19.02.2014
No matter what your age, sleeping well is essential to your physical health and emotional well-being. Many physicians consider sleep to be a barometer of a person’s health, like taking his or her temperature. While sleep requirements vary from person to person, most healthy adults tend to require between seven and a half to nine hours of sleep per night to function at their best.
However, how you feel following a night’s sleep is more important than the specific number of hours you spend asleep. As you age your body produces lower levels of growth hormone, so you'll likely experience a decrease in slow wave or deep sleep.
As you age, you may have to spend longer in bed at night to get the hours of sleep you need, or you may have to make up the shortfall by taking a nap during the day.
While emotional issues such as stress, anxiety, and depression can cause insomnia, the most common causes in adults over 50 are a poor sleep environment and poor sleep and daytime habits.
People are biologically programmed to sleep not only for a long period in the middle of the night but also for a short period in the middle of the day. While adults need some of each type of exercise, studies have shown that participating in moderate aerobic activity can have the greatest impact on improving sleep. A study by Feinberg School of Medicine at Northwestern University found that aerobic exercise resulted in the most dramatic improvement in patients' reported quality of sleep, including sleep duration, on middle-aged and older adults with a diagnosis of insomnia.
CBT is aimed at not only improving your sleep habits but also changing your thoughts and feelings about sleep that may be causing stress and contributing to your insomnia. Sleep Help Center: Learn how to put a stop to nighttime problems and improve the quality of your rest, and with it, the quality of your life.
Sleep Problems in the Elderly – Journal article that provides a wealth of information on seniors and sleep problems. Age-related Reduction in Maximal Capacity for Sleep – Study that suggests healthy older people may require less sleep than younger adults. Foods that Help you Sleep – Foods recommended to help you sleep, and others that keep you awake.
Diet, Exercise, and Sleep – Information about the interrelationships between sleep, nutrition, and exercise. CBT for Insomnia Program – Online, interactive treatment program for insomnia from sleep doctor Gregg Jacobs. See related patient information handout on sleep problems in the elderly, written by the author of this article. The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. Central sleep apnea although is a central nervous system disorder and is directly related with sleep and breathing has strong connection with other health ailments as well. With the help of studies and researches it is found that patients that are taking medicines for arthritis can suffer from central sleep apnea. Back of the brain that is also known as brain stream directly control sleep and respiratory organs. Ailments associated with heart like stroke, attack and heart failure might trigger central sleep apnea and other sleep disorders.
Awakening repeatedly during the night which breaks the sleep cycle and may require a period of time before one can fall asleep again.
Contrary to popular belief, the elderly require 7 to 9 hours of sleep per day as is the case with younger adults provided that there are no repeated interruptions when asleep. The elderly may find that their sleep breaks regularly either to urinate, when in pain, experience difficulty breathing or when, awakened by others for snoring loudly. In these instances, the quality of sleep is poor and a person may require a nap during the day or spend longer hours in bed. There is no definitive way to ascertain how much of sleep is excessive for an older person.
The newborn infant sleeps about sixteen to eighteen hours per day, and its sleep is widely distributed around the twenty four hour day (Figure 1).
Polyphasic (multiphase) sleep following birth changes first to biphasic (two-phase) sleep among preschool children and later to monophasic (single-phase) sleep. Most evidence indicates that as individuals approach old age, the amount of nocturnal sleep decreases; older individuals usually sleep only six to seven hours (Figure 2). The quantity of REM sleep (defined as the proportion of total sleep time) may exceed fifty percent in the newborn; premature babies have even higher amounts (Figure 2).
Over the last fifteen years there has been the recognition that respiration is strongly affected by an individual's sleep and waking states. Sleep is just as important to our physical and emotional health over the age of 50 as it was when we were younger.
