Sleep problems and age: Not necessarily bedmates, say sleep docs

Patients over 65 -- and sometimes their doctors -- often behave as if sleep problems are as inevitable a part of aging as aches and wrinkles. It doesn't have to be that way, says a group of leading sleep doctors. But to get help, physicians need routinely to screen their older patients for signs of sleep disorders, and patients have to ask for help when they find they consistently can't fall asleep, awaken frequently or too early, have daytime sleepiness or experience unusual movements while sleeping.

There are "sleep hygiene" tips and treatments -- from cognitive behavioral therapy for insomnia to weight loss and breathing aids for sleep apnea -- that can remedy most sleep problems. And while the experts agreed they are overused, hypnotic sleep drugs can be a help for some patients.

In a slate of recommendations for the treatment of sleeping disorders in older patients, 10 leading sleep experts acknowledge that aging does bring changes in sleep patterns. Many of the sleep disruptions most commonly reported among seniors seem to come along with chronic medical conditions, many of which also grow more common with age -- diabetes, high blood pressure, cardiovascular disease, depression. When these are treated, sleep problems often get better.

But the medications that treat some of these conditions also can be implicated in sleep disturbances, said Dr. Harrison Bloom, a geriatrician with the International Longevity Center in New York City. Bloom chaired the consensus committee and was lead author of the paper, published this week in the Journal of the American Geriatrics Society. Certain antidepressants and medications for asthma can cause restless limbs and difficulty in falling asleep. Beta-blockers that treat heart failure can come with vivid dreams and insomnia, and even statins can keep some patients awake. Many narcotic pain relievers cause next-day hangovers with drowsiness, especially for older patients.

Physicians often fail to warn patients about these side effects, or to ask about sleep troubles when a patient comes in for follow-up.

The sleep experts also pointed a finger of blame at alcohol, caffeine, sedentary lifestyles and television in bedrooms. Older people frequently fall asleep soon after dinner -- often in front of a television -- and awaken at 2 a.m. unable to return to sleep. The result is fragmented sleep that night, sleepiness the next day and a vicious cycle of sleep disruption that can wreak havoc on a person's health and his wake-sleep cycle. 

"The bedroom should be used for sleep and sex," said Dr. Bloom, "not for heated arguments, watching TV or reading important documents."

-- Melissa Healy

Comments

[AASM]

Actually, the paper wasn't published this week. Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons was published online in April and in the print edition in May (Volume 57, Issue 5, p. 761-789).

[Alice Wahl]

Why no mention of melatonin? That's what gets me to settle down and fall asleep. When I became plagued with "2:30 am wakitus" (i.e. waking up at 2 am and then lying there, unable to go back to sleep again), I learned about slow release melatonin and now when I wake up to go to the bathroom, I fall back to sleep again with no more "wakitus". I'm now 73 and have been using melatonin for at least five years.

[Carole Heath]

I have had sleep problems since i entered the menopause, i am 62 years old now but still have sleepless nights. Recently i brought some herbal tablets for this problem containing hops, valerian. and passion flower which you take about an hour before you go to bed. This particular medication does seem to help me get a better night's sleep. As before i was waking up after a few hours and could not get back to sleep. I found pnce i woke up my legs and arms started to ache as i felt very restless and stressed and next day i used to wake up with a migraine, but recently these problems are less and i am more able to function better next day without having to go for a nap to catch up on my sleep during the day.

[Kathy Goodwind]

I read all that I can about sleep deprivation. I have always had a problem but I think it started when I was young due to my mother's overconcern. That is one story. The most pertinent that I experience now is due to I believe menopause. I am 65 and I take Ambien every other night. I try not to get addicted but I need that one night of good sleep. I only sleep 6 hours but can get into deep sleep at least. It keeps me going.
Now to the real culprit-menopause. Why isn't there more information about this devastating aspect of a woman's life??? No one wants to talk about it. Most women physicians are too young to have experienced it and really do not understand the effects on a person's life. There are so many effects not mentioned in all the things I have read on the internet. I quit going to Gynecologists for this issue-they are totally useless. Get more dialogue going about this change in a person's life. Was Stephen King right that eventually an older person will not need sleep at all because they can't?