state.  But sleep changes with age.

Pediatric sleep expert Jodi Mindell Chairs the Pediatric Sleep Council Board of Directors.  Dr. Mindell explains, “There are major changes in sleep from newborns to late in life, with differences in sleep amounts, how sleep is distributed across the day, and sleep architecture.” Although there are commonalities, each group must be studied differently.

Babies aren’t born with an ‘adult’ circadian rhythm-based sleep cycle. The circadian rhythm for sleep only emerges 4 to 8 weeks after birth. Babies gradually begin to sleep more at night than day. At 12 weeks, babies sleep mostly at night and only nap during the day. By 6 months, the sleep phases and circadian rhythms of infants resemble those of adults.

Healthy sleep

Measures of healthy sleep include:

1. Sleep latency: how long it takes us to fall asleep.

2. Sleep stages: as measured by brain waves, and the relative time we spend in each stage.

  • non-REM sleep, includes stages 1, 2, and 3 (delta wave or deep sleep. Also called slow wave sleep (SWS).
  • REM (rapid eye movement) sleep.

3. Wake after sleep onset (WASO) or sleep fragmentation: how often we wake after falling asleep.

4. Total sleep time (TST): the total of all REM and NREM sleep.

5. Sleep efficiency: the ratio of total sleep time to time spent in bed.

As We Age

As we age, our circadian rhythms shift.  We go to sleep earlier whether we want to or not.  The average bedtime for adults aged 18 to 29 is 12:38am. By age 64, it plummets to 10:38pm. This advanced sleep phase syndrome means older people tend to become sleepier in the early evening and wake earlier in the morning, as compared to younger adults.  

It’s not that older adults need less sleep. The need for sleep remains constant with age. But as we age our "sleep architecture" (patterns of sleep) shifts. After age 50, “The amplitude of our brain waves changes,” explains Board-certified Anesthesiologist Alex Roher M.D. ”To be classified as deep, restful, restorative sleep, brain waves have to reach a certain height, and after age 50, the spikes simply don't get as high. That lighter sleep means you become a lot easier to wake up in the middle of the night.

The National Sleep Foundation identifies specific aspects of sleep that change with age:

  • REM declines as a percentage of sleep
  • Total sleep (TST) decreases.
  • Deep sleep decreases.
  • Waso increases (sleep fragmentation, waking frequently through the night).

Sleep efficiency continues to decrease after 60.  There is an increase of sleep disorders with age, including apnea and insomnia. But research indicates that many age-related sleep changes are not caused by the aging process itself, but by physical and mental disorders that may accompany aging, and the medications used to treat them.

Impact of Poor Sleep

As we age, we have more medical problems, some chronic. People with poor health have more trouble sleeping.

Sleep deprivation causes cognitive decline, memory and attention problems, and slows response time. These symptoms can mimic dementia in the elderly, leading to misdiagnosis. Sleep deprivation -- and the medications used to treat it -- also increases the risk of falls.

Sleep deprivation has also been linked to weight gain in both toddlers and adults as we expend more energy and then eat more to compensate.

Sleep Hygiene

Although some changes of sleep quality over time are inevitable, basic common sense steps can help improve our slumber.  Sleep hygiene is the practice of changing our behavior and environment to promote sleep.

  • Track your sleep. Wearable tech helps us analyze our sleep
  • Same time. Going to bed and waking on a consistent schedule promotes sleep.
  • Exercise.  Physically tired people sleep better. But don’t exercise right before bed.
  • Avoid caffeine and late drinking. (Alcohol causes early wakening.)
  • Nap judiciously. 30 minutes can restore energy but too much compromises our night sleep.
  • Reduce stress.  
  • Turn off the light. A dark, quiet, uncluttered space facilitates deep sleep.

On the Horizon

Sleep is essential to health. In hospice, the sleep patterns of the near-dying return to those of infants. Long periods of sleep are punctuated by occasional bursts of wakefulness. But until our last days, the power to improve our sleep—and through it our health—is within our control.  The science of sleep continues to enlarge  our understanding, bringing with it  innovative research-based interventions including apps, medication, virtual reality, medicine, technology, even biotech implants.  The future for a good night’s sleep is bright.

After all, if we’re fated to spend a third of our life asleep: let’s make it a good one.

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