What Are The Signs Of Sleep Changes In Older People?
Your hair is turning gray, vision is changing, 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.
When you were younger, you probably fell asleep quickly and slept soundly. As you’ve aged, you may find settling down to sleep more difficult; or you may awaken more often and it may take longer to fall back to sleep. The honk of a car horn or the bark of a neighbor’s dog may be enough to disturb your sleep. Maybe you find yourself dozing off more easily while watching TV, reading the newspaper, sitting at a show or even just relaxing. These are normal age-related changes, but 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. That’s why it is important for you to try to recognize which changes in your sleep are normal signs of aging and which are signs of other problems.
This may be a bit difficult to do, considering normal age-related changes can disguise some sleep disorders. Medical or psychiatric illnesses especially those involving pain or depression may actually promote sleep disorders, especially in older people. This can make it difficult for our healthcare professionals to tell which problem came first.
Our best chance at identifying and coping with changes in our sleep, whether brought on by illness or normal aging, is to learn about sleep and distinguish fact from fiction when it comes to aging’s effects on our sleep. For instance, 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.
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.
In addition, 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.
What Are The Common Causes Of Sleep Problems In Older People?
According to a panel of experts from the National Institutes of Hea1th, more than half of all people age 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 arthritis are typical causes of sleep problems. Even pain, fever, 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. While people over age 65 make up only about 13% of the American population, they take more than 30% of prescription drugs and 40% of all sleeping pills. Studies show that some commonly used drugs may not work well in older people, and may even make sleep problems worse.
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. Walking 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 death 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, or exercising too late in the day. Sleep problems can be the result of hospitalization, recovery after an operation, or travel. They may care up during times of worry, or may smolder under constant stress.
What Can I Do?
As we age, we often become more sensitive to emotional stresses and to the external factors that can disrupt our sleep. Becoming aware of your habits, such as what you eat and drink, what medications you take, when you exercise, and what you think about, is a good first step in addressing simple sleep problems.
For instance, some older people find that their minds race and their worries overwhelm them when they lie down to go to sleep. It can be helpful to set aside a time during the day for a “worry timeout” to allow for the consideration of problems and the formulation of solutions. With worry out of the way, bedtime can be devoted to relaxing. ‘Trying harder to sleep by staying in bed with our racing thoughts and worries will usually only make matters worse.
As we age our internal sleep “timing” (also referred to as our circadian rhythm or internal clock), which regulates our bodies to sleep and wake at the same time each day, may take longer to adjust to changes. if you still work but have irregular work hours, it may be harder for you to deal with schedule changes. Or if you travel often, it may become more difficult for you to adjust to the changes brought on by jet lag and crossing of time zones.
Temperature, light, and noise changes can also affect your internal clock. So it is important to try to keep your environment and your schedule as comfortable as possible and to avoid sudden or drastic changes.
If you suffer from insomnia or simply lead a quiet or restricted lifestyle, try to avoid sleeping too much during the day. A general rule to follow is to try to confine your sleep to nighttime or a brief (no more than one hour) nap.
Staying physically active can also help keep you from sleeping too much during the day, and improve your nighttime sleep. Walking, gardening, strength training, stretching, and yoga are good exercises for sleep. Check with your healthcare professional before starting an exercise program.
if you fall asleep too early at night or waken too early in the morning, getting some bright sunlight in the afternoon may help you to stay up a little later and sleep later in the morning.
What Specific Sleep Disorder Could I Have Or Develop Later?
Sleep Apnea
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 apnea therefore may cause problems while sleeping (not getting enough oxygen) or during the day (causing daytime sleepiness). Sleep apnea 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, particularly loud snoring, might be a sign of a sleep problem.
Obstructive Sleep Apnea (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 disturbance causes brief awakenings 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 apnea may contribute to difficulty thinking and concentrating during the day, and may cause heart or lung disease, hypertension or diabetes if left untreated. Quality of life and interpersonal; relationships with friends and family may suffer.
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 Apnea (CSA)
People with CSA may or may not snore. When the central nervous system breathing fails to work properly, sleepers may sigh 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 well before 9:00 pm. And they wake up earlier than desired, often at 3:00 or 4:00 am. 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 social life, since it is frustrating to be awake early in the morning while others are still 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:
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. Bed partners sleep is also disturbed.
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 bedsheets 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 medication or treatment.
Rapid Eye Movement (REM) Sleep Behavior Disorder
Ordinarily the body is virtually paralyzed during dream sleep. This normal REM sleep-related muscle paralysis does not occur in people with REM sleep behavior disorder.
People with this disorder literally act out their dreams. They may crash into furniture, break windows, or fall down stairs, injuring themselves and sometimes their bed partners. Most sufferers 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. Bed partners should also sleep in separate beds. 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, wandering, and confusion (sometimes called sundowning) 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.
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 behavior.
After an appointment is made at a sleep center, a sleep log of your sleeping and waking patterns may be needed before you are seen at the center.
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- sized 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 test, 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 throughout 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 medications 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 – get their drowsiness-inducing effect from antihistamines. Like prescription sleep aids, OTC drugs may cause sleepiness the next day, and require similar caution.
WARNING: A complaint of insomnia sometimes signals disturbed breathing during sleep. It may be a mistake to use sleeping pills, since they tend to make interruptions in breathing occur more often and last longer. If you experience frequent problems sleeping, you should discuss it with your healthcare professional.
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 help 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. One elderly woman, for example, who entered the hospital for a gallbladder operation, informed her physician that she had been taking barbiturates every night for years, and felt that “going to sleep” meant ”taking a pill.” The physician switched her to a safer benzodiazepine.
After the patient returned home, she became agitated and irritable, and another doctor prescribed a tranquilizer. The result was confusion, forgetfulness, and depression. When her doctors recognized that her medications could be the cause of her problems, they stopped them. She quickly returned to her former alert self.
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.