| Sleepopolis

Episode 12: How Sleep Changes For Older Adults

Show notes
Is it true that seniors need less sleep? How do various health conditions affect sleep duration and comfort as we age? Dr. Shelby Harris discusses all the myths and realities for rest past the retirement age with Dr. Kerry Burnight, a gerontologist with a passion for instilling older adults with confidence and capability — even in the bedroom.

Transcript

Dr. Shelby Harris: How are you sleeping? Are you sleeping? I’m Dr. Shelby Harris. Licensed clinical psychologist, and I’m the Director of Sleep Health at Sleepopolis, where we dive deep into all things sleep, so you can get the rest you deserve.

How do our sleep needs change as we age? How can we advocate for older adults to protect their quality of sleep? And more importantly, as we mature, how should we adjust to make sure we’re getting the best sleep possible? To explore these questions and more, we’ve invited Dr. Kerry Burnight, a professor of geriatric medicine for 17 years and co-founder of the nation’s first elder abuse forensic center. Recognized for her work by the U. S. Department of Justice, with appearances on the Dr. Phil show, The Doctors, Money Matters and Headline News, Dr. Burnight works to combat elder abuse and neglect.

Dr. Burnight, thank you for being here and welcome to Sleep Talking with Dr. Shelby. I am so excited to have you here and you said I could call you Dr. Kerry, so that’s what I’m going to do.

I fangirl over your Instagram page because I love everything geropsychology, gerontology, and there’s so few really wonderful experts out there and you are doing so many amazing things online. So thank you for everything. I’m so glad you’re here.

Dr. Kerry Burnight: Thank you very much.

DS: Let’s talk about how people age. Can you tell us a bit about some of the bigger changes that seem to go on in our bodies, really from middle age onward and what age range are we talking about when we’re talking about that?

KB: So I am 55. I think life starts to get interesting, maybe in our fifties. It’s different for everybody, but I think that the big picture is we’re going to have changes and I like to group these changes into things that are reduced and things that are increased.

So, as we’re aging, we’re going to have reduced muscle mass and bone density, slower metabolisms, Lower hormones, estrogen, testosterone, melatonin. Changes in our vision and hearing. For some people, there’s reduced exercise. And for some people, unfortunately, reduced social connection.

DS: Yeah.

KB: Now, what about the things that are increased? Well, some are not great. Increased weight. Increased acute and chronic medical conditions. Increased trips to the bathroom at night. I’m already having those.

DS: Yeah.

KB: But it’s not all bad. Because there are increases as we get older in the second half of life that are making life better also. So we don’t care as much what people think. Hooray! We have more emotional stability. We have greater depth of relationships and appreciation for our relationships and greater spirituality.

So I can’t talk about aging just as all decline.

DS: Yeah.

KB: Because it simply isn’t. And it’s dangerous to think that it is.

DS: What would make someone want to go see a gerontologist? Like what age would someone maybe go and see someone like yourself?

KB: Again, it’s really different for different people. And so, you know, I have some people that I get to see who are in their 60s and 70s. I think a lot of times most of my folks are in their 80s, 90s.

My oldest right now is 112.

DS: Wow.

KB: So I think rather than by age, because age is so different for different people, I think it’s more when we start to notice things that are changing or things getting in the way of maximizing living our best life. So if you have, you know, a condition that’s really bugging you or a couple of conditions, or like you’re, gosh, I’m really wanting to make sure that I can do this, that’s a time when people might see a gerontologist, That’s somebody with a PhD, or a geriatrician, that is somebody with an MD. And I think that’s an important distinction.

So just as we go to a pediatrician with our kids, we could go to a geriatrician.

DS: Yeah.

KB: And there aren’t very many geriatricians or very many gerontologists. So if you can find one, I would grab on.

DS: Yeah, that’s for sure. So talking about things that change as we age, what would you say would be the biggest sleep challenges that you see in older adults physically?

And I mean, just like you were talking about going to the bathroom more at night, like what sort of changes are happening as people age with sleep?

KB: Yeah, well, we start with health conditions. So some health conditions that become more common as we get older, arthritis, diabetes, heart disease, they can interfere with your sleep.

And some of them make it hard to fall asleep. Some of them make it hard to stay asleep. Some of them make it hard to get comfortable. And so we are moving more.

DS: Yeah.

KB: In addition to health conditions are the medications that we take for these conditions. So as we get older, we tend to take more medications. And they can have side effects that impact sleep.

