"Americans need more sleep. We may be the most sleep deprived culture in history," says Alan Kominsky, MD, an otolaryngologist and sleep specialist at the Cleveland Clinic Sleep Disorders Center. "People sleep less as they get older and many seniors complain bitterly about lack of sleep."
"Sleep patterns change substantially throughout the lifespan, from infancy to childhood, and into adulthood. During the last decades of life, sleep evolves even further. Unfortunately, the changes seen in the elderly are almost always negative in nature, and cause distress, mood changes and an overall decline in the quality of life." —Geriatrics & Gerontology International
A recent review article published in the journal Geriatrics and Gerontology International states that aging is associated with changing sleep patterns that lead to reduced stages of restful sleep as well as increasing periods of wakefulness. Sleep disorders such as restless leg syndrome and obstructive sleep apnea also increase with age. Identifying and managing sleep problems in the elderly is important because lack of sleep can contribute to depression, memory impairment and physical disease.
Causes of Sleep Disturbance
In addition to the natural changes in sleep patterns that occur with age, there are many other reasons for sleep problems in the elderly. "There are many factors," says Dr. Kominsky, "including arthritis pain, sleep apnea from loss of muscle tone and enlargement of the prostate gland that causes men to wake up to urinate frequently at night. Seniors in nursing homes may develop sleep disorders because they lose their normal schedule, don't get outside in the sunlight and nap more frequently."
Consequences of Sleep Disturbance
In the past, other than daytime sleepiness, the health consequences of sleep deprivation were not appreciated. We now know that over 50 percent of all older adults complain of significant sleep disturbance and that these disturbances can have serious health consequences:
- Forty percent of people with long-standing insomnia also have a psychiatric disturbance such as anxiety disorder or substance abuse.
- Depression was once thought to cause the type of insomnia characterized by waking early in the morning. Growing research indicates that insomnia itself may be a risk factor for depression.
- Other recent studies have found a connection between shortened periods of sleep and development of diabetes.
- Obstructive sleep apnea in the elderly is associated with decreased blood supply to the heart and the brain as well as decreased mental function.
Help For Sleep Disorders
"Strategies that combine cognitive behavioral therapy with good sleep hygiene work best in the elderly. Sleep medications can be effective if more conservative treatments are not working but must be prescribed with care. Only short-acting sedative hypnotics should be used," says Dr. Kominsky.
A review of 48 clinical trials that evaluated the benefits of non-drug treatments for insomnia found these treatments were successful over 70 percent of the time. These treatment strategies may include:
- Maintaining a regular bedtime schedule
- Limiting alcohol and caffeine
- Increasing daytime sunlight exposure
- Encouraging physical activity
Advice For Caregivers
"If you are a caregiver for a loved one who seems sleepy during the day or whose mental functioning seems to be declining, try observing them during sleep,” advises Dr. Kominsky. “Look for restless sleep, loud snoring or periods of interrupted breathing. These could be signs of sleep apnea which is a condition that increases with age. Sleep apnea can be treated with a continuous positive airway pressure device, a treatment that is well tolerated by seniors." If you suspect a sleep disorder, ask the doctor for a sleep evaluation. Help for sleep problems in the elderly is available and effective.