Sleep patterns and needs change as we age, making quality sleep even more essential for older adults. Many caregivers have the challenge of managing sleep disorders in their aging loved ones. Understanding the common sleep issues in older adults and how to address them can significantly improve their quality of life. Is it common for elderly patients to have poor sleep quality? How can you help your loved one achieve restful sleep?
Sleep patterns: normal changes over time
Sleep patterns evolve as we age. Understanding these changes can help caregivers and family members better support older adults in maintaining healthy sleep habits.
Young adults (18-25 years)
Sleep patterns are pretty stable in young adulthood. Most young adults require 7-9 hours of sleep per night. During this stage, sleep is typically deep and refreshing, with a higher proportion of slow-wave sleep (SWS) essential for physical and mental recovery. Circadian rhythms regulating the sleep-wake cycle are also well-established, often leading to consistent sleep and wake times.
Middle-aged adults (26-64 years)
As people transition into middle age, several changes in sleep patterns may occur:
- Decreased sleep duration: Although the recommended sleep duration remains 7-9 hours, many middle-aged adults say they get less sleep due to lifestyle factors such as work, family responsibilities, and stress.
- Changes in sleep architecture: There is a gradual reduction in the amount of deep sleep (SWS) and an increase in lighter stages of sleep. This can lead to more frequent awakenings during the night.
- Shift in circadian rhythm: Middle-aged adults may experience a shift in their circadian rhythm, often becoming "morning people." They might feel sleepy earlier in the evening and wake up earlier in the morning.
Older adults (65+ years)
In older adults, sleep patterns undergo more noticeable changes, which can include:
- Increased sleep fragmentation: Older adults often experience more fragmented sleep, waking up multiple times at night, which may be caused by factors like medical conditions, medications, and changes in sleep architecture.
- Reduced sleep duration: Many older adults sleep less than the recommended 7-8 hours per night. However, they might spend more time in bed to compensate for poorer sleep quality.
- Advanced sleep phase syndrome: This condition is characterized by a shift in the circadian rhythm, where individuals feel sleepy in the early evening and wake up very early in the morning. If their sleep needs are not met at night, this can lead to daytime sleepiness.
- Daytime napping: Older adults are more likely to take naps during the day. While short naps can be beneficial, excessive daytime sleep can interfere with nighttime sleep, creating a cycle of poor sleep quality.
- Changes in sleep architecture: There is a further reduction in deep sleep and an increase in lighter stages of sleep. REM (Rapid Eye Movement) sleep also starts to decrease, which can impact cognitive function and emotional health.
Sleep needs of older adults
The National Sleep Foundation recommends that adults 65 and older aim for 7-8 hours of sleep per night. However, actually getting this amount of sleep may be compromised due to factors that contribute to changes in sleep patterns as we age:
- Medical conditions: Chronic conditions such as arthritis, diabetes, heart disease, and respiratory disorders can disrupt sleep. Pain and discomfort can make it difficult to stay asleep.
- Medications: Many medications prescribed to older adults can affect sleep. For example, diuretics can increase nighttime urination (nocturia), while certain antidepressants and antihypertensives can alter sleep architecture.
- Lifestyle changes: Retirement, reduced physical activity, and changes in daily routines can impact sleep patterns. Lack of social interaction and mental stimulation can also affect sleep quality.
- Psychological factors: Anxiety, depression, and loneliness are common in older adults and can lead to sleep disturbances. Worries about health, finances, and family can also contribute to poor sleep.
Common sleep disorders in older adults
Most sleep disorders fall into a few categories, and older adults tend to have insomnia, sleep apnea, or restless legs syndrome. How can you improve the sleep quality of your loved one?
Insomnia
Insomnia is characterized by difficulty falling asleep, staying asleep, or experiencing restorative sleep. It often results in daytime fatigue and impaired functioning. Medical conditions, medications, and changes in sleep patterns associated with aging can exacerbate insomnia.
Obstructive sleep apnea
Obstructive sleep apnea causes breathing pauses at night because of a blocked airway. Sleep apnea disrupts sleep quality, leading to daytime sleepiness and symptoms like high blood pressure.
Restless legs syndrome
Willis-Ekborn disease, commonly known as restless leg syndrome, causes your loved one to move their legs uncontrollably at night. The uncontrollable movement might include pain or tingling, lessening sleep quality.
Periodic limb movement disorder
Periodic limb movement disorder involves involuntary leg movements that disrupt sleep quality. Common symptoms include random leg jerks in older adults and poor sleep because of the spontaneous movements.
REM sleep behavior disorder
REM sleep behavior disorder (RBD) is a condition in which individuals physically act out vivid, often unpleasant dreams during REM sleep, sometimes resulting in violent movements or vocalizations. This disorder is more common in older adults and can be associated with neurodegenerative conditions such as Parkinson's disease.
