There are a lot of myths and misunderstandings about sleep and taking naps in the senior population. This is partly because studies show some conflicting results. However, there are some basic truths.
The first myth is that seniors need less sleep than the average middle aged adult. Studies have shown that sleep needs change little with aging. There are some changes in the sleep architecture, with the older population spending more time in a lighter stage of sleep; but the total sleep time stays unchanged. While many seniors report more sleep disruption and less satisfaction with their nighttime sleep, many of these issues are related to other health concerns, and medications. Healthy seniors show sleep that is no more disrupted than their younger counterparts. Problems such as arthritis, the need to urinate in the middle of the night (which may be related to medical issues, or sometimes to medications), and other health issues may affect your ability to have good restorative sleep.
Seniors, for reasons that are not well understood, have a tendency towards advanced sleep phase syndrome. This just means that many seniors go to bed early, but then wake up before dawn. If you are asleep by 8 p.m., then awakening at 4 a.m. is not indicative of a problem. You have had 8 hours of sleep. Many teenagers have the reverse problem, delayed sleep phase syndrome. They stay awake until 4 a.m., but then sleep until noon. There is nothing intrinsically wrong with either scenario, both individuals get 8 hours of sleep. It is just not at the times when society says we should be sleeping.
So, what is normal sleep in seniors? Seniors frequently take a little longer to fall asleep, due to multiple causes. Occasional arousals are common as well. Both can be related to the other medical problems the individual has. Studies have shown that up to 40% of seniors take naps during the day, and many say they wake refreshed. However, persistent and prolonged problems falling asleep and excessive daytime sleepiness are not normal and should be evaluated by a physician.
The second myth is that napping is not good for you. The information on this is much more confusing. For a long time napping was thought to represent laziness, or to have the potential to ruin your night time sleep and for those reasons to be avoided. What is clear is that sleeping too little (less than 7 hours over the 24 hour period) or sleeping too long (greater than 9 hours over the 24 hour period) may be associated with a greater health risk.
If you are sleeping an extended time at night, waking tired and taking prolonged or multiple naps in the day, then you should see your physician. Seniors are at increased risk for sleep apnea or other health issues that disturb your sleep and make it non-restorative. Sleep apnea, a process where you stop breathing for a period of time, is associated with increased risk of cardiovascular disease, and stroke, as well as headaches, memory loss and depression. It is very treatable but needs to be recognized and brought to your doctor’s attention.
On the other hand, if you are a short sleeper, several studies show a nap can actually improve health. For a healthy senior an afternoon nap of a half hour to an hour has only minor effects on the night time sleep, and can improve alertness and activity levels later in the day.
The take home message? Sleep when you are sleepy, and a short nap is okay. Don’t worry about when you sleep as long as it works for you. If you are tired all the time, that is a different story. Talk to your doctor and get the appropriate evaluation.
Dr. Knowles is board certified in Sleep Medicine as well as Neurology. He currently practices at Erlanger Hospital in Chattanooga, TN.