- Aging changes in sleep
- Sleep Changes in Older Adults
- Path to improved health
- Medical Causes of Sleep Problems
- If You’re Not Sleeping Well, There May Be a Medical Cause
- Chronic physical conditions
- Mental health disorders
- Neurological disorders
Aging changes in sleep
Sleep normally occurs in several stages. The sleep cycle includes:
- Dreamless periods of light and deep sleep
- Some periods of active dreaming (REM sleep)
The sleep cycle is repeated several times during the night.
With aging, sleep patterns tend to change. Most people find that aging causes them to have a harder time falling asleep. They awaken more often during the night and earlier in the morning.
Total sleep time stays the same or is slightly decreased (6.5 to 7 hours per night). It may be harder to fall asleep and you may spend more total time in bed. The transition between sleep and waking up is often abrupt, which makes older people feel like they are a lighter sleeper than when they were younger.
Less time is spent in deep, dreamless sleep. Older people wake up an average of 3 or 4 times each night. They are also more aware of being awake.
Older people wake up more often because they spend less time deep sleep. Other causes include needing to get up and urinate (nocturia), anxiety, and discomfort or pain from long-term (chronic) illnesses.
EFFECT OF CHANGES
Sleep difficulty is an annoying problem. Long-term (chronic) insomnia is a major cause of auto accidents and depression. Because older people sleep more lightly and wake up more often, they may feel deprived of sleep even when their total sleep time has not changed.
Sleep deprivation can eventually cause confusion and other mental changes. It is treatable, though. You can reduce symptoms when you get enough sleep.
Sleep problems are also a common symptom of depression. See a health care provider to find out whether depression or another health condition is affecting your sleep.
- Insomnia is one of the more common sleep problems in older people.
- Other sleep disorders, such as restless legs syndrome, narcolepsy, or hypersomnia can also occur.
- Sleep apnea, where breathing stops for a time during sleep, can cause severe problems.
Older people respond differently to medicines than do younger adults. It is very important to talk with a provider before taking sleep medicines. Avoid sleep medicines, if possible. However, antidepressant medicines can be very helpful if depression affects your sleep. Some antidepressants do not cause the same side effects as sleep medicines.
Sometimes, a mild antihistamine works better than a sleeping pill for relieving short-term insomnia. However, most health experts do not recommend these types of medicines for older people.
Use sleep medicines (such as benzodiazepines) only as recommended, and only for a short time. Some of these medicines can lead to dependence (needing to take the drug to function) or addiction (compulsive use despite adverse consequences). Some of these drugs build up in your body. You can develop toxic effects such as confusion, delirium, and falls if you take them for a long time.
You can take measures to help you sleep:
- A light bedtime snack may be helpful. Many people find that warm milk increases sleepiness, because it contains a natural, sedative-like amino acid.
- Avoid stimulants such as caffeine (found in coffee, tea, cola drinks, and chocolate) for at least 3 or 4 hours before bed.
- DO NOT take naps during the day.
- Exercise (moderately) in the afternoon.
- Avoid too much stimulation, such as violent TV shows or computer games, before sleep. Practice relaxation techniques at bedtime.
- Try to go to bed at the same time every night and wake at the same time each morning.
- Use the bed only for sleep or sexual activity.
- Avoid tobacco products, especially before sleep.
- Ask your provider if any of the medicines you take may affect your sleep.
If you cannot fall asleep after 20 minutes, get out of bed and do a quiet activity, such as reading or listening to music.
When you feel sleepy, get back in bed and try again. If you still cannot fall asleep in 20 minutes, repeat the process.
Drinking alcohol at bedtime may make you sleepy. However, it is best to avoid alcohol, because it can make you wake up later in the night.
- Aging changes in the nervous system
Many adults assume that if they spend eight hours in bed, they are meeting their daily needs for rest and rejuvenation. What they fail to take into account, however, are the number of times they wake up throughout the night, or minutes spent tossing and turning under the covers, which can seriously cut down on both the quantity and quality of that sleep.
Interrupted sleep refers to sleep that is punctuated by prolonged periods of waking up throughout the night, usually at least four times over the course of eight hours. The condition can be caused by a sudden shift in routine (for example, a new baby in the house), unexpected noises (such as a party at your neighbor’s house or a partner’s snoring), bathroom trips, or racing thoughts.
