Sleep problems in later life

Health, illness and pain

Many people we talked to believed it was important to have a healthy diet and to take some form of exercise. They were also aware of the need for sleep, although the amount needed varied from person to person, and several people believed that less sleep is needed in later life. In particular, several people were actively changing their diets to try and eat more healthily, such as eating more fruit and vegetables, and they ranked sleeping well alongside eating well, in terms of maintaining their health.
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Anne strongly believes in a link between eating well, getting enough exercise and sleeping well,...

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Age at interview: 71
Sex: Female
And is there anything else. Have you ever heard anything else mentioned in terms of how to get a good night’s sleep?
Oh well I’ve tried all sorts of things. I’ve tried the milky drink. I’ve tried the restful music. And I had a tape of I think it was surf or something. I don’t eat after, heavily after seven o’clock. I certainly don’t have caffeine after 7 o’clock. So all the things I recommend I try to keep to.
So you have already tried all those things?
Yes, I still do those yes.
And is that purely because of how it might impact on your sleep or are there other reasons?
That is basically to keep me, try and get into good health.
So it’s all about health?
It’s all about health. Yes. I’m on a health thing at the moment.
Are you?
Does that also go to food as well. Because I’m also interested in that?
Yes. We have adapted our diet.
Is that recently?
That was started last year yes.
Okay and have you noticed any change?
Oh yes. Yes. I have lost a lot of weight. I’ve got more energy, but I haven’t got much stamina. Which sounds a bit strange.
Oh right. So you have got more interested in doing things, but it doesn’t last?
It doesn’t last for very long no. It takes me twice as long to do things now.
So you are quite conscious of health messages?
Absolutely yes.
You link those in. And where does sleep fit into that?
Sleep at the moment is a disappointment I suppose, because I feel I’ve improved by life style by doing all the things, diet, exercise and all this, and I’d hope that the sleep would improve more than it has.
So how important then is sleep to you?
It is, if you don’t want me to be bad tempered! 

Les believes getting enough sleep and eating the right kind of foods are equally important in...

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Age at interview: 80
Sex: Male
So I get an impression that you obviously value healthy eating and then are conscious of those links to diet and health?
I hate the word junk food. And I hate junk food. Won’t have it in the house. The only take away meal I will have is, I love fish and about, well, once every seven or eight weeks I will have fish and chips. Now she doesn’t like fish, so I have to get something different for her. But, no, I love fish so therefore I do have a take away I suppose you’d call it.
Yes, so food’s important. How do you feel sleep fits into health. Do you feel sleep is important?
I think it’s very important.
You do.
In what way?
I put it on a par, sleep with food, because without food, without a proper type of food, you can still get, you soon get physically run down.
Others felt that a healthy diet, physical activity and sleeping well were all important, not just for their health, but also if they wanted to carry on with their daily routines.

Eating well, exercising and sleeping well are all important to Jacqui for being able to do the...

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Age at interview: 69
Sex: Female
No I am very careful what we eat.
So that sounds like you have a healthy attitude to life?
Well I hope so. Yes.
Where does sleep itself fit into that? Do you regard it as something that’s important?
Ah terribly important. It goes alongside eating properly and exercising. You know, eating properly isn’t it, having exercise and sleeping are the three main things to keep you going to keep you functioning. To keep you healthy.
Is sleep something, I mean foodis something you go without, but is sleep something you cut short or curtail at any point or something you feel you can manipulate I suppose is what I am asking?
Oh that is interesting.
I have really got to have my sleep. I am a much better, not better person, but more active and I as see it a nicer person if I’ve had my sleep, otherwise I can get very scratchy.
So if you’ve had a really bad night or you have those shifts do you notice a change in your temperament?
Yes. I’m very short tempered.
Are you. So are other people aware of that?
I think they might do yes. I think so. I try not to be but you can’t help it. It is how your body is. 
A lot of the people we talked to, though, had some serious health problems, such as heart disease, stroke, diabetes, arthritis, and prostate cancer. Indeed some of the people had several illnesses at the same time and were unsure which had the most impact on their sleep. Sometimes they thought the illness itself caused them sleeping problems, and sometimes they thought it might be the medications they were taking. Mary wonders whether the medicine she takes for her heart might be stopping her from sleeping well (see 'Sleep medication, other medication and over the counter remedies').
Many of the people we talked to had some form of arthritis, whether it was osteoarthritis or rheumatoid arthritis and this often caused discomfort and pain in the night. Sometimes people talked of finding it difficult to get to sleep because of the pain, or waking up in the night in pain when they have moved. For some it was difficult to get comfortable in bed. Juliet, who has rheumatoid arthritis, has a special bed so that she can sleep partly upright and to help her get up more easily if she wakes up in the night to go to the toilet.

