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maltatoday | SUNDAY • 8 MAY 2022 8 ELDERLY CARE Sleep tips for seniors Research has shown that older people can take steps to improve their sleep. These steps often involve focusing on improving sleep hygiene and developing habits that encourage quality sleep. Here are a few tips for getting a better night's rest in your golden years: Exercise Older people who exercise regularly fall asleep faster, sleep longer, and report better quality of sleep. Exercise is one of the best things older people can do for their health. The National Institute of Aging offers helpful tips for exercising safely as an older person. Reduce bedroom distractions Televisions, cellphones, and bright lights can make it more challenging to fall asleep. Keep the television in another room and try not to fall asleep with it turned on. Move electronics out of the bedroom and reserve the bedroom for only sleeping and sex. Avoid substances that discourage sleep Substances like alcohol, tobacco, caffeine, and even large meals late in the day can make sleep more challenging. Try quitting smoking, reducing caffeine intake, and eating dinner at least four hours before bedtime. Keep a regular sleep schedule Remember that aging makes it more difficult to recover from lost sleep. Avoid sudden changes in sleep schedules. This means going to bed and waking up at the same time every day and being careful about napping too long. Develop a bedtime routine Find activities that help you relax before bed. Many older people enjoy a bath, reading, or finding some quiet time before getting into bed. THE United Nations estimates that the amount of people over 60 will double by 2050 and triple by 2100. Aging is tied to numerous health con- cerns, including sleep difficulties. In fact, poor sleep can contribute to many of these problems, reducing quality of life in people over 65. In order to address the unique needs of older adults, it's more important than ev- er to understand the effects of aging on health. Since almost one third of our lives are spent sleeping, reviewing the relation- ship between aging and sleep is a funda- mental part of promoting overall health in the elderly. Why does aging affect sleep? It's common for older adults to experi- ence changes in the quality and duration of their sleep. Many of these changes oc- cur due to changes in the body's internal clock. A master clock in a part of the brain called the hypothalamus is composed of about 20,000 cells that form the suprachi- asmatic nucleus (SCN). The SCN controls 24-hour daily cycles, called circadian rhythms. These circadian rhythms influence daily cycles, like when people get hungry, when the body releases certain hormones, and when a person feels sleepy or alert. As people get older, their sleep changes due to effects of an aging SCN. Deteriora- tion in the function of the SCN can disrupt circadian rhythms, directly influencing when people feel tired and alert. The SCN receives information from the eyes, and light is one of the most powerful cues for maintaining circadian rhythms. Unfortunately, research shows that many older people have insufficient exposure to daylight, averaging around one hour each day. Daylight exposure may be even more restricted for people who live in nursing homes as well as those with Alzheimer's disease. Changes in production of hormones, such as melatonin and cortisol, may al- so play a role in disrupted sleep in older adults. As people age, the body secretes less melatonin, which is normally pro- duced in response to darkness that helps promote sleep by coordinating circadian rhythms. Health conditions and sleep Mental and physical health conditions may also interfere with sleep. Conditions that commonly affect sleep in older people include depression, anxiety, heart disease, diabetes, and conditions that cause dis- comfort and pain, such as arthritis. The relationship between physical health and sleep is complicated by the fact that many older adults are diagnosed with more than one health condition. In fact, the 2003 National Sleep Foundation Sleep in America Poll looked at 11 common health conditions and found that 24% of people between 65 and 84 years old re- ported being diagnosed with four or more health conditions. Those with multiple health conditions were more likely to re- port getting less than six hours of sleep, having poor sleep quality, and experienc- ing symptoms of a sleep disorder. Sleep issues may also be related to the side effects of medications. Almost 40% of adults over the age of 65 take five or more medications6. Many over-the-counter and prescription drugs can contribute to sleep issues. For example, antihistamines and opiates may cause daytime drowsiness, while medications such as antidepressants and corticosteroids may keep older people awake and contribute to the symptoms of insomnia. The interactions of multiple medications may cause unanticipated ef- fects on sleep. Lifestyle and sleep Poor sleep quality in seniors can be related to the lifestyle changes that often come with aging. For example, retirement leads to less working outside of the home and possibly more napping and less of a structured sleep schedule. Other significant life changes, such as loss of independence and social iso- lation, can increase stress and anxiety, which can also contribute to sleep issues. How does aging affect sleep? Aging affects people differently. While some older adults may have no significant disruptions in their sleep, others complain about getting less sleep and having worse sleep quality. Experts have found sever- al common sleep disturbances in older adults: Shifting sleep schedule: As people age, the body's circadian rhythms actually shift forward in time. This shift is called a phase advance. Many older adults experience this phase advance as getting tired earlier in the afternoon and waking up earlier in the morning. Waking up at night: Research has also shown that as people get older, they often experience changes in their sleep architec- ture. Sleep architecture refers to how peo- ple cycle through the different stages of sleep. Older adults spend more time in the earlier, lighter stages of sleep and less time in the later, deeper stages. These shifts may contribute to older people waking up more often during the night7 and having more fragmented, less restful sleep. Daytime napping: Research estimates that about 25% of older adults take naps, compared with around 8% of younger adults8. While some experts suggest that a short daytime nap may be beneficial, many agree that extended napping and napping later in the day can make it harder to fall asleep at bedtime and create nighttime sleep disruptions. Longer recovery from changes in sleep schedule: Alterations in how the body reg- ulates circadian rhythms make it more dif- ficult for older people to adjust to sudden changes in their sleep schedules, like dur- ing daylight savings time or when experi- encing jet lag. How aging affects sleep