Advances in science and social evolution are altering our internal clocks. We in the western world enjoy average life expectancies of over 80 years and it is anticipated that this average will reach 100 years in the near future. By constantly moving nature’s “signposts”, are we not risking disruption to our original life “blueprint”? Have our bodies and brains evolved enough to cope with life at such a grand old age? What about sleep - does ageing a ect it? Do we age faster because the quality of our sleep drops? Why do elderly people sleep less despite requiring more rest?
Our western culture celebrates life and is obsessed with “immortality”, ignoring the fact that ageing and death are an integral part of it.
We will pay the price for our pretentiousness with as yet unknown consequences.
Ageing is not easy. As we age, we are increasingly susceptible to sleep disturbances. Age creeps up on us and brings with it many misfortunate “bedfellows” such as psychiatric problems, increased risk of medical illness, chronic pain, reduced social contacts, loss of loved ones, and many others. The irony is that disturbed sleep worsens other illnesses.
Today we know that ageing is related to changes in the architecture of healthy sleep which works hand in hand with the degeneration of the brain. Older adults spend less time repairing tissues in what we call “deep sleep”. Further, they su er changes to their internal “clock”. The consequence is that after a disruption in sleeping patterns, for example after a flight overseas, elderly people take longer to get back into normal sleeping routines.
The main sleep disorders elderly people may suffer are:
1. Sleep-disordered breathing
3. Circadian sleep rhythm disorders
4. Sleep related movement disorders
5. Secondary sleep disturbances
Breathing disorders disrupt healthy sleep patterns and cause sleepiness during the day. The most common is Sleep Apnoea, which is associated with a severe reduction in oxygen concentration causing the person to wake brie y. Although obstructive Sleep Apnoea is seen in all ages, the incidence in elderly people is higher. This is due to risk factors like neurological and psychiatric disorders, cardiac problems, cerebro-vascular accidents, metabolic syndromes, obesity, and post menopause.
Insomnia is a very complex disorder characterised by difficulty in initiating or maintaining sleep. Inadequate, insufficient or poor quality sleep has all been linked to health problems ranging from mental impairment to compromised immunity. Insomnia occurs more frequently after age 70, and more than half of all adults aged 65 and older report at least one chronic sleep complaint.
Circadian Sleep Rhythm Disorders
We all have an internal clock that functions to establish a communication link between our internal sleep/wake rhythms, the time (hours, seasons), and the space in which we live. Any disturbance to this finely tuned system results in an imbalance between the real and the required sleep/wake periods. The middle and long-term consequences are disturbances in the hormonal, mental (cognitive) and immunological systems.
Sleep Related Movement Disorders (SRMD)
We recognise three types of SRMD, the Restless Legs Syndrome, the Periodic Limb Movement Disorder, and the REM Behaviour Disorder. The first two are characterised by unpleasant sensations leading to an irresistible urge to move the limbs. This obviously interrupts healthy sleep architecture. Illnesses that cause this disorder are anemia, renal failure, diabetic neuropathy and vascular disorders, among others. The REM Behaviour Disorder is characterised by dream enactment. These people can kick, punch, jump out of bed or talk while they are experiencing the REM sleep phase.
Secondary Sleep Disturbances
As the name indicates, these are sleep disturbances caused as a consequence of other medical problems. The reasons for these disturbances can be found in the illnesses themselves or in their treatments. Other secondary disturbances are as a result of the consumption of “social drugs” like alcohol or ca eine. One of the most important things to recognize is that secondary sleep disturbances accompany psychiatric disorders like depression, anxiety, dementia and delirium.
From this discussion, it is evident that ageing affects natural sleep patterns. Gladly, we can say that the process of ageing is not a guarantee that one will develop a sleep problem, which is why millenary medical schools like the Indian Ayurveda, have long used sleep as a way to slow the ageing process, assist healing, and live healthier.
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Quality Index can be used to detect sleep disturbances or de cits.
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