Sleep seems to be more problematic and disordered in older adults.
The effects of certain medications more commonly taken by older adults, together with coexisting medical conditions, result in older adults being less able, on average, to obtain as much sleep, or as restorative a sleep, as young adults.
That older adults simply need less sleep is a myth. Older adults appear to need just as much sleep as they do in midlife, but are simply less able to generate that (still necessary) sleep. Affirming this, large surveys demonstrate that despite getting less sleep, older adults reported needing, and indeed trying, to obtain just as much sleep as younger adults.
There are additional scientific findings supporting the fact that older adults still need a full night of sleep, just like young adults.
The core impairments of sleep that occur with aging
These three key changes are:
(1) reduced quantity/quality (2) reduced sleep efficiency (3) disrupted timing of sleep.
The postadolescent stabilization of deep-NREM sleep in your early twenties does not remain very stable for very long.
Soon, sooner than you may imagine or wish, comes a great sleep recession, with deep sleep being hit especially hard.
In contrast to REM sleep, which remains largely stable in midlife, the decline of deep NREM sleep is already under way by your late twenties and early thirties. As you enter your fourth decade of life, there is a palpable reduction in the electrical quantity and quality of that deep NREM sleep.
You obtain fewer hours of deep sleep, and those deep NREM brain waves become smaller, less powerful, and fewer in number.
Passing into your mid and late forties, age will have stripped you of 60 to 70 percent of the deep sleep you were enjoying as a young teenager. By the time you reach seventy years old, you will have lost 80 to 90 percent of your youthful deep sleep.
Certainly, when we sleep at night, and even when we wake in the morning, most of us do not have a good sense of our electrical sleep quality. Frequently this means that many seniors progress through their later years not fully realizing how degraded their deep-sleep quantity and quality have become.
This is an important point: it means that elderly individuals fail to connect their deterioration in health with their deterioration in sleep, despite causal links between the two having been known to scientists for many decades. Seniors therefore complain about and seek treatment treatment for their health issues when visiting their GP, but rarely ask for help with their equally problematic sleep issues.
As a result, GPs are rarely motivated to address the problematic sleep in addition to the problematic health concerns of the older adult. To be clear, not all medical problems of aging are attributable to poor sleep.
But far more of our age-related physical and mental health ailments are related to sleep impairment than either we, or many doctors, truly realize or treat seriously.
An elderly individual who may be concerned about their sleep should not to seek a sleeping pill prescription. Instead, they should first explore the effective and scientifically proven non-pharmacological interventions that a doctor who is board certified in sleep medicine can provide.
The second hallmark of altered sleep as we age, and one that older adults are more conscious of, is fragmentation. The older we get, the more frequently we wake up throughout the night.
There are many causes, including interacting medications and diseases, but chief among them is a weakened bladder. Older adults therefore visit the bathroom more frequently at night. Reducing fluid intake in the mid and late evening can help, but it is not a cure-all.
Due to sleep fragmentation, older individuals will suffer a reduction in sleep efficiency, defined as the percent of time you were asleep while in bed. If you spent eight hours in bed, and slept for all eight of those hours, your sleep efficiency would be 100 percent.
If you slept just four of those eight hours, your sleep efficiency would be 50 percent. As healthy teenagers, we enjoyed a sleep efficiency of about 95 percent. As a reference anchor, most sleep doctors consider good-quality sleep to involve a sleep efficiency of 90 percent or above.
By the time we reach our eighties, sleep efficiency has often dropped below 70 or 80 percent; 70 to 80 percent may sound reasonable until you realize that, within an eight-hour period in bed, it means you will spend as much as one to one and a half hours awake.
Inefficient sleep is no small thing, as studies assessing tens of thousands of older adults show. Even when controlling for factors such as body mass index, gender, race, history of smoking, frequency of exercise, and medications, the lower an older individual’s sleep efficiency score, the higher their mortality risk, the worse their physical health, the more likely they are to suffer from depression, the less energy they report, and the lower their cognitive function, typified by forgetfulness.
Any individual, no matter what age, will exhibit physical ailments, mental health instability, reduced alertness, and impaired memory if their sleep is chronically disrupted.
The problem in aging is that family members observe these daytime features in older relatives and jump to a diagnosis of dementia, overlooking the possibility that bad sleep is an equally likely cause.
Not all old adults with sleep issues have dementia.
A more immediate, though equally dangerous, consequence of fragmented sleep in the elderly warrants brief discussion: the nighttime bathroom visits and associated risk of falls and thus fractures. We are often groggy when we wake up during the night. Add to this cognitive haze the fact that it is dark.
Furthermore, having been recumbent in bed means that when you stand and start moving, blood can race from your head, encouraged by gravity, down toward your legs. You feel light-headed and unsteady on your feet as a consequence. The latter is especially true in older adults whose control of blood pressure is itself often impaired.
All of these issues mean that an older individual is at a far higher risk of stumbling, falling, and breaking bones during nighttime visits to the bathroom.
Falls and fractures markedly increase morbidity and significantly hasten the end of life of an older adult.
Some tips for the elderly:
(1) have a side lamp within reach that you can switch on easily (2) use dim or motion-activated night-lights in the bathrooms and hallways to illuminate your path (3) remove obstacles or rugs en route to the bathroom to prevent stumbles or trips (4) keep a telephone by your bed with emergency phone numbers programmed on speed dial.
We will continue with this topic on the next blog
Coach HB