# 4 Rules That Fix 95% Of Sleep Problems For Seniors

## Метаданные

- **Канал:** Sleep Doctor
- **YouTube:** https://www.youtube.com/watch?v=0eHiJsJbgp8
- **Источник:** https://ekstraktznaniy.ru/video/43126

## Транскрипт

### Segment 1 (00:00 - 05:00) []

Hey everyone, Dr. Michael Bruce, the sleep doctor here. Gotta be honest with you, I had a birthday recently and I feel like I'm getting a little bit on the older side and so I started to really look into some of the ways, shapes, and forms that I can increase my health span along with my lifespan. What does that mean? That means I want to age better. And as we do that, we want to get better sleep. So, I'm going to talk with you today about a few of the things that the research shows and that I do personally that are going to give me better sleep and a longer life. So, one of the questions that I'm asked all the time, and it seems to be more prevalent now that I'm actually getting older myself, is what happens to sleep as we age? So, there's a lot of different things that goes on here. And I want to be clear, this isn't absolutely everything, but there are a few things that I think are important for us to highlight. First of all, something called sleep efficiency has a tendency to get lower and lower. Sleep efficiency is basically an idea of how much time in bed do I actually spend asleep. Generally speaking, in our younger years, we like to see that be in the 80, 85, even 90% of time. But man, that really does seem to change over the course of time. And as we get older, we spend more time in bed awake than we really ever wanted to. We also know that there have been big changes in something called your arousal system. A lot of times you will wake up in the middle of the night and not necessarily know all the reasons for it, but it's not that frequent. As we get older, unfortunately, we're waking up all the time. Our arousal threshold seems to be a bit uh higher than it once was. And so, anything that's out there seems to be able to wake us up. Not only that, but we have this thing called the glimpmphatic system in our brain. This is kind of like what I call the waste management system of the brain or the garbage truck of the brain. It comes in and it scoops out all of these really uh important proteins that accumulate during the day. Now, when we look at Alzheimer's disease, which is really something that a lot of people are concerned about, we know that this is directly related to the quality of sleep that you're getting. So, not that I want to scare anybody out there and say, "Hey, if you ain't getting good sleep, you're going to end up with Alzheimer's. " But what I can tell you is the quality of your sleep is going to be a factor in overall brain health. And I think that's something that's going to be important for you to understand. When I start to look at the research, here's what I found is that looking at the evidence-based studies, it indicates that there's basically three major factors uh that affect longevity. One is genetics. So, whoever your mom and your dad were, how old they were, and how healthy they were, that's definitely going to have a big impact. Number two is lifestyle. And there's a lot of good information that I'm going to give you on changes you can make to your lifestyle. And the third one has to do with environment. Um people weren't expecting to hear that one probably, but your environment definitely has an effect on your longevity. Um I want to really start to look at the idea of what is longevity. What are the kind of the core concepts of longevity? I would say that it would be extending an individual's lifespan, expanding the health of somebody, and then controlling and maybe even reversing some of the hallmarks of aging. Now, genetics are a big factor. There's been some very interesting twin studies that have found that approximately 20 to 30% of the variation in human lifespan can be related to genetics. So, if you never got around to doing 23 andMe or ancestry. com or one of those genetic testing things where you learn a little bit about your genetics, that's okay. Just try to remember your parents and what happened there. How long did they live? Uh what did they die from? How healthy were they? How did they take care of themselves? This is really going to be a good insight for you as to what's going on maybe later on in your sleep. If we wanted to get really serious about the biology of it all, there are apparently four biological pathways of aging. Um, these are four very wellstudied aging pathways and we know that sleep affects every single one of them. One of them has to do with your insulin. something called AM activating protein kinace. mTor and then something else called assertuin. I don't want you to worry about all those terms, but what I do want you to know and understand is these are wellestablished factors and sleep affects each one of them. More importantly, poor sleep, specifically poor quality sleep, makes each and every one of these not go according to plan. So, I want people to be thoughtful and understand that, hey, this is an area of study that we're starting to learn more about, but in fact, we really need to be thoughtful about our sleep. I want to break into lifestyle because I think that is the area where we can all maybe do a little bit of tuning. So in a 2012 study uh this study actually found that