Health conditions contributing to excessive sleep in older adults
Excessive sleep (hypersomnia) can be a concern for older adults and their caregivers. Various health conditions can contribute to this issue, making it essential to identify and manage the underlying causes. Here are some key factors:
Chronic diseases
Cardiovascular Diseases
Conditions such as heart failure, coronary artery disease, and hypertension can lead to fatigue and excessive sleepiness. Reduced cardiac output and poor circulation can decrease energy levels, making individuals feel the need for more sleep.
Diabetes
Uncontrolled diabetes can cause fluctuating blood sugar levels, leading to fatigue and increased sleep. Both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) can disrupt normal sleep patterns, resulting in excessive sleepiness during the day.
Respiratory disorders
Chronic obstructive pulmonary disease (COPD) and sleep apnea are common in older adults and can significantly impact sleep quality. Sleep apnea, characterized by repeated pauses in breathing during sleep, can cause fragmented sleep and excessive daytime sleepiness.
Medications
Older adults often take multiple medications, some of which can cause drowsiness or fatigue as side effects. Common culprits include:
- Sedatives and tranquilizers: Medications prescribed for anxiety or insomnia, such as benzodiazepines, can lead to prolonged drowsiness.
- Antidepressants: Some antidepressants, particularly those with sedative properties, can cause excessive sleepiness.
- Antihistamines: Often used for allergies, these medications can have sedative effects.
- Pain medications: Opioids and certain over-the-counter pain relievers can induce drowsiness.
Healthcare providers should review your loved one's medication regimen regularly to identify and adjust any drugs that may be contributing to excessive sleep.
Mental health disorders
Depression and anxiety
Depression is prevalent among older adults and can manifest as hypersomnia, with individuals experiencing persistent feelings of sadness, hopelessness, and fatigue that lead them to sleep more than usual. Unlike the typical presentation of insomnia in depression, some older adults may oversleep as a way to escape negative emotions. Similarly, anxiety disorders can affect sleep patterns, causing both insomnia and hypersomnia. Chronic anxiety is mentally exhausting, making someone feel excessively tired and wanting to sleep more during the day.
Dementia
Neurodegenerative disorders like Alzheimer's disease and other forms of dementia can disrupt the sleep-wake cycle. These conditions can cause a range of sleep disturbances, including excessive daytime sleepiness, due to changes in brain function and the internal biological clock.
Diagnosis and treatment options
Figuring out why your loved one might have sleep troubles can be challenging, but there are effective ways to diagnose and treat sleep disorders in older adults.
Diagnosis
To diagnose sleep disorders, doctors use several tools and methods:
- Detailed health and sleep history: Physicians will ask about sleep habits, overall health, and any symptoms. Keeping a sleep diary, noting bedtime, wake-up time, and any nighttime interruptions can be very helpful.
- Physical examination: A thorough physical exam helps rule out underlying medical conditions that might contribute to sleep problems. Sometimes, simple blood tests are necessary.
- Sleep studies and polysomnography: Polysomnography (PSG) is an overnight sleep test where the patient spends a night at a sleep center or uses special equipment at home to monitor brain waves, breathing, and muscle activity during sleep. The patient sleeps in a quiet room hooked up to monitoring equipment, and a sleep specialist observes through a two-way window. Detailed sleep data helps doctors pinpoint the exact problem, such as serious breathing problems, uncharacteristic body movements, or other common symptoms.
Treatment options for sleep disorders in the elderly
Once a diagnosis is made, there are several treatment options available:
- Behavioral therapies and sleep hygiene: Improving sleep habits with relaxation techniques, consistent sleep schedules, and creating a sleep-friendly environment can significantly enhance sleep quality.
- Medications and pharmacotherapy: Targeted medications can address specific sleep disturbances, such as insomnia or restless legs syndrome (RLS).
- Non-pharmacological interventions:
- Light therapy: Exposure to bright light at specific times can help regulate the sleep-wake cycle.
- Exercise programs: Regular physical activity promotes better sleep.
- Dietary changes: Adjusting diet can improve sleep quality.
- CPAP therapy: For those with sleep apnea, Continuous Positive Airway Pressure (CPAP) therapy delivers a steady stream of air to keep airways open during sleep.
- RLS medications: Dopamine agonists or iron supplements can manage restless leg syndrome symptoms.
- Melatonin supplementation: In some cases, melatonin, a natural sleep hormone, can help regulate sleep-wake cycles.
- Cognitive Behavioral Therapy for Insomnia (CBT-I): This therapy addresses underlying thoughts and anxieties that contribute to insomnia.
- Physical therapy: For elderly individuals experiencing pain-related sleep issues, physical therapy can improve mobility and comfort, leading to better sleep.
A note from Givers
At Givers, we understand the vital importance of quality sleep for the well-being of older adults. We're here to support you every step in ensuring you and your loved one have the information you need to live—and sleep—well.
