Why Do Older Adults Have Trouble Sleeping? Debunking Sleep Myths and Common Causes

Why Do Older Adults Have Trouble Sleeping? Debunking Sleep Myths and Common CausesLi, a 74-year-old man, used to sleep soundly every night, getting around 8 hours of sleep. However, for the past six months, he often lies in bed for two to three hours without falling asleep, wakes up frequently in the middle of the night, and sometimes even stays awake until dawn

Why Do Older Adults Have Trouble Sleeping? Debunking Sleep Myths and Common Causes

Li, a 74-year-old man, used to sleep soundly every night, getting around 8 hours of sleep. However, for the past six months, he often lies in bed for two to three hours without falling asleep, wakes up frequently in the middle of the night, and sometimes even stays awake until dawn. Adhering to the 8-hour sleep theory, he feels anxious and irritable, easily snapping at others, causing his family to keep their distance. During a conversation with his neighbor, he discovered that they were experiencing similar issues. Why do older adults tend to have trouble sleeping?

I. The Myth of the 8-Hour Sleep: Many Get It Wrong

Commonly believed, the optimal sleep duration is 8 hours a day, with the assumption that only sufficient sleep allows for adequate rest. However, the 8-hour sleep theory originated during the Industrial Revolution, when workers proposed dedicating 1/3 of their day to rest to accommodate factory work schedules. This theory has been widely accepted ever since.

• Nevertheless, with increasing research on sleep, this theory has faced significant scrutiny. In April 2023, a joint study by the Chinese University of Hong Kong and the Guangdong Academy of Medical Sciences, published in The Journals of Gerontology. Series A, analyzed data from over 90,000 participants and found a U-shaped correlation between sleep duration and all-cause mortality, reaching its lowest point at 7-8 hours. Maintaining this sleep duration was associated with a lower risk of death from cardiovascular diseases, cancer, and other factors.

• As early as 2021, a large cohort study encompassing over 320,000 adults published in JAMA Network Open demonstrated that attaining 7 hours of sleep per day minimized mortality rates. Any deviation, either an hour more or less, resulted in a certain increase in the risk of death. Regardless of gender, all-cause mortality significantly rose when sleep duration exceeded 10 hours, increasing by 43% and 55% for men and women, respectively.

However, we cannot make blanket statements about the optimal sleep duration. More crucial than sleep duration is the sleep cycle. Adults experience 4-5 sleep cycles per night, each lasting 90-110 minutes. Maintaining sleep within these cycles generally indicates healthy sleep. Therefore, sleep duration recommendations vary across age groups:

II. Is Sleeping at 11 PM and Waking Up at 5 AM Normal for Older Adults?

• Many people have doubts not only about sleep duration but also about the optimal bedtime and wake time. How should we address this question? A study published in European Heart Journal Digital Health suggests that 10-11 PM is the ideal time for sleep, minimizing the risk of heart disease. The Healthy China Action recommends that adults in China obtain 7-8 hours of sleep nightly. Sleeping at 10-11 PM would make 6-7 AM the optimal wake-up time.

A common phenomenon observed among most older adults is that they sleep less and wake up earlier. Many individuals over 50 often go to bed at 11 PM and wake up at 5:30 AM. Is there a problem with this? From a duration standpoint, there isn't much of an issue. If they wake up refreshed without frequent middle-of-the-night awakenings or insomnia, their sleep quality likely remains good. However, if they feel tired and drowsy after waking up, it suggests insufficient sleep.

III. Frequent Awakening in the Middle of the Night - Is It a Sign of Health Issues? Be Aware of Disease Signals

• The China Sleep Research Report (2022) reveals that in 2021, the average daily sleep duration of Chinese residents was 7.06 hours. 64.75% of participants slept less than 8 hours daily, while only 7.97% slept more than 8 hours. Among them, 42% of older adults took more than 30 minutes to fall asleep, and the insomnia rate reached 21%.

The tendency of older adults to experience sleep problems relates to factors such as aging, chronic diseases, and disruptions caused by long-term medication use. If poor sleep quality affects daily life, seeking medical attention is crucial. Moreover, poor sleep quality may be associated with these diseases:

1. Cerebrovascular Ischemia

Individuals with cerebrovascular ischemia experience temporary narrowing, spasms, and insufficient blood supply to their brain. During the night, when blood flow slows down, they may experience discomfort such as headaches and dizziness, making them prone to awakening in the early morning hours.

2. Diabetes

Long-term hyperglycemia can damage blood vessels, nerves, and multiple organs, disrupting neurological and endocrine function, ultimately affecting sleep quality. Furthermore, many diabetic patients experience polydipsia (excessive thirst) and polyuria (frequent urination), further impacting their sleep.

3. Heart Disease

The vagus nerve is more active at night, potentially causing coronary artery constriction, reducing blood supply to the heart, and increasing the risk of heart disease. Additionally, the supine position adopted during sleep increases venous return and places a greater burden on the heart.

4. Lung Diseases

Individuals with conditions like asthma and chronic obstructive pulmonary disease (COPD) are prone to nocturnal exacerbations, as lower temperatures during the early morning hours can easily trigger bronchospasms and hypoxia (lack of oxygen). Brain hypoxia stimulates the arousal system, resulting in early morning awakening.

Sleep is paramount to health. Don't blindly pursue a specific sleep duration. Determining whether sleep duration suits you depends on your state upon waking. If you feel refreshed upon waking, even if you only slept for 7 hours, it is perfectly acceptable.

References:

• [1] "Optimal Sleep Duration" Revealed! JAMA, Nature Sub-Journal, etc., Confirm: Sleeping Less or More Than This Duration Shortens Lifespan and Damages the Brain! China Medical Forum 2023-05-20

• [2] "Optimal Sleep Time" Unveiled! Sleeping Too Much or Too Little Shortens Lifespan, The Key is to Grasp These Times! Science China 2023-07-23

• [3] Poor Sleep in Older Adults: Don't Be Passive | Science Time Healthy China 2023-10-02

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