Sleep Problems in The Elderly

When we age, we start to notice the differences in our appearance. We see the amount of white hair is increasing, more wrinkles and pigmentation. Our inside is changing as well, including our sleep patterns.

You may wake up earlier because you sleep earlier. You may wake up during the night and have a less deep sleep. These sleep problems in the elderly are considered common. However, it is not normal if you wake up tired every day and experience disrupted sleep every night. These can be the symptoms of a sleeping disorder. Insomnia in the elderly isn’t a usual problem. Sleep disorders in the elderly involve any disrupted sleep pattern. This can include problems falling or staying asleep, excessive sleepiness during the day, or abnormal behaviours while sleeping.

Sleep is essential for everyone, for your physical health and emotional well-being. For adults in the elderly stage of life, a good night of sleep is critical to improving their memory and concentration. Your body repairs damaged cells during your sleep. Sleep also refreshes your immune system that prevent you from having diseases. However, many people have the misconception that the older you are, the less sleep you need. It has been proven that the amount of sleep you need stays the same throughout adulthood. An average adult needs 7-9 hours of sleep to stay healthy. What makes it difficult for the elderly to reach the required sleeping hours? What causes excessive sleepiness in the elderly? Why do elderly have insomnia? What are other sleeping problems in the elderly? What types of sleeping disorder occurs in the elderly?

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Insomnia in the elderly

There are two categories of insomnia in the elderly. Sleep onset insomnia and sleep maintenance insomnia. Sleep onset insomnia is when you have difficulties falling asleep. Sleep maintenance insomnia is the inability to remain asleep throughout the night. The duration of insomnia can also be categorized in transient insomnia, acute insomnia and chronic insomnia. Transient insomnia can last a few days to a week while severe insomnia may last several weeks. Constant may appear nightly for months and if left untreated for years. This can have significant effects on health, safety, productivity and the quality of life.

Symptoms of insomnia in the elderly are:

DayNight
  • Excessive sleepiness
  • Depression
  • Accidents due to sleep deprivation
  • Irritability
  • Impaired memory
  • Difficulty concentrating
  • Takes more than 30-45 minutes falling asleep
  • Trouble staying asleep
  • Waking up early, unable to sleep again
  • Night falls

Sleep cycle changes in elderly

 A normal sleep cycle has some stages during each sleep period. You can divide your sleep into non-REM (non-rapid-eye-movement) sleep and REM (rapid-eye-movement) sleep. When you fall asleep, your body enters into non-REM sleep. Non-REM sleep is subdivided into four stages. It begins with light sleep, progressing to deeper sleep. The deepest non-REM sleep usually occurs early at night.

After the four stages of non-REM sleep, you will enter the fifth phase of sleep. It is known as REM-sleep, and it occurs at approximately 90 minutes cycles. Your breathing becomes irregular, and your eyes move rapidly in this stage. Also, you won’t be able to use your limb muscles. It’s common that dreams occur in this phase as well. The duration of REM sleep tends to increase each time throughout the night. One sleep cycle lasts about 90-110 minutes and is repeated 4 to 5 times during the night of healthy sleep.

Research has shown that in the elderly, people spend more time sleeping in the lighter stages. The deepest stages 3 and 4 is shortened or nonexistent in the elderly. Also, the time spent in the REM sleep is reduced, but the frequency stays the same.

The reason you sleep lighter is because your body produces lower levels of growth hormone. When you produce fewer growth hormones, you also produce less melatonin. You will often experience more fragmented sleep and wake up more often at night. The changes can influence your health, and the disruption may lead insomnia in the elderly.

Circadian rhythm changes the elderly

The tendency to sleep and wake up earlier than usual is one of the sleep problems in the elderly. This is caused by the changes in your circadian rhythm, also known as you internal clock. Your circadian rhythm controls your energy levels and tells you when to sleep and wake up. In the elderly, your sleep rhythm is shifted forward. This makes you want to go to bed earlier. You still get your 7-9 hours of sleep, because you also wake up earlier. This change is called advanced sleep phase syndrome.

Older people may find this annoying to wake up at 5 AM instead of 7 AM. However, there may be consequences if they don’t listen to their body and sleep earlier. Sleep problems such as sleep deprivation and excessive sleepiness in the elderly may occur. You can also consider taking naps during the day to compromise the sleep lost. Don’t take the naps close to bedtime, this can make it more difficult later to fall asleep. Resulting in delayed sleep and less duration of night-time sleep.