P. had a spell when the pain from arthritis in his hips made it very difficult for him to get to...

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Age at interview: 95
Sex: Male
But then eventually I read a book. I don’t really worry about not going to sleep. I just get a book out and read it, and that gets you through, quite a lot of them I eventually go off. But last year I had a lot of trouble with arthritis. And I couldn’t get to sleep because of the pain, so I used to get up and make myself a cup of tea and come down and look at the television. See all the midnight programmes on the television. And then I would have to doze off in the day time. I was rather short of sleep. But now, at the moment…
So you had this spell when you were in pain?
You were in pain and that was stopping you getting to sleep?
Yes. Hm.Hm.
And did it wake you up in the night as well?
No. No. Once I got to sleep it seemed to be all right. But it was over the hip.
Well that is a bit better this year and I am not actually, when I am in bed it doesn’t get… just walking about it is a bit painful. But actually lying in bed doesn’t seem to make much difference.

Christopher, who also has motor neurone disease, suffered so much pain from a back problem that...

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Age at interview: 68
Sex: Male
I was diagnosed with Motor Neurone Disease in 2002 and I was given two to five years to live and its now 2008 and I’m very lucky that the disease has gone into some sort of stabilisation. My legs are greatly affected by it, but luckily from my thighs up it doesn’t seem to have impinged. It did for a while, and one of the symptoms of that is twitching and I had twitching in my arms and my pectoral muscles which worried me to the degree that I was, we were both worried sick, but that seems to have somehow gone into some sort of holding pattern as it were. But my legs twitch at night and also unfortunately my spine is breaking at the bottom on four and five I think it is, the spine, the actual column has opened up and the nerves inside have been exposed to the elements as it were and I have, in the last three years, I have had very, very severe pain in my legs, it was absolutely terrible and it was so bad that I was falling over and things like that, and together with the very weakened muscles in my legs it made walking very difficult. So luckily I went to a pain clinic and they gave me first of all a drug called gabapentin and then they gave me a drug called pregabalin and they’re drugs that control as far as I know control the brain’s perception of pain and at one stage I couldn’t sleep for any length of time at all, the pain in my leg was absolutely terrible. Terrible shooting pains up my legs, which would keep me awake for hour after hour after hour. I’d get up, and this is something I really should have mentioned before, but I used to get up and just put cold ice packs on my legs and I’d do anything to control the pain and then it was like my, you know, my spiritual moment, when this doctor at Windsor at the pain clinic gave me these drugs and its reduced the pain by about I should think 80%, 70-80%. So now generally I get a good night’s sleep, undisturbed sleep, because of my legs, because the pains have been controlled. If I sit on a seat… if we go out to dinner or we have people in for dinner say and I sit on a dining table for four, or five or six hours somehow it impacts on my spine and my legs start playing up again and the drugs don’t control it completely. But I must admit in general terms apart from that I sleep all right, but for a period of around eighteen months, it was truly horrendous.
Right so you feel that’s all under control now?
Yes. I mean my feet and legs hurt all the time, but not bad enough to keep me awake at night.
Is that linked to the Motor Neurone Disease or is that just a separate issue?
No it’s a double whammy, it is not fair is it. 
Other illnesses also brought pain and disturbed sleep and people tried to manage this pain in different ways. Some took over the counter painkillers, others were prescribed stronger painkillers by their doctor, and some tried their own remedies. Anne puts lavender oil drops on a wheat pack, which she then puts in the microwave to heat up before applying to her back before going to bed.
Those who suffered from diabetes sometimes found their sleep was affected in different ways. A few were very concerned that they may suffer from a ‘hypo’ (hypoglycaemia), where the sugar level in their blood drops dramatically and they may feel unwell in the night. Another common side effect that people with diabetes reported was having to get up to go to the toilet a lot more frequently in the night. Occasionally it was the partners of those with diabetes whose sleep was disturbed. Robert’s wife, who had diabetes, frequently needed help going to the toilet in the night and he was often ‘on guard’ listening for her movements.

