A recent survey of 5,525 Canadians, as published in the Journal of Sleep Research 2020, reported sleep difficulties increased from 36 per cent before the COVID outbreak to 51 per cent during the outbreak.
This is problematic because adults over the age of 45 who were dissatisfied with sleep quality have higher odds of multiple long-term conditions (including heart disease, stroke, diabetes, dementia, lung disease) as reported in the Canadian Longitudinal Study on Aging of over 30,000 participants. As well, among 408,802 UK Biobank study participants aged 37 to 73, with a healthy sleep pattern, had a 42 per cent reduction in the risk of heart failure compared to participants with an unhealthy sleep pattern.
Humans spend about 30 per cent of their life sleeping. Our sleep is composed of several sleep cycles throughout the night. One sleep cycle takes approximately 90 minutes and each cycle is comprised of the following five stages:
Stage 1: 4 to 5 per cent – Light sleep, slowed muscle activity, and occasional muscle twitching.
Stage 2: 45 to 55 per cent – Decreased breathing rate and heart rate.
Stage 3: 4 to 6 per cent – Rapid Eye Movement (REM) sleep begins – brain gets rid of dead particulate organic material that accumulated throughout the day.
Stage 4: 12 to 15 per cent – Very deep sleep characterized by rhythmic breathing, limited muscle activity, and delta waves.
Stage 5: 20 to 25 per cent – REM sleep where brainwaves speed up, dreaming occurs, muscles relax, heart rate increases, breathing becomes rapid and shallow.
Sleep is regulated by certain neurochemicals in the brain responsible for producing different aspects of alertness and sleep. Our internal clock, also known as our circadian rhythm, determines when we feel the desire to sleep, as well as our susceptibility to sleep disorders. The circadian rhythm is the 24-hour sleep-wake cycle that governs many physiological processes including production of sleep hormones, gene expression and body temperature.
The two types of problems with sleep are insomnia and sleep-disordered breathing.
Insomnia, where people have difficulty falling or staying asleep, is related to another existing health problem more than 90 per cent of the time. Some common causes of insomnia are depression, arthritis, chronic pain, chronic obstructive lung disease, stressful life events, grief, and medications. This is especially relevant during COVID times, when there is additional financial, psychological, and social stress.
Insomnia in older adults is associated with falls, poor quality of life, deterioration in balance and ambulation, slower reaction or reflex time and slower wound healing.
Sleep-disordered breathing increases with age. It is connected with snoring and feeling tired even after a full night’s sleep, caused by fragmented and/or disturbed sleep cycles. Sleep-disordered breathing is often under-diagnosed and under-treated, which can be dangerous because it increases risks of multiple long-term conditions. Insomnia, heart disease, stroke, sedative drugs, alcohol, smoking and being overweight increase the risk of sleep-disordered breathing.
Am I on the right track with my sleep?
The following checklist can be used in checking that you are advancing your efforts to have good-quality sleep (note that children may require more sleep than what is listed below):
1. I am getting between seven and nine hours of sleep each night.
2. I do not wake up during the night more than once.
3. I am able to go to sleep most nights.
4. I do not sleep during the day.
What are some routines that can help you with your sleep?
• Get up at the same time each morning (even on weekends), regardless of when you go to sleep.
• Develop relaxing pre-sleep rituals, such as reading, and avoiding screen time before bed.
• Avoid caffeine and alcohol within six hours of bedtime.
• Do not smoke at bedtime.
• Exercise regularly – vigorous exercise such as jogging should be done in the morning, and more mild exercise, like walking, should be done two to three hours before bedtime.
What sources of support are there for people who want to have good quality sleep?
Friends and family
Loved ones can help assess and set up your bedroom to be conducive to sleep. Try to eliminate computers or televisions in the bedroom, block as much lighting and sound as possible, or consider using a fan or white noise machine to disguise background noises.
In the community
Seek out peers in the community who also struggle with sleep quality. You can empathize with and support each other. The most helpful peer will likely be someone your age (or generation), gender, disease status, socioeconomic status, religion, ethnicity, place of residence, culture or education.
In the health service
If these self-help strategies are not sufficiently addressing your sleep concerns, talk to your doctor. Use of a continuous positive airway pressure (CPAP) device may be prescribed if you have sleep-disordered breathing. A physician can help rule out any sleep disorders and identify lifestyle factors or medication that might be getting in the way of quality sleep.