SLEEP & THE ELDERLY

Early in life most people fall asleep quickly and sleep soundly. As they grow older they may find winding down to sleep more difficult. They may awaken more frequent and then take longer to fall back to sleep. Trouble falling asleep at night on a regular basis is not considered normal at any age, nor is involuntarily falling asleep during the day. It is not true that we need less sleep as we grow older. As we age our ability to sustain sleep decreases; however, the opportunity to nap during the day is expanded with retirement and older age. Research shows that our bodies are programmed for at least one daytime nap...see Circadian rhythm for details.

Although older people spend about the same amount of time in REM (dreaming) sleep as younger people do, they get less of the deeper stages of sleep they need and awaken more frequently. Studies show that some people over age 60 may awaken briefly well over a hundred times a night, obviously resulting in some daytime fatigue.

The overuse of prescription drugs and over-the-counter drugs by older people to aid sleep is a tremendous concern. While people over age 65 make up only about 13% of the American population, they take more than 30% of the prescription medications and 40% of all sleeping pills. Some research suggests that some prescription medications may not be effective in older people, in some cases sleep problems actually worsened. Another factor that may compromise the sleep process as we get older is the likelihood of developing chronic medical conditions. A few examples of these conditions are asthma, COPD, heart disease and arthritis.



Some common sleep disorders:

Sleep apnea - disrupts sleep in 25% of people over the age of 60.

Periodic limb movements - About 50% of people age 65 and over experience some twitching in the legs and sometimes in the arms during the night.

REM Behavior Disorder - is most common in men over age 50, which suggests that age has a role in this disorder. The drug clonazepam can improve sleep in patients with this problem and may eliminate the sometimes dangerous behavior.



Sleepwalking and other Parasomnias

A vast majority of care givers who decide to institutionalize an elderly person refer to sleep disturbances, wanderings and confusion as a factor in their decision. Two thirds of people living in long-term care facilities suffer from some form sleep disturbances. In a nursing home or hospital setting, nighttime problems usually continue or increase, prompting widespread use of sedative type medications. Unfortunately, these drugs can contribute to further confusion and an increased likelihood of self inflicted injuries.



About sleeping pills

As we age, our bodies break down drugs less efficiently, because drugs stay in the body longer as we grow older and their effects may last longer. A sleeping pill should help a person fall asleep faster and wake up less often, without any "hangover" feeling the next day, this is not always the case. The sleeping pills prescribed most often today come in both short and long-acting forms. Short acting drugs help bring on sleep onset, but their effects usually wear off quickly. Long acting drugs help maintain sleep throughout the night, but sometimes cause sleepiness the next day. A doctor will prescribe the type of drug and the particular dosage that is right for each patient. Short-acting drugs commonly used to aid sleep include triazolam and temazepam. A frequently prescribed long-acting drug is flurazepam.