A Good Night’s Sleep

Summer 2009 CSANews Issue 71  |  Posted date : Jul 21, 2009.Back to list

For many older adults, getting a good night's sleep is one of their major health problems. When younger, we often experienced times when we needed an alarm clock to begin the day. As we age, sleep disorders become more common, but there is much that we can do to manage these problems, make our sleeping hours more normal and accordingly, feel much better during the day.

The most common sleep disorder is insomnia, but others such as snoring, sleep apnoea and restless legs syndrome can pose serious health problems to some.

Insomnia

Just as with younger adults, as we age, most of us still need seven to nine hours of sleep each night. Older adults tend to go to bed and arise earlier, but the time needed for healthy living is still about the same. If our sleep pattern is significantly altered, our general health and well-being can suffer.

Statistics Canada, reporting on the latest available data from the 2002 Canadian Community Health Survey, states that an estimated 3.3 million Canadians over the age of 15 had insomnia. Insomnia is defined as routinely having difficulty getting to sleep, staying asleep or awakening early. Furthermore, the study revealed a higher incidence among individuals who had significant obesity, chronic and disabling painful conditions such as arthritis, suffered from stress and overused alcohol or cannabis. Persons who reported most of their days as being stressful were twice as likely to experience insomnia. The prevalence of insomnia rose from 10% in the age group of 15 to 24 to almost 20% at the age of 75 or older. Some of this was thought to be likely due to the associated medical conditions that are more prevalent in the elderly.

There are two types of sleep, non-REM sleep (non rapid eye movement) and REM sleep (rapid eye movement). There are four stages to our non-REM sleep, stage four being deep sleep, usually in the first half of our sleep cycle. As we age, the duration of this deep stage diminishes. REM (rapid eye movement) sleep is the lighter stage of our sleep cycle and is when we dream. The younger adult usually has two awakenings per night, but these are short and rarely remembered. As we age, these awakenings increase to four or five times a night and we are aware of them. Even experiencing this change alone often makes people think that they have slept "poorly."

Falling asleep can be troublesome for many. One study found that 36% of women and 13% of men take more than 30 minutes before falling asleep. Prostate problems, urinary frequency, arthritis and other causes of pain are common ailments that result in awakening, often followed by difficulty going to sleep again. Early awakening is experienced by some, especially when noise or light stimulants are present.

The adverse effects of insomnia include a variety of physical and mental complications. Excessive fatigue, loss of mental acuity, difficulty coping, increased "disability" days from work, anxiety and depression can be experienced. The most common symptom is feeling tired each day, often resulting in individuals resorting to daytime or evening "naps" to overcome the feeling. Unfortunately, this can aggravate the nighttime insomnia.

Short-term insomnia as a result of a sudden life event such as losing a loved one, an illness, a move or an accident will often resolve itself in a month or two. During that time, a physician might advise, in addition to general tips, the short-term use of a sleeping pill (hypnotic). These prescribed drugs should be limited to no more than several weeks. Chronic insomnia, on the other hand, should not be treated with such medication, as the need for stronger dosage, dependency and rebound insomnia are serious adverse results.
  • The management of chronic insomnia may include some of the following measures:
  • Having your physician rule out any other type of sleep disorder
  • Ensuring that no underlying disease process has begun
  • Having known chronic conditions being treated as effectively as possible
  • Keeping fairly consistent times for retiring and arising
  • Avoiding naps, if possible, especially in the evening
  • Reducing alcohol consumption, especially in the evening
  • Keeping your sleeping environment conducive to a good sleep, e.g. good mattress, quiet and darkened room
  • Getting treatment for a snoring spouse
  • Sometimes snacking (a cracker and a small glass of milk ) before bed
  • Avoiding fluids after dinner, especially for persons who routinely have to void during the night
  • Keeping active during the day, especially daytime exercise
  • Avoiding excessive weight gain
  • Managing, as much as possible, your daily causes of stress

To learn more about insomnia and sleep apnoea, review some of the reputable online websites such as the National Institutes of Health, Senior Health at www.health.nih.gov/category/SeniorsHealth  

Snoring

It is estimated that up to 50% of adults snore, with an even higher percentage in those who are overweight or obese. Snoring is caused by vibrations of the soft tissues in the nose and throat occurring during sleep, when the muscle tone is relaxed. This turbulence of air may be the result of nasal obstruction, the soft palate vibrating or the tongue falling back into the throat during sleep. Although usually harmless to the individual, it can be terribly disruptive to one's partner and can cause undue stress and insomnia for both.