So some of them give us insomnia. Some of them give us daytime drowsiness. And overall, it’s those medications that we need to be so careful with, not only about our sleep, but also how they interact with other medications. And sometimes you’ll be taking a medication and then over time, it will change because you’re changing and it won’t work anymore or it’ll work too much.

Or I have some patients, like I’m most proud when we take people off medication.

DS: Yeah.

KB: And then, you know, there’s an increase in sleep disorders, of your expertise, of sleep apnea, restless leg syndrome, and those can impact our quality of our sleep. Also just changes in circadian rhythm. So our internal body clock may shift and that can disrupt sleep.

DS: Yeah, I think one of the things that I see often in my practice, cause I work with older adults a lot, is people will come to me saying, well, I have insomnia. I have insomnia because I wake up at three in the morning every night. But going with that circadian pattern shift, it’s so rare that someone says to them, well, what time do you go to bed?

And oftentimes it’s like seven or eight o’clock at night. I’m like, you’re actually sleeping a full night. You’ve just advanced it. It’s not insomnia. It’s a different issue. And now we need to work on light therapy and other things to keep you up.

But it’s simple little questions that I think don’t always get asked and instead get people get put on medication because the complaint comes out as I’m up at three in the morning and I can’t go back to sleep for hours. Well, you’ve already slept seven hours at night, so…

KB: What a great point. Sometimes you try to get fancy and it’s just the simple, like, Oh, if you go to bed at seven-

DS: You’re going to get up at three! But that shift is such a common thing, and I think it gets forgotten about sometimes. And I love that you mentioned sleep apnea, because that’s a huge one that I think we see happen for both women and men.

And as their airway begins to loosen, as the older we get, everyone has this happen. The sleep apnea is really going to cause even poorer sleep quality. If you’re already taking a medication that might be a little sedating already and then you’re having sleep apnea on top of it, there’s the risk of dozing during the day and that just leads to more and more broken sleep at night.

So it’s like we only sometimes think about the night. We have to think about how these things are impacting the day and if we’re not as mobile, doing things, getting light exposure during the day, of course, that’s going to impact the night.

KB: Yes.

DS: Is that stuff that you see all the time with patients?

KB: 100 percent. Getting up and getting morning sun by taking a little walk matters. It doesn’t cost anything. It doesn’t have any side effects. The greatest thing that we can do is getting out and getting some natural light in the morning. And it’s so good for our mood. And so every day I have to remind myself that you’re always rewarded by it. And for those of you, and there are so many of us who have challenges with mobility and you think, well, forget it. I can’t walk. And therefore I’m not going to listen to that advice. There is still getting yourself outside, even if it’s not for a walk. Ideally, it’s for a walk, but if it isn’t getting out to sit outside. And being a little creative and insisting, like, you know what? No. Let’s say I’m in a wheelchair. Let’s get out here. We’re going out. We’re going outside into this patio and I’m going to get some sun and enjoy some nature in the morning.

DS: What about structure? So I think that’s one of the things that I see a lot of times when patients will come to me and say, I was actually a good sleeper until I retired or until my kids left the house because they lose that, that structure routine of that 24 hour day. How do you work with older adults to build in the structure? Because what I see a lot in my insomnia practice is patients won’t sleep well at night. And then they’ll say, but I get my best sleep from six to eight in the morning and then they’ll sleep in in the morning because they don’t have to get up for something in particular.

So how do you recommend like getting structure into the day and getting patients to really kind of just keep that in a routine daily?

KB: I believe that the answer is continuing to challenge ourself. So I’m a little of the tough love department. Part of wellness is continued growth.

DS: Yeah.

KB: And continued growth means pushing ourselves. And sometimes I think as we get older, other people inadvertently take our power by trying to do for us. And even worse, we tell ourselves inaccuracies, which is, ah, it doesn’t matter. I can’t do this. Oh, what’s the use? I’ll just- nah, we’re going to keep growing all the way until that very last day, until we’re 110.

And so that requires a little tough love on ourself of saying, nah, you can get up. I’m going to- before I go to bed- I’m going to think through a structure of a day and, or do this any time of the day to think, okay, my bedtime is going to be this. My wake up time with an alarm is going to be this. I then go outside. I then eat.

Whatever it is, make it yourself, but you know, pushing ourselves to exercise, to learn new things, to reach out and serve because that keeps us going. So if we stop, if we take our foot off the gas, in my opinion, we’re not offering all that we have, and I think the world needs older people to serve and be engaged.