### Segment 2 (05:00 - 10:00) [5:00]

even modest amounts of leisure time physical exercise can extend life expectancy by as much as 4. 5 years. So we know that physical exercise is going to be definitely one of the things that we want to put into our routine in order to give us a longer health span and lifespan. Uh we also know that dietary habits are going to be important. We know that living conditions are important. Obviously, uh pharmaceuticals can play a role as we get older and maybe sometimes those have a tendency to change. When you're looking at the optimal range of sleep in terms of how long should people sleep in order to potentially live a bit longer, the data is pretty interesting. It shows that somewhere between 7 and 8 and a half hours per night has been associated with healthy and chronic diseasefree life expectancy between the ages of 50 and 75. Whereas shorter times like less than 7 hours or even longer times like 9 hours plus these can be linked to 1 to 3 years of fewer healthy years of increased uh risk for chronic disease. Now when we take a look at depression this is something that I found to be very interesting because in a lot of my patient population we see that people have a tendency as they get older to potentially get some higher levels of depression. We also know that physical activity can wayne over those years. And so one of the things that the data would now suggest is that depression mediates the relationship between poor sleep and lower quality of life. Meaning if you're depressed, even if you're sleeping well, that can have a problem. So both of these need to actually improve in order for the quality of life to improve. Physical activity can also act as a buffer for some negative effects of poor sleep. But let's do a quick double tap on exercise, right? So, regular physical activity is highly effective for improving sleep quality in older adults. Other forms of beneficial uh exercise include resistance training and Tai Chi. Exercise interventions definitely help improve total sleep time and more sleep efficiency and also help reduce insomnia. So, one of the things that I'm committed to doing is moving my body 20 to 25 minutes every single day if at all possible. Now, you've probably heard a lot about mindfulness and meditation. And if I'm honest with you, I didn't grow up in a world where there was a lot of mindfulness and meditation going on, at least not that I was exposed to. But things like Tai Chi, yoga, chiong, these are all things that are going to be extremely beneficial for you having a longer and healthier life. but they also improve sleep quality and they reduce depression and anxiety. So definitely going to be something that you want to consider. My favorite thing to do though is a little bit different. I like to combine different approaches, right? So how can we use exercise and mindfulness at the same time to be able to really kind of double down on these effects? Well, you could go for a walk in the woods. Being in the woods with the quiet in the woods, you don't have earphones on. You're just listening to the nature, but you're exercising and being present at the same time. This is a wonderful way to be able to help yourself live longer and quite frankly live a lot happier. Would you believe me if I told you that aroma therapy can also be one of those things? Now, I know that some of my videos on aroma therapy, people are loving it and enjoying the heck out of it. And guess what? Aroma therapy, especially aroma massage therapy, has a moderate to large effect on improving sleep quality and can also reduce stress, pain, anxiety, and depression. So, combining these two together might actually be another great idea to try to do. Now, I also want to talk to you about maintaining a consistent sleep schedule. You know me, I've been talking about this for years, but aim to go to bed and wake up at roughly the same times, including the weekends. If you can't go to bed at the same time and can only wake up at the same time every day, you know, that's good enough. But if you really want to do that extra little bit, I would argue that you want to try to get both of those pretty much dialed in. Now, the other thing I ask people to do is you really want to consider prioritizing sleep quality. You want to create maybe a sleep conducive environment that's dark, that's quiet, that's cool, and limit exposure to screens like your telephone or television in the nighttime. Also, you want to monitor how long you sleep for. If you can get somewhere between 7 and 8 hours per night, adjusting as needed for individual health conditions and lifestyle, I think that's probably a way to shoot for it. The eight hour myth is still kind of a myth, but as we get older, getting closer to that might actually be beneficial. There's another big one, and you've heard me say it before, but I'm going to say it again. You've got to address your sleep disorders. Many of us out there have been thinking, "Oh, well, I don't want I

