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Sleep is a vital aspect of overall health and well-being, and it becomes even more critical as we age.
But as we grow older, our sleeping patterns tend to change, and we may end up facing sleep problems and disorders like sleep apnea, insomnia, etc. This can significantly affect our physical and mental health, leading to a decline in cognitive function, increased risk of accidents and falls, and more.
Now, the relationship between aging and sleep is complex and multifaceted. As we age, our body undergoes various physiological changes that can affect our sleep cycle, like a decrease in the production of certain hormones and changes in our circadian rhythm. Moreover, older adults tend to experience sleep disorders, which can exacerbate existing health issues.
That said, today, we’ll discuss the various ways in which aging affects sleep, the common sleep disorders affecting older adults, and some tips for enjoying a good night’s sleep.
Insomnia is defined as a sleep disorder wherein the affected individual experiences persistent trouble falling asleep. They may even go through disturbed sleep cycles, leading to a lack of restorative sleep. Notably, insomnia affects almost half of the adult population aged over 60 in the United States.
Some telltale signs of insomnia among older adults are as follows:
The initial symptoms of sleeplessness are often termed short-term insomnia. If the symptoms persist for over a month, doctors will diagnose it as chronic insomnia.
Sometimes even when the underlying cause of insomnia has been treated, secondary insomnia can continue. As such, there are two major types of insomnia based on the symptoms - sleep onset insomnia and sleep maintenance insomnia. The former refers to having trouble falling asleep, while the latter implies waking up frequently during the night and not being able to remain asleep for normal periods.
Moreover, insomnia can be classified as primary and secondary. While primary insomnia is a condition that may arise on its own, secondary insomnia is linked to several physiological factors. Most physicians believe that older adults tend to have secondary insomnia caused by medical conditions, side effects of medicines, etc.
Insomnia has been linked to changes in sleep patterns throughout the night. This progression of sleep is also known as “sleep architecture,” and it can be classified into three stages:
This process is known as the circadian rhythm. As people age, the amplitude of their circadian rhythm usually decreases, which can lead to gradual changes in their sleep patterns. Elderly individuals tend to experience less slow-wave sleep and more light sleep on a nightly basis. Plus, the duration of REM sleep decreases by around 10 minutes per night for every decade of life.
On a similar note, older adults often struggle to regulate their body temperature, which can impact their sleep patterns. Body temperature plays a crucial role in our sleep, as rising temperatures in the morning signal wakefulness, and decreasing temperatures in the evening promote sleepiness.
When thermoregulation is compromised, the body temperature can become out of sync with the circadian rhythm, leading to a condition called circadian desynchronization. This can cause insomnia and other sleep-onset problems, as well as hypothermia and hyperthermia during certain seasons.
Further, insomnia has been associated with psychiatric disorders such as depression and anxiety. But it’s not clear whether these disorders cause insomnia or vice versa.
That said, poor sleep habits can worsen insomnia, particularly in older adults. For instance, elderly individuals who take daytime naps and spend more time in bed are less likely to fall asleep on time.
Moreover, insomnia can have serious consequences, including excessive daytime sleepiness and difficulty concentrating, thereby increasing the risk of falls, car accidents, etc. Long-term insomnia can also lead to increased irritability and chronic headaches.
Sleep apnea is a prevalent dysnomia disorder among older adults, which involves temporary cessation of breathing during sleep for up to a minute. Due to its disruptive nature, sleep apnea can significantly impact the circadian rhythm.
The condition is further classified into two types - obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA, the more common type, obstructs the airway and affects breathing, while CSA arises from faulty communication between the brain and breathing muscles.
Individuals with sleep apnea are at a greater risk of developing cardiovascular diseases. In fact, obstructive sleep apnea is a predecessor of coronary artery disease and has been linked to conditions such as heart failure, hypertension, cardiac arrhythmia, and stroke. Similarly, central sleep apnea is more common among individuals with congestive heart failure.
According to a report by the American Heart Association, people who suffer from continuous interruptions in their sleep are more likely to develop arteriosclerosis (hardening of the arteries). The study also found a correlation between long-term sleep disruption and an increased risk of infarction, which is the death of tissue due to a lack of oxygen. Both of these health issues are known to be risk factors for stroke and cognitive problems.
Narcolepsy is a type of sleep disorder that causes people to feel very tired and sleepy during the day. This leads to sudden and uncontrollable episodes of falling asleep or “sleep attacks.”
In addition to this, narcolepsy can cause other symptoms like hallucinations when falling asleep or waking up, sudden muscle weakness, and the inability to move when waking up (sleep paralysis).
