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Sleep & Growing Older


  Related Articles

  Related Articles
Disorders:
Obstructive Sleep Apnea
Snoring
Inadequate Sleep Hygiene
Insomnia
Adjustment Insomnia
Treatments:
Cognitive Behavioral Therapy (CBT)
CPAP
Medications
Oral Appliances
Surgery

  Related Articles
Problem Sleepiness
Overnight Sleep Study
Narcolepsy
Obstructive Sleep Apnea
Medical Disorders

National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services

I. Introduction

Sleep needs change over a person's lifetime. Children and adolescents need more sleep than adults. Interestingly, older adults need about the same amount of sleep as younger adults -- seven to nine hours of sleep per night.

Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep. A study of adults over 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep.

Also, older people often sleep less deeply and wake up more often throughout the night, which may be why they may nap more often during the daytime. Nighttime sleep schedules may change with age too. Many older adults tend to get sleepier earlier in the evening and awaken earlier in the morning.

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 -- and may awaken because of -- changes in their environment, such as noise.

Older adults may also have other medical and psychiatric problems that can affect their nighttime sleep. Researchers have noted that people without major medical or psychiatric illnesses report better sleep.

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. Poor sleep is also associated with a poorer quality of life.

Many people believe that poor sleep is a normal part of aging, but it is not. In fact, many healthy older adults report few or no sleep problems. Sleep patterns change as we age, but disturbed sleep and waking up tired every day are not part of normal aging. If you are having trouble sleeping, see your doctor or a sleep specialist. There are treatments that can help.

II. Sleep Disorders

If you have a sleep disorder it can be hard to get a good night's sleep. Sleep disorders can make it hard to fall asleep or stay asleep during the night and can make you drowsy during the day. The following are the most common sleep disorders among older adults:

  1. Insomnia
  2. Sleep-disordered breathing, such as snoring and sleep apnea
  3. Movement disorders, such as restless legs syndrome

Insomnia

Insomnia is the most common sleep complaint at any age. It affects almost half of adults 60 and older.

If you have insomnia, you may experience any one or any combination of the following symptoms:

  1. Taking a long time -- more than 30 to 45 minutes -- to fall asleep
  2. Waking up many times each night
  3. Waking up early and being unable to get back to sleep
  4. Waking up feeling tired

Short-term insomnia, lasting less than one month, may result from a medical or psychiatric condition. Or it may occur after a change in personal circumstances like losing a loved one, relocating, or being hospitalized. If insomnia lasts longer than a month, it is considered chronic, even if the original cause has been resolved.

Many factors can cause insomnia. However, the most common reason older adults wake up at night is to go to the bathroom. Prostate enlargement in men and continence problems in women are often the cause. Unfortunately, waking up to go to the bathroom at night also places older adults at greater risk for falling.

Disorders that cause pain or discomfort during the night such as heartburn, arthritis, menopause, and cancer also can cause you to lose sleep. Medical conditions such as heart failure and lung disease may make it more difficult to sleep through the night, too.

Neurologic conditions such as Parkinson's disease and dementia are often a source of sleep problems, as are psychiatric conditions, such as depression. Although depression and insomnia are often related, it is currently unclear whether one causes the other.

Many older people also have habits that make it more difficult to get a good night's sleep. They may nap more frequently during the day or may not exercise as much. Spending less time outdoors can reduce their exposure to sunlight and upset their sleep cycle. Drinking more alcohol or caffeine can keep them from falling asleep or staying asleep.

Also, as people age, their sleeping and waking patterns tend to change. Older adults usually become sleepier earlier in the evening and wake up earlier in the morning. If they don't adjust their bedtimes to these changes, they may have difficulty falling and staying asleep.

Lastly, many older adults take a variety of different medications that may negatively affect their sleep. Many medications have side effects that can cause sleepiness or affect daytime functioning.

Sleep-Disordered Breathing

Sleep apnea and snoring are two examples of sleep-disordered breathing -- conditions that make it more difficult to breathe during sleep. When severe, these disorders may cause people to wake up often at night and be drowsy during the day.

Snoring is a very common condition affecting nearly 40 percent of adults. It is more common among older people and those who are overweight. When severe, snoring not only causes frequent awakenings at night and daytime sleepiness, it can also disrupt a bed partner's sleep.

Snoring is caused by a partial blockage of the airway passage from the nose and mouth to the lungs. The blockage causes the tissues in these passages to vibrate, leading to the noise produced when someone snores.

There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea occurs when air entering from the nose or mouth is either partially or completely blocked, usually because of obesity or extra tissue in the back of the throat and mouth.

If these episodes occur frequently or are severe, they may cause a person to awaken frequently throughout the night. This may disrupt their sleep and make them sleepy during the day.

Central sleep apnea is less common. It occurs when the brain doesn't send the right signals to start the breathing process. Often, both types of sleep apnea occur in the same person.

Obstructive sleep apnea is more common among older adults and among people who are significantly overweight. Obstructive sleep apnea can increase a person's risk for high blood pressure, strokes, heart disease, and cognitive problems.

However, more research is needed to understand the long-term consequences of obstructive sleep apnea in older adults.

Movement Disorders

Two movement disorders that can make it harder to sleep include restless legs syndrome, or RLS, and periodic limb movement disorder, or PLMD. Both of these conditions cause people to move their limbs when they sleep, leading to poor sleep and daytime drowsiness. Often, both conditions occur in the same person.