For older adults, a good night’s sleep is especially important because it helps improve concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system, which in turn helps to prevent disease. Older adults who don’t sleep well are more likely to suffer from depression, attention and memory problems, and excessive daytime sleepiness. Frequently waking up not feeling rested or feeling tired during the day are the best indications that you’re not getting enough sleep at night and may have a sleep problem that needs to be addressed. When this happens you produce less melatonin, meaning you'll often experience more fragmented sleep (more rapid sleep cycles) and wake up more often during the night. These include irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on. Older adults tend to take more medications than younger people and the combinations of drugs, as well as their side-effects, can impair sleep.
In many cases, older adults develop these poor sleep habits over a lifetime but find they create more and more problems as they age. Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep.
Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy.
Anxiously watching the minutes tick by when you can’t sleep is a surefire recipe for insomnia.


There are countless activities you can do to increase strength, improve aerobic capacity, burn calories, and prepare yourself for a good night’s sleep at the end of the day. Everyone has worries and lists of things to do, but it is important to teach yourself to let go of these thoughts when it’s time to sleep.
Try not to stress over the fact that you can’t get back to sleep, because that very stress encourages your body to stay awake. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time.
For optimal daytime alertness, humans require an average of about eight hours of sleep for a 24-hour period.
Nighttime insomnia and excessive daytime sleepiness should not be viewed as isolated symptoms. Primary sleep disorders may delay sleep onset, cause multiple arousals and awakenings, and promote excessive daytime sleepiness (Table 3). Implementation of good sleep habits and daily physical activity should help create an environment conducive to restorative sleep (Table 4). With constant researches and studies it was found that there are certain ailments that can trigger central sleep apnea sooner or later in your life.
As a result the overall respiratory system is affected and the patient might experience serious symptoms of central sleep apnea.
Medicines used in all heart problems affect respiratory system and sleeping habits of a person simultaneously causing severe central sleep apnea or obstructive sleep apnea symptoms. Most sleeping disorders are associated with difficulty falling asleep or maintaining sleep. Certain diseases or medication can also affect the sleep cycle or causes discomfort that leads a person to awaken regularly at night. However, at other times, certain diseases and medication may cause fatigue, sleepiness or even drowsiness. These tips can help you overcome age-related sleep problems and get a good night’s rest. As your circadian rhythm (the internal clock that tells you when to sleep and when to wake up) changes, you may also find yourself wanting to go to sleep earlier in the evening and waking up earlier in the morning. In addition, many health conditions such as a frequent need to urinate, arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, menopause, and Alzheimer's can interfere with sleep. Regular aerobic exercise during the day, at least three hours before bedtime, can promote good sleep. Sleeping pills don’t address the causes of insomnia and can even make insomnia worse in the long run.
The regular aerobic exercise improved the participants' sleep quality from a diagnosis of poor sleeper to good sleeper.
Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body. Your doctor may then refer you to a sleep specialist or cognitive behavioral therapist for further treatment. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Sleep deprivation causes increased sleepiness and may cause cognitive impairment.Under normal conditions, the circadian rhythm promotes a daily cycle of nighttime sleep and daytime alertness. It is important to obtain a complete sleep history that includes the entire 24-hour day to examine all of the factors that may influence sleep and wakefulness (Table 2). Mental or physical conditions that are directly associated with breathing or sleep can later on prompt other sleep disorders.
During surgery if there is some complication, respiratory system is brutally affected as a result patient is vulnerable not just central sleep apnea but also to other sleep disorders. However, the elderly may find that eventually they need more sleep than they did earlier in adulthood.
After the mid thirties, a person may find that they can manage adequately on as little as 6 hours of sleep per day.
