Everyone experiences an occasional restless night. But for those who toss and turn regularly, the inability to sleep can be a source of intense frustration and may even have serious consequences. Sleep is just as essential as air, water or food. We need continuous, uninterrupted sleep to restore energy, feel refreshed and maintain our health and well-being.
Difficulty falling asleep and/or staying asleep, a disorder known as insomnia, is more prevalent than people may realize. In fact, insomnia for seniors is very common, affecting almost 50% of adults 60 and older, reports the National Institute of Health. This form of sleep deprivation is often debilitating and can last for days, months or even years. Normal sleep patterns are disrupted, affecting both sleeping and waking hours. Memory loss, irritability, depression and a variety of other symptoms can result.
Sleep requirements and patterns change throughout the life cycle according to the National Sleep Foundation. Newborns and infants need about 16 hours of sleep in a 24-hour span. A shift to a later sleep-wake cycle occurs for adolescents and 9 hours of sleep is adequate. Adults require 7-9 hours of sleep each night. Surprisingly, seniors need the same 7-9 hours, though they do experience a shift to an earlier sleep-wake cycle.
Quality sleep is as important as quantity for rejuvenating the body. While drifting off, our body enters into NREM (non-rapid-eye-movement) sleep and goes through four stages, beginning with light sleep, progressing to deeper sleep. During the fifth stage, known as REM (rapid eye movement) sleep, breathing becomes irregular and shallow, our eyes move rapidly, limb muscles become immobile, and dreaming may occur. The entire NREM-REM cycle lasts about 90-110 minutes, and usually takes place 4-5 times during normal sleep.
Research shows that seniors tend to sleep lighter and for shorter spans, spending less time in REM sleep. This change is attributed to the aging process, but can also result from other health problems. Whatever the cause, disruptions in the sleep cycle may lead to insomnia for seniors.
Dr. Sunit Mistry, a pulmonary, critical care, and sleep medicine specialist in Los Angeles and a Diplomate of the American Board of Sleep Medicine, refers to two categories of insomnia. Sleep onset insomnia, characterized by difficulty with falling sleep, and sleep maintenance insomnia, which relates to the inability to remain asleep throughout the night. Chronic insomnia, regarded as more serious than transient or intermittent insomnia, appears nightly for a month or more and left untreated, may persist for years.
Recognizing that your loved one has insomnia can be challenging since sleeplessness occurs overnight. The following checklist may be useful in helping you identify possible signs and symptoms.
|Taking more than 30-45 minutes to fall asleep* Having trouble staying asleep* Waking up early, unable to fall back asleep* Depression Night falls||Feeling drowsy, tired or exhausted* Complaining of being up all night Depression Accidents due to sleep deprivation Irritability Impaired memory Difficulty concentrating|
Insomnia may be a primary-but more often secondary-disorder stemming from some other health condition. It can also be triggered by medications, and in some cases, caused by sleeping habits or the sleep environment. Mistry cites the most common causes (in no particular order):
Additional factors may also cause insomnia for seniors:
Diagnosing and determining the causes of insomnia may involve the following tests:
If it is determined that another condition or medication(s) is causing insomnia, addressing these issues first is important.
As a preventative as well as a treatment measure, Mistry recommends focusing on proper sleep hygiene and provides some suggestions to promote healthy sleeping and improve habits, or the environment:
|Create (or begin):||Avoid:|
|A regular sleep/wake schedule Exercise early in the day or no later than 4 hours before bed A sleep environment that is dark, quiet, safe and comfortable Activities that encourage relaxation before bed, such as a warm bath or shower, or calming music.||Caffeine, other stimulants and alcohol no later than 3 hours before bedtime Heavy meals, spicy food, and excessive amounts of liquid before bedtime (a light snack or warm milk is okay) Naps (or limit them) Activities in bed that may cause anxiety such as work, reading, or television.|