For Seniors, A Wake-Up Call Concerning Sleeping Disorders by Gina Shaw Not sleeping well? If youíre over 50, you might assume that itís simply the kind of thing that happens with age. And itís true that sleep patterns do change as we get older, with less time spent in restorative, deep-sleep stages and more time in light-sleep stages when weíre more easily awakened. But this doesnít mean that tossing and turning all night is normal. According to the National Sleep Foundationís 2003 Sleep in America poll, around 37 million older adults suffer from some type of sleep disorder or have difficulty sleeping. Thatís about 67 percent of the population between 55 and 84. Only 7 million of these people have had their sleep woes addressed by a doctor, however, which means that the other 30 million or so are suffering in silence. Especially for seniors, a bad nightís sleep does not just mean a grouchy morning. ìThe 2003 Sleep in America poll indicates that poor health, and not age, is a major reason why many older people in this country report sleep problems, providing an important wake-up call that identifying and treating these sleep problems must be a priority concern,î said National Sleep Foundation Executive Director Richard L. Gelula. ìSleeping w ell is vital to aging well.î Many of the major diseases related to aging appear to go hand in hand with inadequate sleep. The NSF study reported that the vast majority of older people with impaired mobility (84 percent) have sleep problems, as do 81 percent of people who have suffered a stroke, 76 percent of those diagnosed with heart disease, and 75 percent of people diagnosed with lung disease. By contrast, only about half of those with no reported medical conditions (53 percent) told surveyors that they had difficulty sleeping. ìIn spite of the emerging science linking sleep and health, only a small fraction of the many reported sleep complaints of older adults are actually diagnosed and treated,î said NSF President James K. Walsh. ìThe Sleep in America poll reinforces the position that sleep problems should not be viewed as an aspect of normal aging, and they can significantly increase the overall burden of illness on patients.î A recent study in the journal Psychosomatic Medicine backs up the surveyís findings, even suggesting a possible link between sleep disturbances and an increased risk of death. Researchers at the University of Pittsburgh School of Medicine found that lying awake for 30 minutes or more, and spending a smaller percentage of the night asleep, appeared to boost the risk of death among older adults. In eight different studies between 1981 and 1997, researchers monitored the sleep patterns of 185 healthy adults ages 60 to 90 years old. Upon following up in 2001, they found that the 66 adults in the study who had died were more likely to have had abnormally high or low amounts of REM sleep, to sleep less ìefficientlyî during the night, and to lie awake for long periods. Itís a bit of a chicken-and-egg question: Do health problems that might lead to death cause a lack of sleep, or does lack of sleep cause health problems that might lead to death? The Pittsburgh researchers admit that they donít yet know if sleep disturbances cause potentially deadly biological changes, or if theyíre just the outward signs of changes that are already happening. Nonetheless, said the studyís lead author, Dr. Mary Amanda Dew, ìInterventions that optimize or protect sleep initiation and sleep quality in old age might not only add quality of life but prolong life as well.î It is certainly clear from the NSF survey that the better older adults sleep, the healthier they feel. Only 9 percent of those who rated their health as ìvery goodî or ìexcellentî reported regular daytime sleepiness, compared to 29 percent of those who called their health ìfairî or ìpoor.î In fact, people who felt in fair or poor health reported nearly twice as much insomnia symptoms as those in good health (71 percent, compared to 38 percent). Of the relatively few insomnia sufferers who do receive treatment, the most common approach is medication. But sleeping pills arenít necessarily the best choice for older adults who might already be on a number of other medications, and who may be at risk for falls or fractures if left groggy by sleeping pills during the day. ìOlder people are often prescribed a range of drugs for their health problems, many of which have side effects. Such side effects are just one reason why there is an argument to be made for clinical use of non-pharmacological treatments,î said Dr. Paul Montgomery, a lecturer and researcher in the Department of Social Policy and Social Work at the University of Oxford. In an article written in January in Sleep Medicine Reviews, Montgomery suggested instead that cognitive behavioral therapy (CBT) be used to provide a solution to the sleep deficit without the drugs, noting that several high-quality studies have found that ìsleep educationî can reduce sleep problems in older people. Gina Shaw is the medical writer for The Washington Diplomat. Suggestions for Good Nightís Sleep Some ìgood sleep habitsî anyone can practice include: - Reducing your caffeine intake after 4 p.m. - Skipping late-night snacks or drinks that can stimulate your digestive system and wake you up to go to the bathroom. - Creating a relaxing bedroom environment by controlling temperature and lighting, and making sure you have the right mattress. - Learning muscle relaxation techniques such as meditation and biofeedback. - Getting regular exerciseóbut in the morning, not in the evening. Scientists at the Fred Hutchinson Cancer Research Center in Seattle reported last year that women who exercised in the morning had better sleep, while women who exercised in the evening were more likely to be up at night. óGina Shaw