Along with the physical changes that occur as we get older, changes to our sleep patterns are a part of the normal aging process. As people age they tend to have a harder time falling asleep and more trouble staying asleep than when they were younger. It is a common misconception that sleep needs decline with age. In fact, research demonstrates that our sleep needs remain constant throughout adulthood. So, what’s keeping seniors awake? Changes in the patterns of our sleep – what specialists call “sleep architecture” – occur as we age and this may contribute to sleep problems. Sleep occurs in multiple stages including dreamless periods of light and deep sleep, and occasional periods of active dreaming (REM sleep). The sleep cycle is repeated several times during the night and although total sleep time tends to remain constant, older people spend more time in the lighter stages of sleep than in deep sleep.
Many older adults, though certainly not all, also report being less satisfied with sleep and more tired during the day. Studies on the sleep habits of older Americans show an increase in the time it takes to fall asleep (sleep latency), an overall decline in REM sleep, and an increase in sleep fragmentation (waking up during the night) with age. The prevalence of sleep disorders also tends to increase with age. However, research suggests that much of the sleep disturbance among the elderly can be attributed to physical and psychiatric illnesses and the medications used to treat them.
In addition to changes in sleep architecture that occur as we age, other factors affecting sleep are the circadian rhythms that coordinate the timing of our bodily functions, including sleep. For example, older people tend to become sleepier in the early evening and wake earlier in the morning compared to younger adults. This pattern is called advanced sleep phase syndrome. The sleep rhythm is shifted forward so that 7 or 8 hours of sleep are still obtained but the individuals will wake up extremely early because they have gone to sleep quite early. The reason for these changes in sleep and circadian rhythms as we age is not clearly understood. Many researchers believe it may have to do with light exposure and treatment options for advanced sleep phase syndrome typically include bright light therapy.
The prevalence of insomnia is also higher among older adults. According to NSF’s 2003 Sleep in America poll, 44% of older persons experience one or more of the nighttime symptoms of insomnia at least a few nights per week or more. Insomnia may be chronic (lasting over one month) or acute (lasting a few days or weeks) and is often times related to an underlying cause such as a medical or psychiatric condition.
It is worthwhile to speak to your doctor about insomnia symptoms and about any effects these symptoms may have. Your doctor can help assess how serious a problem it is and what to do about it. For instance, cutting back on caffeine and napping may help solve the problem. If insomnia is creating serious effects, complicating other conditions or making a person too tired to function normally during their waking hours, this would suggest that it is important to seek treatment. When effects are serious and untreated, insomnia can take a toll on a person’s health. People with insomnia can experience excessive daytime sleepiness, difficulty concentrating, and increased risk for accidents and illness as well as significantly reduced quality of life. Both behavioral therapies and prescription medications singly or in combination are considered effective means to treat insomnia; the proper choice should be matched to a variety of factors in discussion with a physician.
Snoring is the primary cause of sleep disruption for approximately 90 million American adults; 37 million on a regular basis. Snoring is most commonly associated with persons who are overweight and the condition often becomes worse with age. Loud snoring is particularly serious as it can be a symptom of obstructive sleep apnea (OSA) and is associated with high blood pressure and other health problems. With OSA, breathing stops – sometimes for as long as 10-60 seconds – and the amount of oxygen in the blood drops, often to very low. This alerts the brain, causing a brief arousal (awakening) and breathing resumes. These stoppages of breathing can occur repeatedly, causing multiple sleep disruptions throughout the night and result in excessive daytime sleepiness and impaired daytime function.
Untreated sleep apnea puts a person at risk for cardiovascular disease, headaches, memory loss and depression. It is a serious disorder that is easily treated. If you experience snoring on a regular basis and it can be heard from another room or you have been told you stop breathing or make loud or gasping noises during your sleep, these are signs that you might have sleep apnea and it should be discussed with your doctor.
Restless legs syndrome (RLS) is a neurological movement disorders characterized by an irresistible urge to move the limbs. With RLS, unpleasant, tingling, creeping or pulling feelings occur mostly in the legs, become worse in the evening and make it difficult to sleep through the night. Its prevalence increases with age and about 10% of people in North America and Europe are reported to experience RLS symptoms. About 80% of people with RLS also have periodic limb movement disorder (PLMD) and in one study, it was found that approximately 45% of all older persons have at least a mild form of PLMD.
As we age, there is an increased incidence of medical problems, which are often chronic. In general, people with poor health or chronic medical conditions have more sleep problems. For example, hypertension is associated with both snoring and OSA and heart failure – which affects approximately 5 million Americans – is linked with OSA. In addition, menopause and its accompanying hot flashes, changes in breathing, and decreasing hormone levels can lead to many restless nights.
Gastroesophageal reflux disease (GERD) is another common cause of sleep problems. The pain also makes it difficult to sleep. Medical conditions such as diabetes mellitus, renal failure, respiratory diseases such as asthma, and immune disorders are all associated with sleep problems and disorders. Diseases such as Parkinson’s disease and multiple sclerosis also commonly cause problems sleeping.
Reviewed by Michael V. Vitiello, PhD (December 2009).
Associate Director of the Northwest Geriatric Education Center and a Professor of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. Dr. Vitiello’s research, funded by the National Institute of Mental Health and the National Institute on Aging, focuses on the causes, consequences and treatments of sleep disturbance in older adults. Dr. Vitiello is the author of over 320 scientific publications and has received two National Institute of Mental Health Independent Scientist Research Career Awards. He is a Fellow in Clinical Medicine of the Gerontological Society of America, a past-member of the Board of Directors of the Sleep Research Society, and the Editor-in-Chief of Sleep Medicine Reviews.