### Segment 3 (10:00 - 15:00) [10:00]

don't want to get checked for apnea because I don't want to end up on a CPAP machine, or maybe I've got insomnia and I've always had it, so wh why would I ever try to fix it now? " This is actually the right time to do that. you really want to think through, could I have an underlying sleep disorder? And if I do, how can I maybe address that because that will absolutely help me live a longer and kind of healthier lifestyle. So, what I want to do is I want to put it all together in what I call the four pillows of better sleep. You like that pillows? I thought that was cute versus pillars. Um, these are sleep tactics. So, what should you do every night? Sleep supplements. What supplements should I be taking? Sleep mindset. How should I be thinking about my sleep? And then your sleep environment. Equipment really matters in overall sleep activity. Let's start with sleep tactics. So this is what I do every single day and night. And I'm going to recommend that you try to do most of these as well. So once again, wake up at the same time 7 days a week. When you wake up in the morning, at the same time, sunlight hits your eye and turns off the melatonin faucet in your head, but it also sets a timer so that it knows when to produce melatonin at night. As we get older, melatonin production can be a little bit on the wonky side. So, being able to have a steady morning wake up time is really going to be productive for you in the long run. Being able to then allow for your melatonin to kick off at the right time at night. Of course, you know me and the chronotypes. I want you to know your chronotypical wake up time and bedtime and use those as a guideline for yourself to know, hey, I need to get to bed around this time. I need to wake up at around this time. Again, consistency really matters here. Now, this is a biggie and sometimes people tell me it's not too fun, but you really want to take a look at your caffeine consumption and your alcohol consumption. As we age, unfortunately, our metabolism has a tendency to slow down. That is not good when it comes to caffeine and really alcohol. Alcohol basically destroys stage three and four sleep. And as I said earlier, that's when the glimpmphatic system comes in, scoops out all those proteins, and helps us avoid things like Alzheimer's. And so, unfortunately, what I'm telling you is the closer to bedtime that you drink alcohol, the more it has a tendency to affect the system. Now, I want to be clear. I'm not advocating for day drinking, but what I am saying is if you want to have a glass of wine or maybe a beer, I don't think I have a problem with that, but you want to place that as far away from your bedtime as possible. So, maybe 3 to four hours before bed, maybe around 6:00 if you're going to bed at 10:00. Now, this is a big one, and I mentioned it earlier, but I think it's important to talk about, which is napping. You really want to avoid napping as you get older. Now, you might say, "What? What are you talking about? I've been living my whole life to be able to take a nap during the middle of the day and hang out and relax. When you nap during the day, you lower adenosisin stores, which is the thing that makes you fall asleep at night. And so, if you're napping during the day, it could cause difficulty falling asleep and staying asleep in the evening. Again, we really want to tighten up that sleep schedule and make sure that you're only sleeping during that period of time, which by the way increases that sleep efficiency that we were talking about earlier. Now, people oftentimes ask me, "What is optimal sleep duration and how does that affect when am I going to live and when am I not going to be around? " Remember, the shorter your sleep or the longer your sleep, this is where we see what we call a mortality risk. So, optimal sleep duration is somewhere between 7 and 9 hours of sleep. Like I said, get inching yourself closer to that eight if possible. But if you do go below six, this is associated with higher risks of cardiovascular disease, stroke, and what we call all cause mortality. Longer actually is also linked to things like mortality potentially due to underlying health issues, narcolepsy, or even depression. So again, try to get yourself somewhere in the 7 to 8 hour range. Don't worry too much if it's not quite eight, but definitely lean more towards more sleep rather than less. People always want to know about supplements. So, let's move on to pillow number two, supplements. If I had to choose just one, I think it's vitamin D. Remember, vitamin D deficiency is associated with poor sleep quality, insomnia, excessive sleepiness, and increased risk for sleep disorder. These deficiencies are very common in my elderly patients and even myself. Uh, and it's linked to both poor sleep and in some cases, cognitive impairment. Now, you've heard me talk about vitamin D before, but there are a few others as well. Vitamin E, folate, and selenium are three things that a lot of people don't think about, but these three in particular can be very helpful. I like