Jim’s diabetes means he may have a ‘hypo’ in the night which wakes him up and he has to get up to...

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Age at interview: 78
Sex: Male
So perhaps if you could just start by giving me a description of what your normal night’s sleep is for you as it is now?
Well, I we sit around, watch television up to about ten, ten thirty. Retire at 10.30 to 11. Basically we hope to sleep throughout the night which is not always the case. Due to, as I mentioned earlier, about being a diabetic and suffering some hypos they can come on at any time. Day time or even during night time hours, so consequently if you get one, it sort of automatically triggers things so that you wake up, you know, you can’t have one and continue to sleep. It wakes you up, so you have to do something about it.
So how are you aware that you are having a hypo what happens?
Well it is a strange sort of feeling really, you sort of become disorientated, but of course that doesn’t matter really if you are lying in bed. You are not going to fall down or anything but the point is you have got to make the effort, get a grip of yourself to get out in the kitchen to make a cup of tea, you know. You tend to shake and you lose focus with your vision that sort of thing you know, it can be very bad outdoors anything like that, but of course if you are indoors you are all right.

Juliet not only suffers pain from rheumatoid arthritis, but also has to get up to go to the...

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Age at interview: 69
Sex: Female
I think it is not always the pain, I get, I often get very hot at night and I try and keep… and then I get cold. So you tuck the bedclothes, a bit, you know, a bit like, you know, the old hot flushes, you know, you toss the bedclothes off and then you are cold. It is quite often with diabetes as well having to go to the lavatory. So it is not always the pain, but it is a lot of the time. I am conscious of it. And I am conscious of having quite a low level of sleep before I actually wake up. It is almost as if I take a long time to come round, you know.
So when you wake up in the morning after a night like that, you don’t feel… how do you feel?
I feel pretty yucky actually, but then that is expected with RA and I have learned now how to deal with that. I don’t suppose you ever really feel rested is the word. And I do take a long time to get moving, but that is part of the illness. I knew that from day one, but as I have got older, it has got more severe.
So you were diagnosed in 1996?
Yes, in the October, yes.
Before that how long did you have the diabetes or was it…?
No the diabetes wasn’t diagnosed until four years later. So I was having excellent sleep, you know, I was a straight forward really like I have been all my life. 
Other health problems that disturbed sleep included cramp, twitching and shooting pains in the legs. Some took over the counter remedies for cramp, others were prescribed quinine tablets, or drank tonic water, which contains quinine. Others didn’t take anything for cramp and just got out of bed and stretch their limbs.
One person we spoke to had sleep apnoea which is a condition which causes interruptions in breathing during sleep and often makes people feel very sleepy during the daytime. 

Daniel has been diagnosed with sleep apnoea but hasn’t followed up with this treatment because he...

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Age at interview: 78
Sex: Male
Can you take me back to, you mentioned about this diagnosis of sleep apnoea, could you take me back to that and tell me how that came about, what sort of led up to you seeking help for it and how that happened?
A good question. Very difficult now in 2008 to remember. All I can think of was the snoring that I must have gone to my GP and the GP referred me to the unit in the local hospital. Because they did this research into sleep apnoea, and therefore I was taken on board there and I spent two separate nights, they did one sleep study and then because of the results of that whatever they were, they said we want you to come back and do another one, which I did and that was difficult because I had a camera like this focused on me like that and I found it was hard to get to sleep. I was too aware of it, but whatever, they said I had sleep apnoea and gave me this CPAP machine and as I say it was too much to cope with.
How long did you have it for?
Well I only coped with it for a few weeks really.
Did you have anybody sort of advice you mid-term what they do now, is they go back to you and say how are you getting on, they try and help you get through?
The thing that spoilt it if you like, was when that was diagnosed, because I was on their books as it were, by this time you see we had moved south, so that it split, it cut me off from them, because you know, once they’d done this diagnosis and I’d had this machine and I couldn’t cope with it, I suppose really it was my fault, I could have gone back and said look I’m not coping and can you help me. But I didn’t do that. So there is no responsibility on the hospital. 
Two of the people we spoke to, who also have heart problems, told us how they often wake up in the night with a sensation of finding it a struggle to breathe. If the problem with their breathing continues, they may find that they then suffer a panic attack and have to get up and try and relax to calm their breathing down. They both believed the cause of their breathing difficulties and subsequent panic attacks were worries or stress, but know that they have to get up and calm their breathing down before they can go back to sleep.