The Health Fallout
Interrupted sleep can have negative consequences on your overall health. During the night, your body progresses through different stages of sleep. If one stage is interrupted, your body has to reset and start going through the stages again, meaning you may never get to the deep, restorative sleep that occurs during later stages.
Even just one night of interrupted sleep can negatively affect your mood and cause you to experience a decline in attention span. Interrupted sleep can slow your reaction speed and make it harder to learn or remember things. It can also lead to a buildup of amyloid proteins in the body, which are linked to Alzheimer’s disease.
Finding a Fix
If you suffer from interrupted sleep, there are lifestyle changes you can implement to try and sustain sleep for longer periods of time. First, try restricting your sleep a little bit. Figure out how many hours you’re actually getting per night, minus any periods of wakefulness, and only allow yourself to be in bed for that long. After cutting down on your sleep, you’ll naturally become sleepier at night, leading you to sleep more deeply.
Next, if you find yourself awake at night for more than fifteen minutes, get out of bed. Go to a quiet, dimly lit couch or comfortable chair, and do a relaxing activity like reading, meditating, or gentle stretching. Once you feel drowsy again, head back to bed.
Finally, stick to your normal wake up time, even if you had a bad night of sleep the night before. Staying consistent with a bedtime and wakeup time will help your body remain in tune with its circadian rhythm, and help your chances of resting peacefully through the night.
Sleep Changes in Older Adults
Path to improved health
Older adults often see their sleep-wake cycle change. This can be caused by age, lifestyle, or health conditions. Your body’s chemicals and hormones are a factor, too. For example, as you age, your body produces less melatonin. This is the natural hormone that regulates your sleep cycle. Lifestyle habits can affect your sleep. These include smoking and drinking alcohol or caffeine.
Certain medicines can make it hard to sleep. Dealing with pain can keep you awake. Some health conditions can even cause sleep problems. Diabetes and prostate issues can contribute to sleep disturbance and make you fatigued.. The problem caused by these conditions is that you are being woken up to urinate many times through the night. Conditions such as congestive heart failure or kidney disease may cause sleep issues. You may have trouble lying flat and getting comfortable enough to fall asleep. If you find yourself sleeping in a recliner or waking up many times throughout the night, it is important to talk to your doctor. He or she can make sure underlying health problems aren’t causing your sleep issues.
One common sleeping disorder is sleep apnea. It causes a person’s breathing to abnormally stop and start, while sleeping. People who have sleep apnea often snore loudly. You stop breathing for 10 to 30 seconds at a time. When you start breathing again, you gasp or snort, which can wake you up. This can occur hundreds of times in a single night. Each time you wake up, it disrupts your sleeping pattern. Sleep apnea makes it hard to get a good night’s rest. It can be harmful if you stop breathing for too long. It also can cause high blood pressure and increase your risk of a heart attack.
Restless legs syndrome (RLS)
RLS is a condition in which you have leg pain or discomfort. It occurs when you are sitting or lying down. It can feel like your legs won’t be still. RLS can make it hard for you to sleep.
Periodic limb movement disorder (PLMD)
PLMD is a condition in which you kick your legs while you sleep. Most of the time, you don’t know you’re kicking. If you have a bed partner, they may tell you about it. PLMD can prevent good sleep and cause daytime fatigue. Some people may have RLS and PLMD.
Medical Causes of Sleep Problems
A Harvard Health article
If You’re Not Sleeping Well, There May Be a Medical Cause
People who feel they sleep perfectly well may still be troubled by excessive daytime sleepiness because of a variety of underlying medical illnesses. A sleep disturbance may be a symptom of a health issue or an adverse effect of therapy to treat the problem. The stress of chronic illness can also cause insomnia and daytime drowsiness.Common conditions often associated with sleep problems include heartburn, diabetes, cardiovascular disease, musculoskeletal disorders, kidney disease, mental health problems, neurological disorders, respiratory problems, and thyroid disease. In addition, a number of prescription and over-the-counter medications used to treat these and other health problems can impair sleep quality and quantity (see table below).