Types of medication may effect sleep of elderly

Many elderly people are on medications that can affect and disrupt sleep. Medications such as antidepressants often have sleep-related side effects. Also, diuretics is often taken for high blood pressure or glaucoma. Using diuretics at night time can cause you to wake up more often to go to the bathroom. Other medication that can disrupt the sleep in the elderly are:

            Prescribed for those with chronic obstructive pulmonary disease (COPD)

            Used to treat high blood pressure

            Used to treat conditions like rheumatoid arthritis

            Used to treat gastroesophageal reflux disease (GERD) or peptic ulcers

            Medication used to treat Parkinson’s disease

            Drugs used in extreme situations, such as an asthma attack or extremely low blood pressure

Medical conditions in the elderly

Elderly people may also have an underlying medical condition that causes sleep problems. Neurological conditions such as Parkinson’s disease and Alzheimer’s disease are often accompanied by sleep problems. Acute and chronic medical conditions such as arthritiscardiovascular diseaseprostatic hypertrophy, gastrointestinal and pulmonary conditions may cause sleep disruption. The discomfort and pain may make it harder to fall asleep and sleep less long. Conditions that affect the bladder can wake you up more often to go to the bathroom. Depression, anxiety and dementia can also cause sleep problems.

Sleep disorders in the elderly

Several primary sleep disorders are associated with aging. Primary sleep disorders can cause difficulties in falling asleep and awakenings at night. The lack of sleep can also cause excessive daytime sleepiness. Sleep disorders are often diagnosed through history, physical examination and polysomnogram. Primary sleep disorders that are associated with people in the elderly are:

  • Sleep apnea

Sleep apnea causes brief interruptions in breathing while sleeping. This results in sleep disruptions and also awakenings throughout the night. This can lead to insomnia and excessive daytime sleepiness. Snoring is a common sign of this disorder.

Weight lose, mouthpieces and breathing devices such as CPAP (continuous positive airway pressure) can be used to treat sleep apnea. Surgery to widen breathing passage is also possible.

  • Restless leg syndrome

Restless legs syndrome causes discomfort in the legs and the urge to walk to get rid of the feeling. It is often described the unpleasant, tingling and creepy feeling. The feeling gets worse during the evening and makes it hard to sleep throughout the night. Excessive daytime sleepiness may result from this sleep disruption.

Regular exercise and soaking the legs and feet in a warm bath can be a relief for some restless legs syndrome patients. Dopaminergic agentsbenzodiazepines and opiates can also be used to treat restless legs syndrome.

  • Periodic limb movement disorder

Periodic limb movement disorder can occur independently or accompanied with restless leg syndrome. Periodic limb movement disorder causes muscle contractions. This can make your arms and legs move (kicking legs).

Dopaminergic agents are often used to treat periodic limb movement disorder. This can reduce the number of problems during sleep and increases the time of deep sleep.

  • REM-behaviour disorder

The REM-behaviour disorder is a rare condition and occurs most commonly in elderly people. Usually, you can’t make many movements while you dream. However, this disease doesn’t prevent the muscle activity. It can cause you to crash into bed, fall or leap from the bed, which can create injuries.

To control this disorder, treatment with bedtime doses of the benzodiazepine such as clonazepam are often provided.

Treatment for sleep problems in the elderly

Avoid

  • Caffeine, other stimulants and alcohol no later than 3 hours before bedtime
  • Heavy meals, spicy food, and excessive amounts of liquid before bedtime (a light snack or warm milk is all right)
  • Taking naps close to bedtime
  • Activities in bed such as work, reading or watching television

Start

  • A regular sleep/wake schedule
  • Exercise early in the day or no later than 4 hours before bed
  • A sleep environment that is dark, quiet, safe and comfortable
  • Activities that encourage relaxation before bed, such as a warm bath or shower, or calming music.

Sleeping pills

Elderly people tend to absorb medicines quickly, and the medications may last longer in the body. This can potentially lead to interaction with other medications. It is advised to consult a doctor first before using any sleeping pills. Sleeping pills, which are available in pharmacies, are usually for temporary sleep issues. Dependence on sleeping pills can be the physical necessity, but it can also become an addiction.

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