### Segment 4 (15:00 - 20:00) [15:00]

to try to get all of these through my food, but sometimes it's not always possible. Lower blood levels of vitamin E and folate and selenium are significantly associated with sleep disorders in older adults and a combined deficiencies in these nutrients can be a very strong predictor of sleep problems. Vitamin A, magnesium, copper and iron deficiencies in these areas um with these kind of what we call micronutrients are also more common in elderly individuals with sleep disorders compared to those with good quality sleep. So what does that mean? Well, vitamin D deficiency is the most common and wellestablished micronutrient deficiency affecting sleep quality in the elderly. Deficiencies in vitamin D, folate, selenium, and other minerals and vitamins are also linked to poor sleep. And this highlights the importance of a comprehensive nutritional assessment in older adults with sleep problems. And you guessed it, blood work. I really can't recommend enough that people get regular blood work, maybe once every six months. specifically looking at these things that I've been mentioning. If you find that you have these deficiencies, there are some dietary changes that you can make, but also there's some things that you can do in terms of taking different supplements that are available. Now, we've talked about consistency and scheduling and things like that. We've talked about supplementation, which I also think is important, but I would say one of the big areas is what I call sleep mindset. Mindset is really kind of unlocking sleep success for people and I feel it does this in a lot of different ways. But the first thing I want people to do is to cultivate what I call a positive sleep mindset. So what am I talking about? Letting go of stress, prioritizing relaxation before bedtime can help foster really good nights, less restfulness, and allow for better deep sleep. establishing consistent routines for mindset. So, regular bedtimes so your brain knows what's going on with calming activities, signaling the brain that it's time to sleep, what I've said in the past, I call sleep anchors. These are things that you can do to again remind the body that it's time for bed. This can definitely aid in falling asleep faster and having more peaceful rest. And then, of course, embracing healthy attitudes towards sleep. Remember, view sleep and rest as essential improvements because what it can do is improve your overall quality of life. Now, how would you get an a positive sleep mindset? Well, there's a whole host of different things that you could potentially do. One of the do is potentially practice meditation. Another thing maybe do some light stretching before bed while sitting on your bed. I call it bed yoga, but it's really just stretching while you're lying down so that way you don't lose your balance and fall. Um, or just spending some quiet time reflecting or maybe journaling. One of my favorite things to have my patients do is to journal before bed, allowing them to get out any of the stressors that they might be thinking about and record some of the cool things that they've been doing during the day. All right, now we're back to sleep environment. And you know, I like to talk about sleep environment quite a bit. Let's think about sleep environment based on the five senses. Um with the first one being sight or light. So remember when you walk into the bedroom, whatever the number one light source is, you want to tone it down. Maybe add a dimmer switch to the wall or you could change the bulbs in your night side table beds to be able to have a 40 W bulb versus a 80 watt bulb. Uh, other things to do, install night lights maybe in the hallway along the way to the bathroom if that's something that's going to be helpful for you as well. There are effects of sound and light together. That's called the television. Now, everybody here knows I sleep with the television in my bedroom and it's usually on and usually on all night long. That's probably not the best thing in the world for me to do. Um, but my wife can't sleep without it. So, I will sleep with the sleep mask on and sometimes I'll even have earplugs to help me out. Here's what's interesting is as we get older and our hearing becomes uh less acute, uh you would think, oh, well, then you don't have to worry about it because your hearing isn't so good. Well, that can actually produce anxiety for some people. And so, maybe having an alarm to help you know when to go to bed and when to wake up, that could be val very valuable for you. But I got to be honest with you, please don't use the snooze. Remember, the snooze is kind of the worst invention in all of sleep. Average snooze is somewhere between seven and nine minutes long, and your body can't get back into a good uh rhythm of sleep during that period of time. So, I'd rather you just set an alarm and get up and get out of bed after that. If you get up at one time, but your partner gets up at another time, maybe having earbuds specifically designed to be slept in can be helpful, or a vibrating alarm. Those can be really good as well. And personally, I love a good sound machine. Um, I think they work really

