Growing older brings many changes. Changes in sleep are part of the normal ageing process, but some elderly people find it difficult to adjust.
Sleep is important to our health and wellbeing at any age and sleep disturbances affect many elderly people. They may remain undiagnosed causing distress and impacting on health and wellbeing.
As the average life expectancy increases, many people live long and healthy lives and enjoy the freedom of retirement. For others and their families and carers, old age can bring a number of health problems that impact on sleep. The relationship between sleep and general health is shown in a number of studies. Many believe that poor sleep is a consequence of ageing and doctors often accept that sleep problems are a consequence of medication or other health problems. Sleep disturbances may not be investigated independently as they may be seen as a ‘side affect’ of other problems.
There are natural changes in sleep caused by ageing. Sleep Stages are affected and after the age of 60 there is less Stage three and four sleep. These are the deeper stages associated with growth and cellular renewal. One theory is that we no longer need this type of sleep, although the REM sleep which is related to dreaming remains unchanged.
Those suffering from dementia and Alzheimer’s have particular health problems. They are often drowsy during the day and may be disturbed and active during the night. This makes it hard for family and carers who may need to keep 24 hour watch and inevitably suffer from loss of sleep themselves. It is often this behaviour that results in the sad decision to seek care outside the home.
Sufferers do not respond to medication which may even make other symptoms worse. It is estimated that two thirds of the elderly in care homes have sleep problems. Drugs aimed at improving sleep can cause further confusion and result in falls and accidents.
It has been estimated that a significant number of dementia patients also suffer from sleep related breathing problems including sleep apnea. These should be investigated as treatment may also result in an improvement of the dementia.
Medication, Alcohol and Smoking
Sleep problems are often hard to diagnose as they may be a side effect of prescriptions or over the counter medications. The elderly account for a significant amount of prescriptions and some, such as antidepressants and antihypertensives (prescribed to control blood pressure) affect sleep. Alcohol may create a feeling of sleepiness but the relaxing effect is short lived. It causes sleep disturbance and may also impact with other drugs and prevent sleep. It is believed that the elderly are particularly susceptible to the affects of alcohol on sleep, and it should be limited particularly in the hours before bedtime.
Smoking also affects sleep and withdrawal may be difficult and have a negative impact on sleep.
Bereavement, loss of independence, health and financial problems, changes in circumstances and loss of routine may cause depression and result in insomnia and difficulty sleeping. Depression can lead to loss of interest in food, increase in alcohol and other behaviours which affect sleep. Depression may also be confused with dementia.
Depression may be short term and with support a full life and improved sleep may be regained. Longer term depression should not go undiagnosed and accepted as part of the ageing process. Elderly people may suffer from feelings of ‘worthlessness’ and be unwilling to seek medical advice and other help. Early intervention and support may be lacking causing problems to compound and leading to continuing distress.
Health Problems that Affect Sleep
Pain and illness affect the ability to fall asleep. Cramps, arthritis and back pain are just a few of the painful conditions that make it difficult to sleep. Finding a comfortable position in which to relax and fall asleep is difficult, and pain can cause night wakening. Medications aimed at relieving the pain may not help sleep and the lack of sleep often seems to make the pain worse.
Pain relief such as TENS (transcutaneous electrical nerve stimulation) is a technique that uses small electrical impulses to interrupt pain signals from reaching the brain and can provide relief from persistent pain. Corticosteroid injections for joint pain, drug therapy and acupuncture may be prescribed to help relieve the pain.
Exercise is often avoided as movement may be painful and difficult. Exercises such as swimming and yoga help keep limbs mobile and help relaxation. Any exercise taken outdoors helps the body regulate the night/day cycle. The elderly should be encouraged to include some physical activity in the day and adopt a routine that will encourage sleep.
Travel and the Elderly
The elderly are often more affected by Jet Lag. Although this may differ between individuals, studies have shown that the elderly are more likely to suffer for longer from sleep disruption and daytime drowsiness. By following guidelines for dealing with Jet Lag and taking particular care when driving, many older people continue to enjoy travelling.
Insomnia and sleep problems in the elderly may be assessed and treated in the same way as younger adults. Elderly people may have less routine in their lives and should be encouraged to value the quality of their sleep. Napping is seen to be beneficial especially if there is a loss of nighttime sleep. Naps should be taken early in the afternoon and other aspects of ‘sleep hygiene’ such as avoiding caffeine, alcohol and heavy exercise during the hours before bedtime adopted.
Anxiety is one of the main causes of insomnia and many elderly people find aspects of life challenging. They may need help in adopting a routine that will help them sleep. Financial restrictions may cause them to go without heat and sufficient food which will affect their ability to sleep, and ultimately undermine their health.
Studies have shown that good health and a positive outlook go hand in hand with reports of sleep satisfaction in the elderly. Poor sleep is not a consequence of ageing but may be related to other health factors and should be diagnosed and treated in the same way as younger adults. Less sleep, or a change in the amount of sleep may accompany ageing, but other sleep disturbances should not be accepted as normal.