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National Institutes of Health AgeVenture News Service We all look forward to a good night's sleep. Sleep allows our body to rest and to restore its energy levels. Without enough restful sleep, not only can we become grumpy and irritable, but also inattentive and more prone to accidents. Like food and water, adequate sleep is essential to good health and quality of life. There are two types of sleep: non-rapid eye movement (NREM sleep) and rapid eye movement (REM sleep). NREM sleep includes four stages, ranging from light to deep sleep. We cycle through these four stages of sleep approximately every 90 minutes. Then we go into REM sleep, the most active stage of sleep when dreaming often occurs. During REM sleep, the eyes move back and forth beneath the eyelids and muscles become immobile. Researchers believe that two body systems: the sleep-wake process and our circadian biologic clock regulate our sleep. They program our bodies to feel sleepy at night and awake during the day. The sleep-wake process works by balancing the amount of sleep a person needs based on the time spent awake. Our circadian biologic clock is a 24-hour body rhythm affected by sunlight. It regulates hormones such as melatonin, which is secreted during the night and promotes sleep, and other processes like body temperature. Sleeping at a time that is in sync with this rhythm is important for healthy sleep. Sleep needs change over a person's lifetime. Children and adolescents need more sleep than adults. Interestingly, older adults need about the same amount of sleep as younger adults, seven to nine hours of sleep per night. Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep. A study of adults over 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep. Also, older people often sleep less deeply and wake up more often throughout the night, which may be why they may nap more often during the daytime. Nighttime sleep schedules may change with age too. Many older adults tend to get sleepier earlier in the evening and awaken earlier in the morning. There are many possible explanations for these changes. Older adults may produce and secrete less melatonin, the hormone that promotes sleep. They may also be more sensitive to, and may awaken because of, changes in their environment, such as noise. Older adults may also have other medical and psychiatric problems that can affect their nighttime sleep. Researchers have noted that people without major medical or psychiatric illnesses report better sleep. Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life. Many people believe that poor sleep is a normal part of aging, but it is not. In fact, many healthy older adults report few or no sleep problems. Sleep patterns change as we age, but disturbed sleep and waking up tired every day are not part of normal aging. If you are having trouble sleeping, see your doctor or a sleep specialist. There are treatments that can help. Quiz 1. Older adults require less sleep than younger adults. FALSE is the correct answer. As we age, our sleep requirements remain similar to those of younger adults. That is, most people need the same seven to nine hours of sleep per night. 2. Poor sleep is a normal part of aging. FALSE is the correct answer. Many people believe that poor sleep is a normal part of aging, but it is not. In fact, many healthy older adults report having no or few sleep problems. Sleep patterns change as we age, but disturbed sleep and waking up tired every day are not part of normal aging. 3. People without major medical or psychiatric problems tend to sleep better. TRUE is the correct answer. Researchers have noted that persons without major medical or psychiatric illnesses tend to sleep better. 4. Poor sleep can lead to attention and memory problems. TRUE is the correct answer. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Sleep Disorders If you have a sleep disorder it can be hard to get a good night's sleep. Sleep disorders can make it hard to fall asleep or stay asleep during the night and can make you drowsy during the day. The most common sleep disorders among older adults are insomnia, sleep-disordered breathing, such as snoring and sleep apnea, and movement disorders like restless legs syndrome. Sleep Disorders - Insomnia Insomnia is the most common sleep complaint at any age. It affects almost half of adults 60 and older. If you have insomnia, you may experience any one or any combination of the following symptoms.
