Sleep as we Grow Older
Your hair is turning grey, vision is blurring and fine lines are appearing on your face. Even your sleep patterns seem to shift as you grow older. While sometimes hard to adjust to, these are all natural changes in older people, even healthy ones.
COMMON CHANGES IN SLEEP
- settling down to sleep is becoming more difficult
- you may awaken more often
- it may take longer to fall back asleep
- small noises disturb your sleep
- dozing off more easily while watching TV, reading the newspaper, sitting at a show or even just relaxing.
It is important for you to recognise which changes in your sleep are normal signs of aging and which are signs of other problems. Our best chance at identifying and coping with changes in our sleep, whether brought on by illness or normal aging, is to distinguish fact from fiction when it comes to the effects of aging on our sleep.
NAPPING
If you are finding that it is easier to nap during the day, do not assume that this is abnormal or that it is simply an age-related change. Recent research suggests that our bodies are designed for at least one afternoon nap a day. Only later in life, freed from the pressures of work and other heavy responsibilities, can we let ourselves do what comes naturally… nap! Even society’s common misconceptions, such as people needing more sleep as they age, can cloud the facts about our sleep changes. We actually need about the same amount of sleep as we age, but we are likely to sleep less in one stretch than we did when we were younger. As we age our bodies become less skilled at maintaining sound sleep.
FREQUENT AWAKENINGS
Although older people spend about the same amount of time in dreaming sleep (also known as REM or rapid eye movement sleep) as younger people do, they get less of the deeper stages of sleep. They also tend to awaken more often. Studies show that some people over age 60 awaken briefly an amazing 150 times a night! Young adults, on the other hand, wake up briefly about five times a night. Even though these awakenings are rarely remembered the next morning, they may create the impression of restless sleep.
BATHROOM VISITS
Most people over 65 wake up at least once a night for a trip to the bathroom. This too is often a normal age related change.
IMPORTANT!
Repeated problems with sleep – whether you have difficulty falling or staying asleep at night or you fall asleep often during the day – are not normal at any age, and you should see a healthcare professional if your problems persist.
WHAT ARE THE COMMON CAUSES OF SLEEP PROBLEMS IN OLDER PEOPLE?
According to a panel of experts from the National Institute of Health, more than half of all people aged 65 or over experience disturbed sleep. Insomnia is the most common complaint and it can be brought on or worsened by numerous conditions and actions.
MEDICAL ILLNESS
As we get older, we are more likely to develop chronic medical illnesses that can interfere with our sleep. Asthma and other respiratory diseases, heart disease and itching and coughing can contribute to insomnia.
MEDICATION
Many drugs used to treat our medical problems also disrupt sleep. If you take medication for any of the above problems, you should discuss its effects on sleep with your healthcare professional. Even a slight change in the timing or amount of your medication may bring about a change in your sleep and how you feel during the day. Paying close attention to your sleep habits and using relaxation or meditation techniques before going to bed may also help. Some people benefit by having sleeping pills on hand for occasional use, however the overuse of prescription drugs and over the counter medications by elderly people to aid sleep is of serious concern.
ALCOHOL
Alcohol may help you fall asleep quickly but you may find yourself waking a few hours later. Waking too early after drinking alcohol in the evening hours may represent a “rebound” from the use of alcohol. Waking too early may also be the result of aging and a change in your sleep/wake “timing”.
DEPRESSION
Difficulty falling asleep, sleep disruption and waking up too early in the morning can be caused by depression, which is common as we grow older. For some people, depression begins gradually and progresses until “feeling blue” becomes a chronic way of life. Others focus on their poor sleep and become convinced that their lives would be better if they could just get a decent night’s sleep. As poor sleep progresses, some people may stop eating regularly and may lose their usual interest and pleasure in the normal activities of daily life.
LOSS OF A LOVED ONE
Loss of a loved one often triggers insomnia and depression. Surveys show that three quarters of newly widowed people report trouble sleeping a month after the heath of their spouse. One year later, half report that their sleep problems continue.
OTHER CAUSES OF DISTURBED SLEEP
While some older people may focus on trouble with sleep, others may have trouble with mood or performance during the day. Not all sleep disorders have symptoms that are obvious to individuals or to their families.
Trouble sleeping sometimes stems from simple, easily correctable causes, such as
- use of caffeine
- eating heavy meals
- exercising too late in the day
- hospitalization
- recovery after and operation or travel
- times of worry or while under constant stress
WHEN SHOULD I SEEK MY HEALTHCARE PROFESSIONAL’S HELP?
Poor sleep for a month or longer and sleepiness during the day that interferes with normal activities is good reason to see your healthcare professional. Your healthcare professional may even refer you to a sleep specialist, who will conduct a medical history, a physical exam and laboratory tests such as those of hormone function, to help identify certain sleep disorders. The specialist may ask your bed partner or other members of your household about your sleeping and waking behaviour.
After an appointment is made at a sleep centre, a sleep log of your sleeping and waking patterns may be needed before you are seen at the centre.
You may also be asked to spend a night undergoing polysomnography (PSG) sleep monitoring. Monitoring is sometimes the only way to uncover a disorder that occurs during sleep. Before bedtime, a technician will place dime-size sensors at various locations on your body to record brain waves, muscle activity, leg and arm movements, heart rhythms, breathing and other body functions during sleep. These monitoring devices will cause little or no discomfort and will not hamper your movements during the night. Sleep specialists may also want to study your sleep during the day by asking you to nap at two hour intervals. The rate at which people fall asleep on this test, known as the multiple sleep latency tests, records the level of daytime sleepiness.
SHOULD I USE MEDICATIONS TO HELP ME SLEEP?
SLEEPING PILLS
As we grow older our bodies break down drugs less efficiently than when we were younger. Because drugs stay in the body longer as we age their effects may last longer too.
For example, drowsiness – which is desirable at bedtime – is dangerous when driving a car the next day. Ideally, a sleeping pill should help you fall asleep faster and wake up less often, with no “hangover” the next day. Short acting drugs help bring about sleep, but their effects may wear off quickly. Long-acting drugs help maintain sleep through the night, but sometimes cause sleepiness the next day.
Your healthcare professional will prescribe the type of drug and the particular dosage that is right for you. Short acting drugs commonly used to aid sleep include Zolpidem and Zaleplon. These drugs are part of a new class of medication that have shown some usefulness in older persons. They are effective in inducing sleep, but may not necessarily promote longer or less interrupted sleep during the middle and late parts of the night.
Sleeping pills bought without a prescription – known as over the counter (OTC) drugs – gets their drowsiness inducing effect from antihistamines. Like prescription sleep aids, OTC drugs may cause sleepiness the next day and require similar caution.
MELATONIN
Melatonin is a naturally occurring hormone that helps tell the brain when it is time to sleep. Melatonin may be useful for treating sleep problems caused by travel across time zones, but it has not helped with routine insomnia. Since melatonin can potentially produce harm, you should consult your healthcare professional before using it.
MEDICATION INTERACTIONS
The use of inappropriate or multiple medications can cause problems.
IN SUMMARY
The use of prescription sleeping pills alone or in combination with other drugs (over the counter drugs included) must be closely supervised by your healthcare professional.
WHAT SPECIFIC SLEEP DISORDER COULD I HAVE OR DEVELOP LATER?
SLEEP APNOEA
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.