As we get old sleep gets harder , having a bedtime routine helps.
As you get older, you may find that you have a harder time sleeping than you used to, but with a few changes, you can get back on track.
When the world shut down in March 2020 due to the COVID-19 pandemic, Marlene Smith’s daily routines were disrupted to the detriment of her sleep and her overall health.
Before the pandemic, Smith, 85, of Kings Mountain, North Carolina, regularly went out shopping and dining with her daughter, who lives nearby. She was vigilant about keeping her house neat and tidy, which kept her active, and followed a consistent sleeping routine.
(COURTESY OF MARLENE SMITH)
But the forced inactivity of the COVID-19 lockdown wrecked Smith’s sleep habits.
Lack of Sleep and Strokes
“I had so many hours of doing nothing during the day, I couldn’t fall asleep at night,” says Smith, a retiree from a company that manufactures CDs. “The brain needs to be stimulated, and your body needs to be active to sleep well. It’s like a big circle. Staying home all day made it harder for me to sleep.”
In February 2022, Smith suffered three transient ischemic attacks, also referred to as “mini-strokes.” Unlike major strokes, mini-strokes typically last a few minutes, and most symptoms are gone within an hour or so, though on rare occasions they may last up to 24 hours.
Research suggests that irregular sleep may be a risk factor for stroke. In fact, “abnormal sleep duration may be a marker of chronic disease, which may itself be associated with (stroke),” according to a study published in 2018 in the Expert Review of Neurotherapeutics.
How the Pandemic Ruined Sleep
The COVID-19 pandemic has adversely affected the sleep of people of all ages, including older people.
“The prevalence of sleep problems during the COVID-19 pandemic is high and affects about 40% of people from the general and health care populations,” according to a meta-analysis of 44 papers published in 2021 in the Journal of Clinical Sleep Medicine. The research shows that people with active COVID-19 appear to have higher rates of sleep issues.
However, individuals need not have active COVID-19 to experience poor sleep. Many people – including seniors without active COVID-19 – are experiencing poor sleep because of the disruptions in daily life and anxiety caused by the pandemic.
“With the pandemic, we’ve seen a lot of changes in the regular schedules of patients,” Horvat says. “Some patients started taking naps in the afternoon and engaged in less social interaction. These are all factors that lead to changes in sleep rhythm and sleep quality.”
The interruption of many social activities important to seniors is a key factor in widespread sleep disruption among older people, agrees Dr. Lisa Gibbs, medical chief of geriatric medicine at the University of California, Irvine, and medical director of the SeniorHealth Center at UCI Health.
“Lockdowns caused a majority of seniors to be isolated,” Gibbs says. “People who enjoyed social connections at community centers, through regular gatherings, group outings, book clubs or other activities were no longer able to have these gatherings.”
Some seniors who were homebound with paid caregivers declined to let them into their homes out of concerns of contracting COVID-19, she adds, leading to gaps in care and further isolation.
These social disruptions have created loneliness and isolation among many seniors, which in turn contributed to anxiety and depression.
The lockdown also derailed the exercise routines of many people, including seniors. Getting regular exercise is important when it comes to getting good sleep, research suggests. Exercise disruptions of the kind Smith experienced is another way the COVID-19 pandemic negatively affected the sleep of many seniors.
Research published in 2021 in the journal Sensors showed that older adults exercised significantly less after the pandemic began, which in turn led to a sharp spike in depression. The results of the study demonstrated that the amount of time older adults spent walking decreased by 52% and the amount of time spent standing dropped by nearly 33%, which was associated with a 150% increase in depression symptoms. Their findings suggests that the reduction in sleep duration also contributed to their depression.
Many people who haven’t previously experienced sleep disruptions don’t appreciate the importance of getting good sleep until they lose it, says Carleara Weiss, a sleep researcher at the Center for Nursing Research at State University of New York in Buffalo. She’s also a scientific sleep advisor for Aeroflow Sleep, a company that sells masks and other equipment used by people with sleep apnea.
“Unfortunately, we often learn to function with little or no sleep because of our busy work life,” Weiss says. “However, our body keeps score of sleep deprivation. Think about using your car without changing the oil – sooner or later, it will break.”