In recent years, there have been many remedies for snoring which significantly help in reducing or eliminating the problem. There are excellent websites containing information about how you can help yourself or your partner through appropriate testing to determine the particular cause. One such site is www.britishsnoring.co.uk . In addition, there are many sleep disorder clinics throughout Canada which specialize in diagnosing and managing sleeping disorders, including snoring. If you or your spouse has this problem, consider asking your family doctor for a referral or phone a clinic yourself for more information. Although it can rarely be cured, most people will be able to control the problem very effectively.

Sleep Apnoea

A more serious form of snoring in which the breathing is interrupted during sleep by temporary partial or complete blockage of the upper airways can be a life-threatening condition requiring expert medical attention. These pauses in breathing while sleeping can cause deprivation of the oxygen supply to the brain. It can cause one to awaken many times during the night and results in excessive fatigue during the day. Increased risk of this condition occurs in smokers, heavy drinkers, those with nasal congestion and post-menopausal women, but the most common factor is obesity. It is estimated that gaining just 10% more weight will increase your chances of developing sleep apnoea by six times. Dieting is an essential component of treatment in such individuals.

Often suspected by a spouse because of periods of quiet after loud snoring, numerous awakenings and frequent napping in the daytime, immediate reporting to a physician is important to achieve an early diagnosis and treatment. Recent research reported in the May edition of the Journal of Cerebral Blood Flow and Metabolism reveals that snoring linked to sleep apnoea may impair brain function much more than previously thought. For years, there has been known to be an increased risk of learning impairment, stroke and premature death, but this new information adds importance to the need for early diagnosis and treatment.

Sleep clinics are now able to analyze particular disorders and are usually able to offer significant relief to those who suffer from sleep disturbances. One of the tests used is a sleep study, or polysomnogram. Through this recording of one's different sleep stages, specialists are able to interpret the findings, arrive at a specific diagnosis of the problem and in most cases, prescribe effective means of relieving the symptoms.

The usual treatment for sleep apnoea, in addition to weight control, is the use of a CPAP machine (Continuous Positive Airway Pressure). Prescribed by a sleep disorder specialist, this apparatus, although difficult to get used to, is very effective when worn at night in controlling this serious condition. It prevents collapse of the upper respiratory passage airway during sleep by maintaining positive airway pressure.

Restless Legs Syndrome

This less-common form of sleep disorder is associated with an intense urge to move the legs, along with a creeping sensation or a feeling of pins and needles under the skin. It is more common in older adults, especially women. There is often a family history of the condition. Occurring mainly at night, untreated it can lead to very sleepless nights. Moving the legs gives temporary relief, but there are now prescribed medications that provide considerable relief to most patients.

Although the primary cause is unknown, it is sometimes associated with a reaction to other drugs. As with all diagnoses, there are excellent websites devoted to educational materials for those who suffer from specific disorders. In the case of Restless Legs Syndrome, an excellent site is the RLS Foundation at www.rls.org .

Sleeping soundly is important to all of us. While there are many persons who suffer from these and other less-common sleep disorders, modern techniques and medical expertise have led to numerous remedies, many of which, after appropriate assessment, can be instituted through simple changes in lifestyle. Don't settle for continued problems with yourself or your spouse without seeking medical advice. Chances are good that most of us can get a good night's rest.





Related links
National Institutes of Health, Senior Health
British Snoring