Daniel may wake up in the night with trouble breathing, which can lead to a panic attack.

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Age at interview: 78
Sex: Male
I can’t really remember in detail but you see there are a lot of other times, I can’t remember if it was then, but there were times, when I have woken, this is the problem that I think I have had for years, and that is, occasionally I wake up with problems with my breathing. Breathless and for people who don’t have that problem they probably don’t appreciate what it is, but when you are breathless it can lead to a panic attack and I have had them. And it's pretty nasty. You feel you are not going to breathe again and it’s a horrible feeling. So it's your mind as well as the physical side.
How often does that happen?
Thankfully now not so often, but it used to be more frequent. It used to be a big problem, because I can remember I would wake up, and [my wife] would be very helpful to me, you know, reassuring me that everything was okay and that. And of course I had probably woken her up. But it would gets so bad sometimes I would have to say, I’m sorry but I’m going to have to get out of bed and I did and I would get up and go in the kitchen and make a drink of tea and sit down here for sometimes an hour, two hours before I went back, and even when I went back to sleep then it wasn’t good sleep you know. 
Several people we spoke to had more than one serious health problem and sometimes just worrying about their health kept them awake at night (see 'Worries'). Ron has diabetes, prostate cancer and is awaiting major heart surgery. Worrying about his future surgery wakes him up at about three in the morning and he is then unable to get back to sleep. Otto was very anxious that he hadn't heard when he was due to have his cataract operation and the worry over this made him wake up a lot in the night.
Changes that were brought about by prostate problems were mentioned by several of the men we talked to. Some people had prostate surgery for cancer or other problems, whilst others were on some form of medication. All those who had problems with their prostate reported needing to get up more frequently in the night to go to the toilet. Sometimes surgery worked for them and they got up less frequently in the night, but for others surgery made no difference. Otto has had prostate surgery, but believes it made no difference because he still gets up the same number of times in the night.

Fred found the prostate surgery he had has made a big difference to his sleep because he now gets...

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Age at interview: 67
Sex: Male
How I sleep now? Well we basically go up at the same sort of time. Round about elevenish. We never used to go to sleep till… sorry we would never go later then say ten o’clock half past ten when I was working. But because of this problem about not being able to sleep, I said well it would be probably be better if I go later when I would be more tired. So we tried that and it didn’t make any difference. I mean I could be sitting down here and I would sit and do the crossword, if there wasn’t much on the television, I used to do sodoku puzzles as well and then I would go out for a last cigarette, and go upstairs, into bed and by that time I am really feeling tired. I can get into bed and just for some reason I will lay there and initially the first five minutes, lovely, snuggle down like you do, and then all of a sudden, something just seems to wake me up and then I just turn over this side, turn the other side, lay on my back, I can’t sleep on me back or me left hand. I always go to sleep on the right hand side, on my right. And when that doesn’t work, I start to get frustrated then. And, well this is no good, just laying here I am not getting anywhere. Then I come downstairs in the garden, have a cigarette, about twenty minutes or something like that, then pop upstairs again and eventually I would go off.
But it just takes such a long time and then I possibly go to toilet, about say 2 o’clock, because it is only about a year I had prostate operation because I had a bladder problem you know, and that’s made a hell of improvement. It really has, from the point of view of not getting up during the night. But once I do wake up, then it’s a job to get back to sleep again.

Last reviewed October 2018.

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