This is not unusual with age but can only be considered normal if it follows a period of activity. A lesser known sleeping disorder is excessive daytime sleepiness which is marked by tiredness during the day with the need to sleep or at least nap on a regular basis. A person may complain of feeling tired or sleepy even after awaking and may therefore be sleeping excessively. Even after your original reason for sleep disruption has passed, the learned response can remain. Therefore, it’s best to limit sleeping pills to situations where your health or safety is threatened. Asking the patient to keep a sleep log that covers all sleep over a period of several weeks may be helpful in establishing the patient's sleep patterns. These measures have the greatest potential for improving the quality of sleep in elderly persons. Following is given an overview of other ailments that might initiate central sleep apnea afterwards. Difficulties with sleeping, however, may mean that sleeping for one long period is not possible. However, there comes a point in the senior years where a person revert backs to sleeping for longer hours similar to childhood. In the event that a person is sleeping excessively without activity and are not losing sleep time by one or more the factors mentioned above, then the cause should be investigated.
A person who is physically active, mentally healthy and functioning in a manner that is considered the norm for others of their age can therefore be said to be sleeping sufficiently irrespective of the actual number of sleeping hours in a day. It is now well established that a person's circadian rhythm is strongly influenced by exposure to light.Normal sleep progresses through a number of stages during each sleep period. Instead the elderly may sleep in several shorter sessions throughout the day, often giving the impression that they are sleeping excessively.
It has to be ascertained whether a person is sleeping for too many hours or not, based on the quality of sleep.


Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs.
Rapid-eye movement (REM) sleep encompasses 15 to 25 percent of the total amount of sleep and is associated with dreaming, as well as increased lability of heart rate, blood pressure and respiration.
Overall, the sleep-wake cycle in the elderly may be fragmented, with interrupted nighttime sleep and daytime wakefulness interrupted by naps. A full investigation of a complaint of insufficient sleep or excessive daytime sleepiness includes consideration of other potential problems that contribute to disrupted sleep, such as poor sleep habits, medical illness, medications and psychiatric disorders.POOR SLEEP HABITSPoor sleep habits are a very common cause of sleep disruption. Restless legs syndrome may significantly interfere with the onset of sleep.Periodic limb movement disorder, another primary sleep disorder, may accompany restless legs syndrome or occur independently. In persons with a late sleep onset and problems with late awakening in the morning, regular exposure to bright light at an early-morning hour may help shift the sleep-wake rhythm to an earlier time for sleep at night and awakening in the morning. Some seniors do sleep for long periods and this can occur for various reasons which may just be a normal part of aging (physiological), related to diseases (pathological) or induced by medication (iatrogenic).
The deepest stages of non-REM sleep are frequently reduced or nonexistent in elderly persons; however, REM sleep tends to be preserved.
Irregular sleep-wake patterns related to lifestyle or work requirements can undermine the ability of the circadian system to effectively provide sleepiness and wakefulness at appropriate times. Melatonin appears to help shift the phase of sleep, but further study is needed to clarify its use for treatment of insomnia, as well as jet lag.Many patients with insomnia have excessive anxiety deriving from their failed attempts to sleep and respond well to a behavioral approach. Evaluation of sleep problems in the elderly includes careful screening for poor sleep habits and other factors that may be contributing to the sleep problem. Although a mild deterioration in sleep quality may be normal in the aging process, an elderly patient's complaint of significantly disrupted nighttime sleep or impaired daytime functioning because of excessive sleepiness must be evaluated.Another common age-associated sleep change relates to the circadian rhythm of the typical sleep period. If hyperarousal at bedtime has evolved, it might be useful for the patient to spend less time in bed trying to go to sleep. Formal sleep studies may be needed when a primary sleep disorder is suspected or marked daytime dysfunction is noted. Episodes of REM sleep occur at approximately 90-minute cycles, with the duration of each episode tending to increase throughout the night. Although exceptions exist, elderly persons tend to go to sleep earlier in the evening and to awaken earlier in the morning. Alcohol consumption in the evening, while initially sedating, prevents deeper sleep and increases arousals during the latter part of the night.
