Ease Aging Insomnia with These 7 Ways

Sleep Cycles and Insomnia

Our sleep architecture also changes as we age. A normal sleep cycle is divided into four stages. These include two stages of “light” non-rapid eye movement (NREM) sleep, one stage of “heavy” or “slow-wave” NREM sleep, and a final stage of rapid eye movement (REM) sleep before the cycle begins again.

Polysomnographic studies have shown elderly people experience a lower percentage of both slow-wave NREM and REM sleep than their younger counterparts. This leaves them more susceptible to waking episodes during the night and also affects how refreshed and alert they feel in the morning.

Recognizing and Diagnosing Insomnia in Seniors

Insomnia and age often go hand in hand. While many seniors experience sleep problems because of natural changes to their circadian rhythm and sleep-wake cycle, a diagnosis for insomnia must meet certain criteria. According to the International Classification of Sleep Disorders (ICDS), a person with insomnia must report at least one of the following symptoms despite having enough time allotted for sleep and a relatively comfortable sleep area:

• Difficulty falling or staying asleep
• Repeated instances of waking up earlier than desired
• Feelings of resistance about going to bed at a reasonable time
• Difficulty sleeping without intervention from a caregiver

Insomnia must also include daytime impairments. These may include excessive daytime sleepiness, feelings of fatigue and malaise, mood disturbances and irritability, and trouble concentrating and paying attention. People with insomnia are at higher risk of accidents, and many struggle in social and family situations.

If these symptoms occur at least three times per week and persist for at least three months, then doctors may diagnose the patient with chronic insomnia. Until then, the condition is considered short-term insomnia⁵.

Determining the root causes of insomnia in older adults is key to a successful diagnosis. Primary insomnia refers to insomnia symptoms that occur independently, while secondary insomnia occurs due to an underlying medical or psychiatric condition that causes sleep loss. Insomnia symptoms are the same regardless of whether the condition is considered primary or secondary. However, treating secondary insomnia typically requires patients to first address the primary condition that causes their sleep problems.

Other Common Sleep Disorders for Seniors

In addition to insomnia, studies have shown seniors are at higher risk of other sleep disorders. Many older patients experience insomnia along with other sleep disorders, which complicate treatment plans. Sleep disorders with a high prevalence rate among elderly populations include the following:

Circadian Rhythm Sleep Disorders

When a person’s circadian rhythm is not aligned with their external environment, they may experience a circadian rhythm sleep disorder. Older people are at higher risk of these disorders because the internal mechanisms that regulate circadian rhythm deteriorate with age.

Advanced sleep-wake phase disorder is particularly common in older populations. People with this order routinely feel tired in the early evening, typically between 7pm and 9pm, and will naturally wake up between 3am and 5am. Even if they go to bed later than usual, they often wake up relatively early due to their sleep-wake cycle. Timed light exposures in the evening can be used to treat these disorders for some elderly patients. A regimented sleep schedule can also be effective.

Another example is irregular sleep-wake rhythm disorder, which is predominantly found in adults with neurological and neurodegenerative conditions such as Parkinson’s disease and Alzheimer’s disease. This disorder is characterized by fragmented sleep patterns that do not follow a normal 24-hour day-night cycle.

While melatonin supplements can be used to treat circadian rhythm sleep disorders in younger people, physicians should carefully consider whether to prescribe this type of medication to senior patients. Melatonin supplements are not regulated by the U.S. Food and Drug Administration, and long-term efficacy and safety of these supplements are considered questionable.

Sleep-Related Breathing Disorders

Sleep-related breathing disorders, which include obstructive sleep apnea and central sleep apnea, are highly prevalent in older populations. These disorders are particularly common with elderly nursing home patients with dementia. Obesity, alcohol consumption, and smoking can also contribute to these disorders over time.

Sleep-related breathing disorders often cause seniors to snore heavily, which can lead to nighttime arousals and produce feelings of excessive daytime sleepiness. The disorders are also considered predictors for other medical conditions, such as congestive heart failure, myocardial infarction, and stroke.

Many seniors with sleep apnea are treated with continuous positive air pressure (CPAP) therapy, during which patients receive pressurized air through a breathing mask while they sleep. Those who comply with CPAP treatment often snore less and experience fewer apnea episodes during the night.

Restless Legs Syndrome and Aging Insomnia

Restless leg syndrome is common that often occurs with age, and it is may be triggered by certain medications.So it only makes sense that to associate these involuntary movements with  sleep disruptions as we age.

Both of these conditions can cause nighttime arousals that lead to waking episodes and tiredness the following day. Studies have shown the prevalence rate for these conditions almost doubles with age.

REM Sleep Disorder

People generally dream the most during REM sleep. Unlike most adults, those who have REM sleep behavior disorder (RBD) will physically act out on their dreams. This can entail violent movements that put the sleeper and their partner at a higher risk of bodily harm.

RBD has shown to be unusually common in elderly men. There is also a link between this disorder and degenerative neurologic conditions such as Parkinson’s disease and Lewy body dementia.

Since BZD medications are often prescribed for RBD, treating this disorder can be difficult for elderly patients. However, people with RBD can take precautions by optimizing the safety of their sleep area. Measures may include locking windows, placing the mattress on the floor, and removing objects from the bedroom that can cause injuries.

Tips for Insomnia and Aging Adults

The average senior needs seven to nine hours of sleep⁶ each night in order to feel well-rested and alert the next day. Sleep disorders like insomnia can greatly interfere with your sleep schedule. If you experience sleep difficulties, try one of the following to ensure you get enough rest and feel refreshed in the morning:

• Impose strict bedtimes and waking times, and stick to them – even on the weekends or when you’re traveling.
• Avoid napping close to bedtime. If you need a few minutes of shut-eye, try to isolate your naps to the morning or early afternoon.
• Establish a routine that will help you wind down each night. Reading or listening to calming music can be effective.
• Do not use electronic devices such as televisions, cell phones, or computers in your bedroom. These devices emit a blue light that can make it harder to fall asleep.
• Maintain a balanced, comfortable temperature and low light levels in your bedroom.
• Exercise during the day but avoid working out within three hours of your bedtime.
• Do not consume caffeine in the late afternoon or evening.
• Do not drink alcohol as a sleep aid. While alcohol has sedative properties, it can actually cause sleep disturbances.

If you still experience problems with sleep onset or duration despite taking these measures, then you may have a sleep disorder. Consult with your physician about diagnosing the problem and treating it in accordance with your medical history.