Treating Elderly Sleep Problems

Age is a risk factor for many diseases and chronic conditions. Sleep is no different. The elderly face a host of sleep-related problems and disorders. Researchers point to dramatic changes in sleep as we age. The news isn’t all bad, though, and many elderly sleep problems can be treated with proper care. This article will look at treating senior sleep issues based on current research and best practices.

Worrying More, Sleeping Less

Most people sleep less as they age. Total sleep time drops from an average of 8.9 hours per day in young adults to about 7.4 hours per day in older adults. (After age 60, the sleep time stabilizes and stops dropping.) Moreover, older adults spend upwards of 60 minutes awake after sleep onset, the transition from wakefulness to sleep.

Dr. Matthew Walker in the Wall Street Journal describes the changes this way:

“Older adults face a number of challenges. The first is a reduction in the quantity and quality of deep sleep—the stage that beneficially overhauls your cardiovascular, immune and metabolic systems and refreshes learning and memory abilities. As you enter your 30s and 40s, your deep-sleep brain waves become smaller, less powerful and fewer in number. Reductions in deep-sleep quality increase your risk of heart attacks, obesity and stroke, as well as the buildup of a toxic brain protein—called beta amyloid—that is linked​to Alzheimer’s disease.

Passing into your mid- to late-40s, age will have stripped you of 60% to 70% of the deep sleep you were enjoying as a teen. By the time you reach age 70, you will have lost 80% to 90% of your youthful, restorative deep sleep.”

Passing into your mid- to late-40s, age will have stripped you of 60% to 70% of the deep sleep you were enjoying as a teen. By the time you reach age 70, you will have lost 80% to 90% of your youthful, restorative deep sleep.

On top of that, the elderly experience the problems of sleep fragmentation. The older we get, the more frequently we wake up during the night. Walker says the causes may include chronic body pain and a weakened bladder. In the morning, the off-kilter circadian rhythms of the aged mean many get up around 4 or 5 a.m., even with poor sleep the night before. It’s a vicious sleep cycle, leaving a large number of senior citizens tired and depressed.

Insomnia and the Aged

We know that 25–35% of older adults over 60 complain of insomnia, often caused by sleep apnea problems. Fortunately, the actual clinically significant number of insomniacs is far less at about 5%. But if left untreated, insomnia can be associated with an increased risk of depression and a lower quality of life.

The odds of having sleep disturbance are markedly increased with poor health. Demographic and ethnic factors also come into play, with African-Americans reporting very high dissatisfaction with their sleep quality. Women over the age of 45 are almost twice as likely to have insomnia than men, and that is also true of newly divorced, separated or widowed persons.  Clearly, life experiences and stress affect how we sleep, and older people often suffer the most. No wonder 1/3rd of older people take some kind of medication for sleep, according to a University of Michigan survey.

We know that the elderly with insomnia are at a higher risk for a variety of medical conditions, including heart disease and cancer.  There is also a link between insomnia and cognitive impairment as well as increased risk of developing Alzheimer’s Disease.

Common Elderly Sleep Disturbances

Sleep apnea is common in patients with cognitive impairment, with 63% of AD patients showing signs of breathing disturbances at night.  Less common in older adults are sleep disorders like narcolepsy and primary hypersomnia, which involve sudden or excessive daytime sleepiness.

Other elderly sleep problems include sleepwalking, Restless Leg Syndrome (RLS), Periodic Limb Movement Disorder (PLMD), and REM Behavior Disorder (RBD) which may involve violent dream-related behavior. Severe disorders might require a visit to a sleep center for further monitoring. Medications such as clonazepam or even over-the-counter melatonin have been shown to relieve symptoms of dangerous sleep behaviors.

Mental Illness and Elderly Sleep Problems

What about mental illness and sleep? In studies of older patients, depression played a large part in insomnia problems. Likewise, older adults with insomnia symptoms show a 23% increase in their risk of developing depression.

As insomnia could be a risk factor for suicide (and the results are mixed), doctors are beginning to take elderly sleep complaints more seriously and monitor other medications the patient is taking. Unfortunately, most symptoms are self-reported, and there is still no single test used by medical professionals to diagnose insomnia. Sleep diaries and polysomnography at sleep labs are common ways to make insomnia evaluations in the elderly.

Sleep Medications and Other Treatments

Prescription sleep medicines for older people sound like a quick remedy, but they can be dangerous in an elderly population. Doctors say they may bring on constipation, confusion, dizziness, and memory lapses, leading to falls, car accidents and other harmful events.

Prescription sleep medicines for older people sound like a quick remedy, but they can be dangerous in an elderly population. Doctors say they may bring on constipation, confusion, dizziness, and memory lapses, leading to falls, car accidents and other harmful events.

“Although sleep problems can happen at any age and for many reasons,” says Dr. Preeti Malani at the University of Michigan, “they can’t be cured by taking a pill, either prescription, over-the-counter or herbal, no matter what the ads on TV say.”

Remake the Sleep Environment

The elderly are advised first to look at their own environment to make sure it’s conducive to a restful sleep, including a quiet and dark space. Beyond that, researchers say a cognitive-behavioral therapist might be able to assist insomniacs in tackling bad behaviors and beliefs that perpetuate insomnia. The goal is to reduce anxiety and get the aged person to sleep in bed without the use of drugs.

Other non-pharmacologic aids for better sleep include bright light therapy and exercise (just simple walking), but there is more research needed on their effectiveness. Melatonin, when taken two hours before bedtime, has worked in trials with older adults for up to six months.

Light therapy is being tested in nursing homes. It can have a positive impact on sleep, mood, and behavior for patients with Alzheimer’s disease, according to new research. People with Alzheimer’s disease and dementias often experience sleep problems, including wandering and daytime irritability.

Relief for Senior Sleep Apnea

For sleep apnea sufferers, continuous positive airway pressure or CPAP therapy is recommended. Often used in conjunction with oral appliances (mouth guards), CPAP machines are an effective and safe devices for the elderly. Some weaker older adults may need the assistance of family members or a caregiver in order to get the correct mask fit and room comfort.

Cost is always a concern, but Medicare will provide coverage if there is documented and consistent usage. The good news is that elderly who stick with their CPAP treatments experience similar longevity rates as other healthy senior citizens.

Tips for Elderly Sleepers

Sleep research is ongoing for elderly sleep problems, and there is now a greater understanding of how sleep patterns change as we age. There are better remedies than 20 years ago. Taking a sleeping pill might be recommended for certain life-threatening sleep disorders or insomnia. But most doctors take a more cautious and nuanced approach with the elderly.

Dr. Malani at the University of Michigan offers these tips for older sleepers:

  • Keep the same sleep schedule every day
  • Stick to a bedtime routine to wind down and to cue your brain
  • Keep gadgets out of the bedroom, reducing harmful “blue” light that can interfere with sleep
  • Limit or stop consuming caffeine in the afternoon and evening
  • Avoids naps during late afternoon or evening, which can throw off your sleep cycle.
  • Don’t use alcohol to help you get to sleep, which can disrupt sleep cycles
  • Cut back on all liquids late in the day to avoid disruptive late-night trips to the bathroom
  • Use “talk therapy” with a cognitive behavioral specialist to address serious sleep and insomnia issues.

In Summary

Older persons often do not notice how poorly their sleep has deteriorated over the years. They can be stubborn and stoic. Relief is available. But it will be up to a dedicated doctor and caregivers in treating these elderly sleep problems and coming up with customized treatments that result in a more restful night.