Sleep, or Lack of It, & Aging

We have written before about the value of a good night’s sleep and health. To summarize, healthy aging requires about 7 to 8 hours of restful, healthful sleep each night. Unfortunately, as we age our sleep number (of hours) declines. In fact, as many as 50 percent of older people report insomnia although the range is thought to be 10 to 40 percent. Insomnia is a common problem.

Insomnia is defined as inability to fall asleep or stay asleep at night, with the resulting loss of the recommended 7 to 8 hours of sleep each night.

• Failure to fall asleep within 30 minutes of trying.
• Waking in the middle of the night.
• Early arousal.
• Tired on awakening.
• Irritability.
• Increased errors during the day.
• Worry about sleep.

Insomnia has at least four classifications that describe the problem from an etiologic point of view or length of the disturbance. Thus the four types of insomnia are: primary, secondary, acute, and chronic. 

Primary insomnia means that there are no known concurrent diseases that cause the loss of sleep whereas secondary insomnia is a result of or contributed to by an underlying known disease. Acute and chronic insomnia are defined by the time one suffers from insomnia: If one has insomnia at least three times a week for a month or longer, it is considered chronic. No matter what the classification, insomnia has many causes.

As we age, the reasons for insomnia increase and this explains the greater incidence in the elderly. To have good sleep, one needs to be relaxed, healthy, and a bit worn out from exercise and work. Needless to say, as we age, anxiety increases, health is dissipated, and sedentary lifestyles (including naps during the day) are common. This is the general setting for insomnia in the elderly. 

There are other very specific causes for sleeplessness in the elderly. Many medications have insomnia as a side effect (check to see if this is the case for you.) Travel, particularly long-haul trips, is disruptive to sleep. A very long list of diseases cause insomnia including depression, other mental illnesses, arthritis, cancer, narcolepsy, heart failure, heartburn, coronary artery disease, sleep apnea, large prostate (frequent urination,) acute injuries, and many more. One common cause that worsens with age is the snoring of a sleep partner. Other factors are too much caffeine, alcohol, excitement before bed (including arguments with pillow-fellow), and overeating, especially soon before bedtime. Anything that causes stress or worry such as personal health, finances, or lives of children can cause sleeplessness. Finally, the bedroom is not to be used to watch TV, read, etcetera: It is meant for sleep and sex — other uses can contribute to insomnia.

There are a number of things to do to improve sleep. These include setting a regular schedule for sleep each day (same time to bed and out each day.) Avoid excitement, medicines, caffeine, and excess food and alcohol before bedtime. The bed should be clean and fresh and the bedroom dark and quiet, with an ambient temperature in the range of about 66 to 72 degrees. If your are unable to sleep within an hour, get up and go somewhere else and relax until you're tired and then return to bed. Finally, avoid over-the-counter sleep aids, since most are unproven and some may be harmful to the elderly.

Sleep deprivation, especially in the elderly, can lead to many diseases (not just be a result of them), worsen existing conditions, lead to accidents, and impair thinking and judgment. Thus, lack of sleep is not something to ignore or figure “well, I am just getting old and not sleeping.” There are many reasons that seeing your doctor about this problem is important, and it never hurts to ask your physician if you need some diagnostic studies and treatment by him or her or a sleep medicine expert. To save time, one important thing to take to your physician is an accurate sleep diary. 

A sleep diary should record for each day in a typical month, bedtime and time getting up. Record the amount of sleep during that interval spent in bed. Exercise type and amount each day, as well as the amount of caffeine and alcohol consumed, should be noted. The use of any sleep aids should be registered as well as the number of trips to the bathroom or other disturbances. Finally, naps (which can be a good thing if not too long or numerous during the day) should be written down in the diary.

Sleep deprivation for us as we age can lead to abnormal or impaired function in our normal routines. If this happens, it is time to talk with your physician about sleep as a cause.