Inherent problems of older age contribute to poor sleep

Many older adults have sleep problems that can be caused by aging. But other issues also contribute to the prevalence of sleep complaints, and they should be discussed and investigated, experts say.

A national poll conducted by the University of Michigan and released in October found that almost half of those 65 and older have trouble getting to sleep, and more than a third are taking prescription or over-thecounter sleep aids.

Older adults also have problems staying asleep, said Adam Spira of the Johns Hopkins Bloomberg School of Public Health. “Good sleep protects against negative outcomes, and those who sleep poorly are at higher risk of functional decline and depression,” he added.

The American College of Physicians defines chronic insomnia as the presence of symptoms of distress and impairment that last for at least three nights a week for at least three months and are not linked to medical or mental problems or other sleep disorders, such as obstructive sleep apnea and restless legs syndrome.

Changes in sleep occur throughout a person’s life, Spira said. In later years, there are decreases in total sleep time, increases in sleep fragmentation and decreases in deep sleep, he said.

Many people experience a circadian rhythm shift as they age, such that they awaken earlier in the morning and do not feel they are able to get enough sleep, said David N. Neubauer of the Johns Hopkins Sleep Disorders Center.

Later in life, there tend to be other factors that undermine good sleep quality, Neubauer said. Older adults may have suffered personal losses or have worries about the future.

Older adults also have more health problems, which can be major drivers of sleep problems, Spira said.

However, both older adults who are healthy and those with chronic medical conditions should use caution in taking over-the-counter and prescription sleeping aids, experts said.

Studies show that older people who take sleeping pills sleep only a little longer and a little better than those who don’t take them, according to Choosing Wisely, an initiative of the American Board of Internal Medicine.

The ACP recommends that medications be taken for only a short time (four to five weeks). The Food and Drug Administration advises that if insomnia doesn’t go away within seven to 10 days of treatment with drugs, a patient should see a doctor for re-evaluation.