Shifting Schedules, Daytime Naps, and Sleep Medications: How to Deal With Sleep Problems as You Age

It's easy to assume that sleep problems are a normal part of aging. Adults past middle age might begin to notice that they're falling asleep earlier or waking more throughout the night. Some may be dealing with other health issues that keep them up, while others' problems may be related to lifestyle changes, such as retirement or spending more time indoors.

But feeling run down during the day or being unable to sleep at night are problems that should not be ignored, no matter what your age or health situation. If your sleep patterns are changing, it's important to understand exactly how aging affects sleep, and what you can do to stay rested and refreshed.

An afternoon nap might help
One common sleep issue you may experience as you grow older is what scientists call an advanced sleep cycle: You feel sleepier much earlier in the evening and wake up hours before you're used to waking up, maybe even when it's still dark outside. Your body wants to get its eight hours of sleep from 8 p.m. until 4 a.m., for example, even though the schedule you've followed for years doesn't allow for bedtime until at least 10. This creates a sleep deficit of two hours every night, and may lead to chronic sleep deprivation if the problem isn't addressed.

When older patients tell Ronald Kramer, MD, that they're unable to get the sleep they need at night, he often suggests a brief nap around lunchtime.

"If older patients have the ability to make this schedule adjustment, it often works really well to make up for the sleep they're not getting at night," says Dr. Kramer, medical director at the Colorado Neurological Institute's Sleep Disorders Center in Denver and a spokesperson for the American Academy of Sleep Medicine. "For a patient who is used to waking up at 6 a.m. but now can't sleep past 4 a.m., that's fine—if he or she can make up a portion of that sleep later in the day."

Of course, a nap isn't the right solution for everyone. For people who have trouble falling asleep at night, it can make transitioning into sleep even more difficult, perpetuating the problem. If you do decide that it works for you, be sure to take your nap at the same time every day so your body can get used to your new schedule.

Should you consider medication?
For some people, an afternoon nap just isn't feasible—and neither is going to bed at 8 p.m. or waking at 4 a.m. every day. If an older adult just wants to get his sleep schedule back in sync with everyone else's, a doctor may suggest prescription medication to help him fall asleep or stay asleep for eight hours straight.

"We think natural sleep without medication is the healthiest option for all patients," says Dr. Kramer, "and so we'll push for lifestyle adjustments first. But bad sleep without medication, just to avoid medication that may otherwise work, is not the healthiest option either. I do have patients who are 80 and want to be 18, and if giving them medication will make them feel better and allow them to keep their jobs and their schedules, then that's something for the patient and doctor to consider together."

When used responsibly, prescription sleep medication for older people with sleep problems seems safer than the alternative—sleep-deprived seniors at risk for falls, automobile accidents, and other dangers. Dr. Kramer cautions against the use of over-the-counter medication for the elderly. "It can really slow people down and cause cognitive impairment, and that's when we start to see older people having side effects during the day and injuring themselves," he says.

The over-the-counter hormone melatonin or the prescription drug Rozerem, which acts on the brain’s melatonin receptors, are also options for seniors who suffer from sleep problems. Because the body produces less melatonin as we age, these medications may help get the brain back on track. Because they don't have sedating qualities, these options are generally safer for the elderly.

Practice good sleep hygiene
No matter what age you are, the basic rules of sleep hygiene still apply: You'll sleep better if you go to bed and wake up at the at the same time every day, relax for an hour before bed, and get some natural daylight and exercise during the day. If you do decide to use medication—prescription or over-the-counter—check with your doctor before taking anything on a nightly basis.