It is rare for someone to be diagnosed with either Narcolepsy Type 1 or 2 at any age. But it usually starts to appear in the mid-late teenage years, and symptoms tend to get worse over time. Another period of diagnosis is between 45 and 60 years.
Restless legs syndrome is a sleep disorder commonly experienced by elderly individuals. It is characterized by an uncomfortable sensation under the skin, often accompanied by tingling, cramping or physical pain. These symptoms typically occur at bedtime and can cause difficulty falling asleep.
Periodic limb movement disorder is another condition that shares similar symptoms with restless legs syndrome, but it only affects individuals during sleep and can cause sleep disruption.
Snoring is a parasomnia disorder frequently diagnosed in adults of all ages, especially seniors with weakened airway muscles. While it is not usually life-threatening, it can be a predictor of more serious health concerns, such as stroke or heart disease.
This condition is mostly diagnosed among individuals over 60 years of age and is associated with age-related neurological conditions such as Alzheimer's disease and Parkinson's disease. This disorder causes temporary paralysis during REM sleep, leading to thrashing, flailing, sleepwalking, or engaging in abnormal behaviors.
Around 20% of older adults use sleep aid to manage chronic sleep disorders, such as long-term insomnia. There are various categories and types of sleep medication available in the US, each with distinct characteristics, effects, and user warnings. We recommend seeking medical advice from a doctor or healthcare professional before trying any sleep aid for the first time.
Benzodiazepine receptor agonists, also known as BzRAs or “benzos,” are a class of prescription drugs that work by slowing down the central nervous system through interactions with GABA neurotransmitters. These drugs are minor tranquilizers used to alleviate anxiety and promote restful sleep.
However, due to their potency, elderly patients usually start with half the recommended dose compared to younger patients. Benzodiazepines also have the potential for harmful interactions with alcohol, so it is important to avoid combining the two.
Non-benzodiazepine hypnotics or Z-Drugs function as benzodiazepine receptor agonists, similar to the benzodiazepine drug class. However, these drugs differ from benzodiazepines as they selectively induce drowsiness without interacting with other receptors, while benzodiazepines affect a broader range of receptors.
Notably, Z-Drugs have a lower potential for dependence and may cause milder side effects than benzodiazepines. As such, doctors prefer prescribing them as sleep medicine.
This medication is used to induce drowsiness in individuals that face trouble sleeping. Antihistamines block the histamine receptors in the body that play a role in regulating the sleep-wake cycle.
Over-the-counter sleep aids containing diphenhydramine, such as Tylenol PM, Sominex, Nytol, and Excedrin, are commonly prescribed as antihistamine sleep aids. Some allergy relief medications, like Benadryl, also contain diphenhydramine and can be used as sleep aids. Another effective antihistamine sleep aid is doxylamine, found in Unisom sleep tablets.
Many people turn to herbs and dietary supplements as a natural alternative to treat sleep problems like insomnia, restless legs syndrome, sleep apnea, etc. Melatonin is the most commonly used sleep aid supplement and is considered effective for most people with sleep-onset or sleep-maintenance insomnia. It can also help alleviate jet lag symptoms.
Other options include 5-HTP, derived from tryptophan and Valerian root, a plant with sedative properties.
Adults facing sleep disturbances due to chronic pain can consider pain relievers. Unlike antihistamines, pain relievers generally do not cause daytime sleepiness. As such, acetaminophen, found in Tylenol, can be used to induce sleep. Non-steroidal anti-inflammatory drugs like ibuprofen, found in Advil and Motrin, may also be prescribed.
When treating insomnia in older patients, weight gain is a major concern due to the potential lack of energy and motivation that can discourage physical activity. Plus, poor sleep can reduce the production of leptin, which can cause overeating.
Hence, physicians may monitor weight gain in older patients with sleep disorders and make dietary or exercise recommendations to prevent unhealthy weight gain.
Gender can play an important role in treating sleep problems, as senior women are more likely to report age-related sleep issues than men. Also, poor sleep is more strongly linked to weight gain in women.
Postmenopausal women with sleep apnea may experience changes in EKG heart patterns, which can indicate an increased risk of cardiovascular conditions. In such cases, sleep aids with strong side effects like benzodiazepines may not be suitable for patients with serious heart-related issues.
As we age, our sleep patterns change, leading to an increased risk of sleep disorders and mental health issues.
However, by understanding the causes of sleep disruptions in older adults and implementing healthy sleep habits, one can prevent issues like sleep-disordered breathing, restless legs syndrome, and more. Not to forget, maintaining a healthy sleep schedule can also help improve overall health.
Hence, healthcare providers must recognize the unique sleep needs of older adults and offer appropriate interventions to address sleep-related issues.
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