Sleep andSleep andAging WellAging Well

The information in this publication was independently developed by the National Sleep Foundation. © 2003 National Sleep Foundation

Sleep and Aging

How does sleep change as we age?Do we need less sleep as we get older?p gCan a person expect to experience more sleep problems or have a sleep disorder as they advance in age?As we age, how does sleep affect our overall health, medical conditions and general well being?Wh t d t t d l ?What can we do to get good sleep?

Sleep is Essential to Our Overall Healthand Well-Beingand Well-Being

Key to our health performance safetyKey to our health, performance, safetyand quality of lifeAs essential a component as goodp gnutrition and exercise tooptimal healthEssential to our ability to perform both Essential to our ability to perform both cognitive and physical tasks, engage fully in life and function in an effective, fully in life and function in an effective, safe and productive way

Normal Sleep and Normal Aging:Our Internal ClockOur Internal Clock

The biological clock resides in the brainThe biological clock resides in the brainIt helps regulate when we feel sleepy and when we are alertIt works in tandem with light and dark, and our body temperature g , y pand hormones

The Sleep Cycle in Adults

Awake

es REM

REM

REM

REM

REM

1

2

Stag R R R R R3

4

0 1 2 3 4 5 6 7 8

Hours in Sleep

Normal Sleep and Normal Aging:Less Deep SleepLess Deep Sleep

Health and Environment Affect Our Sleep

With age, we become more sensitive to:Hormonal ChangesgPhysiological ConditionsEnvironmental Conditions

LightNoiseT tTemperature

Normal Sleep and Normal Aging:Sleep EfficiencySleep Efficiency

Changes with ageg)

p Ef

ficien

cyin

Bed

Slee

pin

Slee

p(%

Tim

e i

MenWomen Age

The ability to getcontinuous andcontinuous andconsolidated sleep maybecome morebecome moredifficult as we age

Sleep Problems/DisordersPrevalent Among Older PersonsPrevalent Among Older Persons

SYMPTOMS OF SLEEP PROBLEMS BY AGE Symptoms: a few nights a week or more 55-64 65-74 75-84Insomnia 49% 46% 50%Snoring 41% 28% 22%Sleep Apnea 9% 6% 7%Restless Legs Syndrome (RLS) 15% 17% 21%

Insomnia

A perception or complaint of inadequate orA perception or complaint of inadequate orpoor sleep

Difficulty falling asleepFrequent awakeningsWaking too early and having difficultyfalling back to sleepWaking unrefreshed

A highly prevalent condition affectingas many as 48% of older personsas many as 48% of older personsNext day consequences

Insomnia (continued)

Effective TreatmentEffective TreatmentHealthy sleep habitsBehavioral therapyPrescription hypnotic medicationsOther therapies

Snoring

Partial blockage of airway causing abnormalPartial blockage of airway causing abnormalbreathing and sleep disruptions90 million; 37 million experience on a90 million; 37 million experience on aregular basisMales

Those who are overweight and with large neck size most at risk

Loud snoring can be a Loud snoring can be a symptom of sleep apnea

Sleep Apnea

Increases as we age: affecting 4% and 2% of middle-aged men Increases as we age: affecting 4% and 2% of middle aged men and women and close to 27% and 19% of older men and womenCharacterized by pauses or gaps in breathing due to an obstruction of the airway

Sleep Apnea (continued)

Signs and SymptomsLoud, regular snoringLarge neck sizeLarge neck sizeObesity

Associated with major medical Associated with major medical conditionsMost common treatment

CPAP

Restless Legs Syndrome/Periodic Limb Movement DisorderPeriodic Limb Movement Disorder

Neurological movement disordersNeurological movement disordersInvoluntary urge to move due to unpleasant feelings in the legs during sleep or restJerking of legs and arms during sleepIncreases with ageTreatment

MedicationsHealthy lifestyleSleep hygiene

Medical Conditions Increase with Age

M di l C diti i ith d Medical Conditions increase with age and areoften associated with sleep problemsand disorders

Hypertension and Heart DiseaseHeart FailureStrokeMenopauseCancerCancerGastrointestinal Disorders

Medical Conditions Increase with Age (continued)(continued)

Medical Conditions increase with age and areoften associated with sleep problemsoften associated with sleep problemsand disorders

Alzheimer’s, Parkinson’s and cognitive problemsDepressionArthritisOther conditions Other conditions

MedicationsC AlCan AlsoCause SleepCause SleepProblems

The Use of Alcohol, Caffeine and Nicotine Impacts on SleepImpacts on Sleep

How To Enhance Your Sleep:Practical Tips for Good SleepPractical Tips for Good Sleep

Establish a regular schedule withconsistent bed and wake timesMaintain a relaxing bedtime routineCreate a sleep-promotingenvironment that iscomfortable, quiet, darkand preferably cooland preferably cool

Sleep Tips (continued)

Limit fluids and don’t eat too muchclose to bedtimeA oid caffeine nicotine and alcoholAvoid caffeine, nicotine and alcoholtoo close to bedtime andeven after lunchExercise, but not within 3 hoursbefore bedtime

