When Sleep Becomes an Age-Old Problem

Over the past years, only a handful have tried to question the prevailing wisdom that sleep starts to deteriorate in late middle age and steadily erodes from then on.  Majority of sleep researchers believe that the best way to know more about sleep problems is to ask an elderly, and you will surely get a litany of complaints.

According to Dr. Michael Vitiello, a sleep researcher who is a professor of psychiatry and behavioral sciences at the University of Washington, “older people complain more about their sleep. They just do.”And for years, this has been the basis of most sleep scientists who thought they knew what was going on.

Recently, however, new findings are giving experts more reasons to have second thoughts and may lead many to change their minds about sleep as they know it. It came as surprise to them that sleep does not really change much from age 60 onwards. Research shows that sleep problems are not due to aging itself, but mostly caused by illnesses or the medications used to treat the elderly.

“The more disorders older adults have, the worse they sleep,” said Sonia Ancoli-Israel, a professor of psychiatry and a sleep researcher at the University of California, San Diego. “If you look at older adults who are very healthy, they rarely have sleep problems.”

Recent studies are proving that difficulties in sleeping can be traced back to poor health. One of the most common causes of sleep disruption is pain, and a restless night can make pain worse the next day. And when pain becomes worse, it follows that sleep becomes even more difficult.  The situation becomes a vicious cycle common in people with conditions that tend to afflict the elderly, like back pain and arthritis.

Two parallel lines of research have brought up this new view in sleep problems.  The first tried to find out what happened to sleep patterns when healthy people grew old. The second sought to discover the relationship between sleep and pain.  In order to find out what really happens with aging, Dr. Vitiello and some investigators, chose to study a group of elderly who reported no sleep problems. The group actually makes up half of the people who are over 65 years old.

The groups were not really spared by age-related changes in sleep.  In fact, their sleep turned out to be different from sleep in young people.  The group of elderly said that their sleep were lighter, more often disrupted by brief awakenings, and shorter by a half hour to an hour. The reason for these, according to Dr. Vitiello, was that the age-related changes in sleep patterns might not be an issue in themselves. Something else was making people complain about their sleep. 

Another question Dr. Vitiello and his colleagues also asked was that what normally happened to sleep over the life span. It had long been known that sleep changes, but no one had systematically studied when those changes occurred or how pronounced they were in healthy people.

The results based on the analysis of 65 sleep studies, which included 3,577 healthy subjects ages 5 to 102 once again surprised the team of experts. Most of the sleep pattern changes occurred with people between the ages of 20 and 60. In comparison with teenagers and young adults, healthy middle-aged and older people slept a half hour to an hour less each night, they woke up a bit more often during the night, and their sleep was lighter. But to those who were above 60, there was no remarkable change in sleep, at least in people who were healthy.

Changes in sleep during adulthood were subtle. Middle-aged and older people, for example, would fall asleep without much difficulty. The only change in sleep latency, as it is called, came out when the investigators compared latency at the two extremes, in 20- and 80-year-olds. The 80-year-olds took an average of 10 more minutes to fall asleep.

Contrary to their expectations, the investigators did not find any increase in daytime drowsiness among healthy older people. Even aging has no effect with the time it took for people to start dreaming after they fell asleep.  However, the most significant change was the number of times people woke after having fallen asleep.

According to Dr. Donald Bliwise, a sleep researcher at Emory University, healthy young adults sleep 95 percent of the night.  “They fall asleep,” he said, “and don’t wake up until the alarm goes off.”  Healthy people are asleep 85 percent of the night when they reach the age of 60. Their sleep is disrupted by brief wakeful moments typically lasting about three to ten seconds.

Real sleep problems arise when people have conditions that make them wake up in the night, like sleep apnea, chronic pain, restless leg syndrome or urinary problems. What to expect and what to do about it will involve studies of the relationship of sleep to pain. There is no question that pain can disrupt sleep. What's more interesting is that a lack of sleep can somehow increase the sensation of pain.