Aging changes in sleep

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Sleep occurs in multiple stages. The sleep cycle includes dreamless periods of light and deep sleep, with occasional periods of active dreaming (REM sleep). The sleep cycle is repeated several times during the night.

AGING CHANGES

With aging, sleep patterns tend to change. Most people find that aging causes them to have a harder time falling asleep, and that they awaken more often.

Total sleep time remains the same or is slightly decreased (6.5 to 7 hours per night). It may be harder to fall asleep and you may spend more total time in bed. The transition between being asleep and awake is often abrupt, giving older people the feeling of being more of a "light sleeper" than when they were younger.

Less time is spent in deep, dreamless sleep. Older people average three or four awakenings each night, and are more aware of being awake.

Awakenings are related to less time spent in deep sleep, and to factors such as the need to get up to urinate (nocturia), anxiety, and discomfort or pain associated with chronic illnesses.

EFFECT OF CHANGES

Sleeping difficulty is an annoying problem, but it is seldom dangerous. Because they sleep more lightly and wake up more often, older people may feel deprived of sleep even when their total sleep time has not changed.

Sleep deprivation can eventually cause confusion and other mental changes. It is treatable, and symptoms should be reduced when you get enough sleep. Sleep problems are also a common symptom of depression, so you should be evaluated and treated for depression if it might be causing the sleep problem.

COMMON PROBLEMS

• Insomnia is one of the more common sleep problems in the elderly.
• Other sleep disorders, such as narcolepsy or hypersomnia, can also occur.
• Sleep apnea, where the breathing stops for a time during sleep, can cause severe problems.

PREVENTION

The elderly respond differently to medications than do younger adults, so it is very important to consult with a health care provider before taking sleep medications. Avoid sleep medications, if possible. However, antidepressant medications can be very helpful if depression contributes to the cause of the sleep problem. Most antidepressants do not cause the same problems that occur with sleep medications.

Sometimes a mild antihistamine is more effective than an actual sleeping pill for relieving short-term insomnia, but even nonprescription drugs can have side effects.

Sleeping medications (such as benzodiazepines) should be used only as recommended, and only for a short time. Some can lead to dependence (needing to take the drug to function) or addiction (compulsive use despite adverse consequences). Some of these drugs build up in your body, and toxic effects can develop if you take them for a long time. Confusion, delirium, falls, and other side effects can develop.

You can take measures to promote sleep:

• A light bedtime snack may be helpful. Many people find that warm milk increases sleepiness, because it contains a natural, sedative-like amino acid.
• Avoid stimulants such as caffeine (found in coffee, tea, cola drinks, and chocolate) for at least 3 or 4 hours before bed.
• Do not take naps during the day.
• Exercise (moderately) in the afternoon.
• Try to go to bed at the same time every night and wake at the same time each morning.
• Use the bed only for sleep or sexual activity.

If you can't fall asleep after 20 minutes, get out of bed and do a quiet activity, such as reading or listening to music.

When you feel sleepy, get back in bed and try again. If you still can't fall asleep in 20 minutes, repeat the process.

Drinking alcohol at bedtime may make you sleepy. However, it is best to avoid alcohol, because it can make you wake up later in the night.

RELATED TOPICS

• Aging changes in the nervous system
• Insomnia

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References

Minaker KL. Common clinical sequelae of aging. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 23.