Chronic physical conditions
Lying down in bed often worsens heartburn, which is caused by the backup of stomach acid into the esophagus. You may be able to avoid this problem by abstaining from heavy or fatty foods—as well as coffee and alcohol—in the evening. You can also use gravity to your advantage by elevating your upper body with an under-mattress wedge or blocks placed under the bedposts. Over-the-counter and prescription drugs that suppress stomach acid secretion can also help.
Diabetes is a common, chronic disorder marked by elevated levels of blood glucose, or sugar. It occurs when your cells don’t respond appropriately to insulin (a hormone secreted by the pancreas), and when your pancreas can’t produce more insulin in response. People with diabetes whose blood sugar levels are not well controlled may experience sleep problems due to:
- night sweats
- a frequent need to urinate, or
- symptoms of hypoglycemia (low blood sugar)
If diabetes has damaged nerves in the legs, nighttime movements or pain may also disturb sleep.
Heart failure is a condition characterized by a gradual decline in the heart’s ability to “pump”, or circulate blood adequately. Heart failure can cause fluid to build up in the lungs and tissues. Patients with heart failure may awaken during the night feeling short of breath because extra body fluid accumulates around their lungs when they’re lying down. Using pillows to elevate the upper body may help. These people can also be awakened just as they are falling asleep by a characteristic breathing pattern called Cheyne-Stokes respiration, a series of increasingly deep breaths followed by a brief cessation of breathing.
Benzodiazepine sleep medications help some people to stay asleep despite this breathing disturbance, but others may need to use supplementary oxygen or a device that increases pressure in the upper airway and chest cavity to help them breathe and sleep more normally.
Men with heart failure frequently have obstructive sleep apnea—a breathing disorder characterized by multiple nighttime awakenings—which can disrupt sleep, cause daytime sleepiness, and worsen heart failure. In people with coronary artery disease, the natural fluctuations in circadian rhythms may trigger angina (chest pain), arrhythmia (irregular heartbeat), or even heart attack while asleep.
Arthritis pain can make it hard for people to fall asleep and to resettle when they shift positions. In addition, treatment with steroids frequently causes insomnia. You may find it helpful to take aspirin or a nonsteroidal anti-inflammatory drug (NSAID) just before bedtime to relieve pain and swelling in your joints during the night.
People with fibromyalgia—a condition characterized by painful ligaments and tendons—are likely to wake in the morning still feeling fatigued and as stiff and achy as a person with arthritis. Researchers who analyzed the sleep of fibromyalgia sufferers have found that at least half have abnormal deep sleep, in which slow brain waves are mixed with waves usually associated with relaxed wakefulness, a pattern called alpha-delta sleep.
People with kidney disease have kidneys that are damaged to the extent that they can no longer filter fluids, remove wastes, and keep electrolytes in balance as efficiently as they did when healthy. Kidney disease can cause waste products to build up in the blood and can result in insomnia or symptoms of restless legs syndrome. Although researchers aren’t sure why, kidney dialysis or transplant does not always return sleep to normal.
Nocturia is the need to get up frequently to urinate during the night. It is a common cause of sleep loss, especially among older adults. A mild case causes a person to wake up at least twice during the night; in severe cases, a person may get up as many as five or six times.
Nocturia may be a product of age, but other causes include certain medical conditions (heart failure, diabetes, urinary tract infection, an enlarged prostate, liver failure, multiple sclerosis, sleep apnea), medication (especially diuretics), and excessive fluid intake after dinner.
Therapies for nocturia fall into three categories:
- treatments to correct medical causes
- behavioral interventions
The first step is to try to identify the cause and correct it. If this is unsuccessful, try behavioral approaches such as cutting down on how much you drink in the two hours before bedtime, especially caffeine and alcohol. If the nocturia persists, your doctor may prescribe one of a growing number of medications approved to treat an overactive bladder.
An overactive thyroid gland (hyperthyroidism) can cause sleep problems. The disorder overstimulates the nervous system, making it hard to fall asleep, and it may cause night sweats, leading to nighttime arousals. Feeling cold and sleepy is a hallmark of an underactive thyroid (hypothyroidism).
Because thyroid function affects every organ and system in the body, the symptoms can be wide-ranging and sometimes difficult to decipher. Checking thyroid function requires only a simple blood test, so if you notice a variety of unexplained symptoms, ask your doctor for a thyroid test.
