March is National Sleep Awareness month—and it’s a great opportunity to look at our own sleep habits and see if there are ways to improve the quality of sleep we get.
As we age, many people struggle with sleep—whether falling asleep, staying asleep, interrupted sleep, or even getting restful sleep. Because this is such a widespread struggle for so many older adults, we wanted to dig into the topic. So, we chatted with a sleep specialist, Dr. Arun Agarwal.
Dr. Agarwal has practiced medicine since 1990 and has board certifications in sleep medicine, pulmonary medicine, internal medicine, critical care medicine, and palliative care and hospice medicine. He is affiliated with Nuvance Health and holds an academic position at New York Medical College. He currently leads the sleep division, which he started in 1992.
Keep reading to hear what Dr. Agarwal has to say about sleep quantity and quality—along with tips on how to get better sleep.
How much sleep do older adults need?
According to Dr. Agarwal, many older adults need 7-8 hours of sleep every night, with 6-7 hours being the average of what many older adults are getting. But what matters more than the hours themselves are the sleep timing, amount of sleep, and quality of sleep—all of which, he notes, change over your lifespan. “People need to recognize and be mentally prepared to sleep less in number of hours and less deep when we’re older,” he says.
He notes that there’s a difference between ‘restful’ sleep and “fretful” sleep—and the quality of sleep you get often depends on your mental state. He says that expectations play a big role in this. If you expect to get fewer hours of uninterrupted sleep than you did when you were younger, you’ll likely wake up more rested. But “if you fret over sleep, you’re actually destroying sleep,” Dr. Agarwal says.
How does napping impact the amount of sleep you get at night?
“Sleep should be looked at in 24-hour periods,” Dr. Agarwal says. “If you take a 2-hour nap in the afternoon, you may only sleep 4 hours at night.”
What are the different types of sleep?
Sleep is generally divided into REM and non-REM sleep. Non-REM sleep phase can be divided into four stages. More recently, stages 3 and 4 are being labeled as “Delta” sleep. (The name comes from the kind of brain waves that are recorded during that sleep phase.) And it turns out,Delta sleep is actually a deeper, more rejuvenating sleep phase than REM. “REM is active sleep in that when the brain is sleeping, if you record the EEGs, [it will show] the same activity as someone that's awake,” says Dr. Agarwal. “Eyes flicker rapidly during REM sleep, heart rate is high, and breathing patterns are faster. In Delta sleep, everything is very, very quiet. There are shallow wave forms in the brain that are slower than normal. That's the brain wave called Delta.”
And it’s been found that most of our sleep is Delta sleep. Dr. Agarwal notes that, “By the time we're adults, the percentage of REM sleep gets fixed at 20-25%. Even for the elderly. The percent of REM sleep does not change in the elderly.” However, as we age, the amount of Delta sleep we get goes down. And that’s where some people perceive their quality of sleep is impacted. Dr. Agarwal says that older adults “find themselves easily awakened by extraneous events.” But he notes that, if we understand that is normal, then those fewer hours of Delta sleep can be equally rejuvenating, emotionally.
What are the biggest concerns your patients come to you with?
“Insomnia is the main concern—sleep onset, in particular,” says Dr. Agarwal. This means that patients have difficulty falling asleep, and sleep isn’t coming as quickly as they’d like. Others struggle with sleep maintenance, which means you can fall asleep fine but you wake up often throughout the night. Some people struggle with both types of insomnia.
“Physiologically, the elderly take longer to [fall asleep] and they have more awakenings,” Dr. Agarwal says. “The big question is, when I wake up in the morning do I feel rested? If the answer is yes, then one does not have a sleep disorder. If the answer is that I feel too tired and sleepy when I wake up, then that is abnormal.”
How does incontinence affect sleep quality?
Dr. Agarwal says that incontinence can be a significant reason that sleep is interrupted. If this is the case for you, it’s important to find solutions that will help reduce sleep interruptions.
Finding the right overnight underwear and bed protectors can give you more peace of mind when sleeping and allow you to stay asleep longer without needing to change or use the bathroom. Check out Because Overnight Underwear, Boosters, and Bed Protectors for more peace of mind when sleeping.
How can older adults get better sleep overall?
Dr. Agarwal cites two main lifestyle changes that could result in better sleep for adults of any age—plus a few other tips that can help sleep come easier.
“Alcohol is a sleep inducer, but it gets metabolized by the liver in three hours,” Dr. Agarwal says. “When it gets metabolized, the body secretes adrenaline and that will wake you up or break up your sleep.” Specifically, he says that drinking alcohol in the evening, before going to bed, impacts your REM sleep. Often, by the time the body is metabolizing the alcohol, you’ve entered a REM sleep phase. “If you wake up in REM sleep, you have these vivid dreams,” Dr. Agarwal says. “REM sleep is active sleep—you have rapid eye movement, heart rate, and respiratory levels. If you add adrenaline, people wake up with a flutter and sweating and in a bad dream.”
Dr. Agarwal also notes that, “Alcohol has a dual effect, and people who use it to induce sleep often wake up in the middle of the night with this worsened condition. Alcohol should never be used as a sleep inducer.” He encourages patients to limit alcohol intake and suggests not drinking any in the 2-3 hours before going to sleep so that it gets metabolized before you fall asleep.
Limit Exercise Before Bedtime
In the same way that metabolized alcohol releases adrenaline in the body, so does exercise. And if you exercise before bed, you’re contending with that exercise-induced adrenaline, which impacts your ability to fall asleep. But Dr. Agarwal says, of even more importance, that exercise raises the body’s core temperature. “In order for the body to go to sleep, the first thing that happens in the body is the core temperature goes down by half a degree. Exercise will interfere with that.”
Don't do anything in bed other than sleep—no watching TV, even no reading. This helps train your brain that, when you get into bed, you’re going there to sleep. Limit or avoid blue light (in the form of phone, computer, and TV screens) in the evening. Dr. Agarwal also says that some people take a warm bath or shower before sleep. “This draws the blood to the surface of the skin so it's easier to cool the core temperature to induce sleep.”