Many aspects of our life change as we get older and sleep is no exception. Over time, our sleep patterns change. When we are still infants, we need about 14 to 17 hours of sleep per day. This amount of sleep is usually divided into 10 to 12 hours of nocturnal sleep and 3 to 5 hours of napping in the day. When we enter our teenage years, the amount of sleep we need goes down to about 9 hours per night. Once we enter our adult years, the amount of sleep we need per night for the rest of our lives is 7 to 9 hours. However, although the amount of sleep we need in our elderly years don’t change, our sleep patterns do. Unfortunately, senior sleep statistics show that these changes in sleep patterns can cause sleep troubles in the elderly.
(What to Expect), (Nationwide Children’s Hospital), (Sleep Education)
(Oxford Academic Sleep), (U.S. National Library of Medicine), (Medline Plus), (Cleveland Clinic)
The prevalence of insomnia is higher in the older population than in the younger, where insomnia prevalence is around 12 to 20%.
(Kate Crowley, PhD), (Dhaval Patel, MD)
Another study found that total sleep time decreased by 27 minutes per decade from mid-life until the 80s. Compared with younger adults, the elderly spend more time in bed but have deterioration in both the quality and quantity of sleep.
(Maurice M. Ohayon, MD, PhD), (Eve Van Cauter, PhD)
Slow-wave sleep (SWS) refers to phase 3 sleep. This sleep phase is the deepest phase of non-rapid eye movement (NREM) sleep. SWS is characterized by delta waves. Dreaming and sleepwalking can occur during SWS. SWS is thought to be important for memory consolidation. Thus, lower SWS can result in memory problems, a trait that is common among the elderly.
(Maurice M. Ohayon, MD, PhD), (Nature)
Sleep latency is the time it takes for people to fall asleep. Sleep latency has also been observed to increase with age. An analysis of different studies found that sleep latency increases by 5% between 20 and 70 years of age.
(Sleep Education), (Maurice M. Ohayon, MD, PhD)
Sleep efficiency is the time spent asleep in a night divided by the time spent in bed. The amount of melatonin the body produces decreases as we get older. This trait may be a reason for lower sleep efficiency over time. Moreover, light is an environmental cue that keeps our body’s circadian rhythm on schedule. However, elderly people spend too little time in daylight.
(Altug Didkoglu), (Jana R. Cook, MD and Sonia Ancoli-Israel, PhD)
Dreaming occurs most often during REM sleep. The reasons behind the decreases in sleep quality are still unclear. However, some factors may contribute to poorer sleep in the elderly. These factors include poor sleep habits and health conditions whose negative effects may accumulate or worsen with age.
(Maurice M. Ohayon, MD, PhD), (Cleveland Clinic)
Stage 1 is the lightest stage of NREM sleep. Muscle tone throughout the body relaxes and brain wave activity slows down. Stage 1 sleep allows the body to enter Stage 2. For most people, Stage 2 sleep takes about 40 to 60 % of sleep time. The increases in stages 1 and 2 are often attributed to higher sleep arousals and awakenings the elderly experience. As a consequence, their bodies rarely transition to Stage 3 and REM sleep.
(Maurice M. Ohayon, MD, PhD), (Bradley Edwards, PhD)
Naps have been suggested to help older adults function properly during the day. Moreover, older adults who report diabetes and bodily pain are likelier to have longer naps.
(Suzanne Goldman, PhD)
A Chinese study found that adults aged 65 or older who take a 1-hour nap after lunch had better cognition. On the other hand, those who nap for less than 30 minutes and more than 90 minutes did not have the same benefits in cognition.
(Junxin Li, PhD)
A study among Australian adults found that the prevalence of EDS increases with age. By 60 years old, it is expected that around 15% of adults will have EDS. EDS may be a result of other underlying sleep disorders, such as obstructive sleep apnea, or lifestyle, such as poor sleep hygiene.
(Amie Hayley, PhD)
A study in France recruited more than 8,000 subjects with an average age of 74 years. After 6 years, the study found that those with EDS had a 42% increased risk of mortality. Moreover, Moreover, those with EDS had poorer sleep quality, snored more frequently, had more insomnia and more frequently used medication for sleep or anxiety.
(Dr. Jean-Philippe Empana)
Chronic conditions such as depression, chronic pain, and cardiovascular diseases tend to be present in the later and elder years of life. These conditions can cause insomnia symptoms, which may explain the high prevalence of insomnia among the elderly.
(Daniel Foley, LMFT)
The American Insomnia Survey found that respondents older than 65 years complained less about insomnia. Another study found that sleep deprivation severely affected younger women more than older women. The sleep-deprived younger women fell asleep more and rated themselves more sleepy than the older women.
(Dhaval Patel, MD), (Patricia Stenuit, MSC and Myriam Kerkhofs, PhD)
Researchers found that lower physical health, depressed mood, and lower physical (but not social) activity levels consistently appeared as significant risk factors for prevalent, persistent, and incident insomnia.
(Kevin Morgan, PhD)
Sleep disturbances are common in people with depression and are usually a consequence of it. However, this research found that insomnia can occur before depression. The researchers found that insomnia and excessive daytime disorder is a significant risk factor for people aged 65 years and older to develop depression. Insomnia and excessive daytime disorder can cause depression regardless of sociodemographic, behavioral, and clinical characteristics, and even history of major depression.
(Isabelle Jaussent, MSc)
Persistent insomnia can cause the development of new-onset and recurrent major depressive disorder (MDD). However, researchers also found that persistent insomnia can perpetuate MDD. In particular, people aged 60 years or older are less likely to recover from MDD if they have insomnia.
(Wilfred Pigeon, PhD)
Similarly, sleeping for 9 hours or more per night also increases the chances of getting diabetes by around 1.8 times.