DS: Do you think that older adults get kind of brushed to the side when it comes to sleep complaints a lot? That, oh, you’re supposed to get less sleep as you age, and that the quality is poorer as you age. Do you see that, and do patients report that to you?

KB: Very much so. So, the world is ageist.

DS: Yeah.

KB: So we’ve been taught since we were little tiny kids that old people are, like Hansel and Gretel, that old witch will capture you and then she’ll eat you. And then we say, goodnight kids. And so, there is a pervasive ageism. And then we have internalized it. So it’s ageism on ourselves.

DS: Yeah.

KB: So when we erroneously believe that everything gets worse and that like, yeah, of course, I can’t sleep because I’m old. Of course, we’ve got to say like, No, I am going to convey to a sleep specialist or to my physician that I’m having sleep troubles.

We’re going to talk about it and then we’re going to find ways to fix it because there are so many ways to improve sleep. And just like cognitive impairment is not a normal part of aging, having these really severe sleep issues is not a normal part of aging. Common, yes. Normal. No, we can do things to improve it.

DS: Yes! Thank you. I think that’s what people hear so often.

KB: Yes.

DS: Is that, oh, it’s part of aging. The reality is that older adults don’t get drastically less sleep than they did when they were a little younger. It’s really that they nap more sometimes during the day. So in a 24 hour period, it’s about the same.

What changes is the quality, right? So there’s less deep sleep because of awakenings, less human growth hormone happening, all those things. But it’s just less deep sleep. It doesn’t mean that you should expect to have hours awake in the middle of the night. That’s not normal sleep. It just isn’t.

KB: Yes, exactly. That’s exactly right.

DS: And I tell everybody, if you hear someone who’s telling you, yeah, that’s normal, find a different doctor who understands better.

So what strategies or tips have you used to help older adults sleep better that you don’t often hear? You know, besides the caffeine and then the bright light at night. Like, what do you find is useful?

KB: Well, I love to refer to experts like you for CBT for insomnia.

DS: Thank you.

KB: And then I think, you know, addressing the underlying medical conditions. So, you know, it’s overall health of thinking about, okay, how’s my diabetes? How’s my arthritis? Really again looking at the medication. So that’s important.

Of course, like you always say regular exercise, so moving what you can move matters. And so if I can’t move my legs, I can get in and be doing my arms. Thinking about when and how much water we’re drinking and keeping that earlier in the day.

So I love that, to keep everybody hydrated. So frontloading a lot of water, and then having maybe a set time where you say, okay, I am gonna lay off drinking so much water so that I’m not up all night going to the bathroom.

DS: Mm-Hmm.

KB: Then, you know, I like to go into all of it, so mindfulness and relaxation techniques. I love aromatherapy. I like acupressure and massage because sometimes if we live long enough, many of us will lose our partners.

And when we do, we have a little less touch. And so we’re not doing as much hugging and handholding. And just going and spending, you know, whatever for a massage from time to time can be a way that, like, our whole wellness is, because humans need touch. We know this in infants who aren’t picked up, they suffer and they don’t develop.

And so some of my patients who have less touch, I give them a big hug and we hold hands when we’re working together and I am enriched by that, but also will recommend that if they could get in to massage and sometimes, like, one of my patients, we got it on her insurance so that a physical therapist comes to the home and then incorporates massage into the physical therapy. So I just love it cause it doesn’t cost money. And she, her life has really picked up from that human touch.

DS: That is huge. I’ve never really thought about that aspect being so integral and then missing for many people.

KB: Yes.

DS: That’s so lovely that you’re thinking about that. So, so touch is a big one. And then the other, like the, oh, liquids was a big one, you were saying. What would be considered, I get this question all the time, like what’s considered a normal quote unquote amount of time to have to use the bathroom in the middle of the night?

KB: I would love to get your opinion on that because I’m not exactly sure. So if I first start with my own private urinary issues, so like I at 55 go one time a night, I used to go zero times a night.

I am not sure what the normal amount is. And I’d love your input on what that is.

DS: One to two.

KB: Okay.

DS: Yeah, there’s some, I’ve had some urologists say if it’s any more than one time at night, that’s too much. But I think with older adults, you’re going to have it more. But the flip side of that is that one of the common symptoms of sleep apnea, which we see more and more as people age, is having to use the bathroom a lot.

So you always, like you said, you want to rule out any of the medical conditions, anything that might be getting in the way of sleep quality.

KB: Yes.

DS: I’m in my mid forties and I wake up once to use the bathroom already. So, I mean, it’s once to twice, I usually say. And the bigger issue, in my opinion, is if you wake up twice, but you have trouble going back to sleep. That’s the problem.

