Sometimes, there just are not enough sheep to count. Or white noise becomes irritating.
Area experts warn that before-sleep activities may have detrimental effects on what happens after the covers are pulled up.
Stress, screened devices, and irritated stomachs are common causes of sleepless nights and dozed days, according to Elisabeth James, a behavioral sleep specialist with UToledo Health.
“Sleep affects everything, and everything affects sleep,” she said. “We have to look at sleep as a portion of our 24-hour day.”
Many people don’t even recognize insomnia as a health problem, according to results from the National Poll on Healthy Aging that saw participation by 1,065 people ages 65 to 80.
“Although sleep problems can happen at any age and for many reasons, they can't be cured by taking a pill, either prescription, over-the-counter or herbal, no matter what the ads on TV say,” said poll director Dr. Preeti Malani, a University of Michigan physician trained in geriatric medicine.
Ms. James, who points to her extensive waiting list of patients as a sign of the prevalence of sleep disturbances, said having a conversation with a physician about lack of sleep is the first step.
“All sleep problems can be improved to some degree,” she said. “Sleep quality can be more important than sleep quantity.”
Age related
Half of older Americans report that sleep does not come easily, with about one-third having resorted to some sort of medication to help them slumber at night, according to the Healthy Aging poll.
But there are behavioral changes that can be tried without accessing drugs, which are only recommended for short-term use. Seemingly innocuous habits can inflict themselves upon sleep patterns.
Dr. James Tita, a sleep specialist at Mercy Health, says he always starts with a timeframe.
“Go to bed at the same time and get up at the same time,” Dr. Tita said.
Dr. Punithavathy Vijayakumar, a sleep medicine specialist with the Sleep Disorders Center at University of Michigan Health, says physiological changes that occur as people age contribute to new sleep patterns.
For one thing, the production of melatonin does not hit the peaks it once did.
“It flattens as we age,” she said. “The peak comes down."
As a result, many people end up in a cycle of being unable to sleep through the entire night, taking a nap during the day, then going to bed later in the evening and still not being able to sleep through a whole night.
“It becomes fragmented,” said Dr. Tita, adding that older adults still need seven to nine hours of sleep just as younger adults do.
As people age, they tend to develop more health conditions, and a surprising number of medications can interrupt sleep patterns. Pain medications, antidepressants, and diuretics are contributors.
Chemical (and other) interference
“Medications can require a lot of consideration of advantages and disadvantages, which can be considerable for older adults,” Ms. James said.
Alcohol is a known perpetrator for wakefulness later in the night — which is offset by many with caffeine use during the day. That can result in another vicious cycle of inadequate sleep.
A study at the University of Washington concluded that caffeine reduced sleep quantity by 10 minutes per cup consumed the previous day on average. Similarly, those who drank alcohol the day before reported a 4 percent decline in their subjective sleep quality per drink on average.
“Over time, it turns into a cycle of self-medication, as some may call it, in the real world where people will experience bad sleep as a result of alcohol-induced REM sleep suppression,” said Frank Song, a researcher in the UW Department of Psychiatry and Behavioral Sciences.
Stress is a big factor in inhibiting sleep, according to Ms. James. Evening habits may open the door to anxieties that would be better avoided just before going to bed. For instance, many people like to watch the news on television before getting a few zzzzs. After a global pandemic, polarizing political divisions, and conversations on how woke one should or should not be, it is no wonder many toss and turn as they attempt to sleep.
Evening also is when many older adults are FaceTiming with their sons and daughters who may be struggling to pay rent, or trying to decide whether to buy an electric car or a more traditional model.
“Stress can increase your heart rate, increase your blood pressure, make you have an upset stomach, and cause muscle tension,” said Dr. Aneesa Das, a professor of internal medicine at Ohio State Wexner Medical Center. “All those things increase our alertness, making it harder to fall asleep.”
That leads directly to another sleep problem: light from electronic devices. All that information gathering comes from a cell phone, a television screen, a laptop. And there goes the circadian rhythms.
“Our circadian drive is that central clock telling us when we're supposed to be awake and asleep, and that is driven by light more than anything,” Dr. Das said. “When we use smartphones and our TVs right before bed, we increase that bright light exposure at the wrong time.”
One other before-bedtime habit may be to have a snack. Perhaps having a graham cracker with a glass of warm milk is comforting before turning in for the night, according to Ms. James. For some people, the activity of lying flat in bed may induce a bit of acid reflux. One may not even know it is happening. A small irritation wakes one up. Sit up in bed, and the problem may be solved without even a realization there was an issue.
But it did contribute to a more troubled sleep cycle.
“Control those stimulations at night so you can fall asleep,” said Dr. Vijayakumar, suggesting that a warm bath is a calming regimen before retiring for the night.
First Published February 16, 2025, 5:00 a.m.
