Sleep studies have found that up to 50% of people over 65 have chronic sleep complaints. These can include problems with falling asleep, restlessness or waking during sleep, and shortened sleep period. It is often assumed that older people don’t need as much sleep as younger people. This is not true: older people need the same amount of sleep, but the ability to fall asleep and the quality or pattern of sleep can make it appear as though they don’t.
Sleep disorders can lead to or exacerbate a wide range of problems,and severely impact on quality of life. It can make hypertension worse,and increase or cause problems in the cardiovascular system, pulmonary system, and central nervous system. Fatigue can lead to falls, decreased alertness, and cognitive impairment, so can be misdiagnosed as part of a dementing process. Poor sleep can cause mood disturbances such as depression and irritability. Pain tolerance can be lowered, making pain seem worse and the person less able to manage their pain.
As we age the nature of sleep changes. Older people have less or sometimes no stage four sleep, the stage in which we have the most restful sleep. Instead, they have greater frequencies of REM (Rapid Eye Movement) sleep. Older people can wake up more often and for longer periods of time. One reason for this is that, as we age, the body produces lesser amounts of the chemicals that regulate sleep/wake cycles.
Just as sleep problems can cause or exacerbate medical concerns, medical problems can also cause sleep disturbances. Heart disease, gastrointestinal disease,prostate disease, and pulmonary disease affect sleep as can pain, medications, and depression.
Lifestyle and psycho-social factors influence sleep as well. These include use of caffeine and alcohol, napping due to boredom, and loneliness. Examples of psycho-social factors are include changes in beds, changing residence, fear, and anxiety. Loss of a partner can mean a change in sleep circumstances. When mobility becomes impaired and access to outside social activity becomes restricted there is a subsequent decrease in physical activity. These can lead to changes in rest and sleep patterns.
Circumstances of nursing home life can lead to sleep disturbance. A resident may have a roommate who is restless, snores, gets up often, flushes a toilet, etc. Lights may be left on or a staff member may check on them or the roommate every few hours, shining a light in, and opening and closing the door. Cognitively impaired residents may go into the wrong room at night, waking up occupants.
Sleep disturbance is also frequently caused by sleep apnea, restless leg syndrome, and periodic leg movement disorder (PLMD). Sleep apnea, when breathing stops, causes people to wake up, can occur hundreds of times at night.The person may not be aware it is occurring.Sleep apnea can worsen heart disease and blood pressure. Restless leg syndrome can cause a person to want to keep their legs moving, or pace which makes falling asleep difficult. PLMD causes involuntary kicking or thrashing while asleep.
Complaints of sleep disturbance are often not given high importance and assessed for their cause and impact. Treatment may simply mean a prescription. Clearly, however, it is an event that must be taken seriously. Just because a person is older, it does not mean that they have to have a sleep problem. When a person complains of problems sleeping, they should have a thorough assessment by a physician or sleep specialist. Medications should be the last approach tried, and used cautiously.
Sleep and Alzheimer’s Disease
Sleep disorders are common occurrences in people with Alzheimer’s Disease and other dementias. The sleep/wake cycle is frequently disturbed. One study estimated that 80% of people with dementia have sleep apnea. As people’s awareness of time decreases, they are often up doing things at night, which disrupts their sleep/wake cycle. Night wandering and confusion, especially later in the process are seen.
When a person with dementia awakens at night they can often become confused and anxious because they do not know where they are, or if they have a roommate in a nursing home, who the other person in the room is.Sometimes they have limited awareness of when they need to use a washroom, and can awaken in a hurry. While getting out of bed, they can easily lose their balance, slip, or wet the floor which can lead to a fall.
As noted in the article above, sleep disturbance can impact upon cognitive ability, so a person who is not sleeping well can appear more impaired than they are. Difficulties which are attributed to the disease can in fact be due to in part to the sleep disturbance.
Sleep disturbance in the person with dementia often leads to sleep disturbance in the caregiver. It can mean that two shifts of help are needed if the person needing care is not treated. Sleep disturbance is one of the leading causes of placement, because the caregiver becomes exhausted, depressed, and burned out.
Sleep disturbance in care facilities are very often treated with medication as a first step. Many of the medications have side effects which can cause further difficulties. People with dementia deserve the same assessment and interventive attempts as people without dementia.
Sleep on the Web
American Family Physician – http://www.aafp.org/afp/990501ap/2551.html
National Sleep Foundation – http://www.sleepfoundation.org
