SLEEP BASICS

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BASICS:

Along with the physical changes that occur as we get older, changes

to our sleep patterns are a part of the normal aging process. As

people age they tend to have a harder time falling asleep and more

trouble staying asleep than when they were younger. It is a common

misconception that sleep needs decline with age. In fact, research

demonstrates that our sleep needs remain constant throughout

adulthood. So, what's keeping seniors awake? Changes in the patterns

of our sleep – what specialists call " sleep architecture " – occur as

we age and this may contribute to sleep problems. Sleep occurs in

multiple stages including dreamless periods of light and deep sleep,

and occasional periods of active dreaming (REM sleep). The sleep

cycle is repeated several times during the night and although total

sleep time tends to remain constant, older people spend more time in

the lighter stages of sleep than in deep sleep.

Many older adults, though certainly not all, also report being less

satisfied with sleep and more tired during the day. Studies on the

sleep habits of older Americans show an increase in the time it

takes to fall asleep (sleep latency), an overall decline in REM

sleep, and an increase in sleep fragmentation (waking up during the

night) with age. The prevalence of sleep disorders also tends to

increase with age. However, much of the sleep disturbance among the

elderly can be attributed to physical and psychiatric illnesses and

the medications used to treat them.

In addition to changes in sleep architecture that occur as we age,

other factors affecting sleep are the circadian rhythms that

coordinate the timing of our bodily functions, including sleep. For

example, older people tend to become sleepier in the early evening

and wake earlier in the morning compared to younger adults. This

pattern is called advanced sleep phase syndrome. The sleep rhythm is

shifted forward so that 7 or 8 hours of sleep are still obtained but

the individuals will wake up extremely early because they have gone

to sleep quite early. The reason for these changes in sleep and

circadian rhythms as we age is not clearly understood. Many

researchers believe it may have to do with light exposure and

treatment options for advanced sleep phase syndrome typically

include bright light therapy.

The prevalence of insomnia is also higher among older adults.

According to the 2003 NSF Sleep in America poll, 44% of older

persons experience one or more of the nighttime symptoms of insomnia

at least a few nights per week or more. Insomnia may be chronic

(lasting over one month) or acute (lasting a few days or weeks) and

is often times related to an underlying cause such as a medical or

psychiatric condition. (See Insomnia)

It is worthwhile to speak to your doctor about insomnia symptoms and

about any effects these symptoms may have. Your doctor can help

assess how serious a problem it is and what to do about it. For

instance, cutting back on caffeine and napping may help solve the

problem. If insomnia is creating serious effects, complicating other

conditions or making a person too tired to function normally during

their waking hours, this would suggest that it is important to seek

treatment. When effects are serious and untreated, insomnia can take

a toll on a person's health. People with insomnia can experience

excessive daytime sleepiness, difficulty concentrating, and

increased risk for accidents and illness as well as significantly

reduced quality of life. Both behavioral therapies and prescription

medications singly or in combination are considered effective means

to treat insomnia; the proper choice should be matched to a variety

of factors in discussion with a physician.

Snoring is the primary cause of sleep disruption for approximately

90 million American adults; 37 million on a regular basis. Snoring

is most commonly associated with persons who are overweight and the

condition often becomes worse with age. Loud snoring is particularly

serious as it can be a symptom of sleep apnea and associated with

high blood pressure and other health problems. In sleep apnea,

breathing stops – sometimes for as long as 10-60 seconds – and the

amount of oxygen in the blood drops, often to very low. This alerts

the brain, causing a brief arousal (awakening) and breathing

resumes. These stoppages of breathing can occur repeatedly, causing

multiple sleep disruptions throughout the night and result in

excessive daytime sleepiness and impaired daytime function. (See

Sleep Apnea)

Untreated sleep apnea puts a person at risk for cardiovascular

disease, headaches, memory loss and depression. It is a serious

disorder that is easily treated. If you experience snoring on a

regular basis and it can be heard from another room or you have been

told you stop breathing or make loud or gasping noises during your

sleep, these are signs that you might have sleep apnea and it should

be discussed with your doctor.

Both restless legs syndrome (RLS) and periodic limb movement

disorder (PLMD) are neurological movement disorders characterized by

an irresistible urge to move the limbs. In RLS, unpleasant,

tingling, creeping or pulling feelings occur mostly in the legs,

become worse in the evening and make it difficult to sleep through

the night. Its prevalence increases with age and about 10% of people

in North America and Europe are reported to experience RLS symptoms.

About 80% of people with RLS also have PLMD and in one study, it was

found that approximately 45% of all older persons have at least a

mild form of PLMD. Many people with these disorders also report

insomnia and daytime sleepiness.

Treatment of RLS and PLMD involves prescription medications, vitamin

supplements, and developing good health and sleep habits including

avoidance of alcohol and nicotine, regular exercise and establishing

a regular sleep-wake schedule. In the older adult, it is important

to watch for side effects as well as interactions with other drugs.

(See RLS)

As we age, there is an increased incidence of medical problems,

which are often chronic. In general, people with poor health or

chronic medical conditions have more sleep problems. For example:

Hypertension is associated with both snoring and sleep apnea - both

increasing as we age.

Heart failure affects approximately 5 million Americans and as many

as 40% of people with heart failure also have sleep apnea.

Menopause, with its accompanying hot flashes, changes in breathing

and decreasing hormonal levels can lead to many restless nights.

(See Menopause)

Recent studies indicate that up to 50% of cancer patients experience

sleep problems.

GERD (gastroesophageal reflux disease) causes difficulty both

falling and staying asleep. Of heartburn sufferers, about 80%

experience nighttime heartburn, causing discomfort and awakenings.

This is more likely to occur while in the prone (on your back)

position. (See GERD)

Sleep patterns among people with dementia are typically fragmented

and this fragmentation increases as dementia worsens. Sleep-

disordered breathing also occurs more frequently in those with

Alzheimer's disease. Those with Parkinson's disease are more likely

to have RLS symptoms.

Depression is most closely associated with insomnia; depression is a

risk factor for having difficulty sleeping while poor sleep also

contributes to depression. This is especially true for those who

have chronic insomnia. It is estimated that 50% of people with

depression have some type of sleep impairment.

The pain and discomfort of arthritis, and other musculoskeletal

conditions such as back pain, make it difficult to sleep through the

night.

Other conditions such as diabetes mellitus, renal failure,

respiratory diseases such as asthma, and immune disorders are all

associated with sleep problems and disorders.

Medications for chronic medical conditions and the interactions that

can occur when someone takes multiple medications for several

illnesses can adversely affect sleep.

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Reviewed by V. Vitiello, PhD on March 28, 2005

Content for the SLEEPTIONARY™ has been independently created by the

National Sleep Foundation.