To combat the body’s naturally evolving circadian timing, encourage patients to practice sleep hygiene as an alternative to prescription meds.
Aging often brings with it a few more wrinkles, several more pounds, and perhaps a bit of forgetfulness. In addition, sleep habits tend to evolve with age, and these changes can lead to serious medical conditions.
According to a 2015 study published in Disorders of the Nervous System, the body’s circadian timing systems shift as a person grows older, often leading to less and lower quality sleep. The authors of this research indicate “aging profoundly alters circadian behavior and physiology.”
Michael C. Marino, DO, FACP, medical director of Geisinger Health System sleep labs, agrees. “Younger people tend to stay up later and sleep later,” he says. “As we age, our sleep cycle changes. A 17-year-old goes to bed at midnight. Someone who is 70 goes to bed at 7 p.m. The young person wakes between 10 a.m. and noon, while those over 55 wake between 4:30 and 6 a.m. Our circadian rhythm changes.”
People also tend to nap more as they get older, Marino says. “This means less REM sleep at night.” REM (rapid eye movement) sleep provides daytime energy and is also the phase during which dreaming happens. Disruption in the sleep stages (both REM and non-REM) can affect cognition, he explains. “If you take a 15 to 20 minute nap during the day, it could translate to trouble falling asleep. Ideally, the older population has the opportunity to get eight hours of sleep—not that everyone needs that much. Six to nine hours is the norm and should be compacted at night, not during the day.”
Comorbid medical conditions
Reduced sleep efficiency, decreased time spent in bed, and consistent disruptions to rest can be complicated by diagnoses such as arthritis, fibromyalgia, abd chronic heart conditions. These problems may then lead to other medical conditions. “There is an increased risk of sleep apnea, especially in women,” he says. “In pre-menopausal women, the risk is 0.6 percent. After menopause, the risk goes up to 4.5 percent.”
Sleep deficiencies also increase the chances of developing restless leg syndrome (RLS). “People with restless leg syndrome describe it as a crawling sensation in their legs or dancing feet,” Marino notes.
Furthermore, a 2011 study cites a correlation between insomnia and hypersomnia (excessive sleepiness) and comorbid conditions, such as diabetes and chronic pain as well as cardiovascular, respiratory, gastrointestinal, urinary, and neurological disorders.
Many of these illnesses can thwart efforts to get a good night’s sleep in those over 55. A person with congestive heart failure may have to use propped pillows to help with circulation and breathing, Marino says. Also, conditions like arthritis, rheumatoid arthritis, and spinal stenosis are associated with pain, which rouses us from sleep when we shift position. “Movement exacerbates pain,” he says.
Medication side effects
Physical ailments and an increase in medications go hand-in-hand. But sometimes medications exacerbate existing medical conditions or cause new ones. For instance, anti-depressants, anti-anxiety medications, selective serotonin reuptake inhibitors (SSRIs), and antihistamines may cause RLS. “Beta-blockers can cause insomnia, and ace inhibitors affect slow wave sleep,” Marino adds.
While some people may turn to over-the-counter or prescriptions to induce slumber, Marino urges caution. He indicates that the number of Americans using sedative hypnotics for sleep has doubled over the last decade. In 2013, the Centers for Disease Control (CDC) reported more than 9 million Americans using prescription sleep aids. Marino explains that prescription or OTC sleep medications can increase the risk of “confusional arousal” and the risk of falling, which could lead to debilitating problems such as orthopedic fractures.
Cleaning up your act with sleep hygiene
Instead, Marino recommends consistent sleep and other efforts that comprise “sleep hygiene.” The National Sleep Foundation defines sleep hygiene as implementing a variety of practices to necessary for quality sleep, including:
- An exercise routine that involves rigorous activity in the mornings and afternoons, and relaxing exercises in the evening.
- Avoiding naps that can disturb normal sleep patterns.
- Getting ample exposure to natural light during the day.
- Reserving your bed for sleep rather than listening to music or watching TV in your resting space.
Marino emphasizes setting standard hours for going to bed and waking up as a critical part of sleep hygiene. “And make sure your sleep environment is comfortable,” he says. While some people insist background noise helps in getting shut-eye, he asserts that it might not be helpful at all times. “It could cause arousals and make a difference in the amount of deeper sleep, if left on all night.”
Creating and sticking with good sleep habits could mean the difference between deep, restful repose and broken slumber with the potential for developing other medical conditions. Help patients understand that there are effective alternatives to over-the-counter and prescription medication when, most likely due to aging, they face a startling reduction in sleep quality.