By Rakesh Kharwar
When I used to wake up for a late night snack, I sometimes found my grandma sitting on her favorite chair and sewing till late hours. I remember asking her why she was she up so late and her reply “now that I am old, I have trouble getting the sleep you all children get so easily.” Her being awake was great for me because she used to tell me the best stories late at night.
It is true that most of the common problems that elderly face today are sleeping disorders. They might have problem falling asleep or might be waking up in the middle of night and then have trouble in falling back to sleep again and getting only light sleep.
However, the amount of nightly sleep that we need in old age remains the same as what we needed when we were younger; it’s the ability to get sleep that changes. It has been found that it’s the various illnesses and the medication that are to be blamed for the sleep disorders among the elderly today.
Aging also affects the circadian rhythm or the natural body clock, which can alter the timing of sleep. That’s the reason that your mum is fast asleep by 10 and is up by 4 doing yoga. Other factors that affect the body clock are lack of physical exercise, lack of mental stimulation and excessive time spent in the bed.
The types of sleeping disorders are Insomnia or Sleep deprivation and Narcolepsy or Excessive Sleep.
Insomnia or sleep deprivation affects almost half of adults aged 60 and older. In some patients, insomnia can be caused by an underlying medical condition or a medication side effect which is called secondary insomnia. In the absence of a causative factor, it is referred to as primary insomnia. Women tend to complain more of insomnia than men; it may be due to the post menopausal period.
Narcolepsy is a neurological disorder that causes extreme sleepiness and may even make a person fall asleep suddenly and without warning. Specific causes of narcolepsy are not known but people with narcolepsy are lacking hypocretin, a brain chemical which regulates sleep and wakefulness. The “sleep attacks” experienced by people with narcolepsy occur even after getting enough sleep at night, and make it difficult for people to live normal lives.
Causes of disturbed sleep:
Chronic Pain: With Age come the various pains in the back or the legs. For some, this pain might prevent them from getting restful sleep. Even when asleep, the body continues to register the pain. With constant pain and light sleep, the body is deprived of the growth hormone released during deep sleep which helps body’s healing mechanism. With lack of sleep there is also increase in sensation of pain the next day, thus it seems like an endless loop.
Sleep apnea: Obstructive sleep apnea (OSA) affects almost 40 percent of adults, and is more common among older adults. In this condition, the upper airway becomes too narrow due to relaxing of muscles of the wind pipe. People with sleep apnea stop breathing repeatedly during their sleep, often for a minute or longer and as many as hundreds of times during a single night.
The alternatives are avoiding alcohol or muscle relaxants and losing weight but if it doesn’t work, other solutions are sleeping on the side, sleeping with 30 degrees elevation, using CPAP masks.
Restless Limb Syndrome: This condition causes uncomfortable feelings in the legs, such as tingling, or pins and needles. Periodic limb movements cause people to jerk and kick their legs every 20 to 40 seconds during sleep. One study found that about 40 percent of older adults have at least mild form of this condition.
Restless Limb Syndrome can cause chronic insomnia and one of the contributing factors for the day time fatigue felt by them. Some solutions are taking Folic acid and iron supplements, going for walks before sleeping and relaxation techniques like meditation.
Urinary Problem: It is common for the elderly to wake up many times at night to urinate. This condition is called as Nocturia. Due to age, the body reduces the production of anti- diuretic hormone which slows the production of urine so they tend to have bladder full at night. Also with age, the size of the bladder decreases and thus making trips to the washroom frequent.
Solutions are reducing fluids before sleeping, not taking diuretics like alcohol.
Depression, Stress and Worries: Most of the old people have a habit of worrying and this has a negative impact on sleeping pattern. As we age, our vulnerability to stress hormone Cortisol increases. Thus the prevalence of insomnia can be result of sensitivity to these stress hormones.
Like Stress even Depression has an impact on the sleep. Those who are suffering from depression are likely to be unsatisfied with the amount of sleep that they are getting. Other way around, not getting enough sleep also produces symptoms similar to those of depression. Risk factors for depression in older people include loss of a spouse, retirement, social isolation and onset of dementia.
The only way to fight depression is by taking steps to be positive and cheerful. Going out, socializing, joining a club are some of the ways to be positive and fight sleeping disorder.
Medication: Some widely used medications can have stimulating effects and cause sleep disruption. Included among them are some antidepressants, decongestants, bronchodilators, anti-hypertensives and corticosteroids. Night time use of diuretics can promote repeated sleep interruptions to go to the bathroom.
Lack of Sleep causes: There are significant effects on the overall health of the elderly. A study conducted by North Carolina State University indicates that inadequate sleep is one of the main causes of memory problems among elderly people.
Other functions like ability to learn and remember information, organize, plan, and problem-solve; focus, maintain, and shift attentions are also affected.
Research shows that sleep is critical for healing disease processes and for general well-being. When patients don’t get good sleep they tend to complain more of arthritic and other pains.
Should you go the medication way?
Medication should be the last resort to sleep, as they also have their side effects and can lead to dependency. It is advisable not to take sleeping pills for more than 2 consecutive days and not more than 3 times in a week.
Ways to deal with it:
Below are some of the alternative ways to cope with sleeping disorders.
* Avoid napping in the day time especially after 3 pm.
* Do not drink tea or coffee before going to bed
* Establish a routine for sleep
* Do not use the bed for any other activity than sleep or intimacy
* Keep your bedroom dark, quite and a little cool
* Make a sleep ritual like- having a warm bath, drinking milk, an oil massage before sleeping
* If you can’t sleep within 20 minutes into the bed, leave the room and do some other activity. Go back once you are mentally and physically tired
Research shows that individuals who receive counseling about their approach to bedtime have the best long-term chance of getting a good night’s rest than those who take medication for it.
Sleeping disorders are not a part of aging process, 50% of elderly get good sleep. Try relaxation techniques, get into some activity, have good sleeping habits and see how manageable the sleeping disorder seems.
