Sleep problems in seniors
Sleep can be compromised from the decline in sleep quality due to increasing age and with seniors affected by a range of conditions like menopause. So what do we do?
Sleep problems are not just segregated to the youth and the adult population, it can also affect seniors. With increasing age, there is a natural decline in sleep quality and with seniors being affected by a wide range of conditions like menopause and bereavement, sleep is further compromised.
Dr Lim Li Ling, consultant neurologist, Singapore Neurology & Sleep Centre at Gleneagles Medical Centre, highlights the problem and how one can deal with it. She is also the director of the Sleep Disorders Unit at the Singapore General Hospital and the president of the Singapore Sleep Society:
How susceptible are sleep disorders among senior population? How prevalent is it?
Seniors are more prone to sleep disturbances because there is a natural decline in sleep quality with age. Older people also tend to be on more medications, which can affect normal sleep. With age, there is also an increasing prevalence of primary sleep disorders like obstructive sleep apnoea (OSA) (difficulty with breathing in sleep due to blockage of the upper air passage) and restless legs syndrome, as well as other conditions, which can disturb sleep – Parkinson’s disease, stroke and dementia.
Certain other conditions like depression and anxiety also may occur more frequently with increasing age, associated with changes such as menopause, retirement, bereavement and other losses. From international studies, the most common sleep-related disorders in general are OSA – which affects 5 percent to 15 percent of the population, and insomnia (difficulty initiating and maintaining sleep), which affects between 10 percent to 30 percent of people to varying degrees of severity.
Can you explain how neurological conditions can affect sleep?
Common neurological conditions like stroke and Parkinson’s disease (PD) are associated with sleep disturbances because the parts of the brain, which control normal sleep, are also affected by these conditions. Sometimes the medications used to treat these conditions can also affect sleep. For example, PD drugs can cause both insomnia and sleepiness. Anxiety and depression are frequent causes of insomnia among seniors, with common associated factors being the onset of illness (e.g. stroke), loss of independent function or relationship difficulties within the family. OSA in older patients is related to weight gain, and changes in the normal breathing mechanism as we age. Multiple medication use in seniors is another frequent cause of sleep disturbances. There is a long list of drugs that affect sleep, including antidepressants, PD drugs, steroids, etc.
Are sleep problems part of the ageing process? What could be some underlying medical conditions, reasons that could affect seniors’ sleep patterns?
Sleep quality declines with age so that a person may appear to sleep less, often going to bed and waking up earlier. The body’s natural “sleep hormone” – melatonin – also declines with age. A person who has worked in the same shift work job for decades since young may develop insomnia as they grow older in the same job, because they become unable to tolerate changing shifts less well than in the past. Menopause in women is associated with insomnia, related to declining hormone levels, mood changes and physical symptoms like hot flashes. Overall seniors have more propensity to develop sleep disturbances because they have more medical problems that also affect sleep, as well as take more medications that affect sleep.
I understand that poor quality and lack of sleep can cause a lag in focus and lapses in memory. With seniors who may be at risk of dementia, how can caregivers recognise the differences between a sleep disorder and dementia?
Dementia is a neurodegenerative condition in which there is a gradual decline in intellectual functions including memory. This can be associated with sleep disturbances because the parts of the brain, which control normal sleep, are also damaged. Patients with dementia will usually have a noticeable drop in mental functioning before they develop sleep disturbances. Conversely, the lack of good quality sleep or sleep deprivation as a cause of poor focus and memory should be evident by taking a history from the patient, ie simply asking them how much they sleep regularly.
Focus and memory problems associated with profound lack of sleep can be reversed by improving sleep quality and quantity. Dementia is a slow but progressive state of decline, which is not reversible, and in the most common forms (e.g. Alzheimer’s disease) are not curable. It may not be easy for a caregiver to make a distinction. Usually a doctor will be able to make the diagnosis of dementia based on the pattern of mental decline, and investigations such as blood tests and brain scans (e.g. MRI, PET). Generally caregivers should ensure that the patient gets good quality and adequate sleep regularly, and if there is any disturbance in the normal sleep pattern, which is unexplained or prolonged, they should seek medical attention.
So how many hours should a senior sleep? Can this amount be broken up in half, for example they do several hours at night and then make it up in the day?
The normal amount of sleep required in an adult ranges from six to 10 hours. As we grow older this quantity normally decreases, so an elderly person may require only six to seven hours of sleep a night. Since sleep quality which includes sleep consolidation also declines with age, some older people may sleep in bouts, e.g. four to five hours at night, as well as one to two hours spread out during the day as naps, to make up a daily total sleep duration of six to seven hours. As long as one gets enough sleep in a day to make up at least six to seven hours, even if it is “broken up” into sleep bouts throughout the day, this is acceptable as long as the person’s social/work schedule is not disrupted and the person feels refreshed throughout the day.
What about “power naps”?
“Power naps” usually refers to catch-up sleep, which people who do not get enough sleep at night, take in the form of naps during the day. Naps are encouraged in people who do not get enough sleep during the night and are sleep deprived. A mid-afternoon “power nap” in someone who got only five to six hours of sleep the previous night, instead of his usual seven to eight hours can be very refreshing and improve daytime alertness in sleep deprived people.
What advice would you give for those having a hard time getting to sleep? Or who suffer from insomnia or OSA?
Anyone who has difficulty sleeping for more than one to two weeks should seek medical attention. Sleeping pill use should not exceed two to four weeks and must be closely supervised by a medical practitioner. These carry significant risks of addiction and cannot be used in certain types of patients. If your sleep problem has begun to affect your mood or work performance, or you have been involved in an accident because of sleepiness, and you have been dependent on sleeping pills to sleep for more than two to four weeks, you should see a doctor immediately. Untreated sleep-related disorders can cause serious physical and emotional health problems. Most sleep disorders can be managed with simple interventions. Good sleep should be considered, together with regular exercise and a balanced diet, to be one of the major prerequisites for good health.
The Singapore Sleep Society has launched a 10-day campaign called Singapore Sleep Awareness Week 2010 (www.singaporesleepsociety.com/ssaw2010), which features interesting sleep-related activities:
• Good Sleep for Good Health Public Symposium (March 27, SMU Conference Hall 1, registration fee $10).
• Visit a Sleep Lab Open House programme at Changi General Hospital, KK Women’s & Children’s Hospital, Singapore General Hospital and National University Hospital.
• Sleep An Hour More Movement – become a Fan on Facebook –www.facebook.com/pages/Sleep-An-Hour-More-Movement/276905042096?ref=mf.
• Online Sleep Forum – get your pressing sleep questions answered online by our panel of sleep experts – www.singaporesleepsociety.com/ssaw-forum.
(PHOTO CREDIT: DREAMING BEAUTY © Serghei Starus | Dreamstime.com)