Getting older means you sleep better, not worse, study shows

Older people often complain about sleeping poorly as a sign of aging. Turns out that sleep improves during an adult’s lifetime. A new study in the March edition of SLEEP analyzed 150,000 responses to questions about sleep issues. The adults with the least complaints about sleep disturbances and daytime tiredness were in their 80s. Sleep complaints in general declined over the years, with a slight uptick in middle age.

Researchers said the results challenge conventional beliefs. They said physicians tend to ignore sleep complaints among older adults as a normal part of aging. Granted, there are contributing factors like illness and depression that affect slumber. But those things aside, older folks should be feeling good about their sleep, the study said. If not, they need to talk to their doctor.

Read more blog posts about sleep issues with older adults. Or learn more about sleep and growing older.

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Sleep Apnea and Sleepiness Raises Older Adults’ Death Risk

A study in the latest issue of the journal SLEEP provides further evidence that sleep apnea should never be left untreated. Older adults have twice the death risk when excessive daytime sleepiness is paired with obstructive sleep apnea.

The study involved 289 participants at least 65 years old and with no clear signs of dementia or depression. The average age at the start of the study was about 78 years old. About three-quarters of the patients were female.

An overnight sleep study at the beginning of the study was used to diagnose participants with obstructive sleep apnea. Subjects who indicated that they felt sleepy or struggled to stay awake during the daytime at least three to four times a week had excessive daytime sleepiness.

Social security death index records indicate after 14 years nearly 55 percent of the participants died. Results show that participants with excessive daytime sleepiness combined with sleep apnea were more than twice as likely to have died. Being sleepy in and of itself did not lead to an increased mortality risk.

The lead author of the study says it’s still unclear exactly why sleep apnea and excessive daytime sleepiness increase the risk of death in older adults, but he suspects it may be related to inflammation. Cases of inflammation may increase the risk of other medical problems such as hypertension.

Obstructive sleep apnea affects nearly 20 percent of older adults. It occurs when the soft tissue in the back of the throat collapses and blocks the upper airway during sleep, causing pauses in breathing.

The study was unable to demonstrate whether treatment for sleep apnea reduced the risk of death. The Sleep Education Blog strongly recommends that anyone with moderate to severe sleep apnea seek treatment immediately.

CPAP therapy is the first-line treatment for obstructive sleep apnea, especially in more severe cases. Surgery and oral appliance therapy are also effective options for lesser cases.

If you think you may have sleep apnea, get checked out at one of the more than 2,200 AASM-accredited sleep disorders centers in the United States. Go to http://www.sleepcenters.org/ to find a sleep center near you.

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Sleep in America 2011: Sleep & Technology

The powerful technology that keeps us connected, entertained and informed is deeply engrained in our lives and our culture. We carry around phones as powerful as personal computers, a movie about Facebook almost won the Oscars and every new Apple product announcement is celebrated like a national holiday. We can – and often do – spend the entire day in front of a screen, using a desktop computer at work all day, an iPhone on the commute or at the gym and a tablet or e-reader at home.

So maybe we’re overdoing it with all these gadgets. For all of the societal benefits, there are some drawbacks. We’re less active and we’re getting fatter. Our children face the threat of bullying online as well as the schoolyard. And our many devices are keeping us from getting enough sleep each night.

Sleep problems related to technology have been a recurring topic on Sleep Education Blog. This year, the annual Sleep in America Poll also focused on technology and sleep. The National Sleep Foundation released the results of its 2011 Sleep in America Poll earlier this week.

The findings are no surprise - Americans are using technology before bedtime and they’re not getting enough sleep. Out of the more than 1,500 people surveyed, 95 percent use some type of electronic device within an hour of going to bed at least a few times a week.

Results show 43 percent of Americans rarely sleep well on weeknights and 60 percent regularly have insomnia, snore or wake up un-refreshed in the morning. Nearly two-thirds admit to sleeping less than the recommended 7-8 hours per night. About 15 percent of adults and 7 percent of children are seriously sleep deprived – logging less than six hours of sleep during the week.

