Editors' Note: This is a repeat of a series published in December and January.
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UPI surveyed 71 specialists for a 7-part series of articles examining the consequences and costs of the industrialized world's nightmarish sleep debt and ways to turn around the troublesome trend. Part 6 explores sleep matters in the elderly.
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The seniors are growing restless, a sleep-disturbing trend that may mean more malaise, malady and premature mortality among mature populations.
Two-thirds of adults 55 to 84 complain of an inability to get a good night's rest, increasingly shown as a vital component of optimal physical, emotional and mental health. A 2003 National Sleep Foundation poll found 15 percent of the elderly experience daytime drowsiness severe enough to frequently disrupt their daily activities.
"Sleep in and of itself tends to worsen with age, with more spontaneous interruptions and a decrease in the amounts of REM (rapid eye movement, a state during which dreams occur) and deep, slower sleep," noted Dr. Clete Kushida, director of the Stanford Center for Human Sleep Research in Palo Alto, Calif. "The ability to fall asleep is impaired, and worsens as we age."
Prone to illness, pestered by sleep disorders, such as breath-choking apnea and limb-jarring restless legs syndrome, and paced by a degenerating biological clock, seniors have slumber troubles all their own.
"The prevalence of sleep problems in the elderly is largely due to association with chronic medical problems such as pain, nocturia (passing too much urine at night), lung and cardiovascular disorders, neurological disorders and depression," observed Phyllis Zee, professor of neurology at Northwestern University in Evanston, Ill. "Of course, there are changes in the sleep architecture (loss of deep sleep) and circadian rhythms (the biological clock) that contribute to the poor sleep of older people."
Snoozing patterns break up with the breakdown of the body's delicate time-keeping mechanisms, including the pineal gland, whose tiny size belies its large role as a dispenser of the hormone melatonin, a natural sedative stimulated by darkness and stifled by light, explained Matthew Walker, instructor of psychiatry at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"When people grow old, their sleep needs decrease, their sleep is more fragmented, and they tend to sleep more during daytime in addition to their nocturnal sleep," remarked psychologist Avi Sadeh of Tel Aviv University in Israel. "However, many elderly people, particularly in special homes, are expected to sleep 'like babies,' and the result is that they get excessive sleep medication to make them sleep, sometimes much more than they need."
Although older adults may nod off for a total of 8 hours to 10 hours a day, they catch only snippets of slumber at a time, which may leave them drowsy, disoriented and destined for further disturbances, scientists said.
"Seniors have a high rate of sleep disorders, which reduces restful sleep," noted Dr. Susanna McColley, division head of pulmonary medicine and director of the Cystic Fibrosis Center at Children's Memorial Medical Center in Chicago.
Chronic insomnia, which keeps up to 20 percent of the general population awake nights, leaves an even larger segment of the senior set sleepless. "In the elderly, it goes up to nearly 50 percent and in older people with medical illnesses may be as high as 60 to 70 percent," Zee estimated.
The result is a perennial cycle of restlessness.
"The elderly still need their sleep and the disruption due to medical problems may result in attempts to make up for lost sleep by napping," explained Mary Amanda Dew, professor of psychiatry, psychology and epidemiology at the University of Pittsburgh School of Medicine and Medical Center. "Too much napping can then make nighttime sleep even worse."
The 2003 survey showed a direct correlation between the number of diagnosed medical conditions reported by America's older adults and the quality of their slumber. Nearly eight in 10 elderly who suffer from four or more ailments fail to get sufficient shut-eye, compared to only half of those with none. Sound sleep evades more than 70 percent of patients with depression, heart or lung disease, diabetes, arthritis, hypertension or those struck by a stroke. Insomnia also often accompanies pain, restricted mobility and overweight.
In contrast to sleep-easy adolescents, seniors tend to struggle for every wink, researchers remarked.
"The environment becomes especially important as one ages," Kushida said in a telephone interview. "Older people are far more discriminating sleepers than teenagers, becoming sensitive to noise, light, even the firmness of the bed."