(Daniel Gottlieb, MD)
Sleep apnoea is a breathing disorder in sleep usually caused by repetitive upper airway obstruction. Its primary symptoms include snoring, daytime sleepiness and decreased cognitive functioning. The prevalence of sleep apnea appears to increase with age.
(Dr. Giora Pillar and Tamar Shochat)
Researchers suspect that the reason sleep apnea and EDS increases the risk of mortality in older adults is inflammation. Interestingly, older adults who only have either sleep apnea or EDS are safe from the higher chances of mortality.
(Nalaka Gooneratne, Md, MSc)
Researchers now recommend that physicians ask all patients with cardiovascular disease about sleep symptoms, especially obstructive sleep apnea symptoms.
(Neurology Today)
Obstructive sleep apnea (OSA) is commonly treated with continuous positive airway pressure (CPAP) therapy. Researchers found that elder patients with OSA and treated with CPAP have a lower chance of dying from cardiovascular diseases.
(Martinez-Garcia MA, PhD)
Many of the limb movements are flexions that last between 0.5 to 5 seconds, and they can occur every 10 to 90 seconds. These periodic movements can also last from minutes to hours.
(Dr. Magdolna Hornyak and Claudia Trenkwalder, MD), (Healthline), (Cleveland Clinic)
People with RLS commonly get an unpleasant and eve painful feeling in their legs. The feeling temporarily goes away by moving the legs. Patients with poorly controlled RLS may develop related problems like insomnia and depression.
(Dr. Shawn Milligan and Dr. Andrew Cheson)
Older men with RLS may also have a slightly increased risk for an ischemic heart disease event
(Professor Peter Elwood)
A common cause of secondary RLS is. Iron is needed to make dopamine. Dopamine is an important neurochemical in the brain that is involved in sleep, movements, and the control of pleasurable emotions iron deficiency.
(Won-Hyoung Kim, MD), (Richard Allen, PhD)
Nearly all patients with end stage renal disease have anemia, which why RLS can also occur in patients with renal disease.
(Won-Hyoung Kim, MD), (American Kidney Fund)
Sleep problems can palgue anyone, but they can be more problematic in the elderly population. Many older adults have trouble falling asleep and awaken after only a few hours. As a consequence they can be more fatigued during the day. Therefore, it is important to know what changes, whether big or small, can we make to improve their sleep so they can feel more at ease in their twilight years.
References
What to Expect:
https://www.whattoexpect.com/first-year/newborn-sleep.aspx
Nationwide Children’s Hospital:
https://www.nationwidechildrens.org/specialties/sleep-disorder-center/sleep-in-adolescents
Sleep Education:
http://sleepeducation.org/news/2013/08/07/sleep-and-growing-older
Foley et al., 1995:
https://academic.oup.com/sleep/article-abstract/18/6/425/2749669
Foley et al., 1999:
https://pubmed.ncbi.nlm.nih.gov/10394609/
Medline Plus:
https://medlineplus.gov/ency/article/004018.htm
Glasser et al., 2011:
https://breathe.ersjournals.com/content/7/3/248
Cleveland Clinic:
https://my.clevelandclinic.org/health/diseases/14177-periodic-limb-movement-disorder-plmd-in-adults
Crowley, 2011:
https://link.springer.com/article/10.1007%2Fs11065-010-9154-6
Patel et al., 2018:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991956/
Ohayon et al., 2004:
https://academic.oup.com/sleep/article/27/7/1255/2696819?login=false
Van Cauter et al., 2000:
https://pubmed.ncbi.nlm.nih.gov/10938176/
Nature:
nature.com/subjects/slow-wave-sleep
Didikoglu et al., 2019:
https://onlinelibrary.wiley.com/doi/abs/10.1111/jsr.12898
Cooke and Ancoli-Israel, 2012:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142094/
Edwards et al., 2010:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500384/
Cleveland Clinic:
https://my.clevelandclinic.org/health/articles/12227-sleep–aging
Goldman et al., 2008:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2398743/
Li et al., 2016:
https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.14368
Hayley et al., 2014:
https://www.sciencedirect.com/science/article/pii/S1389945714000203?via%3Dihub
Empana et al., 2009:
https://www.ahajournals.org/doi/full/10.1161/strokeaha.108.530824
Foley et al., 2004:
https://www.sciencedirect.com/science/article/pii/S0022399904000327?via%3Dihub
Patel et al., 2018:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991956/
Stenuit & Kerkhofs, 2005:
https://academic.oup.com/sleep/article-abstract/28/10/1283/2708118
Moran,2003:
https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2869.2003.00355.x?sid=nlm%3Apubmed
Jaussent et al., 2011:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138165/
Pigeon et al., 2008:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2279755/
Gottlieb et al., 2005:
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486518
Shochat & Pillar, 2003:
https://link.springer.com/article/10.2165%2F00002512-200320080-00001
Gooneratne et al., 2011:
https://academic.oup.com/sleep/article-abstract/34/4/435/2433778
Neurology Today:
Martínez-García et al., 2012:
https://europepmc.org/article/med/22983957
Hornyaka & Trenkwalder, 2004:
https://www.sciencedirect.com/science/article/pii/S0022399904000200?via%3Dihub
HealthLine:
https://www.healthline.com/health/sleep-disorder-periodic-limb-movement#causes
Cleveland Clinic:
https://my.clevelandclinic.org/health/diseases/14177-periodic-limb-movement-disorder-plmd-in-adults
Milligan & Chesson Jr., 2012:
https://link.springer.com/article/10.2165%2F00002512-200219100-00003
Elwood et al., 2006:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465538/
Kim et al., 2012:
https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.2754
Allen et al., 2011:
https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.23397
American Kidney Fund:
https://www.kidneyfund.org/anemia/anemia-in-esrd/
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