Technology use and sleepiness is generational, as the 2011 Sleep in America Poll demonstrates. Millennials are more connected than their parents. Older generations watch more television while younger generations prefer the interactivity of video games, computers or mobile devices.

Younger generations are also sleepier, the poll reports. About 1 in 5 millenials rated themselves as sleepy using the Epworth Sleepiness Scale compared to only about 1 in 10 baby boomers and generation x’ers.

Sleep changes as you age. Teenagers and young adults may have difficulty falling asleep in the early evening because their circadian rhythms prefer the night. Early start times for school or work leave almost no time for natural night-types to sleep.

Older people have their own sleep problems. The National Institute on Aging reports that older adults may produce and secrete less of the sleep-promoting hormone melatonin and as a result may get less sleep, sleep less deeply and wake up more throughout the night.

Every generation copes with sleeplessness in the same way, poll findings show. All age groups use caffeine and naps to fight fatigue. Many of the participants openly admitted that sleep deprivation affects their work, their sex lives and their ability to drive safely.

If you fit in these statistics, you might want to make some changes to your sleep hygiene. Schedule a nightly wind-down time away from the screen. Turn off your television or computer 30 minutes earlier each night and do some light chores, read a book or even a Kindle.

If a sleep disorder is keeping you from getting the rest your need, contact an AASM-accredited sleep center for help.

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Sweating off Insomnia Works, New Study Contends

The benefit of exercise for insomnia continues to be a hotly debated topic in the sleep research community. Recently, several high-profile reports have come to conflicting conclusions on whether a workout routine can promote sleep.

The latest published study by Northwestern University researchers shifts the argument back in favor of exercise for insomnia. The article concludes that older adults can counteract the sleeplessness associated with aging by taking up an aerobic workout routine.

Many of the adults who started exercising during the study improved from poor sleepers to good sleepers. The group reported reduced depression and overall improved mood along with enhanced of sleep quality.

The study involved 23 mainly sedentary adults of average age of 55. The group was randomly assigned to either aerobic conditioning or a non-physical activity such as a cooking class or museum lecture. Only the exercise group saw improved sleep.

A June study in the Journal of Clinical Sleep Medicine came to a similar conclusion for slightly younger insomnia patients. A 50-minute jog on the treadmill 4-8 hours before bedtime helped middle-aged insomniacs sleep sooner. Moderate aerobic exercise was more effective in promoting sleep than high-intensity cardiac routines or resistance training. The authors believe the routine helps with bedtime anxiety.

Another study published in May claims the benefits are all mental. Swiss researchers found people who rated themselves as physically fit slept better, even if they were not necessarily in good physical shape.

Normal adults with no history of insomnia may not see any benefit at all, a 2003 study concluded. Wrist actigraphy demonstrated active young adults fell asleep only a minute and a half faster than their peers.

In some cases exercising can actually hurt sleep. Never exercise within a few hours of bedtime. Evening workouts run counter to the evening wind-down process and can actually make you wake up.

There’s one thing all sleep experts can agree on: exercise is important for your overall health. While insomnia may or may not improve, you’re reducing your risk of getting obstructive sleep apnea by controlling your weight and taking care of your body.

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Majority of assisted living residents have “significant sleep disturbances”

It’s no secret people sleep less as they get older, and there’s no better example of this than residents of assisted living facilities.

65 percent have some type of clinical sleep disorder, according to a study published in the American Geriatrics Society.

The authors tracked 121 seniors after they enrolled in one of 18 assisted living facilities in the Los Angeles area.

The subjects took the Pittsburgh Sleep Quality Index, a self-rated questionnaire. Researchers then measured their sleep quality by wrist actigraph. The subjects took both tests at enrollment and after three and six months at the facility.

A majority of people had some type of sleep disturbance. About 60 percent of residents complained of some form of insomnia. Slightly more subjects said they woke up in the middle of the night or early morning than had trouble sleeping.

