How did you sleep, Honey?

I say this to my wife almost every morning. It’s my way of showing affection because sleep is very important. We are lucky in three ways: 1) Despite our many ups and downs, we have a good marriage, even better over the years. 2) Our sleep clocks are quite similar and 3) We are good sleepers …. most of the time. Every once in a while, because of life stresses, one of us doesn’t sleep well. The result? We’re tired and maybe a bit grumpy.

Eating, sleeping, and bowel movements (E-S-BM) are essential. I call them life vital signs. A frail senior is on a good path to an enjoyable day when these needs are met. (Connections and exercise are other key factors.)  In previous posts, we’ve discussed eating and bowel movements. The next several posts cover the subject of sleep.

Sleep gives us energy to begin the day. When we’re sick, a good sleep helps more than any pill. A recent study showed that good sleep results in longer life expectancy. Good sleep optimizes physical, mental, and emotional well-being.

What happens during sleep that reenergizes the mind and body?

When we are awake, we respond to the outside world. When we’re asleep, the body becomes still. The mind becomes less responsive to outside stimuli. But sleep is not the same as shutting down a computer or turning off the car. Instead, sleep is when attention shifts from the outside world to the inner universe. This is nature’s design throughout the animal kingdom. Sleep is the time reserved for the body to take care of itself. Critical work is done during sleep. This includes:

Hormone Regulation

Growth hormone is activated during sleep. It is important for growth in children. However, the hormone is important throughout life. The hormone promotes muscle and tissue repair during sleep.

Cortisol is sometimes known as the stress hormone. It is needed for the body to respond appropriately to the environment. Yet, too much cortisol, like too much stress, is harmful. Sleep lowers cortisol levels. This results in less sugar entering the blood stream. Stress responses are deactivated. Less muscle tissue is broken down. Immunity increases when the cortisol level declines.

Information integration

The brain accumulates a vast amount of information when a person is awake. The brain must then learn from and make sense of this information. This occurs during sleep. The brain deletes unneeded information. Connections are made between important added information and what is already known. The brain fits the two together. Then it stores what it has learned. That is why sleep results in better decisions. “I slept on it” is a common and true statement. Sleep improves cognition, emotions, and motor skills.

Brain waste removal

The brain accumulates waste products during waking hours. An exciting area of study is the glymphatic system (glial lymphatic). This system is activated during sleep. It removes deteriorated brain cells, energy by-products and chemical waste. Each of these interferes with brain function. Beta amyloid and tau are examples of waste that needs to be removed. There is an excess of these in the brains of people who have Alzheimer’s Disease and other dementias.

Muscle relaxation

Muscle tension is higher when a person is awake. Prolonged muscle tension leads to fatigue and injury. Musculature relaxes and recovers during sleep. This includes relaxation of the heart and arteries. The heart rate decreases and blood pressure falls.

What is the impact of poor sleep?

Without good sleep, the brain is not able to process emotional, mental, and physical data. Hormones are not in balance. The body is not restored. These are simple explanations why good sleep is essential. The lack of good sleep leads to confusion, irritability, and impaired physical performance.

The hospital doctor who has not slept all night will not make the best decisions in the morning. In addition, the doctor is less likely to be in a good mood. Likewise, a sleepy surgeon is more likely to make a mistake.

A frail person is more likely to fall after sleeping poorly. A person who has Alzheimer’s Disease is more likely to be confused and irritable. A person with heart failure is more likely to become acutely ill. A diabetic person is more likely to have uncontrolled blood sugars.

What is a good sleep?

I have had patients tell me they sleep terribly. The spouse then says that the patient is incorrect. “He’s always sleeping!!” But the patient is correct. Good sleep is not just quantity, it is also quality. Long sleep is not the same as good sleep. In fact, sleeping too much can be harmful. A good sleep is when all the work that needs to be done during sleep is done. The person then wakes up feeling refreshed and energized.

Imagine a day in which there are many interruptions. The day does not go smoothly. Although a person is awake, little is accomplished during the day. This is similar to poor sleep. Fragmented sleep means that sleep cycles are interrupted. As a result, the work that needs to be done during sleep is not completed. After this poor-quality sleep, a person is less alert and less attentive. The person is not refreshed. Thinking is disorganized.

7-8 hours of sleep are recommended for adults. The recommendation does not change with aging. But this recommendation does not consider the fact that there are many types of seniors. A 75-year-old person who has the body and health of a 40-year-old probably needs the same amount of sleep. But the 72 year old person who has severe COPD needs much more. Many frail seniors have Alzheimer’s Disease. Their sleep is very fragmented. Improved sleep results in better mood, cognition, and quality of life.

Good sleep must be custom fit for frail seniors. Figure out sleep patterns that bring out the best in a person. Determine if a person does better with a longer sleep and/or a nap. Good sleep will maximize mental, emotional, and physical wellbeing. We should all find out what sleep pattern is best for each of us. After all, Lebron James does not sleep the recommended amount. He sleeps for peak performance. (see box)

What do Albert Einstein and Lebron James have in common?

Lebron James is one of the greatest basketball players of all time. Albert Einstein is one of the greatest scientists of all time. What do they have in common?

They are not normal sleepers. They do not sleep the recommended amount of time. Lebron James sleeps an average of 12 hours. Einstein slept an average of 10 hours. And he was also an enthusiastic fan of naps. Both these people know the power of sleep.

Posted in Active Aging, Caregiving, Dr. Warren, Geriatrics with Aloha and tagged , , , , , , , , , .


  1. Another highly informative article! Keep up the great work, Warren. In this point of my aging process, you are my favorite source for information. You are the rock star of geriatrics!

  2. Dear Warren, thank you SO much for these wonderful informing articles you give to us all.
    Learning us/me a lot about “landscapes” of elderly people. With such care, respect and warmth.
    So carefully giving us all much wider views to this (for me) rather unknown world. Great. Once more thank you so much!

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