KB: Yes.

DS: Right? Or you’re waking up three, four, five times and you can never get into any sort of real like rhythm with your sleep. That’s problematic. So once or twice is kind of-

KB: Exactly.

DS: I think the other thing too to think about is that, what is normal aging, right? Like we were talking about deep sleep, kind of reducing as people get older.

But I think understanding that, what normal looks like for sleep is really important, too, because a lot of people are taking these medications that give them this false understanding of what sleep is, and that ain’t usually what sleep is.

So talk to me quickly just about your thoughts about sleep aids. Like, I’m sure you’ve encountered many patients who are on them, like, what are your thoughts about them?

KB: I have seen, you know, people helped, but I have also seen people harmed.

DS: Yeah.

KB: I have seen people who, when we discontinue the sleep aids, live better lives. It is something to be judicious about. I think it’s important that your doctor is in on what you’re taking and looking at how it combines with others.

It’s never something to take real super lightly like, oh, whatever. I just take this every night for the rest of my life. Or I, I, it’s not working. So I’m taking more and more. I’ve even had clients who have seeming cognitive impairment. And then when we clear out some of these sleep aids, their cognition clears.

And that’s a really big deal. And you should really know what every single thing you’re taking, you know what it’s for.

I had somebody not too long ago who seemingly had cognitive impairment. And then we did a medication review. And one of the things she was taking, she wasn’t sure what it was for, and there wasn’t a label anymore because it was in a baggie.

So we took it in and it ended up being marijuana and she was taking a lot of it.

DS: Wow.

KB: So I was like, you are very stoned. And because of that, we need to address this.

DS: Yeah.

KB: So we just need to be careful with it.

DS: Right. Right. Wow.

KB: Yeah.

DS: That’s so interesting. Did she – any, any clue that she was taking that?

KB: No. Zero.

DS: Wow.

KB: Yes.

DS: Okay. Yeah. So I think that’s a huge thing too. One of the things I really love about doing telehealth sessions is when I work with patients, I can be like, show me all your medication. Because they’re not always bringing them into sessions. So I can say, where do you keep it in your house? Is it organized? What’s it for? It’s so useful. Like there’s so many benefits of doing telehealth, in-home visits. It’s really great.

So medication, I agree. It’s got to be done judiciously and thinking about the other things that you’re taking. Cause I think it just gets put on too quick and people don’t always think about the other medications you’re taking.

And if it’s not enhancing your daytime, then what’s the point of doing it? Just to knock you out at night, right? You want to have a better quality of life during the day. So I agree wholeheartedly.

KB: Yes. And something I haven’t mentioned, I talked about challenging yourself. And part of challenging yourself is making yourself tired. Right? So if we’re just like, we’re sitting, like do what you can do and challenge yourself and try to get, there’s- it’s a blessing to get into bed and feel tired and think this is the time now that I’m going to recover with sleep. But if you’re not pushing yourself, then you’re less likely to be tired and tired is a gift.

DS: Yeah. It’s a battery that’s recharging at night. And if you’re not using the battery during the day, it’s not going to recharge.

KB: Yes.

DS: So you have geared a lot of your work towards preventing neglect, loneliness, elder abuse, really the dark end of the longevity spectrum as you would put it. What do you think most people misunderstand about aging and do you think that this contributes to a lot of these issues?

KB: Yeah. Thanks for asking. Yes, for the first 16 years of my career, it was just all, I only worked on cases of elder abuse, neglect and financial exploitation. And I think there’s two things.

One is the importance, the life saving importance of social connection, because the way that these lives of all socioeconomic status all across the country, and in other countries as well, is when you become socially isolated, you are opening yourself up to being preyed upon by a huge cast of characters who would do you harm in terms of taking advantage and stealing your money.

And I wish it was just a case that we could say it’s only others, but it’s also every family has opportunistic people. Like I always say, If you think your family is weird, great, because every family is weird and what you need to have your eyes open to is navigating that a lot of this exploitation is within families and people will say like, oh, you know, I have, let’s say three kids.

Two of them are often working. One of them’s, you know, having a hard time holding a job, maybe has some substance abuse problems, maybe has some mental health problems. That’s the one, unfortunately, that people say, oh, have this person move in with mom. And when that happens, you’re setting up the perfect storm of the person feeling like, well, I am helping, I’m going to take advantage of the financial funds.