Physical and mental health tended to decline at a faster rate for residents who complained of sleep disturbances.

The authors of the study were quick to point out that poor sleep is associated with decline in health at a late age. The authors suggest there’s room to examine for a possible causal relationship by seeing if improving sleep would spur better health.

At this point it’s not known what direction therelationship takes. Does health decline for assisted living residents because of poor sleep or are sleep disturbances a symptom of greater health problems?

A study published in the May issue of SLEEP found people who lived to be 100 slept more than most, averaging 7.5 hours of sleep a day. Generally, older adults tend to get less sleep. However, due to the design of the study, its not known whether sleep increased near 100 years old, or if 100-year-olds were better sleepers than most people ages 65 to 99.

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Daily Routines Help Older Adults Sleep Better

A new study shows that daily routines help reduce insomnia and improve sleep in older adults. The results were published yesterday in the journal Sleep.

The study involved 96 adults in two retirement communities in Israel. Their apartments were fully equipped as independent units. They had an average age of about 75 years.

Eighty-two percent lived alone, and 75 percent reported fair or good health. Sleep medication was used three times or more per week by 23 percent of participants.

Results show that older adults slept better when they had more stability in daily routines. They fell asleep faster and had improved sleep quality.

“We were surprised that our findings were so robust,” said lead author Anna Zisberg.

Examples of these daily routines include bathing, dressing and eating. The authors reported that stability in routines involves the timing, frequency and duration of the activities.

Mean self-reported total sleep time was six hours. On average it took participants 37.5 minutes to fall asleep. Worse sleep quality was associated with less lifestyle regularity.

The authors noted that the natural process of aging often affects sleep quality. They concluded that routine lifestyle rhythms may help adults maintain high-quality sleep as they get older.

Earlier this year a study suggested that healthy older adults without sleep disorders may have a reduced "sleep need." But many older adults have insomnia due to a medical condition. And they may have insomnia as a side effect of a medication.

Read more about sleep and aging. Get help for an ongoing sleep problem at an AASM-accredited sleep center near you.

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Frequent Naps & Type 2 Diabetes in Older Adults

A new study examined the relationship between napping and type 2 diabetes in older Chinese adults. The results were published yesterday in the journal Sleep.

The study involved 19,567 people in China between the ages of 50 and 93 years. About 71 percent of participants were women.

They received a physical exam. They also answered questions about their lifestyle and medical history. This included questions about their napping habits and daytime sleepiness.

Results show that 13.5 percent of the sample had type 2 diabetes. The rate of diabetes was 36 percent higher in people who reported napping four to six times per week. It was 28 percent higher in people who napped daily.

The results were unchanged when people with potential ill health and daytime sleepiness were removed from the analysis. This suggests that it is less likely that diabetes leads to daytime sleepiness. Instead the results raise the possibility that napping may increase the risk of diabetes.

But more research is needed to determine if napping plays a causative role in the development of diabetes. Many other factors may be involved in older adults.

“In many non-Mediterranean, Western countries a large proportion of those that nap are generally older or have other conditions that cause tiredness and create an urge to nap,” lead author Neil Thomas told the AASM. “The napping can therefore be a marker of disease.”

According to the authors, napping is a social norm in China. It is practiced at all ages starting in childhood. At least one nap per week was reported by 67 percent of participants. About 59 percent of these people reported napping daily.

The authors also noted that napping and diabetes were associated even though physical activity levels were higher in nappers. Physical activity has been shown to reduce the risk of diabetes.

Read more about naps and sleep and type 2 diabetes.

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You May Need Less Sleep as You Get Older

A new study suggests that healthy older adults without sleep disorders may have a reduced "sleep need." The results were published in the Feb. 1 issue of the journal Sleep.

The U.K. study involved 110 healthy adults. They had no sleep disorders or sleep complaints. Their sleep was evaluated during an overnight sleep study.

Results show that total sleep time decreased with age. Older adults between 66 and 83 years of age slept about 20 minutes less than middle-aged adults and about 43 minutes less than young adults.

