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Are You a Fragile Sleeper?
Your sleep
patterns change as you age
By Jon Fleming, M.D.
MediResource
The gradual changes in our bodies that occur as
part of the aging process also affect our sleep.
Even
in healthy older people, sleep becomes more fragile.
It becomes harder to settle into sleep, and more
awakenings occur throughout the night.
These changes have been demonstrated in sleep
laboratory studies. Sleep efficiency (the time spent
asleep compared to time in bed), falls from its high
values in youth (95-98%) to 70-80% in older age.
Also, the amount of light sleep increases with age,
and the amount of deep sleep is reduced.
Additionally, the arousal threshold falls as we age,
so that sounds and other interruptions are more
likely to awaken us.
Another aspect of aging is that the normal circadian
pattern (24-hour rhythm) of sleep gradually weakens,
and sleep tends increasingly to be spread across the
24-hour day rather than being consolidated in the
nighttime sleep period.
All
of these changes result in the common complaint of
the elderly: that sleep is shorter and less
restorative than it was in their youth.
Most
elderly people notice that their sleep is
interrupted by other changes in their bodies. For
example, muscle or joint pains may make it difficult
to get comfortable, and most people over the age of
65 must visit the bathroom at least once during the
night. However, these are normal aspects of aging.
The
most problematic and long-term sleep difficulties in
the elderly are due to medical conditions (e.g.,
respiratory disease, arthritis, and heart disease)
and psychiatric problems (such as clinical
depression and dementia). In addition, specific
sleep disorders such as sleep apnea and periodic
limb movement disorder are also associated with age,
and affect sleep.
Since disturbed sleep is common in the elderly, it
can be difficult to distinguish between a normal
aging process and a disease state. Therefore, a
medical check-up is needed to determine the cause
when older individuals experience persistent trouble
in falling or staying asleep that is associated with
daytime problems (e.g., marked sleepiness, mood
changes, pronounced fatigue, forgetfulness, loss of
interest or pleasure, etc.).
Good
lifestyle habits result in better sleep
Poor
sleep habits can worsen the physiological changes
associated with aging. Therefore, by simply changing
these habits, the sleep problem may be reduced or
eliminated, resulting in a better quality of life.
Helpful strategies include reducing caffeine intake,
avoiding large, heavy meals late at night, and
reducing daytime naps.
Also, active seniors report fewer sleep problems
than their inactive counterparts. Physical exercise
such as walking briskly for 30 to 40 minutes has
beneficial effects on sleep, regardless of age.
Specific sleep
disorders
Just
as medical and psychiatric illnesses become more
common as we age, specific sleep disorders are also
more common and affect the amount and quality of
sleep.
Sleep apnea refers to breathing problems during
sleep, and is estimated to affect 1 out of every 4
people over the age of 60.
In
obstructive sleep apnea, loud snoring and pauses in
breathing are noticed by the bed partner, but the
sleeper may have no complaints apart from sleepiness
in the day. Obstructive sleep apnea is due to
narrowing or closure of the airway during sleep. It
is caused by many factors, including obesity. The
breathing disturbance causes brief awakenings, which
disrupt sleep but are not usually recalled in the
morning. Common associated symptoms are difficulty
with memory, concentration and thinking, and daytime
sleepiness, including sleepiness while driving.
Obstructive sleep apnea requires treatment such as
use of a device that uses air pressure to keep the
throat open, plus other strategies such as weight
loss.
The
second, less common type of breathing disturbance
associated with age is called central sleep apnea.
This type of sleep apnea is caused by a failure,
during sleep, of the brain's control of the
breathing process. In this condition snoring is
usually absent. Sighing breaths or shallow breathing
may be noted by the bed partner. Unlike patients
with obstructive sleep apnea, patients with central
sleep apnea are more likely to remember their
awakenings and complain of light and fragmented
sleep.
Periodic limb
movement disorder
About half of all people aged 65 or over experience
twitching in the legs and sometimes the arms during
the night. When these twitches and jerks are
prominent and frequent, the condition is called
periodic limb movement disorder (PLMD).
Diagnosis of PLMD requires a sleep laboratory
evaluation to confirm the presence of the movements
and their effects on sleep.
Commonly, these movements occur in "batches," and
can occur as frequently as 2 or 3 times a minute.
The sufferer may complain of marked sleep
disruption, or may not be aware of their presence at
all. PLMD usually causes insomnia (difficulty
initiating and maintaining sleep) and, more rarely,
excessive daytime sleepiness.
People with PLMD may also experience "restless legs"
when awake. Restless legs syndrome is present when a
peculiar and difficult-to-describe sensation occurs
in the calves or thighs while at rest.
Characteristically, it is relieved by movement but
recurs on resting again. Both PLMD and restless legs
syndrome are treated with a variety of medications.
REM sleep behaviour
disorder
Normally, during the dreaming part of sleep (called
the rapid eye movement or REM part of sleep), the
body is paralyzed. However, in patients with REM
sleep behaviour disorder, this does not occur,
resulting in an enactment of dreams.
A
variety of behaviours can occur associated with
dream enactment (striking out, swearing, falling,
etc.), and self-injury or injury of the bed partner
may occur. This disorder is more common in men over
the age of 50, and can be associated with other
neurological disorders. The drug clonazepam improves
sleep and reduces dream-enactment behaviours.
© MediResource. All rights reserved.
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All of these changes result in the common
complaint of the elderly: that sleep is shorter
and less restorative than it was in their youth. |
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