Restless legs syndrome is a common condition in older adults and affects more than 20 percent of people 80 years and older. People with RLS experience uncomfortable feelings in their legs such as tingling, crawling, or pins and needles.

This often makes it hard for them to fall asleep or stay asleep, and causes them to be sleepy during the day.

Although scientists do not fully understand what causes restless legs syndrome, it has been linked to a variety of conditions. Some of these conditions include iron deficiency, kidney failure and dialysis, pregnancy, and nerve abnormalities.

Periodic limb movement disorder, or PLMD, is a condition that causes people to jerk and kick their legs every 20 to 40 seconds during sleep. As with RLS, PLMD often disrupts sleep -- not only for the patient but the bed partner as well. One study found that roughly 40 percent of older adults have at least a mild form of PLMD.

Another condition that may make it harder to get a good night's sleep is rapid eye movement sleep behavior disorder, also known as REM sleep behavior disorder (RBD). It is somewhat more common in men over the age of 50.

REM sleep, or rapid eye movement sleep, is the most active stage of sleep where dreaming often occurs. During normal REM sleep, the eyes move back and forth beneath the eyelids, and muscles cannot move. In more severe forms of REM sleep behavior disorder, the muscles become quite mobile and sufferers often act out their dreams.

III. Getting Help for Your Sleep

If you are often tired during the day and don't feel that you sleep well, you should discuss this with your doctor or healthcare provider. Many primary care providers can diagnose sleep disorders and offer suggestions and treatments that can improve your sleep.

Before you visit the doctor, it may be very helpful for you to ask for and keep a sleep diary for a week or more. A sleep diary will give you and your doctor a picture of your sleep habits and schedules and help determine whether they may be affecting your sleep.

During your appointment your doctor will ask you about your symptoms and may have you fill out questionnaires that measure the severity of your sleep problem.

It is also helpful to have your bed partner come with you to your appointment since he or she may be able to report symptoms unknown to you like loud snoring, breathing pauses, or movements during sleep.

Since older people are more likely to take medications and to have medical problems that may affect sleep, it is important for your doctor to be aware of any health condition or medication your are taking.

Don't forget to mention over-the-counter medications, coffee or caffeine use, and alcohol since these also may have an impact on your sleep.

The doctor will then perform a physical examination. During the exam the doctor will look for signs of other diseases that may affect sleep, such as Parkinson's disease, stroke, heart disease, or obesity. If your doctor feels more information is needed, he or she may refer you to a sleep center for more testing.

Sleep centers employ physicians and others who are experts in problems that affect sleep. If the sleep specialist needs more information, he or she may ask you to undergo an overnight sleep study, also called a polysomnogram, and/or a sleepiness, or a nap test. A polysomnogram is a test that measures brain waves, heart rate, breathing patterns and body movements.

A common sleepiness test is the multiple sleep latency test. During this test, the person has an opportunity to nap every two hours during the daytime. If the person falls asleep too quickly it may mean that he or she has too much daytime sleepiness.

IV. Treatments for Sleep Disorders

Based on your sleep evaluation, your doctor or sleep specialist may recommend individual treatment options. It is important to remember that there are effective treatments for most sleep disorders.

If you are diagnosed with a sleep disorder, your doctor may suggest specific treatments. You should ask for information to find out more about your condition and ways to improve your sleep.

There are a number of therapies available to help you fall asleep and stay asleep. You may want to try limiting excessive noise and/or light in your sleep environment.

Or, you could limit the time spent in bed while not sleeping, and use bright lights to help with circadian rhythm problems. Circadian rhythm is our 24-hour internal body clock that is affected by sunlight.

Some specialists believe medications also can be useful early in your treatment, and if necessary, you can use them from time to time if you have trouble falling asleep.

People who are diagnosed with sleep apnea should try to lose weight if possible, but often they may need other treatments as well. Adjusting your body position during the night may benefit you if you experience sleep apnea more often when you lie on your back.

The most effective and popular treatment for sleep apnea is nasal continuous positive airway pressure, or CPAP. This device keeps your air passages open by supplying a steady stream of air pressure through your nose while you sleep.

To use the CPAP, the patient puts on a small mask that fits around the nose. Air pressure is delivered to the mask from a small, quiet air pump that sits at the bedside. The patient not only wears the mask at night but also during naps, since obstructions can occur during these times as well.

If you have a mild case of sleep apnea, sometimes a dental device or appliance can be helpful. If your condition is more severe and you don't tolerate other treatments, your doctor may suggest surgery to increase the airway size in the mouth and throat. One common surgical method removes excess tissue from the back of the throat.

Very often, people who suffer from movement disorders during sleep such as restless legs syndrome or periodic limb movement disorder are successfully treated with the same medications used for Parkinson's disease. People with restless legs syndrome often have low levels of iron in their blood. In such cases doctors often prescribe supplements.

Medications can also treat people with REM behavior disorder. If there are reports of dangerous activities such as hitting or running during these episodes, it may be necessary to make changes to the person's sleeping area to protect sufferers and their bed partners from injury.

Many sleep problems will improve with changes that you can make on your own. You can often sleep better by simply following the practices of good sleep hygiene.

Sleep hygiene consists of basic habits and tips that help you develop a pattern of healthy sleep. There are also easy ways to make your bed and your bedroom more comfortable. See the Resources section of this site to find out how you can start down the path to better sleep.

You can also take the Sleep and Growing Older Quiz to test yourself on what you read in this article.

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