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Ageing and Sleep: What happens to our sleep as we age?

Sleep Disorders, Age related illnesses | August 12, 2014 | Author: The Super Pharmacist

sleep

Ageing and Sleep: What happens to our sleep as we age?

With advancing age come many changes that may or may not be a normal part of the process. Some of these changes affect sleep. The more conspicuous of which are feeling sleepy at increasingly earlier hours of the night but taking longer to fall asleep once in bed, a lighter sleep with easy arousal, frequent awakenings, getting up earlier in the morning and an overall decrease in the duration of the refreshing deep phase of sleep.

Underlying mechanisms

Are these changes genetically programmed or do they have more to do with other factors, internal and external, that accompany ageing?

The answer is yet inconclusive but most likely all have a role. We know that growth hormone secretion declines with age. This could be a cause or effect of the sleep changes as deep sleep stimulates growth hormone secretion. Melatonin, a substance secreted by the pineal gland, has an important role in setting circadian (24-hour) rhythms and the body’s biological clock. Its production declines with age too. Perhaps it is behind the sleep changes that occurs with age. The research is ongoing.

Causes of Sleep Dysfunction

While we keep in mind the mechanisms mentioned above, there are so many other factors that can disturb sleep at any age. Why sleep is disturbed more with advancing age? This is because most of these factors are more frequently associated with ageing. Some in fact are exclusive to the elderly.

Causes of Sleep DysfunctionFactors of a nonmedical nature

  • Poor sleep hygiene
  • Poor sleep environment
  • Excessive daytime napping
  • Snoring
  • Retirement
  • Changes in activity levels
  • Changes in social life
  • Sedentary lifestyle
  • Menopause
  • Alcohol
  • Caffeine
  • Death of a loved one/spouse

Factors of a medical nature 

  • Chronic pain
  • Arthritis
  • Fibromyalgia
  • Heart failure
  • Respiratory diseases
  • Renal failure
  • Urinary problems
  • Gastroesophageal reflux disease
  • Prostate issues
  • Allergies
  • Rhinosinusitis

Sleep disorders - Sleep apnoea, periodic limb movement disorder and restless legs syndrome

Neurologic deterioration - Alzheimer’s disease, dementia and parkinson’s disease

Psychiatric disorders - depression, psychosis and anxiety

Medications - antidepressants, antipsychotics, beta-blockers and nicotine

Reviewing the Symptoms

Sleep disturbance and deprivation will take its toll.

Immediate effects

  • Insomnia
  • ‚ÄčDaytime sleepiness
  • Lack of energy
  • Memory lapse
  • Poor task performance
  • Difficulty concentrating
  • Headaches
  • Trouble falling asleep
  • Frequent awakenings
  • Accidents and falls

Long-term consequences

  • Cardiovascular disease
  • Hypertension
  • Stroke
  • Obesity
  • Diabetes
  • Depression
  • Anxiety
  • Reduced life expectancy

Treatment options

Lifestyle changes and Self-remedies

  • Improve sleep hygiene
  • Less naps during the day
  • Keep bed for sleep and sex only
  • Avoid heavy meals before bedtime
  • Avoid caffeine before bedtime
  • Avoid alcohol before bedtime
  • Calming music or light reading before bedtime
  • Regular exercise
  • Keep active/busy during the day
  • Adequate sunlight exposure during the day
  • If unable to fall asleep within 20 minutes after going to bed, get up for a while and then try again
  • Losing weight can improve snoring
  • Avoid over-the-counter sleep aids and medicines
  • Turn off your TV and computer well before bedtime

Medical management

If your sleep disturbance leads to any of the symptoms listed above and appears to be converting into a frequent insomnia, seeking medical advice is recommended. You should initially consult your general practitioner or family doctor. A full interview and physical exam will be conducted. Your doctor may suggest keeping a sleep diary. He/she may also refer you to a sleep clinic for a sleep study. Depending upon the probable underlying cause you could be further managed by your family practitioner, a sleep consultant or a medical specialist, or some other doctor if there is a more specific diagnosis.

Sleeping pills can only be taken with a doctor’s prescription. Their use has declined due to adverse effects and rebound insomnia on withdrawal. They are mostly prescribed for short bothersome episodes of insomnia. Most sleeping pills belong to the benzodiazepine group of medicines. Examples include triazolam and temazepam. Zolpidem is a sleep medication that is not a benzodiazepine.

Treating chronic medical illness. If there is an identifiable cause for the sleep problems and it is a medical condition, your doctor’s first priority will be to treat it. Treating or alleviating a chronic medical illness may cure the sleep disturbance.

Antidepressants such as sertraline may help patients who have insomnia due to underlying depression.

Anxiolytics such as lorazepam may help with sleep if anxiety keeps you awake.

Gaining new Insight

Sleep requirements. It is popular belief that the required sleep duration decreases with age and reduced sleep is a normal component of ageing. 

Latest research however indicates that this is not the case and all adults should get 7 to 9 hours of sleep daily irrespective of age. We could say that any amount of sleep that keeps you fresh and active throughout the day is a normal duration for you. However decreased sleep hours that are followed by daytime sleepiness, fatigue and lack of concentration, among many other symptoms, are not normal for any age. 

Melatonin as a medicine. The role of melatonin in setting circadian rhythms and the biological clock is well established and so is the fact that its secretion declines with age. These findings have generated interest in using it to reverse age-related changes and, at least, cure sleep disturbances in the senescent. Any long-term positive effects, however, have yet to be affirmed. Melatonin in the form of a prescription medicine is available under the brand name Circadin, which has been of some benefit in treating insomnia with ageing.

New Developments

Ramelteon belongs to an altogether new class of sleeping pills. It binds to and activates melatonin receptors in the brain. So it mimics melatonin’s function. It has helped the elderly with sleep disturbance, with minimal adverse effects when compared to conventional sleeping pills. It is approved for use in the United States, but not yet in Australia.

www.superpharmacy.com.au Australia's best online pharmacy

References

Pandi-Perumal SR, Zisapel N, Srinivasan V, Cardinali DP. Melatonin and sleep in aging population. Exp Gerontol. 2005;22:911–925.

Cooke JR, Ancoli-Israel S (2011). Normal and abnormal sleep in the elderly. Handbook of clinical neurology. 98:653–665.

Brower KJ, Hall JM. Effects of age and alcoholism on sleep: a controlled study. J Stud Alcohol. 2001;62:335–343.

Tractenberg RE, Singer CM, Kaye JA. Characterizing sleep problems in persons with Alzheimer's disease and normal elderly. J Sleep Res. 2006;15:97–103.

McCall WV. Sleep in the elderly: burden, diagnosis, and treatment. Prim Care Companion J Clin Psychiatry. 2004;6:9–20.

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