Dear Doctors: I’m a 68-year-old man who cannot remember the last time I awoke in the morning feeling fully rested. My friends laugh and say those days are long gone for people our age. Is this true? I have decent sleep habits in that I’m in bed reading by 9 p.m. and the lights are out by 11 p.m.
Dear Reader: Bring up the topic of sleep struggles at any gathering, and you are likely to start a lively conversation. It is estimated that up to 70 million adults in the United States are failing to get good-quality sleep, many of them on a regular basis. Problems include trouble falling asleep, difficulty staying asleep, lack of deep sleep and the misery of full-on insomnia. This widespread deficit of good-quality sleep is a significant factor in why more than 40% of adults of all ages report nodding off at some point during the day.
Problems with sleep are divided into two main categories. One is sleep deprivation, which is not getting enough sleep. Your question falls into the other, more complex category, which is sleep deficiency. This is when someone doesn’t spend enough time in the phases of sleep. These are light sleep, REM sleep -- which is the rapid eye-movement phase in which we dream -- and deep sleep. Also known as slow-wave sleep, this is the stage of sleep that leaves you feeling rested and refreshed when you wake up. It’s also the one many older adults struggle with.
As we reach older age, slow-wave becomes more difficult to sustain. One factor is hormonal changes that occur, such as a decrease in testosterone production. The hormone testosterone plays an important role in regulating other hormones, such as cortisol and melatonin, which in turn oversee the body’s circadian -- and thus sleep -- cycles. Older adults also begin to process caffeine more slowly. That means the 2 p.m. coffee that previously didn’t affect nighttime rest now may contribute to sleep deficiency. Additional factors include being in pain, the side effects of certain medications and cognitive changes occurring in the brain.
An important consideration is interrupted sleep. This can occur due to outside stimuli such as light, sound, a restless bedmate, the need to get up to use the bathroom during the night and the morning alarm. When it is the latter, and if you are awoken while in the slow-wave cycle of deep sleep, it can take hours to shake the feeling of grogginess. Another piece is that as we age, the circadian cycles that oversee our sleep needs appear to reset to an earlier time. Some people find an earlier bedtime and an earlier wake-up conducive to better sleep.
That brings us to the issue of artificial light. In our modern, brightly lit lives, the visual cues of waning daylight and growing darkness are largely absent. These trigger the circadian cycles that manage the onset of sleep, which is why it’s so important to avoid the blue light of electronic devices for several hours before bed. And when possible, opt for softer, lower lighting in the hours between sunset and bedtime.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
