Sleep Problems Plague the Older Set

FRIDAY Nov. 23, 2007 -- Older Americans often have difficulty getting a good night's rest. It's a huge quality-of-life problem, experts say, because contrary to popular belief, seniors require about the same amount of sleep as younger adults.

"Sleep problems and sleep disorders are not an inherent part of aging," said Dr. Harrison G. Bloom, a senior associate at the International Longevity Center-USA and associate clinical professor of geriatrics and medicine at the Mount Sinai School of Medicine in New York City. "It's pretty much of a myth that older people need less sleep than younger people."

Yet, in a study published recently in The American Journal of Medicine, researchers found that more than half of older Americans have problems getting the shuteye they need.

Older people tend to have "sleep fragmentation," meaning they wake up more often during the night, said study author Dr. Julie Gammack, an assistant professor of medicine in the Division of Geriatric Medicine at St. Louis University.

They also seem to get less "REM" sleep, the type of sleep during which rapid eye movement occurs, Bloom added.

It's unclear what role these naturally occurring changes in sleep patterns have on a person's quality of life, Bloom said. "What is important, though, is that older people often have actual sleep disorders and problems with sleep," he said.

And, experts say, there is usually more than one cause.

"Sleep disturbance in older adults is typically associated with acute and chronic illnesses, including specific sleep disorders like sleep apnea and restless leg syndrome that appear with greater frequency in older populations," said Michael V. Vitiello, a professor of psychiatry and behavioral sciences and associate director of the University of Washington's Northwest Geriatric Education Center.

As people age, they typically develop more diseases and suffer from aches and pains. "These things can disrupt sleep, so what they may perceive as a sleep disorder may actually relate to the effects of some of their other medical problems," Gammack noted.

Taking multiple medications, as many older people do, can also lead to fatigue and "hypersomnia," or being tired all the time, Bloom added.

Another big problem, he noted, is depression and anxiety. "Those are very commonly associated with sleep problems."

Despite the prevalence of sleep difficulties in older adults, many patients aren't getting the help they need.

"The average physician receives very little training about sleep disorders and typically does not routinely screen patients for them," said Vitiello, who serves on the board of directors of the National Sleep Foundation. This may be due to a lack of time or training or the belief that there is little that can be done to improve sleep, he explained.

As a result, problems like insomnia, restless leg syndrome, sleep apnea and circadian rhythm disorders are underdiagnosed and undertreated, Bloom said.

To rectify the problem, a national coalition of aging, geriatric medicine and sleep organizations is currently developing guidelines to promote prevention, diagnosis and treatment of sleep problems in older adults. The National Coalition for Sleep Disorders in Older People expects to publish its recommendations by mid-2008.

"The reason we're concerned with these [problems], besides a major issue on quality of life and being tired the next day and not functioning properly, is that these sleep disorders are associated with hypertension, diabetes, pulmonary disease, heart disease, depression and anxiety," said Bloom, chairman of coalition's expert task force.

A cause-and-effect relationship has yet to be established between sleep disorders and these chronic health problems, but Bloom suspects they at least contribute to each other. And he believes a causal relationship may be found in years to come.

"This is very, very much a tip-of-the-iceberg problem," he said.

Posted: November 2007


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