Sleep and Aging
By Ryan J. Soose, M.D.

As we age, we all experience, to varying degrees, noticeable and expected changes in vision, hearing, the heart, joints, muscles, and just about any other aspect of the body. Such is also the case with sleep. In order to understand sleep problems in the elderly, it is first important to understand the normal or expected changes in sleep that occur with age. Sleep and the disorders affecting it change dramatically across the lifespan, from infancy, through childhood and adolescence, and into adulthood and the elderly.

Several key changes occur in the sleep patterns with advancing age. First, while the percentage of REM or 'dream' sleep often remains constant over time, the amount of slow wave or 'deep' sleep markedly declines in older age. Second, awakenings or arousals from sleep occur much more frequently throughout the night, including early morning awakenings with an inability to return to sleep. As a result, sleep tends to become more fragmented and disrupted with age, and not as deep and continuous and refreshing. Because of these changes as well as other changes in the body's internal clock, elderly adults may nap during the day to compensate for lost sleep at night.

For many people as they get older, however, difficulty sleeping goes beyond the normal and anticipated changes in sleep patterns. In addition to sleep apnea, two of the most common sleep disorders affecting older adults are insomnia and restless legs syndrome. A person may have one or a combination of several sleep disorders at the same time.

Insomnia is a broad term that applies to difficulty falling asleep, difficulty staying asleep, early morning awakening, or just a feeling of non-restorative sleep. Insomnia can result from many different causes including chronic pain, drugs/medications (i.e. antidepressants, steroids, blood pressure medication, caffeine, alcohol), other medical problems (i.e. allergies, asthma, heart disease, cancer), as well as psychological problems such as anxiety, depression, and stress.

Restless legs syndrome (RLS) is a specific sleep disorder that increases in prevalence with advancing age. RLS is characterized by an urge to move the legs or feeling of restlessness, which typically worsens in the evening and when sitting/lying still. Although the exact cause is unknown, RLS has been most-commonly linked to low iron stores in the body and subsequently low dopamine levels in the brain.

A comprehensive sleep history by a trained sleep specialist is the first step in evaluating insomnia, RLS, and other sleep problems associated with aging.

Dr. Ryan Soose can be reached at University ENT Specialists, (412) 232-3687 or visit www.upmc.com/sleep.

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