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Elderly Insomnia May Be A Matter of Poor Sleep Quality

It is widely acknowledged that as we age, our ability to fall asleep easily and stay asleep throughout the night diminishes. Anybody who has an elderly person in their family is familiar with the complaints about middle-of-the-night awakenings combined with the frustration of being unable to get back to sleep, or else of waking up before the first light of dawn and then being tired and needing a nap in the middle of the day. Though this has long been accepted as being simply a natural part of aging, with over half of older adults complaining of experiencing symptoms of insomnia including either the inability to fall asleep or to stay asleep, recent studies are showing that sleeplessness in old age is not necessarily a foregone conclusion, and may in fact be simply a symptom of something that has gone wrong but which may be fixed. 

One recent study into the issue of insomnia in older adults has revealed that the problems that the elderly complain about may be more closely linked to a lack of quality in the sleep that they are getting then in the actual length of time that they are spending in slumber. It has also determined that many of the issues that are interrupting the elderly’s sleep may be a function of health issues that they are facing. This can lead to a vicious cycle, as poor sleep quality often exacerbates or results in deterioration in a person’s health, including the development of heart disease and diminishing cognitive abilities. It also may be directly related to a higher potential for suffering falls.

The study, which was published in the online publication Journals of Gerontology: Medical Sciences, was conducted by researchers at the University of Chicago. The group gathered information via wrist actigraphs from over 700 older adults who were randomly sent invitations to participate in a study titled “Activity and Sleep Study.” Once all of the participants had signed up, they were asked to engage in two separate activities. One involved keeping a sleep diary that included submitting responses to questions about the quality and quantity of their sleep. The second part of the study asked them to wear the actigraphs over a three-day period.

Wrist actigraphs are worn in the same way that a wristwatch or fitness monitor band is. The units contain sensors that monitor and record the individual’s movements and sleep patterns. Once both parts of the study were completed, the researchers compared the biofeedback provided by the actigraphs with the experiences that were self-recorded by the participants in their sleep diaries and in the questionnaires.

Sleep quality may be linked to insomnia in the Elderly Sleep quality may be linked to insomnia in the Elderly

According to one of the study’s authors, Linda Waite, the goal of the study was to determine whether there was an objective relationship between the participants actual sleep experience and their perceived sleep experience. “Older adults may complain of waking up too early and not feeling rested despite accumulating substantial hours of sleep,” she explains, and in fact that is exactly what the study’s results revealed. There were substantive differences between the entries that the study’s participants made in their sleep diaries and the activities that were measured by the wristbands that they wore. The wristband measurements reflected that the majority of the study participants were actually achieving sleep quantities that are deemed sufficient for good health, while the answers that they provided told a very different story. Thirteen percent of the group indicated that they either never or almost never woke up feeling that they were completely rested, and another twelve percent said that they had experienced difficulties in getting themselves to fall asleep at night. Nearly one in three said that they regularly woke up in the middle of the night. Yet the actigraph measurements showed that the participants were for the most part getting an average of 7.9 hours of sleep per night, and in fact it was the older adults who were complaining about waking up in the middle of the night who were actually experiencing the highest total sleep time.

According to Waite, “This suggests that a question about feeling rested may tap into other aspects of older adults’ everyday health or psychological experience.”

Though this may be true, it is also important to remember that there are specific physiologic changes that may be contributing to these issues and keep those things in mind when trying to help elderly adults to feel more rested. Medications that they are taking may be contributing to feelings of drowsiness during the day. They also may be having a difficult time adjusting to changes that occur naturally to their internal sleep architecture. As we age, the amount of time that we spend in REM sleep declines, and this change may be noticeable and give the impression that sleep is being disrupted.

Other problems that impact the elderly are tied in to shifts in their circadian rhythms. As we age, we tend to become sleepier earlier in the evening than we had when we were younger. People often believe that this is an indication that they need more sleep, but in fact our sleep needs do not increase as we age – they remain relatively constant. If we go to sleep earlier but still only need 7 ½ to 8 hours of sleep, then we are likely to wake up much earlier than we are accustomed to, and this may add to the perception that we are not getting the sleep that we need. Some of these problems may be addressed by getting out into the sunlight more frequently, or undergoing a treatment known as bright light therapy that is designed to regulate the body’s production of melatonin.

One way or another, if an elderly person is complaining of insomnia it is important that their symptoms are monitored by their physician. Drowsiness can lead to difficulty in concentrating or a lack of balance that can lead to dangerous falls or an increased risk of accidents. A physician will be able to determine whether there are underlying health conditions that are contributing to the situation or whether a change in medication or sleep hygiene is required.


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