If You Have Difficulty Sleeping

Limit time in bedUse your bed only for sleep andsatisfying sexAvoid watching the clockLimit naps

Keep a Sleep Diary to Identify Your Sleep Habits and PatternsHabits and Patterns

Seek Help From a Sleep Specialist anda Sleep Studya Sleep Study

Summary:Sleep ChangesSleep Changes

Sleep during the night changes with increasing age:Less deep sleep and more lighter sleepLess deep sleep and more lighter sleepMore difficulty maintaining sleep due to arousals and awakeningsSl i l ffi i t d f t dSleep is less efficient and more fragmented

The internal biological clock shifts to earlier bed and wake timesOlder persons experience a higher prevalence of medical conditions and take more medications that interrupt sleep and are associated with sleep problems/disordersOlder persons experience a higher prevalence of sleep disordersp

Summary:Consequences of Sleep ChangesConsequences of Sleep Changes

Tendency to stay in bed longer to get a sufficientamount of sleep results in worse sleepMore likel to take more naps to meetMore likely to take more naps to meetsleep need—may result in worse sleepInadequate or poor sleep results in daytimeInadequate or poor sleep results in daytimesleepiness and fatigueAbility to function well, enjoy life andy , j yoverall quality of life is affected

Summary:What you can doWhat you can do

Learn about sleepLearn about sleepUnderstand how your sleep changes and observe your habits and experiences

Apply healthy sleep practices to your sleep style so that you get sufficient quality sleepTalk to your doctor about your sleep and see a sleep specialist if you experience chronic difficulty sleeping and/or have symptoms sleeping and/or have symptoms of sleep disorders

Th N ti l Sl F d ti i The National Sleep Foundation is anindependent nonprofit organization

dedicated to improving public healthdedicated to improving public healthand safety by achieving public understanding

of sleep and sleep disorders, and byp p , ysupporting public education,

sleep-related research and advocacy.

1522 K Street, NW Suite 500 • Washington, DC 20005 • 202-347-3471 • www.sleepfoundation.org • © 2003

Reference Material

Articles:Ancoli-Israel, S. Sleep problems in older adults: Putting myths to bed. Geriatrics, 1997, 52:20-30Floyd JA, Medler SM, Ager JW, and Janisse JJ. Age-related changes in initiation and maintenance of sleep: a meta-analysis. Research in Nursing and Health (2000); 23(2): 106-117Gentili A and Edinger JD. Sleep disorders in older people. Aging (Milano, 1999); 11(3): 137 14111(3): 137-141Hays JC, Blazer DG, and Foley DJ. Risk of Napping: Excessive Daytime Sleepiness and Mortality in an Older Community Population. J Am Geriatr Soc (1996); 44: 693-698Morin CM Colecchi C Stone J Sood R and Brink D Behavioral and Pharmacological Morin CM, Colecchi C. Stone J, Sood R, and Brink D. Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial. JAMA (1999); 281: 991-999

Reference Material (continued)

Articles:Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio, Teri, Reynolds CF, and Robbins J. Daytime Sleepiness Predicts Mortality and Cardiovascular Disease in Older Adults. J Geriatr Soc (2000); 48: 115-123Phillips B and Ancoli Israel S Sleep disorders in the elderly Sleep Medicine 2 (2001); Phillips B and Ancoli-Israel S. Sleep disorders in the elderly. Sleep Medicine 2 (2001); 99-114.Shochat T, Loredo J, and Ancoli-Israel, S. Sleep disorders in the elderly. Curr Treat Options Neurol (2001); 3(1): 9-36Vitiello, MV. Effective treatments for age-related sleep disturbances. Geriatrics (1999); 54 (Nov): 47-52.Vitiello, MV. Effective Treatment of Sleep Disturbances in Older Adults. Clinical Cornerstone (2000); 2(5): 6-27Cornerstone (2000); 2(5): 6 27Youngstedt SD, Kripke DF, Elliott JA, and Klauber MR. Circadian abnormalities in older adults. J. Pineal Res (2001 Oct.); 31 (3): 264-72

Reference Material (continued)Books:

Ancoli-Israel, Sonia. All I want is a Good Night’s Sleep. St. Louis: Mosby-Year Book, Inc, 1996Bliwise, Donald L. Normal Aging (Chapter 3). Kryger MH, Roth T, and Dement WC (Eds.). Principles and Practices of Sleep Medicine. Philadelphia: W. B. Saunders Company, 1994

Other:Other:National Sleep Foundation

2003 Sleep in America pollLeadership Congress on Sleep, Health and Aging Monograph, 2004g g g gSleep and Aging (Public Education Brochure), 1998

NIH Consensus Development ConferenceThe Treatment of Sleep Disorders of Older People (Volume 8, Number 3), 1990

F i f ti i it th N ti l Sl F d ti ’ b it tFor more information, visit the National Sleep Foundation’s website at

www.sleepfoundation.org