And then they feel like, oh, I don’t want the siblings to know. So I’m going to keep them away from their other loved ones. So I think with social connection, think of it proactively. Like how, like we manage our financial portfolio. We add to it. We diversify it. Do this with our social portfolio. You need to have friends of different ages because friends unfortunately pass away or get cognitive impairment.

So who is in your basket? And I even write it down. I draw a circle with concentric circles. And in the center, I’m like, who is the closest person to you? Okay. Who is in that next five group? Who is in that next five group? Nobody has unlimited friendships. This, for all of us, takes work and it’s going to protect us because you can say, huh, if you have a friend, you can say, wow, I got a phone call saying that I’d won, let’s say that my grandson needs money, so, and your friend would say, oh, oh gosh, I heard that, that’s a scam. Don’t do that. See, like by having social connection.

And then the second part to it and how we can prevent this dark side of aging, cause I don’t want it to happen to another single person is the myth of independence. So there is a myth that like, as long as I can just stay independent all lifelong. We were never independent. We’re interdependent. And when you can recognize the fact that you need people and people need you and that social fabric matters and is something that you need to cultivate, then you’re going to accept help. You’re going to offer help. You’re going to have the support you need not to be isolated by people who would do you harm.

DS: That’s a game changer. I think.

KB: Yeah.

DS: What are some improvements that you think you’ve noticed over the past few years really nationally or globally when it comes to elder care and maybe even sleep health? Are you seeing changes in aging or do you think we’re still kind of stuck in older models?

KB: I have been doing it for 30 years and there have been improvements.

DS: Okay.

KB: So I think we have increased awareness. We know that every day 10, 000 more of us are turning 65. So, there is awareness that there are more of us and that there’s more attention about sleep disorders and there are more experts like you that we can turn to and we’re seeing it on the news and we’re reading articles about it. That’s an improvement.

Recognition that there are more places to age, that is the opportunities to stay in our home with the help of caregivers and with advances in technology and AI. Improvements in some elder care facilities. So there are some that are focusing on wellness and using, again, technology and telemedicine. So there are improvements.

DS: Yeah, it’s changing. It’s just slowly changing.

KB: Yes. And there’s still a lot of work to be done. But I must say there are promising things that I see all the time. Another one that I love so much is intergenerational opportunities. So I’m seeing increased opportunities of, for example, a nursery school inside a place where older adults live. And that like gives me great hope because that is so mutually beneficial.

DS: Wow. Oh, I don’t know of any of those kind of models near us here, but you’re out in California, right?

KB: Yes.

DS: You see that out there?

KB: Yes.

DS: Oh, that sounds lovely.

KB: It’s so great. And I used to do that when my kids were little. And what I did, if you, anybody wants to do this, is that I would, we had three little kids and I would put one in her dance outfit, one in his baseball uniform, and one in her basketball uniform.

And then I would go to a nearby place. Then we would walk in, particularly people living with memory differences, and it was just, people would just light up. And I think it was kind of cues based on the, you know, baseball memories or dance memories, and so good for my kids, too. And it was so good for me, because I was tired, and I just wanted to sit down for a second, and I would just sit catatonic and watch people play with my kids.

DS: Everyone’s changing one another’s lives.

KB: Win, win, win. Yes.

DS: So, Dr. Kerry, we’d like to end each episode with something to sleep on, shall we say, a piece of actionable advice. So do you have any, like a last tip, a take home message for any of our older listeners or family members of older adults who really are struggling with some of the issues that we talked about today?

KB: Yes. Here’s something to sleep on. Challenge yourself. You can get out a journal today or just a piece of scrap paper and write something on it that you are committing to yourself that you’re going to do, whether it’s that morning walk or that teaching somebody or calling somebody. So the one thing to sleep on is challenge yourself, but there’s a million ways that you can do it.

DS: And start small. Right? It sounds like that.

KB: Yes.

DS: Yes. I love that. Thank you so much for being here, Dr. Burnight, and talking about such an important topic that so many people really need to be hearing about and just talking about more. So thank you for this conversation. I really absolutely love digging into it more with you.

KB: Thank you very much.

DS: Thanks for listening to Sleep Talking with Dr. Shelby, a Sleepopolis original podcast. If you’re not routinely getting a great night’s sleep. Remember to follow and subscribe for more Sleep Talking wherever you get your podcasts. And for even more sleep tips, visit sleepopolis.com and you can also visit my instagram page @sleepdocshelby.

Today’s episode was produced and edited by Freddie Beckley. Our Head of Content is Alana Nunez. Our Senior Editor is Molly Stout, and I’m Dr Shelby Harris. Until next time, sleep well.