Sleep Disorders

Glossary

Insomnia in older people

Insomnia is a common complaint in older adults. Chronic sleep difficulties affect older people more often than younger adults. The homoeostatic regulation of sleep changes as we age. Older adults typically have shallower sleep, and fragmentation is more common. Nearly half of all hypnotic prescriptions written are for persons older than 65 years.

Factors that contribute to insomnia in seniors may include medical illnesses and medication use, both of which are more common in older adults. Older people also have too little physical activity and reduced exposure to bright light.

There is also a fundamental age-related alteration in the neurobiology of circadian rhythms, although scientists haven’t figured it all out.

Older people, even healthy ones, often complain about decreased sleep quality, and polysomnographic measurements of physiological indicators have confirmed the reality of these claims. Deep sleep, as a percentage of total sleep, decreases as people age, along with a decrease in growth hormone levels. During late life, REM sleep in a typical night declines about 10 minutes per decade. Wake time during the nocturnal period, a measure of sleep fragmentation, increases about 30 minutes per decade.

There’s also a chicken-and-egg question of the relationship between declining sleep quality and development of chronic illness in older adults. Does low quality sleep contribute to other physical problems or do illnesses cause the low quality sleep? It can be unclear for any individual, and the two factors are intertwined in most people.

Providing a regular schedule of meals, discouraging daytime naps, and encouraging physical activity may improve sleep. Hypnotic prescriptions for older patients must be adjusted for variations in metabolism, increased fat stores, and increased sensitivity. Dosages are typically reduced by 30% to 50%. Problems associated with drug accumulation (especially flurazepam) are weighed against the risks of more severe withdrawal or rebound effects associated with short-acting benzodiazepines. An alternate drug employed by some doctors for older patients is chloral hydrate.

What scientists know

There’s a difference in the sexes. Men lose more of the deep sleep (stages 3 and 4) than women. Daytime sleepiness is more frequent in older men than in older women.

Young and middle-aged adults typically complain of difficulty falling asleep, seniors more often experience nocturnal awakening, early morning awakenings, and non-refreshing sleep.

Some of the sleep hygiene practices recommended for insomniacs are often ignored by older people. Retired people without the regular schedule of a job are more likely to engage in daytime napping, irregular arising time, and increased time in bed compared to employed people. These practices are not conducive to trying to beat insomnia.

Insomnia affects a third of older Americans. Restless leg syndrome and sleep-disordered breathing/apnea are also more common in older people. Sleep-disordered breathing is particularly of interest because there is evidence that connects it will dementia and cognitive deficits in the elderly.

It used to be believed that the human circadian clock had a period of about 25.25 hours and that this period declined as people got older. This explained why teenagers had trouble waking up in the morning while seniors get sleepy early in the evening. However, circadian rhythm amplitude sometime stays strong in very healthy older people. Now scientists think that the intrinsic period of endogenous human circadian pacemaker is not significantly different between health old and young adults and is much closer to 24 hours. The deterioration in the suprachiasmatic nucleus may represent a pathologic rather than a normal change.

Older people spend more time in bed than younger ones, but nighttime sleep is typically shallow and fragmented. Scientific measurements confirm subjective reports of decline in sleep quality with age in otherwise healthy older people. Deep sleep decreased from 18.9% during young adulthood (ages 16 to 25) to 3.4% in midlife (36 to 50). The decrease in slow-wave sleep was accompanied by decreases in growth hormone levels.

During late life, REM sleep declines gradually by about 10 minutes per decade. Sleep fragmentation, as measured by wake time, increases by 30 minutes per decade during late life.

Research

When the U.S. government started the National Insitute on Aging in the 1970s, sleep was a low priority in the medical funding community. In the past few decades the importance of sleep has been recognized, both as an important part of quality of life and as a contributor to and symptom of diseases.

The most recent National Sleep Disorders Research Plan (2003) concedes that most of the research on sleep is conducted on young adults and that there has not been enough scientific exploration of how age affects sleep. There isn’t widespread agreement on what is “normal” age-related changes in sleep patterns and therefore no going agreement on whether any medical treatment is desirable.

Related article: How much sleep does a person need.

Related: Sleep Aids for Seniors

The Experience of Insomnia Among Older Women

Challenges of treating seniors with sleep problems

Insomnia during menopause