Circadian-related changes in the tone of the muscles surrounding the airways can cause the airways to constrict during the night, raising the potential for nocturnal asthma attacks that rouse the sleeper abruptly.
Breathing difficulties or fear of having an attack may make it more difficult to fall asleep, as can the use of steroids or other breathing medications that also have a stimulating effect, similar to that of caffeine.
People who have emphysema or bronchitis may also have difficulty falling and staying asleep because of excess sputum production, shortness of breath, and coughing.
Mental health disorders
Almost all people with anxiety or depression have trouble falling asleep and staying asleep. In turn, not being able to sleep may become a focus of some sufferers’ ongoing fear and tension, causing further sleep loss.
Severe anxiety, also known as generalized anxiety disorder, is characterized by persistent, nagging feelings of worry, apprehension, or uneasiness. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person’s everyday life.
People with general anxiety typically experience excessive, persistent worry every day or almost every day for a period of six months or more. Common symptoms include trouble falling asleep, trouble staying asleep, and not feeling rested after sleep.
Phobias and panic attacks
Phobias, which are intense fears related to a specific object or situation, rarely cause sleep problems unless the phobia is itself sleep-related (such as fear of nightmares or of the bedroom). Panic attacks, on the other hand, often strike at night. In fact, the timing of nocturnal attacks helped convince psychiatrists that these episodes are biologically based.
Sleep-related panic attacks do not occur during dreaming, but rather in stage N2 (light sleep) and stage N3 (deep sleep), which are free of psychological triggers. In many phobias and panic disorders, recognizing and treating the underlying problem—often with an anti-anxiety medication—may solve the sleep disturbance.
Because almost 90% of people with serious depression experience insomnia, a physician evaluating a person with insomnia will consider depression as a possible cause. Waking up too early in the morning is a hallmark of depression, and some depressed people have difficulty falling asleep or get fitful sleep throughout the whole night.
In chronic, low-grade depression (also known as dysthymia), insomnia or sleepiness may be the most prominent symptom. Laboratory studies have shown that people who are depressed spend less time in slow-wave sleep and may enter REM sleep more quickly at the beginning of the night.
Disturbed sleep is a prominent feature of bipolar disorder (also known as manic-depressive illness). Sleep loss may exacerbate or induce manic symptoms or temporarily alleviate depression. During a manic episode, a person may not sleep at all for several days. Such occurrences are often followed by a “crash” during which the person spends most of the next few days in bed.
Some people with schizophrenia sleep very little in the early, most severe stage of an episode. Between episodes, their sleep patterns are likely to improve, although many people with schizophrenia rarely obtain a normal amount of deep sleep.
Certain brain and nerve disorders can contribute to sleeplessness.
Alzheimer’s disease and other forms of dementia may disrupt sleep regulation and other brain functions. Wandering, disorientation, and agitation during the evening and night, a phenomenon known as “sundowning,” can require constant supervision and place great stress on caregivers. In such cases, small doses of antipsychotic medications are more helpful than benzodiazepine drugs.
People with epilepsy—a condition in which a person is prone to seizures—are twice as likely as others to suffer from insomnia. Brain wave disturbances that cause seizures can also cause deficits in slow-wave sleep or REM sleep. Antiseizure drugs can cause similar changes at first, but tend to correct these sleep disturbances when used for a long time.
About one in four people with epilepsy has seizures that occur mainly at night, causing disturbed sleep and daytime sleepiness. Sleep deprivation can also trigger a seizure, a phenomenon noted in college infirmaries during exam periods, as some students suffer their first seizures after staying up late to study.
Headaches, strokes, and tumors
People who are prone to headaches should try to avoid sleep deprivation, as lack of sleep can promote headaches. Both cluster headaches and migraines may be related to changes in the size of blood vessels leading to the cortex of the brain; pain occurs when the walls of the blood vessels dilate.
Researchers theorize that as the body catches up on missed sleep, it spends more time in delta sleep, when vessels are most constricted, making the transition to REM sleep more dramatic and likely to induce a headache. Headaches that awaken people are often migraines, but some migraines can be relieved by sleep. Sleepiness coupled with dizziness, weakness, headache, or vision problems may signal a serious problem such as a brain tumor or stroke, which requires immediate medical attention.
