Sleep and Aging

SLEEP AND AGING
By: Paul F. Schmook, RPSGT, Administrator
Rocky Mountain Sleep Disorders Center - Great Falls, MT 

Sleep is vital to our well being.  Since most people spend roughly one-third of their lives asleep, it’s easy to relate the quality of sleep to the quality of life.  Unfortunately, sleep complaints are very common in the elderly.  As we age, beneficial sleep and sleep maintenance deteriorates.

There are many differences in sleep between the young and the elderly.  First of all, older adults experience numerous brief arousals during the night.  This is one of the reasons why the elderly have difficulty maintaining or achieving deep sleep.  These brief awakenings are often so slight that a person undergoing these events won’t normally realize this is occurring.  However, micro-arousals will generally fragment sleep, thus preventing the elderly from entering deeper stages of sleep, which is necessary in repairing muscle tissue.  There is considerably more napping among the elderly and less of a drop in body core temperature during sleep.  Finally, the elderly prefer earlier bedtimes and wake up earlier as well.

As we age, we are faced with a much higher increase of many sleep disorders.  The most common disorder is called Sleep Apnea.  Obstructive Sleep Apnea is found in approximately 28% of males and 24% of females over the age of 60.  This is a disorder in which involuntary breath holding during sleep occurs several times an hour.  This happens when the muscles holding the airway open relax during sleep, narrowing and obstructing the throat. This then prevents the flow of air into the lungs, causing suffocation and stress to the heart.  Some symptoms of Sleep Apnea are snoring, high blood pressure, morning headaches, obesity, apnea witnessed by bed partner, frequent arousals and daytime sleepiness.  If Sleep Apnea is left undiagnosed or untreated, medical complications such as congestive heart failure and pulmonary hypertension may be a result.  Continuous Positive Airway Pressure (CPAP) or similar forms of ventilation are typically the gold standard treatment of Sleep Apnea.  This consists of a small nasal mask which is placed over the nose during sleep and is connected to tubing to an air pressure pump that is placed on a night stand and plugged into a wall socket.  Air pressure from the tubing is transmitted through the nose into the throat, propping the airway open and preventing it from collapsing during the night.  The removal of the excess tissues of the soft palette through surgery is another form of treatment for Sleep Apnea.  Oral or dental appliances are another option. 

Another sleep disorder more prominent in the elderly is Restless Legs Syndrome.  This involves a creeping or crawling sensation in the legs when the body is at rest.  A person affected by this disorder may often have to walk to relieve this symptom.  Once a person falls asleep, restless legs syndrome can sometimes turn into another sleep disorder appropriately called Periodic Limb Movement.  People with this condition will kick or twitch their legs throughout the night, causing sleep fragmentation for themselves and bed partners.  The sleep fragmentation caused by the previous nights activities will often lead to daytime drowsiness.  Both disorders are normally treated with medication. 

The elderly generally have more medical complications than younger adults.  Heart failure, breathing problems, gastric reflux and chronic pain from arthritis for example, prohibit people from sleeping well.  Other medical problems such as psychiatric disorders commonly impair sleep, as does dementia.  “Sundowning” refers to an increase in agitation and disorientation at night.  It frequently occurs in the demented elderly person, and is a major cause for nursing home placement, as families are unable to deal with another family members nighttime behavior.

Poor sleep habits can lead to impaired sleep and can create other sleep disorders as well, including chronic insomnia.  Some of theses bad habits include keeping an irregular sleep schedule, evening nicotine, caffeine and alcohol intake, and adverse conditioning by spending to much time in bed.  It is recommended that people avoid nicotine, alcohol, sleeping medication over a seven day period, and establish consistent bedtimes and wake times, weekends included.  Avoid exercise and eating heavy or spicy meals before bed, and keep the bedroom dark and cool.  Other suggestions include refraining from watching television or reading in bed, hence keeping the bedroom dark. 

Finally, those who suffer from Advanced Sleep Phase Syndrome are people who sleep and wake at earlier times than what is considered normal, or at inconvenient times.  An example of this is a person who retires for the evening at 7:00 pm and wakes at 4:00 am.  Elderly who have this condition sleep earlier than their desired clock time.  Complaints of difficulty staying awake during evening social functions is an indicator, as well as insomnia at the end of the sleep period.  Delayed Sleep Phase Syndrome is just the opposite.  People go to bed much later than normal, and wake late in the morning or early afternoon in some cases.  People with Delayed Sleep Phase Syndrome will have difficulty staying awake during daytime activities.  Both Advanced and Delayed Sleep Phase Syndromes can be treated by maintaining proper sleep hygiene and by using bright light and chronotherapy devices.  

Trouble falling asleep at night or persistent daytime somnolence is not normal at any age.  Sleep disorders which indulge daytime sleepiness have many negative effects on performance and health.  People who have not had a good nights sleep may have greater difficulty concentrating, reduced energy, mood swings and are at greater risks for accidents.  Sleep disorders should be taken very seriously as some may be life threatening if not treated.  The good news is there are treatment modalities for the majority of the 85 different types of sleep disorders.  If you suspect that you may have a sleep disorder, promptly contact your healthcare provider or a sleep disorders specialist in your area.  Make a good night’s sleep more than just a dream.  It’s definitely worth it for you and you family.