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Grandparents, older adults encouraged to seek help for a sleep disorder

August 14, 2007

WESTCHESTER, Ill. - September 9th is National Grandparents Day, a day to honor grandparents across America as important members of our families and communities. Grandparents play important roles in life, including that of guardian, comforter, and mentor. As they get older, however, several aspects of their lives change, including their sleep patterns. While older adults need about seven to eight hours of sleep each night, many often get less sleep, which may make them more susceptible to health problems.

"As we get older, our sleep is more easily disturbed," says James P. Krainson, MD, of the South Florida Sleep Diagnostic Center in Miami and a spokesperson for the American Academy of Sleep Medicine (AASM). "Underlying health issues are often the cause of these disturbances. Arthritis and pain can cause frequent awakenings and interfere with falling asleep. Cardiovascular, neurologic, urologic and psychologic disturbances can likewise play havoc with our sleep. In fact, most all medical problems can disturb our sleep, and the older adults' sleep is most vulnerable."

Many older adults often have more trouble falling asleep than persons in other age groups. A study of adults over the age of 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep.

There are many other possible explanations for changes in older adults' sleep patterns, says Dr. Krainson. Older adults may produce and secrete less melatonin, the hormone that promotes sleep. They may also be more sensitive to changes in their environment, such as noise, and this may cause them to awaken. Further, older adults may also have other medical and psychiatric problems that can affect their sleep, says Dr. Krainson, adding that researchers have noted that people without major medical or psychiatric illnesses report better sleep.

Several studies that outline the negative consequences of bad sleep among older adults were presented at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies, this past June:

* Cognitive behavioral therapy successfully improves both immediate and long-term self-reported sleep and pain in older osteoarthritis patients. This demonstrates that improving sleep can be "analgesic" in older osteoarthritis patients, and that techniques to improve sleep should be considered for addition to treatment programs for pain management in osteoarthritis and possibly other pain-states.

* Regular aerobic exercise, combined with sleep hygiene education, improves sleep and quality of life in older adults with chronic insomnia.

* Untreated sleep complaints may pose a risk for falls.

* Older adults who reported engaging in shorter and less frequent naps during the day also reported spending more time asleep at night. Such older individuals also experienced more sleep time and slept more efficiently at night.

* A sleep-related breathing disorder may be associated with impairments in cognitive function in older men.

* Objectively determined estimates of short sleep were strongly related to obesity in older men and women.

Dr. Krainson notes that several studies published in recent issues of the journal SLEEP have some interesting findings about older persons and sleep:

* The effects of insomnia are different in older and younger people. While associations between insomnia and separated, divorced or widowed marital status were strongest in younger age groups, longer bouts with insomnia were more common in the older population, who are also more likely to be taking types of sedatives that have particular problems with addiction and side effects.

* As sleep quality and quantity typically decrease with age, objectively measured differences in the amount of sleep a healthy older man gets can affect his level of testosterone in the morning.

* A brief behavioral treatment for insomnia appears to be a promising intervention for older adults who suffer from insomnia.

According to Dr. Krainson, some of the more common sleep disorders in older adults include:

* Insomnia affects almost half of adults 60 and older.

* Obstructive sleep apnea (OSA) can elevate the risk for high blood pressure, stroke, heart disease, and cognitive problems. Snoring, a symptom of OSA, is a very common condition affecting nearly 40 percent of adults, and is more common among older people.

* Restless legs syndrome, where one experiences uncomfortable feelings in the legs, affects more than 20 percent of people 80 years and older.

* Periodic limb movement disorder, a condition that causes people to jerk and kick their legs every 20-40 seconds during sleep, is evident in almost 40 percent of older adults.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls and use more over-the-counter or prescription sleep aids. In addition, recent studies associate lack of sleep with serious health problems such as an increased risk of obesity, cardiovascular disease and diabetes.

Despite obstacles many older adults have to overcome in order to get a good night's sleep, Dr. Krainson says that it does not mean they are doomed to chronic sleep deprivation. While most people require seven to eight hours of sleep a night to perform optimally the next day, older adults might find this harder to obtain, says Dr. Krainson, adding that they must be more aware of their sleep and maintain good sleep hygiene by following these tips:

* Establishing a routine sleep schedule

* Avoiding utilizing bed for activities other than sleep or intimacy.

* Avoiding substances that disturb your sleep, like alcohol or caffeine.

* Not napping during the day. If you must snooze, limit the time to less than one hour and no later than 3 p.m.

* Stick to rituals that help you relax each night before bed. This can include such things as a warm bath, a light snack or a few minutes of reading.

* Don't take your worries to bed. Bedtime is a time to relax, not to hash out the stresses of the day.

* If you can't fall asleep, leave your bedroom and engage in a quiet activity. Return to bed only when you are tired.

* Keep your bedroom dark, quiet and a little cool.

Dr. Krainson says that, although sleep patterns change as people age, disturbed sleep and waking up tired every day are not part of normal aging. Those who have trouble sleeping are advised to see a sleep specialist at a facility accredited by the AASM.

"Be prepared to tell the doctor how you spend your day and night, including your medicines, fluid intake and activities so that they will have all the information needed to decide how best to help you," says Krainson.

American Academy of Sleep Medicine