Doctor's Notes on Sleep Disorders and Aging
Sleep disorders include problems falling or staying asleep, too much sleep, or abnormal behaviors with sleep. The two major disorders that increase with age are sleep apnea and periodic limb movement disorder. Sleep apnea is the interruption of breathing during sleep. Periodic limb movement is repetitive leg jerks in one or both legs during sleep; these are the signs and symptoms of the disorder. Signs and symptoms of sleep apnea are often noticed first by the person’s bed partner – they notice that the individual, while still asleep, has significant pauses between breaths; however, sometimes the patient will awake confused or short of breath. Other symptoms that may occur are snoring, daytime sleepiness, difficulty going to sleep and fatigue.
The exact causes of sleep apnea and periodic limb movement are unclear but the disorders may be manifestations of neurologic changes in the brain that increase over time as people age. More than half of individuals over 64 years old have some type of sleep disorder. Also, many medical problems have sleep disorders as symptoms; for example, depression, dementia, Alzheimer disease, heart failure, chronic pain, emphysema. Medications like beta-blockers, antidepressants and others may interfere with normal sleep. Many aging patients have such progressive diseases and take multiple medications.
Sleep Disorders and Aging Symptoms
Often the bed partner is first to notice problems with a person's sleep. Symptoms of sleep disorders reflect the feeling of not getting enough sleep.
- Feeling tired (fatigue)
- Difficulty concentrating or paying attention
- Not feeling rested
- Unable to go to sleep
- Taking a long time to go to sleep at night
- Frequent awakening at night
- Unable to go back to sleep after awakening
- Daytime sleepiness
- Sleep apnea may cause symptoms in addition to those already named.
- Morning headaches
- Wake up confused
- Wake up gasping for breath
Sleep Disorders and Aging Causes
The sleep disorders that increase with age are sleep apnea and periodic limb movements of sleep (PLMS). Periodic limb movement disorder is also called nocturnal myoclonus. The prevalence of PLMS increases wityh age and may be found in a third or more of patients over 60.
Sleep apnea is the interruption of breathing during sleep. It is commonly caused by obstruction (blockage) of the airway. Rarely sleep apnea is caused by a problem in the nervous system, which controls breathing. Sleep apnea is very common among older overweight people.
- People with sleep apnea often wake up gasping in the night. They may thrash around in bed or get up and wander around in a confused state.
- Sleep apnea can result in daytime sleepiness, high blood pressure, heart rhythm problems, increased risk for heart disease and stroke, an increased risk for motor vehicle accident.
- Sleeping medications can worsen sleep apnea by relaxing throat muscles too much.
Periodic limb movements in sleep refer to repetitive leg jerks during sleep. These jerks may awaken the person from sleep and usually disturb the bed partner. Many describe the movements as kicking movements. The movements may occur in only one leg or both legs.
Medical disorders may also disrupt sleep.
- Pain is one of the most common reasons for poor sleep in older people.
- Heart failure often causes breathing problems that can disturb sleep.
- Rapid heartbeat and palpitations can interrupt sleep.
- Other breathing problems that can disturb sleep include heart disease, certain neurological problems, and emphysema.
- A frequent need to urinate and other urinary problems may cause frequent awakenings.
- Persons with Parkinson disease may experience frequent urination, difficulty turning in bed, and difficulty getting out of bed. These problems may impair sleep.
- Gastroesophageal reflux disease (GERD) causes discomfort that can interfere with sleep.
- Constipation can cause discomfort that can disturb sleep.
- Allergies, sinus problems, nasal congestion, and similar problems can disrupt sleep.
Mental disorders are another common reason for sleep problems in older people.
- Depression disrupts sleep in all ages, and this condition is especially common in older people. Many people with depression have trouble falling asleep at night or wake in the night and are unable to go back to sleep.
- Dementia, especially Alzheimer disease, increases the length of stage 1 sleep and decreases stage 3 and REM sleep. Dementia is linked to more episodes of sleep disruption and awakening, nocturnal wandering, and daytime napping.
- Bipolar disorders, psychosis, and anxiety can result in difficulty falling asleep and/or staying asleep.
Medications are another cause of sleep disturbance. Older patients in the US consume an average of 5-9 daily medications, some of which can interfere with sleep and wakefulness.
- Sedative antidepressants and sedative antipsychotics can cause daytime drowsiness. Sleeping during the day interferes with nighttime sleep.
- Beta-blocker medications can cause difficulty falling asleep, an increased number of awakenings, and vivid dreams.
- Prolonged sleeping medication use may cause daytime drug withdrawal effects or daytime drowsiness.
- Theophylline and caffeine are stimulant drugs. These drugs increase wakefulness and decrease total sleep time. Caffeine's effect can last as long as 8-14 hours and may be more pronounced in older patients. Over-the-counter pain relievers, cold or allergy remedies, appetite suppressants, and tonics may contain caffeine.
- The stimulant nicotine affects sleep like caffeine. Smokers have more sleep disturbances than nonsmokers. Smokers also have difficulty falling asleep and decreased sleep duration. Even a nicotine patch can disrupt sleep.
Lifestyle and social factors can contribute to sleep disorders.
- Many older people are less active, and their bodies are not as ready for sleep at the end of the day.
- Alcohol can disrupt sleep.
- Daytime sleeping or lying on the bed to read or watch television can interfere with nighttime sleep.
- Sadness and bereavement can interfere with sleep.
- Everyday stress can make sleep more difficult.
Sleep disorders are conditions that impair a person's ability to get normal restorative sleep. The causes of these conditions are variable and range from habits people have developed before they go to sleep to a number of medical problems that disrupt the normal sleep cycle. If you notice you have a pattern of not feeling rested in the mornings after you wake up, you should probably see your doctor to determine if you have a sleep disorder. Sleep disorders can have a profound effect on a person’s overall health.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.