Older adults may find that they are sleepier or need to nap during the day, which is often reflective of the normal aging process. In many cases, the need to take a nap results from the sleep disruption that occurred during the previous night. However, increased sleepiness during the day may also be a sign or symptom of something more serious and should be discussed with a doctor. Similarly, if someone has insomnia (persistent difficulty falling asleep either at the start of the night or after waking during the night) they should discuss this with their doctor or psychologist who can discuss methods to improve sleep habits.

Why We Need Sleep

We believe that good sleep is important for maintaining:

• Cognitive and brain functioning
• Positive or upbeat mood
• Lower levels of stress
• Metabolism
• Lower inflammation
• Protein balance

For example, if someone has difficulty sleeping, they may have more difficulty learning or recalling learned information, difficulty problem solving or making decisions, difficulty concentrating, and difficulty regulating their mood and reading other people’s emotions. Communication between brain regions necessary to perform cognitive tasks can become disrupted with poorer sleep. People who have poorer sleep tend to become more stressed, have increased appetite, eat less healthy food and gain weight. Though most of the existing research on the functions of sleep is limited to younger adults, at the Memory and Aging Center we are currently investigating many of these relationships in the older adult population.

Getting Better Sleep

So if sleep is so important, how can we improve sleep? Using behavioral methods to improve sleep are typically referred to as improving someone’s sleep hygiene. Though there are general guidelines for improving sleep hygiene, it can require personalized approaches due to individual habits or needs. Many psychologists or neuropsychologists can discuss sleep hygiene programs with you. Some suggestions to improve sleep are:

1. Go to bed when you are ready to fall asleep
2. Maintain a regular time of getting up in the morning independent of what day of the week it is
3. Do not watch TV in bed and be careful that if reading on a tablet before going to sleep that it does not use a blue backlight
4. Reduce potential sources of sleep disruption (e.g., make sure the room is dark, avoid pets sleeping in your room)
5. Limit caffeine intake and daytime naps to before 3 p.m.
6. Make sure that the room is a comfortable temperature
7. Try to have a wind-down period an hour before bedtime (e.g., reduce potential stressors, don’t watch something too stimulating on TV)
8. As always—exercise is a plus to helping someone sleep better, although exercise too late in the evening can also disrupt sleep

In addition, if you have to get up frequently during the night to urinate, it can be advisable to reduce your fluid intake a couple hours before bedtime. Using earplugs and eye masks while sleeping are perfectly fine and can be advisable as long as you are able to maintain your safety while using them. Using the radio and music when trying to fall asleep may depend on the individual. They can be useful to relax or drown out other noises (as are white noise boxes). However, the music should be relaxing and familiar. It is not helpful to be interested or stimulated by a radio program when trying to fall asleep. It is also advisable that you use a sleep setting so that the radio or music turns itself off after a limited amount of time.

While there are medications for insomnia, many prescription and non-prescription or over-the-counter medications can worsen the chemical imbalance common in memory problems and cause significant confusion and a risk of falls. Some of these medications can also counteract the effects of memory medications. In addition, identifying and treating underlying causes of insomnia or disturbed sleep such as depression, anxiety, high blood sugar leading to frequent urination or use of medications that affect sleep is important to managing insomnia.

Sleep Disorders

Many individuals can have sleep disorders, some of which may be associated with a developing pathology. If you have experienced any of the following only once or twice, it is unlikely that you have a sleep disorder. Night terrors, sleep walking, acting out dreams while asleep, waking up unable to move at first (sleep paralysis), restless leg syndrome, increased sleepiness during the day, a significant shift in preferred bed time and rise time, or interrupted breathing while asleep, are some signs of different sleep disorders that could be associated with cognitive or functional impairment. Part of our research is to determine how specific co-occurring sleep disorders are with neurodegenerative diseases. It is widely accepted tha acting out dreams while asleep is most likely an early indicator of developing parkinsonian pathology. Earlier detection of potentially developing pathologies can allow for earlier intervention and disease management.

Interrupted breathing while asleep is a sign of sleep apnea and has been associated with increased cognitive impairment, which can be reversible. If you have been advised to use a continuous positive airway pressure (CPAP) machine, this can improve your cognitive function and limit or reverse any functional disruptions associated with the sleep apnea. If you have difficulty complying with the CPAP, we suggest that you discuss this with your doctor to determine potential improvements or alternatives. If you think you have a sleep disorder, please discuss this with your doctor.

Sleep Research at UCSF Memory and Aging Center

Our sleep research program at the UCSF Memory and Aging Center is widespread and rapidly growing with many areas of interest. One key area of interest for us is to investigate how sleep affects cognitive functioning in older adults. Another key area of interest is to determine if changes in sleep and circadian patterns may be early indicators of a developing pathology. If we can determine the specific changes associated with individual diseases, we may be able to start treatment plans for those at-risk individuals sooner. If you are a healthy older adult with or without sleep difficulties, or someone with a diagnosis of either mild cognitive impairment or a neurodegenerative disease and are interested in hearing more about our current sleep-studies, please contact Dr. Christine Walsh. We’d love to hear from you.