### Segment 5 (20:00 - 23:00) [20:00]

well. There's data to suggest that it's can be very helpful. So, using noise cancellation by via a sound machine can also be helpful, but I will give you a warning. You if you want to use this, you want to be able to make it portable because if you go to visit your children or your grandchildren or your friends, you you're going to be stuck if you don't have that sound that your body's so used to hearing. Now, if I had to pick one area that I think is really important for longevity in sleep in terms of your environment, it's temperature. So, it turns out sleep follows the core body temperature cycle. And so, you really want to have as consistent and cool temperature as possible. However, there's something that happens as we get older in that we have less subcutaneous fat in inside our bodies, which means we're less insulated, which means we actually can't hold on to heat as well as we used to be able to. So, sometimes we might get too cold or sometimes any heat in the room might make us too warm. So, you may need to experiment with a whole host of different things. Other thing I want to talk about is temperature of the room. You want to probably keep it somewhere between 65 and 70°, which is 15 to 19 degrees uh Celsius for optimal sleep. I would actually ask you to look for something called moisture wicking sheets and blankets. These are uh these are sheets and blankets that are designed to pull the moisture off your skin so you don't get that cold and clammy feeling. I also would ask you to put in a humidifier as well as an air purifier. You want to maintain somewhere around 35 to 40% humidity. That's what the data would suggest is best for sleep. And then air circulation, I can't tell you enough. Having a fan along with an air purifier is probably one of the best ideas that you could have. Why? Well, it's the room that you probably spend more time in. So, you want that air to be fresh and clean. Couple other things we can talk about are mattresses and pillows. Equipment matters. Meaning, the pillow and the mattress shouldn't be the old ones that have been laying around for 15 years. you really want to uh get a new pillow probably once every three years. And a mattress depending upon your medical conditions, maybe you have a bad back, maybe you've got some other stuff going on, probably not nearly as frequently, um but probably every seven to eight years. If you wake up in the morning and you're sore or not feeling great from a physical standpoint more than three days a week, and it's not cuz you were out working in the garden, then it might be time for a new bed. Now, one thing that everybody out there knows is I sleep with two French bulldogs in our bed. A lot of people sleep with animals in the bed, and I certainly don't have a problem with it, but if your animal is getting older and they're not sleeping very well, that can have a big effect on you and your sleep. So, sometimes it might be worthwhile to take a heating pad, put it down towards the bottom of the bed, and train your animal to just go to the heating pad. That way, they're still next to you, but they're not necessarily moving up and getting around all over the place. So, summing it all up, how do you get the best night's sleep as you get older? Step number one is to select one bedtime and stick to it. Step number two, make sure to stop that caffeine earlier in the day than you might have thought of earlier. Step number three, reduce alcohol as much as you possibly can and certainly have it earlier rather than later. Step number four, exercise, exercise. But again, you don't have to run a marathon. 20 minutes of cardio is probably going to be the best thing that you can do. And then waking up at the same time every single morning, go outside and get a little sunshine. That helps with vitamin D. Remember, vitamin D is the one supplement that I say you probably need to take, but if you can get outside, maybe you don't even need to take it then. This is Dr. from Michael Bruce, the sleep doctor, wishing you a long and happy