Duration of Sleep Can Increase Risk of Falling

By | December 14, 2018

Falls may not grab headlines like more sensational causes of injury, but they rank as the second leading cause of accidental or unintentional injury and death worldwide. Every year, more than 37 million falls occur that are severe enough to require medical attention, and 646,000 people die as a result, most of them aged 65 years and older.1

It’s estimated that 1 in 3 older adults falls each year, and the risk increases with age. Failing vision and hearing can contribute to fall risk, as can changes in cognition that may occur with age. Other health conditions like diabetes, foot problems, low blood pressure, muscle weakness and even heart disease may also affect your balance and increase your risk of falling.2

Another important risk factor — one that’s often overlooked — is sleep, or lack thereof. A simple way to lower your risk of falls and related fractures is to ensure you’re getting a good night’s sleep — something that’s elusive to one-third of Americans.3

How Long You Sleep Influences Your Risk of Falls and Fractures

Researchers from the University of Pittsburgh in Pennsylvania used data from more than 157,000 women to investigate the association between sleep and falls.4 Interestingly, there appears to be a sweet spot when it comes to sleep, as both sleeping too much or too little may influence your risk.

The study revealed that, compared to women who slept the recommended seven to eight hours a night, those who slept for less than five hours or more than 10 were about 25 percent more likely to suffer from recurrent falls, defined as falling at least two times in a one-year period.

Along with sleep duration, poor sleep quality, insomnia and other sleep disturbances were also associated with an increased risk of recurrent falls. For short sleepers (less than five hours a night), the risk of fractures, including those in the upper limb, lower limb and central body, was increased.

“In conclusion, short and long sleep duration and poor sleep quality were independently associated with increased odds of recurrent falls. Short sleep was associated with [a] modest increase in fractures,” the researchers said.5 Lead study author Jane Cauley of the University of Pittsburgh said in a news release:6

“Falls are an important public health problem among older adults and lead to moderate to severe injuries. Most fractures occur because of falls, and recent evidence shows that mortality from falls in the U.S. is increasing …

Even though falls are caused by a number of factors, our paper focuses on a novel risk factor: sleep. Results suggest that interventions aimed at improving sleep may reduce the risk of falls.”

Sleep Disturbances Affect Your Bone Health

If you’re sleep deprived, it can make you less steady on your feet and more prone to tripping, thereby increasing your risk of falls indirectly. However, sleep disturbances also have a more direct influence on falls and fractures by influencing bone turnover and muscle strength.7

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Both short and long sleep duration have been indicated as risk factors for osteoporosis, for instance, and a study of older adults revealed that long sleep (eight hours or more a night) was the best predictor of osteoporosis risk.8

In osteoporosis, the net rate of bone resorption (breakdown) exceeds the rate of bone formation, which results in a decrease in bone mass. It turns out that how well you sleep may influence this delicate process, potentially leading to lower bone formation.

In fact, when 10 men had their sleep restricted and their circadian rhythm disrupted for three weeks, it led to an “uncoupling of bone turnover wherein bone formation is decreased but bone resorption is unchanged.”9

“If chronic sleep disturbance is identified as a new risk factor for osteoporosis, it could help explain why there is no clear cause for osteoporosis in the approximately 50 percent of the estimated 54 million Americans with low bone mass or osteoporosis,” lead study author Dr. Christine Swanson, an assistant professor at the University of Colorado, said in a press release.10 It could also help explain why people who sleep too little are at increased risk of fall-related fractures.

Disrupted Sleep Associated With Health Issues That Make Falls More Likely

While sleep may directly affect your bone health, increasing your risk of fall-related fractures, it also relates to falls themselves in complex ways. Sleep influences your health on multiple levels, and is associated with other health problems that may also influence your fall risk, like anxiety, depression, alcohol intake, arthritis, diabetes and stroke. Specifically, as noted in the journal BMC Geriatrics:11

  • Alcohol intake is significantly associated with falls and may also lead to sleep disturbances
  • Both depression and loneliness are associated with falls in the elderly, while depression is linked to sleep problems; loneliness is also associated with more rapid motor decline in the elderly, which could influence fall risk
  • Chronic conditions such as arthritis, stroke and diabetes are associated with both severe sleep problems and fall risk

In the latter case, taking medications such as heart medicines, blood pressure pills or muscle relaxers can further increase your fall risk.