They may, however, produce many brief arousals that disrupt sleep organization and decrease the amount of time in the deeper stages of sleep. Compared with young adults, the elderly tend to have delayed sleep onset, fragmented sleep, early-morning awakening and decreased time in sleep stages 3 and 4. Excessive wakeful time in bed may cause the patient to develop increased arousal that is reinforced nightly.MEDICAL ILLNESSAcute and chronic medical illnesses, such as arthritis, prostatic hypertrophy and cardiovascular, gastrointestinal and pulmonary diseases, may precipitate sleep disruption. The delayed sleep onset related to restless legs syndrome and the sleep disruption from periodic limb movements cause daytime sleepiness. Sleep-wake problems may be compounded further by inappropriate treatment initiated by the patient, family members, physicians or other care providers.The consequences of chronic sleep problems can be considerable. Loss of sleep or chronic use of sedating medications may lead to falls and accidents.4,5 Sleep-disordered breathing may have serious cardiovascular, pulmonary and central nervous system effects. Deterioration of the sleep-wake cycle can accompany neurodegenerative disorders, particularly Alzheimer's disease.MEDICATIONSMany medications can have stimulating effects and thereby cause sleep disruption. This sleep-wake cycle may have been tolerated in the younger years during employment, when the cues of early-morning bright light were stronger and the regularity of sleep-wake hours was greater.
If necessary, the diagnosis can be confirmed by electromyography of limb muscle activity during nighttime monitoring in a sleep laboratory.9 Risk factors for these two disorders include increasing age, renal failure and iron deficiency (serum ferritin level less than 50 ng per mL). On retirement, however, these cues weaken, and the sleep-wake cycle may become delayed by several hours. Up to one third of elderly persons have measurable periodic leg movements during sleep; however, only relatively high rates of events and high percentages of associated arousal should be regarded as clinically significant. The potential sedating effects of medications (especially long-acting sedatives that are inappropriately used as sleep aids) should also be a consideration in patients who report excessive daytime sleepiness.PSYCHIATRIC DISORDERSDistress from acute symptoms of a psychiatric disorder may promote disturbed sleep.
The tendency toward increased arousals and early-morning awakening in an elderly person may be severely exacerbated in the presence of depression. Also contributing to a deterioration in the quality of sleep are the psychologic manifestations of the assorted life changes that elderly persons often experience. The availability of a sleep medication may be reassuring to the patient on particularly difficult nights.
That reassurance will likely decrease the patient's distress on nights when no medication is used.While potentially valuable in offering relief of insomnia, hypnotic agents should not be regarded as the ultimate solution to a sleep problem. They should be used under limited circumstances, following evaluation of the patient's symptoms and in the context of good sleep habits.Consultation with a sleep disorders specialist should be considered in patients with marked daytime sleepiness, because this symptom can be dangerous. Guidance regarding the management of chronic insomnia and sleep-related behavioral problems also may be obtained from a sleep disorders specialist. The frequent sleep interruptions, coupled with repeated drops in the blood oxygen saturation, may cause a marked decline in daytime alertness and performance.
Patients suspected of having sleep apnea are evaluated in a sleep laboratory, where monitoring of the electroencephalogram, blood oxygen saturation, airflow, and chest and abdomen ventilatory efforts can be performed to confirm the diagnosis.The apneic events usually result from complete or partial occlusion of the airway (obstructive sleep apnea) or, less commonly, from a decrease in the respiratory drive (central sleep apnea). Sleep apnea may be associated with hypothyroidism, neurodegenerative disorders and cardiovascular disorders. The major clinical clue to sleep apnea is a history of loud, excessive snoring, punctuated by pauses that are followed by stuttered gasps for breath.
However, the mainstay of therapy is continuous positive airway pressure during sleep, which is accomplished by having the patient wear a tight-fitting nasal mask.
Effective control of sleep apnea can produce more consolidated nighttime sleep and a dramatic improvement in daytime alertness and functioning.REM-BEHAVIOR DISORDERThe rare REM-behavior disorder occurs most commonly in elderly persons.
Underlying this disorder is disinhibition of the process that normally prevents transmission of muscle activity during dreaming.



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