- My name is Brienne Miner, and I'm assistant professor
at Yale University in the section of geriatrics.
I've also done training in sleep medicine.
And today, I'm gonna talk about sleep and aging
and I'm gonna cover the different ways
that sleep might change as we age,
all of the different factors
that might be causing sleep problems as we get older,
and when you should speak with your doctor
about a sleep problem.
Most people think that as you get older you need less sleep.
But if we look at how much sleep is recommended,
it really doesn't change from middle to older age.
So middle-aged adults,
according to the National Sleep Foundation,
should be getting, the real sort of sweet spot
is seven to nine hours.
And in adults 65 and older it's seven to eight hours.
So you know, we do recognize that a little bit
on either side, so five hours or up to nine hours
may be appropriate.
But I think the interesting thing is that
if you compare middle-aged and older age adults,
the recommendation for how much sleep you should be getting
is the same.
As we get older, there are probably multiple things going on
at the same time that might impact our sleep.
So I like to think about what medical conditions
or medications a patient of mine might be taking
and how that might affect their sleep.
Medical conditions could certainly cause pain
or other sleep disruptive symptoms.
People can be on medications
that could make them very sleepy during the day.
Those medications could make it hard for them
to sleep at night.
Or interestingly, those medications might cause
or worsen an underlying sleep disorder.
In terms of behavioral factors,
we like to think about having good sleep hygiene,
having good behaviors around sleeping.
And so those are basic things like going to bed
at the same time every night,
getting up at the same time every morning,
avoiding napping during the day,
especially if you have trouble sleeping at night,
and a big one that I like to touch on
is what substances might contribute to sleep.
So alcohol, especially as you get older,
can cause more problems with sleep
because your body is not as good at metabolizing alcohol
as you get older, and you can't drink the same amount
in your older age that you could in your middle age.
Caffeine, same story as alcohol, and nicotine as well
can make it hard to fall asleep,
can make it hard to stay asleep.
Other things like being socially isolated,
I think we've all been thinking a lot about that
especially in the setting of COVID.
So why does social isolation cause problems with sleep?
Well, you're less physically active during the day
and that can make it harder
to have a normal sleep/wake schedule.
And those social interactions are actually also
very important for giving cues to our body
to help help us maintain a normal sleep/wake rhythm.
And then I would be remiss if I didn't mention what we think
about a lot in sleep medicine, which is that almost all
of the sleep disorders that are out there
become more common as we age.
So people in their older age could have
multiple things going on at the same time.
One of the major changes that's normal
and is not necessarily a sign of disease
is that many older people prefer to go to bed earlier
and wake up earlier.
So as opposed to going to bed at maybe say 10 or 11 o'clock,
some people may have a preference to go to bed at seven
or 8:00 PM, and that's because there's a a change
in the timing of melatonin release from our brain.
So melatonin is sort of setting that time for us.
And in many older people, our brain releases melatonin
in an earlier time.
So again, it's not necessarily a problem
except that many people don't like to go to bed at 7:00 PM
or wake up at three or four o'clock in the morning.
So I would say, if your preference is to go to bed
at 8:00 PM, there's no problem with that.
But you wouldn't want to, or it would be normal then
to wake up at three or four o'clock in the morning.
That's still a normal amount of sleep.
So there's actually no problem with that
unless it's a problem for your schedule.
So some important takeaways about sleep as we age,
are first that the timing of sleep may change.
So older adults may find that they have a preference
to go to bed earlier and therefore wake up earlier.
The amount of interruptions or arousals from sleep
become more frequent as we get older.
But as long as they're brief and you're able
to get back to sleep, that's not a problem.
And then finally, I would say there could be
a lot of things contributing to sleep problems in older age,
but I look at that as a glass half full kind of person.
When somebody comes to me with a sleep problem,
I think there are a lot of things we could do to help sleep,
whether it has to do with medical conditions, medications,
behaviors or treating an underlying sleep disorder.
So I think that's an important takeaway.
If you do have a sleep problem,
you should talk to your doctor,
you should get an evaluation, and there might be
a lot of options for you that don't necessarily mean
having to take another medication.