“People with chronic illnesses that affect their circulation, sensation, mobility or mental alertness as well as those taking some types of medications … are more likely to fall as a result of drug-related side effects such as dizziness, confusion, disorientation or slowed reflexes,” according to the National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center.12

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Addressing Sleep Problems May Lower Your Risk of Falls

By addressing sleep disturbances, you may be able to cut your fall risk. Resorting to sleeping pills to help you sleep better isn’t a valid option, however, as taking prescription sleep aids including benzodiazepines (Valium, Ativan) and “Z-drugs” (Ambien, Sonata, Lunesta) is associated with an increased risk of hip fracture, one of the most serious fall injuries, in older adults.13

More than 95 percent of hip fractures are caused by falling (typically falling sideways).14 If you’re having trouble sleeping, my Guide to a Good Night’s Sleep contains 33 tips for improving your sleep. Avoiding exposure to blue light, including LEDs, after sunset is important and easily achievable by wearing blue-blocking glasses after sunset. I also recommend you:

Avoid watching TV or using your computer/smartphone or tablet in the evening, at least an hour or so before going to bed.

Make sure you get BRIGHT sun exposure regularly. Your pineal gland produces melatonin roughly in approximation to the contrast of bright sun exposure in the day and complete darkness at night. If you are in darkness all day long, it can’t appreciate the difference and will not optimize your melatonin production.

Get some sun in the morning. Your circadian system needs bright light to reset itself. Ten to 15 minutes of morning sunlight will send a strong message to your internal clock that day has arrived, making it less likely to be confused by weaker light signals during the night.

Sleep in complete darkness, or as close to it as possible. Even the tiniest glow from your clock radio could be interfering with your sleep, so cover your clock radio up at night or get rid of it altogether.

Move all electrical devices at least 3 feet away from your bed. You may want to cover your windows with drapes or blackout shades, or wear an eye mask when you sleep.

Install a low-wattage yellow, orange or red light bulb if you need a source of light for navigation at night. Light in these bandwidths does not shut down melatonin production in the way that white and blue bandwidth light does. Salt lamps are handy for this purpose, as are natural, nontoxic candles.

Keep the temperature in your bedroom no higher than 70 degrees F. Many people keep their homes too warm (particularly their upstairs bedrooms). Studies show that the optimal room temperature for sleep is between 60 to 68 degrees F.

Take a hot bath 90 to 120 minutes before bedtime. This increases your core body temperature, and when you get out of the bath it abruptly drops, signaling your body that you are ready to sleep.

Avoid using loud alarm clocks. Being jolted awake each morning can be very stressful. If you are regularly getting enough sleep, you might not even need an alarm, as you’ll wake up naturally.

Be mindful of electromagnetic fields (EMFs) in your bedroom. EMFs can disrupt your pineal gland and its melatonin production, and may have other negative biological effects as well.

A gauss meter is required if you want to measure EMF levels in various areas of your home. If possible, install a kill switch to turn off all electricity to your bedroom. If you need a clock, use a battery-operated one.

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More Tips for Reducing Your Risk of Falls

Once you’ve addressed your sleeping habits, what else can you do to improve your fall risk? Safety is key. Remove tripping hazards, such as loose area rugs, extension cords and clutters. Install safety treads to stairways, rubber mats in showers and tubs and grab bars in bathrooms if you feel unsteady on your feet.

Regular exercise is also important, as improving your balance, coordination and strength can significantly reduce your chances of falling. In fact, older adults who took part in an exercise program were 37 percent less likely to be injured during a fall compared to nonexercisers, one study found.15

This included a 61 percent lower risk of having a fall-induced broken bone and 43 percent lower risk of sustaining a fall-related injury serious enough to require admission to a hospital. Quite simply, as you get older, your muscle and bone mass decrease and the senses that guide your balance — vision, touch, proprioception — may all start to deteriorate, and this can make you unsteady on your feet.

However, you can easily combat this with exercise. For instance, eight weeks of balance training reduced slips and improved the likelihood of recovery from slips among the elderly.16

Strength training should also be part of your exercise routine, as it helps you maintain healthy bone mass, prevent age-related muscle loss and strengthen your connective tissues, tendons and ligaments, which help hold your body in the upright position.

Eating right is another strategy, as nutrients including vitamin D (which you can also obtain from the sun), K2 and magnesium contribute to the formation of strong, healthy bones. Optimizing your vitamin D levels alone may cut your risk of falls in half.17

So, while sometimes falls are inevitable, there’s a lot you can do to lower your risk and even prevent falls from occurring. By making sensible changes to your home, eating right, exercising and tending to proper sleep, you can help yourself stay steady on your feet no matter what your age.