In this disorder, breathing stops for brief periods of time over and over again during sleep. In order to start breathing, the person needs to wake up, often very briefly. Sleep apnoea therefore may cause problems while sleeping (not getting enough oxygen) or during the day (causing daytime sleepiness). Sleep apnoea disrupts sleep to varying degrees for an estimated one in four people over age 60. The primary symptoms are daytime sleepiness and loud snoring.
In some cases disturbed breathing is obvious to bed partners because the sleeper snores loudly. Snoring reflects a partial blockage of the airway during sleep which generally increases with age. Although snoring may seem harmless, snoring, and particularly loud snoring might be a sign of a sleep problem.
OBSTRUCTIVE SLEEP APNOEA (OSA)
A particular type of snoring – that caused by OSA – demands a visit to a healthcare professional. Such snoring consists of loud snoring with snorts and gasping, followed by pauses in breathing due to a narrowing or closure (obstruction) of the throat. The breathing disturbances causes brief awaking which disrupt sleep, but are not usually remembered in the morning.
Some people with OSA awaken hundreds of times a night and feel excessively sleepy during the day. Sleep apnoea may contribute to difficulty thinking and concentrating during the day and may cause heart and lung disease, hypertension or diabetes if left untreated.
Weight loss and sleeping on one’s side can be helpful in some mild cases. Severe OSA requires treatment. Continuous positive airway pressure (CPAP) is a device that uses air pressure to keep the throat open and is the most effective treatment. Surgery and oral appliances can help some patients.
CENTRAL SLEEP APNOEA (CSA)
People with CSA may or may not snore. When the central nervous system breathing fails to work properly, sleepers may sign frequently or appear to have shallow breathing. In the morning they may remember the frequent awakenings and complain of light and broken sleep.
Treatments for CSA include oxygen, CPAP and a variety of medications. Some of these treatments have side effects and should not be used without a complete evaluation with a healthcare professional.
ADVANCED SLEEP PHASE SYNDROME (ASPS)
The tendency to be “early to bed and early to rise” increases as we grow older. Many people adapt successfully, but some people find that their bodies are ready for bed earlier than they desire, often their bodies are ready for bed earlier than they desire, often well before 9pm. They wake up earlier than desired, often at 3am or 4am. This pattern of getting sleepy early in the evening and waking up early in the morning is called advanced sleep phase syndrome.
ASPS can disrupt a person’s life since it is frustrating to be awake early in the morning while others are sill sleeping. It is also hard for the person with ASPS to stay awake later in the evening when others want to take part in social activities.
People with ASPS often try various strategies to stay up later. Even if they are successful in staying up later they may not be able to sleep any later in the morning since their body clocks still wake them early.
One solution sometimes used by healthcare professionals to treat patients with this condition involves exposure to outdoor light late in the afternoon and, when possible, in the early evening.
Bright light affects the timing of the sleep/wake cycle and causes a delay in the feeling of sleepiness in the early evening. It also postpones early morning awakenings. In general, you should avoid sitting in a dark or unlit room during waking hours.
PERIODIC LIMB MOVEMENT DISORDER (PLMD) AND RESTLESS LEG SYNDROME (RLS)
Perhaps half of all people age 65 and over experience twitching in the legs and sometimes in the arms during the night. These muscle jerks may occur infrequently or as often as once or twice each minute for an hour or two at a time. PLMD usually doesn’t completely awaken the sleeper, but it does interfere with sound sleep.
When PLMD is mild the person may be unaware of any impact on sleep or daytime functioning. When it is moderate sleepers often complain of insomnia, reporting restless nights and waking to find the bed sheets in a tangle. When it is more severe, people often feel very sleepy during the day.
People who have PLMD during sleep may also experience restless legs when awake. This syndrome causes a peculiar crawling, uncomfortable feeling in the calves or thighs and occurs when the person is sitting or lying down.
A variety of medications can ease this problem. A healthcare professional should determine the best medications or treatments.
RAPID EYE MOVEMENT (REM) SLEEP BEHAVIOUR DISORDER
Ordinarily the body is virtually paralyzed during dream sleep. This is normal REM sleep related muscle paralysis does not occur in people with REM sleep behaviour disorder.
People with this disorder literally act out their dreams. They may crash into furniture, break windows, or fall down, injuring themselves and sometimes their bed partners. Most suffers are men over age 50, which suggests that age plays a role in this disorder. It is also common in persons with Parkinson’s Disease. Safety precautions, such as removing sharp objects and furniture from the bedroom, should be taken. A healthcare professional should be consulted for treatment of this disorder.
WANDERING AND OTHER DISTURBANCES
Seventy percent of caregivers who decide to institutionalize an older person in a nursing home refer to sleep disturbances, wander, and confusion (sometimes called sun downing) as a factor in their decision. Most caregivers report that their loved one’s problems disrupt their own sleep as well.
Two thirds of people living in nursing homes suffer sleep disturbances, prompting widespread use of tranquilizing drugs. Unfortunately, these drugs can contribute to further confusion and an increased likelihood of falls. Physical and social daytime activities, curtailing daytime napping, light and reducing noise in the nursing home at night may help.