Sleep And The Elderly

Sleep & The Elderly: Understanding How Sleep Changes as We Age

 

As we age, we often experience normal changes in our sleeping patterns. We may become sleepy earlier, wake up earlier, or enjoy less deep sleep. Although these changes are a normal part of aging, disturbed sleep, waking up tired every day, and other symptoms of insomnia are not a normal part of aging. Sleep is just as important to our physical and emotional health over the age of 50 as it was when we were younger.

So, how many hours of sleep do older adults need?
While sleep requirements vary from person to person, most healthy adults tend to require between seven and a half to nine hours of sleep per night to function at their best. However, how you feel following a night’s sleep is more important than the specific number of hours you spend asleep. Frequently waking up not feeling rested or feeling tired during the day are the best indications that you’re not getting enough sleep at night and may have a sleep problem that needs to be addressed.

Complaints of sleep difficulty are common among the elderly.
In a National Institute on Aging study of over 9,000 persons aged 65 years and older, over one half of the men and women reported at least one chronic sleep complaint.

A variety of issues may interfere with sleep and wakefulness in the elderly.
Among them are:

• acute and chronic medical illnesses
• medication effects
• psychiatric disorders
• primary sleep disorders,
• social changes
• poor sleep habits
• circadian rhythm shifts

Sleep-wake problems may be compounded further by inappropriate treatment initiated by the patient, family members, physicians or other care providers.

The consequences of chronic sleep problems can be considerable.
Loss of sleep or chronic use of sedating medications may lead to falls and accidents. Sleep-disordered breathing may have serious cardiovascular, pulmonary and central nervous system effects. Evidence supports a strong association between sleep apnea and hypertension. In persons with dementia, severe sleep disruption often leads to nursing home placement. For all of these reasons, sleep problems in elderly patients should be properly evaluated and treated.

Several generalizations can be made regarding aging and sleep characteristics.
Compared with younger persons, elderly persons tend to achieve less total nighttime sleep. However, it cannot be assumed that elderly persons require less sleep. Elderly persons have more nighttime arousals and awakenings. Increased daytime sleepiness may be the effect of such a pattern. Overall, the sleep-wake cycle in the elderly may be fragmented, with interrupted nighttime sleep and daytime wakefulness interrupted by naps. The deepest stages of non-REM sleep are frequently reduced or nonexistent in elderly persons; however, REM sleep tends to be preserved. Although a mild deterioration in sleep quality may be normal in the aging process, an elderly patient’s complaint of significantly disrupted nighttime sleep or impaired daytime functioning because of excessive sleepiness must be evaluated.

Another common age-associated sleep change relates to the circadian rhythm of the typical sleep period. Although exceptions exist, elderly persons tend to go to sleep earlier in the evening and to awaken earlier in the morning. Early-morning awakening is a common complaint in the elderly. Some people find it annoying to awaken spontaneously at 4:30 a.m. instead of at 6:30 a.m. In these persons, if the onset of evening sleep is not correspondingly earlier, sleep deprivation and excessive daytime sleepiness may result.

Daytime napping may compound the problem by reducing the drive for sleep at the usual bedtime hour, resulting in delayed sleep onset and a further decrease in the duration of nighttime sleep.

Less common in elderly persons, but sometimes dramatic, is the development of a “night owl” pattern, with bedtime delayed until the early-morning hours. This sleep-wake cycle may have been tolerated in the younger years during employment, when the cues of early-morning bright light were stronger and the regularity of sleep-wake hours was greater. On retirement, however, these cues weaken, and the sleep-wake cycle may become delayed by several hours. These patients may complain of day-night reversal, where sleep does not begin until dawn and then continues until mid-afternoon.

If you or a senior loved one is suddenly losing sleep, the first thing to consider is whether it’s affecting daytime function. Do you feel tired during the day? Are you losing concentration or constantly fighting off sleep? If so, talk to your doctor about possible solutions.

BLOG Date: Thursday, September 3, 2015
Writer: Ryan Allen