Almost all people with Parkinson’s disease have insomnia. Just getting in and out of bed can be a struggle, and the disease often disrupts sleep. Some arousals are from the tremors and movements caused by the disorder, and others seem to result from the disorder itself. As a result, daytime sleepiness is common.
Treatment with sleeping pills may be difficult because some drugs can worsen Parkinson’s symptoms. Some patients who take drugs used to treat Parkinson’s treatment may develop severe nightmares; others experience disruption of REM sleep. However, the use of these medications at night is important to maintain the mobility needed to change positions in bed. A bed rail or an overhead bar (known as a trapeze) may make it easier for people with Parkinson’s to move about and, therefore, lead to better sleep.
Adapted with permission from Improving Sleep: A Guide to a Good Night’s Rest, a special health report published by Harvard Health Publishing.
How is insomnia treated?
Lifestyle changes often can help relieve acute (short-term) insomnia. These changes might make it easier to fall asleep and stay asleep.
A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia.
Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it’s important to treat the underlying cause (if possible).
If you have insomnia, avoid substances that make it worse, such as:
- Caffeine, tobacco, and other stimulants. The effects of these substances can last as long as 8 hours.
- Certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines). Talk with your doctor about which medicines won’t disrupt your sleep.
- Alcohol. An alcoholic drink before bedtime might make it easier for you to fall asleep. However, alcohol triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
Try to adopt bedtime habits that make it easier to fall asleep and stay asleep. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath.
Try to schedule your daily exercise at least 5 to 6 hours before going to bed. Don’t eat heavy meals or drink a lot before bedtime.
Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure the temperature of your bedroom is cool and comfortable. Your bedroom also should be dark and quiet.
Go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.
CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.
For example, relaxation techniques and biofeedback are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
CBT also aims to replace sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable time.
CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.
CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you’re usually asleep.
This schedule might make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.
For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone.
For people who have insomnia and major depressive disorder, CBT combined with antidepression medicines has shown promise in relieving both conditions.
Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use.
Talk to your doctor about the benefits and side effects of insomnia medicines. For example, insomnia medicines can help you fall asleep, but you may feel groggy in the morning after taking them.
Rare side effects of these medicines include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn’t work well, tell your doctor. He or she might prescribe a different medicine.
Some insomnia medicines can be habit forming. Ask your doctor about the benefits and risks of insomnia medicines.
Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.
The Food and Drug Administration doesn’t regulate “natural” products and some food supplements. Thus, the dose and purity of these substances can vary. How well these products work and how safe they are isn’t well understood.
Some OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your doctor before taking them.
Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products will benefit you.
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What is insomnia?
Insomnia is a common sleep disorder. If you have it, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.
What are the types of insomnia?
Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common. Common causes include stress at work, family pressures, or a traumatic event. It usually lasts for days or weeks.
Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.
Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.
Who is at risk for insomnia?
Insomnia is common. It affects women more often than men. You can get it at any age, but older adults are more likely to have it. You are also at higher risk of insomnia if you
- Have a lot of stress
- Are depressed or have other emotional distress, such as divorce or death of a spouse
- Have a lower income
- Work at night or have frequent major shifts in your work hours
- Travel long distances with time changes
- Have an inactive lifestyle
- Are African American; research shows that African Americans take longer to fall asleep, don’t sleep as well, and have more sleep-related breathing problems than whites.
What are the symptoms of insomnia?
Symptoms of insomnia include:
- Lying awake for a long time before you fall asleep
- Sleeping for only short periods
- Being awake for much of the night
- Feeling as if you haven’t slept at all
- Waking up too early
What other problems can insomnia cause?
Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you may feel drowsy while driving. This could cause you get into a car accident.
How is insomnia diagnosed?
To diagnose insomnia, your health care provider
- Takes your medical history
- Asks for your sleep history. Your provider will ask you for details about your sleep habits.
- Does a physical exam, to rule out other medical problems that might cause insomnia
- May recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.
What are the treatments for insomnia?
Treatments include lifestyle changes, counseling, and medicines:
- Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep.
- A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia
- Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule
If your insomnia is the symptom or side effect of another problem, it’s important to treat that problem (if possible).
NIH: National Heart, Lung, and Blood Institute