Not good news for a population most prone to spend nights in brightly illuminated, bustling hospitals or nursing homes.
Researchers at Brown University and the Sleep Disorders Clinic at Rhode Island Hospital in Providence noted a strong relationship between the number of sounds as loud as 80 decibels -- about the volume of a beeper -- or more and sleep arousals among elderly patients in the intermediate respiratory care unit.
Other studies have shown at least one-third of sleep-deprived hospital patients have so-called "ICU psychosis," marked by after-dark disorientation and delusion. Insufficient slumber also may hamper the workings of respiratory muscles, possibly hindering weaning from mechanical ventilators, researchers reported in the journal Sleep.
A five-year project funded by the National Institute of Aging implicated even modest increases in noise -- 6 or more decibels above the background level -- in 18 percent of nearly 4,000 nocturnal arousals among nursing home residents.
Those who deem the consequences insignificant are in for a rude awakening, specialists warned. Long stretches of nighttime wakefulness and other sleep disturbances can double the risk of death for healthy older adults, Dew found in a study last year.
"Interventions that optimize or protect sleep initiation and sleep quality in old age might not only add quality of life but prolong life as well," she concluded. "In general, even when the risks are not life-threatening, just going through the day without adequate sleep can have a marked negative effect on a person's quality of life by making him (or) her more irritable and forgetful."
Conversely, sleeping the night away could enhance mental function and prevent or decrease the severity of such age-related chronic health conditions as obesity, diabetes, cardiovascular disease and hypertension, Zee observed.
"Our research is based on the idea that adequate quantity and quality of sleep is important for successful aging," she told UPI.
The caliber of slumber declines with age, so oldsters may need to invest more time in bed than do the young to net a similar amount of shut-eye, scientists noted.
"There is mounting evidence that circadian rhythms change with age, often leading to frequent awakenings during the early morning hours," stated Dr. Anne McTiernan of the Fred Hutchinson Cancer Research Center in Seattle. "Older individuals may need to adjust their sleep cycle to go to bed earlier and get up earlier."
Seniors wanting to stay fit for sound sleep should start the day with lightly intense to moderately exerting physical activity, several studies have suggested.
"Older individuals living in care facilities may improve their sleep by using soft earplugs to reduce noise exposure and an eye covering to reduce light exposure," recommended Shelley Tworoger of the Seattle cancer center.
They may find it unnecessary to soundproof their ears, however, if engineers at the Georgia Tech Research Institute have their way. The team has created a host of sound-stifling mechanisms, including noise-absorbing wall panels, peace-promoting curtain hooks and speaker-embedded bed pillows that minimize the need to turn up the volume on the television set. In tests conducted at five nursing homes, the noise busters went so far as to wrap the rackety ice machines with a specially designed blanket that froze out all but the sounds of silence.
Other research has shown how good sleep hygiene can clean out the tangles of troubled sleep. At the end of one four-month behavior modification program, 54 percent of slumber-deprived, chronically ill participants improved significantly in sleep efficiency, frequency and duration of nighttime awakenings and total time under the covers.
The strategy that put them to sleep called for adhering to a regular schedule for catching their zzzs, curtailing daytime naps, avoiding slumber-defying activities and staying in bed only when drowsy or dozing. The approach had been shown to work in healthy individuals, but the more recent study, by researches at Rush-Presbyterian-St. Luke's Medical Center in Chicago, was the first to demonstrate its effectiveness in the chronically ill.
The findings, reported in the journal Psychology and Aging, raise hope for a drug-free sleep solution for seniors already taking a heavy dose of medicines for their other ailments, the authors noted.
"Lifestyle management, including stress avoidance or reduction, healthy diet, sleep routine and a satisfying social life are most important in my opinion to contribute to a healthy sleep pattern," advised comparative bioscientist Dr. Andrea Zabka of the University of Wisconsin-Madison.
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Next: Sleeplessness may be the root of many childhood evils.
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E-mail Lidia Wasowicz at [email protected].
