Is Sleep Disruption Dragging You Down?
The pandemic may be disrupting your nighttime routine
Sleep and aging
Survey data show that half of elderly individuals report some form of sleep difficulty, including longer sleep-onset times, lower rates of sleep efficiency, more time in bed, more awakenings during the night, earlier wake-up times, and more daytime naps. Elderly individuals complain primarily about insomnia, which is often comorbid with other disorders. The symptoms in the elderly are more likely to be comorbid with an underlying physiologic problem, rather than with stress as seen in younger
Circadian rhythm disturbances
Circadian (24- hour) rhythms are biologic rhythms or changes that control many physiologic functions, including core body temperature, endogenous hormone secretions, and the sleep-wake cycle. These rhythms originate in the suprachiasmatic nucleus in the anterior hypothalamus, which houses the internal circadian pacemaker. The rhythms are also under the control of external cues, such as light, time of day, social activities, and meals. Circadian rhythm sleep disturbances typically develop when
Insomnia
Insomnia is defined as the inability to initiate or maintain sleep that results in daytime consequences. Studies have found insomnia to be the most common sleep disturbance in older adults, with up to 40% to 50% of those over the age of 60 reporting difficulty sleeping [21] and an annual incidence rate of 5% in those over the age of 65 [22]. Insomnia complaints include difficulty falling asleep, difficulty staying asleep, and early morning awakenings. Women tend to have higher rates of insomnia
Primary sleep disorders
Three primary sleep disorders are commonly found in the elderly: (1) sleep-related breathing disorder (SR. DB), (2) restless legs syndrome–periodic limb movements in sleep (RLS- PLMS), and (3) REM sleep-behavior disorder (RBD).
Sleep in dementia
There is considerable evidence that dementia affects sleep differently from the normal aging process [1]. This is not surprising considering that dementing illnesses, such as Alzheimer’s disease, Parkinson’s disease, multi-infarct dementia, or Lewy body dementia, may involve irreversible damage to the brain in areas responsible for regulating sleep. In general, patients with dementia have disturbed sleep at night, and laboratory sleep studies of demented patients have found increased sleep
Sleep in institutionalized elderly
Institutionalized elderly experience extremely fragmented sleep [105]. Middelkoop and colleagues [106] reported that patients living in nursing homes had poorer sleep quality, more disturbed sleep onset, more phase-advanced sleep periods, and higher use of sedative-hypnotics when compared with those elderly living in the community or in assisted living environments. Studies have found that for older adults living in nursing homes, not a single hour in a 24- hour day was spent fully awake or
Summary
Significant changes in sleep accompany aging for most adults. There are a variety of potential causes including medical illnesses; medications; circadian rhythm disturbances; depression and other psychiatric disorders; and primary sleep disorders (SRBD, RLS- PLMS, and RBD). The diagnosis requires a good sleep history and, when indicated, a sleep study. Treatment should address the primary problem rather than the complaint itself and can result in significant improvement in quality of life