Poor Sleep and Health Risks
For Smith and countless other seniors – people ages 60 and above – sleep disruptions associated with the pandemic are putting them at risk for an array of health problems, says Dr. Marri Horvat, a physician with the Sleep Disorders Center at Cleveland Clinic in Ohio.
Health problems associated with poor sleep include:
- Poor cognitive function, including problems with concentration, focus and memory.
- Weight gain and obesity.
- Sleep apnea, a sleep disorder in which an individual’s breathing stops and starts while sleeping.
Sleep apnea, in turn, is associated with:
- Elevated risk for cardiovascular problems.
- High blood pressure.
- Type 2 diabetes.
To treat sleep apnea, physicians typically prescribe patients a CPAP mask, which stands for continuous positive airway pressure mask. A CPAP machine sends a flow of pressurized air into the person’s mouth and nose as she her he sleeps. This helps keep the individual’s airways open to allow normal breathing.
Strategies for Better Sleep
While the pandemic has increased the prevalence of poor sleep among older adults, there are effective strategies that seniors can adopt to improve their sleep hygiene, Horvat says. Sleep hygiene refers to maintaining both daily routines and a bedroom environment that promotes consistent, quality sleep.
Here are seven strategies people can adopt to improve their sleep quality and overall health:
- Avoid alcohol, caffeine and nicotine for four to six hours before you go to bed.
- Use your bed only for sleep, intimacy or sickness.
- Make sure you have the right mattress.
- Keep the bedroom dark.
- Have a “wind down” period each night before bedtime.
- Try yoga postures for loosening up the body before bedtime.
- Practice yogic breathing.
Not only does alcohol affect aging, but consuming alcohol – especially in excess – has been linked to poor sleep quality and duration. according to a paper published in 2022 by the Sleep Foundation. A normal sleep pattern includes four distinct stages. Consuming alcohol before bedtime could have a suppressive effect on REM sleep during the first two sleep cycles, which can diminish overall sleep quality, according to the paper. Dreams typically occur during REM sleep, which is restorative and is important for cognition, learning and memory.
Regarding caffeine, research published in the journal Sleep Medicine Reviews in 2017 suggests that caffeine “typically prolonged sleep latency, reduced total sleep time and sleep efficiency, and worsened perceived sleep quality.” Caffeine stimulates the central nervous system, which can create a rush of energy. It quickly boosts alertness in the brain. These effects can be detrimental to getting good sleep.
As for nicotine’s effect on sleep, research published in the journal Nicotine & Tobacco Research in 2016 suggests an association between nicotine addiction and disrupted sleep, says Steven A. Branstetter, an associate professor of behavioral health at Penn State University and a co-author of the study. Researchers found that one key marker of nicotine addiction – the tendency to smoke soon after waking, usually accompanied by waking earlier in the morning than desired – may be a key factor in the overall disruption of sleep in smokers, he says.
Often, spending too much time in bed outside of these reasons can lead to difficulty falling and/or staying asleep, Horvat says. “The more time you spend in bed watching television, playing on your phone, tossing and turning while trying to fall asleep and worrying, the more it morphs your bed into a cue for wakefulness rather than for sleep,” Horvat says. “Over time, pairing your bed with these sleep-disruptive behaviors can worsen your ability to fall and/or stay asleep.”
Using the right mattress can improve your sleep, and choosing the right one is a highly individual decision. In general, medium firm mattresses are a good choice for many older adults. That’s because medium firm is the minimum standard for good spine alignment and comfort. Before settling on a mattress, try various models with different levels of firmness. You can also try memory foam toppers, which go on top of a mattress, for additional comfort.
Keeping your bedroom dark and free of white light from electronic devices helps promote good sleep, says Dr. Savitha Elam-Kootil, a board-certified sleep medicine expert and internist at Kaiser Permanente in Atlanta. If you need some dim light, amber light is better than white light or blue light.
“White or blue light interferes with secretion of the sleep hormone melatonin, more than amber light, which in turn affects sleep onset,” she says.