Many factors can cause insomnia. However, the most common reason older adults wake up at night is to go to the bathroom. Prostate enlargement in men and continence problems in women are often the cause. Unfortunately, waking up to go to the bathroom at night also places older adults at greater risk for falling. Disorders that cause pain or discomfort during the night such as heartburn, arthritis, menopause, and cancer also can cause you to lose sleep. Medical conditions such as heart failure and lung disease may make it more difficult to sleep through the night, too Neurologic conditions such as Parkinson's disease and dementia are often a source of sleep problems, as are psychiatric conditions, such as depression. Although depression and insomnia are often related, it is currently unclear whether one causes the other. Many older people also have habits that make it more difficult to get a good night's sleep. They may nap more frequently during the day or may not exercise as much. Spending less time outdoors can reduce their exposure to sunlight and upset their sleep cycle. Drinking more alcohol or caffeine can keep them from falling asleep or staying asleep. Also, as people age, their sleeping and waking patterns tend to change. Older adults usually become sleepier earlier in the evening and wake up earlier in the morning. If they don't adjust their bedtimes to these changes, they may have difficulty falling and staying asleep. Lastly, many older adults take a variety of different medications that may negatively affect their sleep. Many medications have side effects that can cause sleepiness or affect daytime functioning. Quiz 1. One symptom of insomnia is A. waking up tired. B. dreaming every night. C. sleeping through the night. A is the correct answer. Waking up tired is one of the symptoms of insomnia. Other symptoms include waking up many times each night waking up early and being unable to get back to sleep taking a long time, more than 30 to 45 minutes, to fall asleep. 2. Short-term insomnia may be caused by A. grieving after losing a spouse or loved one. B. moving to a new area. C. being in the hospital. D. all of the above D is the correct answer. Short-term insomnia, lasting less than one month, may result after a medical or psychiatric condition. Or it may occur after a change in personal circumstances like losing a loved one, relocating, or being hospitalized. If insomnia lasts longer than a month, it is considered chronic, even if the original cause has been resolved. 3. The most common reason older people wake up at night is because A. they hear a strange noise. B. they have to go to the bathroom. C. they are in pain. B is the correct answer. Although many factors can cause insomnia, the most common reason older adults wake up at night is to go the bathroom. Disorders that cause pain or discomfort during the night such as heartburn, arthritis, menopause, and cancer also can cause older adults to lose sleep. Medical conditions such as heart failure and lung disease may make it more difficult to sleep through the night, too. 4. As people age, they tend to A. fall asleep later in the evening. B. wake up later in the morning. C. nap more often during the day. Sleep Disorders - Movement Disorders Two movement disorders that can make it harder to sleep include restless legs syndrome, or RLS, and periodic limb movement disorder, or PLMD. Both of these conditions cause people to move their limbs when they sleep, leading to poor sleep and daytime drowsiness. Often, both conditions occur in the same person. Restless legs syndrome is a common condition in older adults and affects more than 20 percent of people 80 years and older. People with RLS experience uncomfortable feelings in their legs such as tingling, crawling, or pins and needles. This often makes it hard for them to fall asleep or stay asleep, and causes them to be sleepy during the day. Although scientists do not fully understand what causes restless legs syndrome, it has been linked to a variety of conditions. Some of these conditions include iron deficiency, kidney failure and dialysis, pregnancy, and nerve abnormalities. Periodic limb movement disorder, or PLMD, is a condition that causes people to jerk and kick their legs every 20 to 40 seconds during sleep. As with RLS, PLMD often disrupts sleep -- not only for the patient but the bed partner as well. One study found that roughly 40 percent of older adults have at least a mild form of PLMD. Another condition that may make it harder to get a good night's sleep is rapid eye movement sleep behavior disorder, also known as REM sleep behavior disorder. It is somewhat more common in men over the age of 50. REM sleep, or rapid eye movement sleep, is the most active stage of sleep where dreaming often occurs. During normal REM sleep, the eyes move back and forth beneath the eyelids, and muscles cannot move. In more severe forms of REM sleep behavior disorder, the muscles become quite mobile and sufferers often act out their dreams. Diagnosis and Treatment If you are often tired during the day and don't feel that you sleep well, you should discuss this with your doctor or healthcare provider. Many primary care providers can diagnose sleep disorders and offer suggestions and treatments that can improve your sleep. Before you visit the doctor, it may be very helpful for you to ask for and keep a sleep diary for a week or more. A sleep diary will give you and your doctor a picture of your sleep habits and schedules and help determine whether they may be affecting your sleep. During your appointment your doctor will ask you about your symptoms and may have you fill out questionnaires that measure the severity of your sleep problem. It is also helpful to have your bed partner come with you to your appointment since he or she may be able to report symptoms unknown to you like loud snoring, breathing pauses, or movements during sleep. Since older people are more likely to take medications and to have medical problems that may affect sleep, it is important for your doctor to be aware of any health condition or medication your are taking. Don't forget to mention over-the-counter medications, coffee or caffeine use, and alcohol since these also may have an impact on your sleep. The doctor will then perform a physical examination. During the exam the doctor will look for signs of other diseases that may affect sleep, such as Parkinson's disease, stroke, heart disease, or obesity. If your doctor feels more information is needed, he or she may refer you to a sleep center for more testing. Image of woman undergoing a sleep study.Sleep centers employ physicians and others who are experts in problems that affect sleep. If the sleep specialist needs more information, he or she may ask you to undergo an overnight sleep study, also called a polysomnogram, and/or a sleepiness, or a nap test. A polysomnogram is a test that measures brain waves, heart rate, breathing patterns and body movements. A common sleepiness test is the multiple sleep latency test. During this test, the person has an opportunity to nap every two hours during the daytime. If the person falls asleep too quickly it may mean that he or she has too much daytime sleepiness. Suggestions for getting a good night's sleep. A good night's sleep can make a big difference in how you feel. Here are some suggestions to help you.
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