I recently had an older gentleman come to my office with the complaint that he was not getting enough sleep. He was very upset that he was only sleeping 6 1/2 hours per night. He was so upset about this that at one point, he was almost in tears. I was really struck by how seriously he took this and how he felt something was wrong with him. He was convinced he may need a sleep aid.
I started asking a few more questions about his sleep. Did he wake refreshed? Yes. Was he napping during the day or dozing off easily? No. I then asked why he was so concerned. He said that everything he has read about sleep says that you must get 8 hours a night or it could be harmful. I started thinking for a moment and realized that this is true. We do suggest 8 hours a night.
I explained that 8 hours a night is an average — some people sleep less and don’t need as much sleep, and some sleep more because they need more. I further explained that what is most important is how you feel the next day. Do you wake refreshed and feel rested during the day? He seemed relieved. He said that his 6 1/2 hours of sleep seemed sufficient, but he was trying to be as healthy as possible because he wants to live a long life. I complimented him because he is already in his early 80s with little disease, so he must be doing something right.
I did have to break some bad news to him. When we age, we don’t sleep quite as well as we did when we were young. As we age, it is harder to initiate and maintain sleep. Sleep is more fragmented during the night as well. Most older patients complain that they can’t stay asleep during the night. They wake frequently and have a higher incidence of other sleep disorders such as obstructive sleep apnea, restless leg syndrome, and periodic limb movements of sleep.
Older patients often find themselves sleeping during the day. These naps can take away from nighttime sleep and make it more difficult to get a good night’s rest. This population may also get less exposure to sunlight and activity, which help cue the brain about whether we should be asleep or awake.
Treating insomnia in the older population can be difficult because they are often on many medications. They also have increased risk of falls, and sleep medication may leave them feeling drowsy during the day. Education is very important.
Reiterating good sleep hygiene can make a huge difference and is sometimes all that is needed. If this is not helpful, melatonin can be suggested; it has been studied in older populations and can be effective in promoting sleep. There is one prescription melatonin agonist (ramelteon) available if patients are worried about the effectiveness of over-the-counter melatonin. They should be told that they need to use if for at least 2 weeks before they decide if it is effective.
Of course, there are many other sleep aids on the market that can be used. The risks and benefits need to be explained in detail.
When asked, I have now changed my answer about how much sleep we need. I say that people need 7-8 hours on average, but it depends on the individual. Some of us need more sleep and some of us need less. What do you tell your patients?
Sharon M. O’Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
- Clinical Handbook of Insomnia, 2nd edition, Humana Press, 2010.