TIREDNESS...but not much sleep

Working past normal retirement age and thinking I was fit enough to do so, I nevertheless feared falling asleep in front of my clients in the afternoon: too tired to concentrate, too committed to cancel. I’d keep myself awake by eating a couple of squares of dark chocolate, sipping cold water, repositioning myself in my chair and, in extremis, pressing fingernails into the palms of my hands. I’m sure I didn’t fool all the people all of the time, and I’m sorry about that. Like the proverbial frog in slowly boiling water, not everyone knows the right time to jump.

No surprise then to find myself mentally and physically exhausted when I did retire, a bit like the first week of a much-needed holiday but lasting a lot longer. I felt heavy, lethargic, wondering if I’d ever feel like working at anything ever again. Done in.

When I look around at my peers at this age, I note that the most exhausted are not those still working but those committed to regular grandparenting. The real love and joy in grandparenting is only matched by the fatigue, childcare being tiring at any age but more so with gradual decrepitude. Wanting to be useful, seeking ways to express familial love, I see that it can be hard to admit “I can do no more” to equally tired parents.

The next group of tired older friends are the ones with long term physical illnesses. Pain is exhausting, especially when it doesn’t seem to ameliorate with treatment. I am thinking particularly of those with joint, bone or muscle pain but at this age there are the longer term illnesses of cancer, heart disease, diabetes, COPD etc to contend with too.

And then there are those looking after a spouse or older relative with ‘care needs’. Putting someone else first, attending to their every need when you yourself are tired, is a hard gig. 65-plus carers looking after the elderly are not uncommon these days.

It took two years for me to recover fully from my working life, but eventually I did, energy coursing back into my body and brain as if I’d woken from a deep sleep. I find I can do cryptic crosswords again; I walk faster and longer each day; I engage more, talk more, have ideas and want to act on them. I don’t think this is uncommon: my father reported how easily he could memorise cards at the Bridge table a couple of years after his retirement. I am certainly more tired than I was at 26 years old but, if I compare myself to how I was at 66, I have more energy now.

However, tiredness does not necessarily translate into sleep.

I’ve checked this out with older friends and most of us seem to have difficulty either going to sleep or staying asleep or sleeping long enough at night. Some have started taking sleeping pills. Many of us take naps during the day. Why has sleeping at night become so hard?

My own night time malaise is temperature control, with occasional surges of heat that haven’t gone since the menopause, and frozen extremities in winter. I now wear bed socks and a bed jacket to counteract the cold. I keep a glass of water by the bed in case of dehydration but if I drink too much I need to get up to the bathroom, another interruption.

There is a theory that we were all much more in tune with our natural Circadian rhythms in the pre-industrial age when we woke with the daylight and slept in the dark. The coming of electric lights and working from 9 am to 5 pm, whatever the season, led to forcing our waking and sleep times into the demands of industry. But this alteration to our natural rhythm must surely apply throughout our lives, not just when we’re ageing, so I’m not convinced it has that much bearing on broken sleep in older age. In retirement, we can make more choices about when we sleep and, far from resting more in the dark, it appears older people want to close their eyes during the day.

(Those who study these things have come up with a list of barriers to sleep in older age - see below.* And I am not going to rehearse well-known ‘sleep hygiene’ advice - it’s available at the click of a mouse, though one piece of advice is not to go on your screens at bedtime).

What do I think about tiredness in old age? I think it’s a full life lived in a body that is, quite naturally, physically and mentally declining. I think it’s a natural longing to rest more, but an understandable fear of stopping active living. I think it’s difficult to let go when there is much to worry about: young and middle aged adults might be stressed, but older people have their own concerns: the health of others and themselves; loss of memory, loss of identity, loss of important relationships; things done and not done; older loved ones and younger ones; about lack of money; about living alone.

I wonder if the broken nights of older age also have a link to the more primitive anxieties that psychoanalysts talk about: am I alone in the world? will anyone love me just as I am? can I trust my own body not to hurt me? will I ever wake up from this sleep? Like the infant who wakes every couple of hours to check that the parent is there, getting older reconnects us with our physical dependency and the life-giving love of others. Older people are transitioning to a less secure phase of life when we hope for some internal resolution to our lives, and hope that there will be enough goodwill in others to sustain us through difficulties, but we cannot be sure. Perhaps daytime with its light, noise and people, is reassuring enough for the older person to let go of these largely unconscious anxieties and rest - but at night, of course, there is more aloneness, more awareness of bodily changes, more a sense of time being limited, more of the persecutory conscience and anxiety that goes with that. I am thinking too of the need for ‘transitional objects’ that enable a crying baby to sleep - the teddy bear, the dummy… is this why I prefer a hot water bottle to an electric blanket? Of course it is!

So I think ‘soothing’ is the name of the game, much like an infant needs rocking to sleep and a warm bed, someone to cuddle, a full stomach, darkness and quiet. Those things are less easy to come by in older age when more of us sleep alone (divorce, death, separate beds) and uncomfortable bodies disturb us at night. I do know one older friend who sleeps well, but she uses both wine and sleeping pills in the evening, so I consider that cheating. But I can think of others, the childless, who didn’t have their sleep disrupted in their middle years - they seem to do better. There’s masturbation, of course, but sexual desire generally drops off by this age and that means less of the deep relaxation that goes with orgasmic sex. My own remedy to waking up in the night is to have the radio on very quietly at night. If I wake, the World Service bores me gently back to sleep in 5 minutes. Others I know are listening to a music channel. Even couples sharing the same bed use this solution, keeping the sound on just enough to hear but not loud enough to wake the other person.

And if all else fails, there’s medication of one kind or another. I see there’s a new sleeping pill on the market for chronic insomnia (Daridorexant), which you can take for longer with fewer side effects, so perhaps we’ll all be on that soon. But in the meantime, that daytime nap calls….

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*Those who write about sleep difficulties in older age (eg https://www.sleepfoundation.org/) point to the following:

• ‘Nocturia’ (needing to urinate at night) affecting both men and women, but particularly men with prostate problems

• The pain of arthritis and rheumatism in the joints

• Irregular heart beats, chest tightness, coughing

• Restless legs, fragile bones, weak muscles

• Digestive issues and the side effects of medication

• Snoring - yourself or your partner

• Anxiety and depression