Adding blackout liners to your bedroom curtains can be helpful.
Having a designated time every night to review your day and go over what you could and couldn’t control can be part of a relaxation practice that helps with sleep, Elam-Kootil says.
“Assure yourself that you did what you could for that moment to the best of your ability and hence you can’t ask yourself for more,” she adds. “Assure yourself that you deserve your rest because you need to be charged to similarly give your best for the next day.”
Relaxation practices can help your mind from feeling overly busy. Like a laptop with dozens of open tabs, Elam-Kootil explains to patients that mindfulness practices can help “close open tabs and pop-ups in their mind space,” which can prevent them from falling and staying asleep.
Practicing yoga can improve the sleep of older people with insomnia, research published in the journal Alternative Therapies in Health Medicine in 2014 suggests. Research published in the Indian Journal of Psychiatry in 2013 suggests that yoga improved the sleep and the quality of life of 120 older people people in nine elderly group homes.
Elam-Kootil – who serves on the advisory board for MyYogaTeacher, an online yoga platform – recommends yoga nidra, a guided meditation practice that can lead to a kind of “yogic sleep” or state of deep restfulness, in which you have an awareness of relaxation. This is easy to practice at home via online courses or audio recordings.
“It helps people to sleep seven to nine hours daily,” Elam-Kootil says.
She recommends these three yoga poses:
- Child’s pose. You kneel on the yoga mat, bend forward and rest your torso on your thighs, while extending your arms straight forward. Allow your forehead and hands to gently touch the mat. Hold the pose for one to two minutes.
- Butterfly pose. In this pose, you sit quasi-cross legged but allow the soles of your feet to face and touch each other. For a minute, flutter your knees up and down so that your legs open like the wings of a butterfly.
- Supported wall stand. In this pose, you lie down on your back with your buttocks touching the wall while elongating your legs up the wall, perpendicular to your body, for one to two minutes.
Marlene Smith, the North Carolina retiree, initially began taking online yoga classes from MyYogaTeacher a few months in the pandemic to help alleviate her knee pain, but she discovered that practicing yoga daily and taking nighttime meditation courses have improved her sleep and overall health.
“Since starting meditation, I’ve been able to sleep better and get up bright-eyed and ready to go,” Smith says. “My quality of life has improved 100%.”
Yogic breathing, which is known as pranayama in Sanskrit, can help relax the body and mind by stimulating the parasympathetic nervous system.
“(This) counters and balances the sympathetic nervous system, which is in overdrive in people with insomnia,” Elam-Kootil says.
Elam-Kootil recommends these breathing techniques:
- Bhramari pranayama. This is a breathing technique in which you hum like a bee when you exhale. “It releases cerebral tension and helps to lower blood pressure and relax the central nervous system,” Elam-Kootil says. “I recommend practice humming only while sitting upright, not while lying down, and repeat a few times.”
- Anuloma viloma pranayama, or alternate nostril breathing. This practice helps to balance the left and right sides of the brain, Elam-Kootil says. Slowly inhale through the left nostril, using the thumb of the right hand to keep the right nostril plugged. Hold the breath for five seconds while the right nostril remains plugged, then simultaneously release the right thumb and plug the left nostril with your right ring finger so you can slowly exhale through the right nostril. Repeat the slow inhale through the right nostril while using the right ring finger to keep the left nostril closed, holding the breath for several seconds. Then, slowly exhale via the left nostril by releasing the ring finger and using the right thumb to keep the right nostril closed. Repeat this pattern two to five times.
When to See Your Primary Health Care Provider
If you’ve tried various sleep strategies and still need multiple naps during the day to function, are experiencing memory loss and/or have difficulty concentrating, see your primary care health provider, Weiss suggests. A health care provider can evaluate you and, if needed, refer you for a home or lab sleep study, which could identify specific issues, like sleep apnea.
Ultimately, sleep is critical to your overall health – from immune function, hormone regulation, thinking ability and mental health.
“The good news is that you can invest in sleeping better and maintaining your health,” Weiss says. “Make sleep a pillar for your wellness journey.”
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and the The Silver Century Foundation.