The study also found that the sleep of older adults was more fragmented and less intense. Awakenings during the night increased. And time spent in deep, slow-wave sleep decreased.

But it was younger adults who were sleepiest during the day. Older adults took longer to fall asleep during a daytime nap study.

"Our findings reaffirm the theory that it is not normal for older people to be sleepy during the daytime," lead author Derk-Jan Dijk, PhD, told the AASM. "If you are sleepy during the day you either don't get enough sleep or you may suffer from a sleep disorder."

In a 2008 study Dijk reported on the age-related reduction in the “maximal capacity for sleep.” Adults were allowed extended periods of sleep to determine their sleep need. The total daily sleep time of older adults (7.4 hours) ended up being 1.5 hours less than that of younger adults (8.9 hours).

It is unclear what may cause a change in the sleep need of older adults. The authors suggested that alterations in reproductive hormones or changes in the brain may be involved.

They added that the study did not address sleepiness during the evening hours. At that time of day older adults may be sleepier than young adults.

The authors also wrote that the results may help explain why some healthy older adults struggle with insomnia. They may be unaware of their reduced sleep need.

So insomnia may occur because they spend too much time in bed. “Sleep restriction” may help get their sleep back on track. This is one form of cognitive-behavioral therapy.

But it is important to note that many older adults have insomnia due to a medical condition. And they may have insomnia as a side effect of a medication.

Read more about sleep and older adults.

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Chronic Insomnia: Less Brain Gray Matter in Older Adults

A new study from The Netherlands examined regional brain volume in people with insomnia.

The study involved 24 adults with chronic primary insomnia. They were between the ages of 52 and 74 years. Seventeen of them were women. They were compared with 13 people who had no sleep problems.

Results show that people with insomnia had a smaller volume of gray matter in the left orbitofrontal cortex. This reduction in gray matter was strongly correlated with the severity of insomnia.

The NINDS reports that “gray matter” refers to the cerebral cortex. This is where the brain does most of its information processing. The cortex is a layer of tissue with a gray-colored appearance.

The study also found reduced gray matter volume in the precuneus. This cortical area may have a central role in tasks such as episodic memory retrieval.

A press release noted that the affected brain regions play a role in evaluating pleasure. They also have a role in the brain’s “resting state.”

Most people with insomnia have “secondary” insomnia. It occurs along with another medical problem, mental illness or sleep disorder. It also may result from the use of a medication or substance. In contrast primary insomnia is unrelated to another health problem.

A 2008 study in the journal Sleep linked primary insomnia to low levels of a brain chemical. Results show that GABA levels are reduced by 30 percent in adults with chronic primary insomnia.

Last year a study proposed that “cooling the brain” may be a new way to treat insomnia. Subjective benefits were reported by 75 percent of participants.

Read more about insomnia. Get help for an ongoing sleep problem at an AASM-accredited sleep center near you.

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Erectile Dysfunction & Restless Legs in Older Men

A new study shows that older men with restless legs syndrome may be more likely to have erectile dysfunction. The results were published in the Jan. 1 issue of the journal Sleep.

The study involved 23,119 men who were health professionals. They had an average age of 69 years.

Results show that men who reported having RLS symptoms 15 times or more per month were 78 percent more likely to have erectile dysfunction. They had a “poor or very poor” ability to have and maintain an erection for sexual intercourse.

About four percent of participants had RLS. Fifty-three percent of men with RLS reported having erectile dysfunction.

The authors suggested that the two disorders may share common mechanisms. They suspect that both disorders may involve low levels of dopamine in the brain. Dopamine is a chemical that acts as a neurotransmitter.

They also noted that the association between RLS and erectile dysfunction could be related in part to other sleep disorders that co-occur with RLS. For example obstructive sleep apnea may decrease circulating testosterone levels.

The NIDDK reports that erectile dysfunction often is caused by a disease or surgery. It also can be a side effect of a medication.

RLS involves an intense urge to move the legs. The intensity of this urge increases at night and as you lie or sit still. It is relieved only by walking or moving the legs.

