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Don't Lie Awake | Sleep secrets for anyone over 40. | By Susan E. Davis

Weird things have started happening to my sleep at night.

Mostly, I wake up early. As in really early—sometimes around 4 a.m., always by 5. But I also wake up in the middle of the night, startled, I think, by some megaphone hidden deep in my subconscious that picks up a whisper of worry and turns it into a 100-decibel announcement of alarm. “You won’t have enough money to retire!” the voice shouts in my ear. Or “How did 30 years go by without you returning to New England—30 years!” Or “You can’t possibly finish that entire project by 5 p.m. Friday!”

These announcements make it hard for me to sleep.

And not being able to sleep makes me tired during the day, so tired that I sometimes fall asleep before my adolescent children do. Sometimes I even conk out on their beds. In the middle of talking to them.

As it turns out, having difficulty sleeping is not uncommon in middle age, because “aging increases the probability of sleep abnormality,” says Joanna A. Cooper, a neurologist and sleep disorder specialist at Alta Bates Summit Medical Center. That increase is due to a wide variety of factors that affect those of us in the roughly 45-65 age group, only some of which are under our control.

Physically, our brains start secreting less melatonin (a substance that helps regulate our sleep-wake cycle by triggering sleepiness), which means it can be harder to fall asleep. We naturally start spending less time in what’s called slow-wave sleep, the very deepest stage of sleep, which means our sleep is lighter and we wake up at night more easily. Middle-age women may be awoken by the hot flashes and night sweats that accompany perimenopause; many middle-age men have to urinate more often at night, due to an enlarged prostate gland.

In addition, sleep apnea, a dangerous sleep disorder characterized by disrupted breathing, also causes people to wake up repeatedly at night. It affects men more than women—at least until women go through menopause. Then it affects both genders equally, Cooper says. Other conditions related to aging also can do a number on our sleep—including pain (such as from arthritis) and gastrointestinal issues.

Add to that list the psychological woes of middle age and you can see how truly tormented middle-age sleep can be. To wit: We worry about the kids. We worry about the housing market. We worry about retirement. We worry about work. We worry about our aging parents. We worry about global warming (at least some of us do). We worry about how wasted we’ll feel tomorrow at the office, given that we’ve spent the night worrying, instead of sleeping. And then we worry about the fact that we’ve become middle-age people who worry about these kinds of things.


The combination of physical and psychological changes means we baby boomers tend to a) have trouble falling asleep, b) sleep for less time, c) have lighter sleep, and d) wake up more often. The consequences of that can be serious. Besides looking and feeling exhausted, sleep loss can result in:

• Weight gain: When you’re tired, you’re more likely to reach for a high-calorie snack as a picker-upper. But sleep deprivation also messes with your metabolism by increasing the secretion of the hormone ghrelin (which tells you it’s time to eat) and decreasing the hormone leptin (which tells you when you’re full). When those signals get crossed, you can end up wanting to eat more than usual.

• Accidents: Being sleepy, studies show, slows reaction times behind the wheel as much as being drunk. Sleep loss also leads to job-related accidents and injuries.

• Concentration loss: People with chronic sleep loss are less able to focus, reason, and solve problems.

• Mood changes: Sleep loss has been linked to anxiety, irritability, and depression. In one 2007 study, in fact, people with insomnia were five times as likely to develop depression as those without.

• Cancer: Several studies have found that women who get less than six hours of sleep a night are at heightened risk of developing breast cancer, some by as much as 60 percent. Studies have also found that people who sleep fewer than six hours a night are up to 50 percent more likely to develop colorectal adenomas, a precursor to colorectal cancer.

• Heart disease: Short-term sleep loss can raise blood pressure and stress hormones and lead to weight gain and diabetes, all risk factors for heart disease. One study also found that sleep loss leads to a buildup of calcium in the arteries, which itself leads to the development of blockage-causing plaque. In one study of 70,000 middle-age women, Harvard researchers found that women who sleep less than five hours a night are 40 percent more likely to develop heart disease than women who get eight hours of sleep per night.

