Sleep Disorders And The Elderly
A senior-specific discussion of sleep disorders among the elderly and new ways to address the problem.
Complaints of sleep troubles are especially common among the elderly. In a National Institute on Aging study of over 9000 individuals aged 65 and older, more than half of the people reported at least one chronic sleep complaint. Compared with younger people, seniors tend to achieve less total nighttime sleep. Overall, the wake-sleep cycle in the elderly may be fragmented, with daytime wakefulness interrupted by naps and interrupted nighttime sleep. Afternoon napping often compounds the situation, by reducing the drive for sleep at the usual bedtime hour.
What causes these problems? By the time we're in our 60s or 70s, our sleep-wake cycle doesn't seem to work as well as it once did and our circadian rhythms tend to "flatten out." Our bodies have natural daily ups and downs in measurements such as body temperature and alertness. With age, the distance between the peaks and valleys gets a little less extreme. So sleep/wake rhythms can become less pronounced in older people.
Other lifestyle habits such as excessive alcohol, or caffeine impact our ability to get a good night's sleep. Factors such as illness, poor sleep habits and psychiatric disorders could play a role.
For example, nicotine use has been directly linked to poor sleep. According to the National Sleep Foundation (www.sleepfoundation.org), smokers were more likely than nonsmokers to report problems falling and staying asleep. Smokers also reported more daytime sleepiness. Another study found smokers are four times as likely as nonsmokers to suffer from sleep apnea. Nicotine withdrawal too, can lead to short-term sleep troubles.
Two other common disorders which interfere with sleep are sleep apnea and restless legs syndrome. Sleep apnea causes breathing to stop for a few seconds. This can happen as often as hundreds of times per night, without the person realizing it. Each time it causes the person to wake up a little bit. Those with sleep apnea often snore loudly.
Restless legs syndrome is more likely in the elderly and can significantly interfere with the onset of sleep. Those with the syndrome describe a "creepy-crawly" sensation, usually in the evening. They feel a strong urge to keep moving the legs or to get up and walk around to relieve the discomfort.
Some widely used medications can have stimulating effects and cause sleep disruption. Included among them are some antidepressants, decongestants, bronchodilators, antihypertensives and corticosteroids. Nighttime use of diuretics can promote repeated sleep interruptions to go to the bathroom.
The consequences of poor or inadequate sleep can be significant, affecting all aspects of our lives. For instance, a lack of energy can cause impaired performance on the job. Continued use of sedating medications and chronic loss of sleep can lead to falls, car accidents or accidents in the home. Sleep-disordered breathing may have serious cardiovascular, pulmonary and central nervous system effects. There's strong evidence linking sleep apnea and hypertension. Persistent lack of sleep can made even the most even-tempered souls grouchy and irritable.
But, there's good news for those who shy away from pill-popping. Research is now finding individuals who receive counseling about their approach to bedtime and who refrain from using sleeping pills, have the best long-term chance of getting a good night's rest. Seniors who may already take a number of medications, might find this alternative solution especially appealing.
No single remedy works best for everyone. If you experience mild sleeping problems, here's a few suggestions.
1) If you often wake up during the night, go to bed two hours later than usual. That causes a mild sleep deprivation but promotes deeper sleep.
2) Stick to a regular schedule. Rise in the morning, eat meals at normal times, perform other daily activities at roughly the same time.
3) If you nap, limit your sleep time to less than an hour and avoid napping after mid-afternoon.
4) Avoid caffeine in the afternoon and evening.
5) Do not exercise within three hours of bedtime.
6) Create a nighttime ritual of activities which relax you such as a hot bath, or reading.
7) Go to bed only when you feel sleepy. If you don't fall asleep within 20 minutes, get up and do something relaxing.