Home » Daily News

April 16 - Sleep Problems Are More Likely as We Get Older

The theme of this year's Older Americans Month is "Working Together for Strong, Healthy, and Supportive Communities." Working together, communities can improve older adults' overall quality of life by helping them make changes in their lifestyles that can reduce the risk of disease, such as adequate sleep. Unfortunately, many older adults often get less sleep than they need for a number of different reasons. Poor sleep, as outlined in recent studies, is a precursor to serious health problems such as an increased risk of obesity, cardiovascular diseas,e and diabetes. According to the American Academy of Sleep Medicine, although sleep patterns change as people age, disturbed sleep and waking up tired every day are not part of normal aging.

"As we get older, the amount of nightly sleep that we need remains the same as that of what we needed when we were younger. However, the ability to get the sleep that we need does change. Older people have a hard time getting the sleep they need because of the interference of medical illnesses, the medications they take for those illnesses, and changes in their biological clock," says Sonia Ancoli-Israel, PhD, a professor of psychiatry at the University of California San Diego (UCSD) School of Medicine, the director of the sleep disorders clinic at the Veterans Affairs San Diego Healthcare System, and a codirector of the Laboratory for Sleep and Chronobiology at the UCSD General Clinic Research Center.

It is normal for our body clocks to change as we get older, according to Ralph Downey III, PhD, the chief of sleep medicine at the Sleep Disorders Center at Loma Linda University Medical Center in California; an associate professor of medicine, pediatrics, and neurology at Loma Linda University; and an associate professor of psychology at the University of California at Riverside. "Time stands still for no one. However, with aging, our body clock acts a bit differently. We are less apt to sleep for long periods of time at night than teenagers. Rather, sleep is less deep, and we tend to sleep for shorter periods of time at night, with an increased likelihood of napping in the daytime," says Downey.

There are many possible explanations for these changes. Older adults may produce and secrete less melatonin, the hormone that promotes sleep. They may also be more sensitive to changes in their environment, such as noise, and this may cause them to wake up more often. Further, older adults may also have other medical and psychiatric problems that can affect their sleep. Researchers have noted that people without major medical or psychiatric illnesses report better sleep.

In addition to being a risk factor for a depressive episode, persistent insomnia may perpetuate the illness in some elderly patients, especially in those receiving standard care for depression in primary care settings, a study published in the April 1 issue of SLEEP points out. The study involved 1,801 elderly patients (aged 60 or older) with major depressive disorder and/or dysthymia and found that patients with persistent insomnia were 1.8 to 3.5 times more likely to remain depressed compared with patients with no insomnia. The findings were more evident in patients receiving usual care for depression than in those receiving enhanced care. The findings were also stronger in subjects who had major depressive disorder as opposed to those with dysthymia alone.

A higher periodic leg movement index (PLMI) predicted less sleep at night in older people with cognitive impairment and sleep disturbance, according to a study published in SLEEP on February 1. The study, which focused on 102 people aged 59 to 96 who had a clinical diagnosis of cognitive impairment, as well as average nightly sleep of seven or less hours and daytime sleep of 30 minutes or longer, found that 21.6% had at least one painful condition, and 45.1% were diagnosed with depression. The participants' average PLMI was 17.3, with 33.3% having a PLMI greater than 15. Time in bed at night exceeded eight hours yet participants averaged only 5.5 hours of sleep. PLMI, time in bed, and age explained 43.6% of the variance in total sleep time.

One of the first large-scale studies to examine the association of sleep behaviors, neuromuscular performance, and daytime function in a community dwelling of older women finds that poorer sleep is associated with worse physical function in older women during the daytime, a study published last year in SLEEP found. The study involving 2,889 women found that those who slept less than six hours per night walked 3.5% slower than those who slept 6 to 6.8 hours. Those who slept greater than or equal to 7.5 hours took 4.1% longer to complete five chair stands than those who slept 6.8 to 7.5 hours. With higher wake after sleep onset, gait speed was 9.1% slower. It took 7.6% longer to complete five chair stands, and odds of functional limitation were 1.8% higher. Women with 1 to 1.8 hours of daytime sleep had higher odds of a functional limitation than those with less than 30 minutes.

A study published in SLEEP in 2006 found that longer bouts with insomnia were more common in the older population, who are also more likely to be taking types of sedatives that have particular problems with addiction and side effects.

According to Ancoli-Israel, common sleep disorders in the elderly include the following:

- Insomnia, the most common sleep complaint, which affects almost half of adults 60 and older.

- Obstructive sleep apnea (OSA), which can elevate the risk for high blood pressure, stroke, heart disease, and cognitive problems. Snoring, a symptom of OSA, is a very common condition affecting nearly 40% of adults and is more common among older people.

- Restless legs syndrome, where one can experience uncomfortable feelings in the legs such as tingling, crawling, or pins and needles. It affects more than 20% of people aged 80 and older.

- Periodic limb movements, a condition that causes people to jerk and kick their legs every 20 to 40 seconds during sleep. One study found that roughly 40% of older adults have at least a mild form of periodic limb movements.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention, and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids.

While most people require seven to eight hours of sleep a night to perform optimally the next day, older adults might find this harder to obtain. Older adults must be more aware of their sleep and maintain good sleep hygiene by following these tips:

- Establishing a routine sleep schedule.

- Avoiding utilizing bed for activities other than sleep or intimacy.

- Avoiding substances that disturb your sleep, such as alcohol or caffeine.

- Not napping during the day. If you must snooze, limit the time to less than one hour and no later than 3 p.m.

- Stick to rituals that help you relax each night before bed. This can include such things as a warm bath, a light snack, or a few minutes of reading.

- Don't take your worries to bed. Bedtime is a time to relax, not to hash out the stresses of the day.

- If you can't fall asleep, leave your bedroom and engage in a quiet activity. Return to bed only when you are tired.

- Keep your bedroom dark, quiet, and a little cool.

Source: American Academy of Sleep Medicine

(View the Daily News Archive)