• Memory loss: Researchers have long known that as we age, we spend less time in deep, restorative sleep. They also have known for a long time that older people have memory problems. But this past January, neuroscientists at U.C. Berkeley reported a link between the two. In a study published in Nature, they reported that structural changes in the brain decrease the amount of restorative deep sleep that older people get. That lack of good sleep, in turn, results in memory loss.

Other studies have found links between older-age sleep problems and dementia, cognition problems, and abilities like logic and . . . what’s the word again? Oh right, vocabulary.

Are the negative effects of sleep loss reversible? “To a degree,” Cooper says. “Sleep debt cannot be repaid easily if the overall sleep loss is very severe and very chronic. Damage to body tissues, such as the heart and kidneys, may not be reversible. Nor is the damage to the brain reversible.”

“But the effects of short-term sleep loss,” she notes, are “certainly reversible. We see it all the time in people who have had serious sleep loss from obstructive sleep apnea. When they get treated, they begin to feel better, their mood improves, they are less tired, they think better and they’re able to perform better in all areas of their life.”


So now you know—despite the fact that you have way too much to do to sleep the recommended seven to nine hours a night, you really do need that much to stay healthy and productive. Unfortunately, baby boomers, while talented in many areas, are not all that great at figuring out how to get that shut-eye. Here are the top three errors they make, according to Samer Morcos, a pulmonary, critical care, and sleep medicine doctor at Kaiser Permanente’s Walnut Creek Medical Center.

• Drinking alcohol to relax right before going to bed. Alcohol might make you sleepy enough to fall asleep. But depending on how much you drink, alcohol can disrupt the deep stages of sleep necessary for dreaming and memory consolidation.

• Staying in bed for more than 30 minutes if you can’t fall asleep or fall back to sleep. This sets your mind up to associate bed not with sleep, but being awake. Morcos recommends getting out of bed to read a book or listen to soothing music in a different environment if you cannot fall asleep within 20 minutes. Then “return to your bed only when sleepy,” he says.

• Watching the clock. If you’re up, don’t count the minutes. That just adds to your anxiety. Instead, keep your alarm clock under the bed or covered up. You don’t need to know that it’s 3:32 a.m. Just focus on getting back to sleep.

Here are some simple (but easy) ways to get better shut-eye:

• If you’re waking up earlier, go to bed earlier.

• Solve underlying medical problems that might be keeping you up, such as pain, depression, frequent urination, or perimenopausal symptoms. Pay special attention to any breathing problems your partner may say you have while you’re sleeping—they may be a sign of sleep apnea.

• Deal with underlying stress. You know the drill by now, right? Exercise. Drink less caffeine. Take up yoga or meditation. Stay in touch with friends and family. See a therapist if you need help.

• Go outside more, so you get enough natural light to keep your circadian rhythms functioning correctly.

• Turn off electronic devices, like computers, televisions, tablets, and smartphones, an hour before you want to fall asleep. They can affect the secretion of melatonin, which can affect your desire to sleep.

• Wake up and go to sleep at the same time every day (even on the weekends).

• Keep pets out of the bedroom, no matter how much you love them.

• Avoid caffeine after noon and alcohol after dinner.

• See your primary care physician or a sleep specialist (if sleep loss is affecting your ability to function).

I have to admit that in the course of researching and writing this article, the combination of sheer fatigue, plus learning how destructive sleep loss can be, and discovering how simple (in most cases) the fixes are, made me change my sleeping tune, big time. I don’t think I can stop waking up at 4 or 5 a.m. My clock just seems to be set there and the cats—did I mention the cats?—seem to think that 5 a.m. is a fine time for humans to wake up.

But I’ve started going to bed earlier, watching my caffeine intake in the afternoon, and building in at least 15 minutes of yoga or meditation a day to help me deal with stress. As a result, I am sleeping more soundly at night. I look and feel more rested. And—surprise, surprise—I’m better able to deal with the many challenges I have to deal with as a middle-age working mother in the busy, busy Bay Area.

Susan E. Davis is a senior editor for WebMD Magazine. Once a night owl, she has learned to love the sunrises, because now that she has reached middle age, she is always awake for them.



Up all night: There are lots of easy ways to improve poor sleep, say experts, including not watching the clock in the middle of the night. Photo by Tom Baker.