RLS often involves other burning, prickly, itching or tingling sensations in the legs. Symptoms of RLS tend to become more intense and last longer over time.

RLS can have a severe effect on your sleep. It may prevent you from falling asleep. It also may keep you from returning to sleep if you wake up during the night.

Read more about RLS. Learn about the genetics of RLS on SleepEducation.com.

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Sleep Problems in Older Adults

Two new studies examined the link between sleep and frailty in older adults.

One study involved 3,133 men from six U.S. centers. They were 67 years of age and older.

Results show that sleep problems were highest in frail men. Statistical adjustment found that certain sleep problems were associated with an increased risk of frailty.

Men who took at least 60 minutes to fall asleep were 42 percent more likely to be frail. The risk of frailty also was elevated in men with either poor sleep quality or sleep-disordered breathing. The odds of being frail were increased in men who were awake for a high percentage of their time in bed.

A smaller study involved 374 adults in Connecticut. They had an average age of 84 years.

Results show that 24 percent were drowsy; 10 percent had clinical insomnia; and 41 percent were frail.

There was a significant association between drowsiness and frailty. Adults who were drowsy were nearly four times more likely to be frail.

In May an expert consensus statement addressed the topic of sleep and aging. It noted that sleep disorders are most common in older adults.

The experts added that aging can involve a profound change in your daily sleep-wake cycle. But most of these changes occur by the age of 60.

As a result, sleep problems in older adults shouldn’t be considered a normal part of aging. Often these problems are related to other medical conditions or frequent medication use.

The statement noted that this relationship is “bidirectional.” People with sleep disorders are more likely to have serious medical problems such as heart disease and depression. At the same time, people with these problems have a higher risk of developing a sleep disorder.

In August a study in the journal Sleep linked insomnia symptoms and daytime sleepiness with quality of life in older adults. Another study reported that other sleep disorders such as leg cramps and sleep apnea are common in older adults.

Another recent study linked excessive daytime sleepiness in older adults with an increased risk of death.

Learn more about sleep and aging. Get help for a sleep problem at an AASM-accredited sleep center near you.

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The Good Life: Sleep & Retirement

A study in the Nov. 1 issue of the journal Sleep suggests that your sleep may improve when you retire.

Results show that 24.2 percent of workers had disturbed sleep in the last year before retirement; this dropped to 17.8 percent in the first year after retiring. The odds of having disturbed sleep in the seven years after retirement were 26 percent lower than in the seven years before retiring.

The greatest reduction in sleep disturbances was reported by people who had depression or mental fatigue while they were working. Depressed workers were 45 percent less likely to have disturbed sleep in the years after retiring.

Men and night-shift workers also benefited greatly from retirement; their odds of having sleep disturbances dropped by 34 percent. In contrast, the odds of reporting disturbed sleep dropped by only 11 percent in women.

The authors link the sleep improvement to the removal of job stress. Sleep improved more in retired managers than in lower-level employees. It also improved more in workers who reported higher psychological job demands.

The odds of having disturbed sleep increased slowly with age. This occurred in both working and retired adults.

People who retired early because of an illness or disability were more likely to have disturbed sleep in retirement. They had a 46 percent increased risk of sleep disturbances after retiring.

The study involved 14,714 employees from the French national gas and electricity company. They retired between 1990 and 2006. The study authors noted that these workers enjoyed some highly favorable employment and retirement conditions.

Their job security was guaranteed. They retired at an average age of 55 years. And they received a company-paid pension that was 80 percent of their salary.

That may sound like a dream to many people in the U.S. But survey data released by the CDC last week suggest that U.S. workers also may enjoy a “sleep benefit” when they retire.

Forty-four percent of retired adults were sound sleepers; they reported getting enough rest or sleep every day in the past month. In contrast, only 29 percent of employed adults were sound sleepers.

In September the Sleep Education Blog reported that your job may be affecting how you sleep. Learn more about sleep and work.

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