Senior Living: Sleep Sliding Away
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“Far from being a passive process during which little happens, sleep is an active phenomenon essential for health,” says Smith. “We all have experienced feeling better after a good night of sleep and, conversely, feeling lousy after a bad night of sleep.”
Sleep deprivation doesn’t only result in daytime crabbiness, drowsiness while staring blankly at a computer screen or instant dozing the minute you hit the sofa after work.
“Aside from the wide array of macromolecular biosynthesis needed for health that takes place during sleep, there are important benefits to the heart as well,” says Smith. Sleep is also closely linked to cognitive functioning, as well as mood and memory disturbances.
Most adults over 50 experience occasional insomnia, which may be caused by simple changes in lifestyle, activity levels or health.
“Older patients may experience sleep disruption more frequently from nocturnal urination, pain, underlying medical conditions, medications, stressors related to life changes such as retirement or moving, mood disorders such as depression or anxiety, and circadian rhythm disorders,” says Watson.
But “occasional” is the operative word here, as it’s normal for all kinds of things to keep us awake at night once in a while.
“For most people, it’s a transient thing,” says Mendez. “It’s when you experience insomnia that lasts longer than three or four months” that you need to seek medical attention.
Snoring is an all-too-common sleep thief (for the snorer and for his or her bed partner). Snoring is the sound that results when air flows too roughly past relaxed tissues in the throat, causing the tissues to vibrate as you breathe. As many as half of all adults snore at least occasionally, and it can often be controlled with lifestyle changes such as avoiding alcohol close to bedtime, sleeping on your side or dropping a few pounds (it helps open up your throat and reduce symptoms).
However, excessive snoring may be due to the potentially serious condition known as sleep apnea syndrome. “For years, people didn’t bring up snoring. They didn’t feel it was anything they needed to mention to their doctors,” says Mendez. “But we now know it is linked to sleep apnea, and even to stroke, heart disease and hypertension.”
There are three types of apnea, which literally means “cessation of breath.”
In central sleep apnea, breathing is disrupted because the brain fails to send a message to your muscles to breathe; this is most often associated with serious illness, and thankfully, is rare.
In obstructive sleep apnea, the most common condition, airflow is repeatedly limited or even completely blocked, causing a person to struggle to draw air into the lungs. These episodes are usually accompanied by gasps, snorts or jerking motions. Complex sleep apnea is a combination of the two.
Sleep apnea is associated with excessive daytime sleepiness, but sometimes it’s the bed partner who discovers it first. It’s more common in older people because as we age there is a decrease in the amount and the tone of muscles, including the ones needed for respiration.
Because one’s sleep is constantly interrupted—Ann learned that she was waking up 19 times per hour—there is a general feeling of fatigue despite having seemingly slept an adequate length of time over all.
The gold standard of treatment for moderate to severe sleep apnea is the CPAP (Continuous Positive Airflow Pressure) machine. This device includes a mask, worn while sleeping, that provides a constant stream of air, keeping breathing passages open through the night.
Most patients, once they get used to sleeping with the mask on, experience immediate relief—and a drastic attitude and energy makeover.
“Getting used to this thing stuck to your head every night and trying to fall asleep was certainly a challenge,” remembers Ann, “but my snoring had stopped, so that was good. Gradually my symptoms started to fade. After a while, I was fitted for a new, smaller, lighter mask—still hard to get used to—but I feel so much better, rested, and I have energy again. It was worth it in the end.”
Another common sleep disorder is restless leg syndrome, a condition whose cause isn’t known, and for which there’s no known cure. One woman likens it to “ants crawling around inside her legs.” It most often occurs shortly after she goes to bed, preventing her from falling asleep, sometimes for hours. Some doctors say that cutting down on alcohol and caffeine may ease symptoms, while others prescribe medications that lower dopamine levels in the brain and reduce leg motions.
There are still such mysteries in the field because the study of sleep medicine is relatively new, says Jose Mendez.
It was only about 15 years ago that sleep study was initiated by ENT (ear, nose and throat) physicians, and specialists in neurology, psychiatry and pulmonary medicine, as they consulted with one another and discovered that sleeplessness was a common thread afflicting their patients.
Finding the root cause of a sleep disorder—and treating it successfully—can be a complex process, requiring a lengthy analysis of one’s personal health history, diagnosis by a sleep specialist (always choose one accredited by the American Academy of Sleep Medicine) and careful observation of sleep habits (see box). “Too often, people who have trouble sleeping think there’s an easy fix,” says Mendez. “Commercials on TV make it seem as though all you have to do is take a pill and little butterflies will be circling your head as you sleep,” she adds. “It’s really not like that at all.”