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Aging News & Information
Three New Studies Focus on Problems in Sleeping for
Senior Citizens
Respiratory disturbances, periodic leg movement with
cognitive impairment, and benefits of daytime nap are explored
 Feb. 1, 2008 - Sleep problems seem to be a common
discussion topic among senior citizens and three articles published in
today’s issue of the journal SLEEP speak to seniors. One finds
respiratory sleep disturbances increase dramatically with age. Another
says a higher periodic leg movement index (PLMI) predicted less sleep at
night in older people with cognitive impairment and sleep disturbance.
The third found a brief bout of non-REM sleep
during a daytime nap clearly benefits a person’s memory performance.
Respiratory disturbances
during sleep increase significantly with age
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Aging News & Information |
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The frequency of respiratory disturbances increases
dramatically with age, even in healthy individuals without symptoms or
signs of obstructive sleep apnea syndrome, according to the first study.
An increase in the prevalence of sleep apnea
syndrome with age has been well documented, according to the authors.
This study focused on breathing irregularities
during sleep in 163 people who are currently completely healthy, as
assessed by passing numerous physical and clinical health tests.
The results showed that, in this group of currently
completely healthy individuals, irregularities in breathing during sleep
are remarkably common, particularly in older individuals.
For example, only around five percent of currently
healthy subjects under 50 years of age had a respiratory disturbance
index (RDI) of more than 15 events per hour. This degree of
sleep-disordered breathing is considered to be clinically significant by
many physicians.
In contrast, about half of currently healthy
subjects over 65 years of age had an RDI of more than 15 events per
hour. Respiratory disturbances, therefore, increase dramatically with
age even in healthy individuals without symptoms or signs of obstructive
sleep apnea syndrome.
“There are still discussions among clinicians
regarding the clinical significance of the different degrees of sleep
disordered breathing. Also, there is discussion concerning the best
criteria for defining breathing abnormalities, which can range from
completely obstructed breath (i.e., choking - leading to reduced oxygen
supply and life-saving arousals) to loud snoring that may, or may not,
lead to reduced oxygen supply and arousal from sleep,” said Steven A.
Shea, PhD, of Brigham & Women’s Hospital in Boston, Mass., senior author
of the study.
“In addition, there are few long-term studies of
clinical outcome in patients with sleep apnea, and the criteria and the
measuring techniques have evolved substantially over recent years. Thus,
we do not yet know the clinical relevance of these new findings.”
Dr. Shea added that, since this high degree of
respiratory abnormality is so common in the healthy elderly, it seems
likely that this is a consequence of the normal aging process.
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Earlier Finding of
Problems in Older People with Sleep Disordered Breathing
Although the prevalence of obstructive sleep apnea syndrome (OSAS)
is estimated at 1 to 4% of the adult population,
sleep-disordered breathing (SDB) that is not of
sufficient severity to be diagnosed as OSAS is now recognized
to be quite common, affecting as much as 25 to 50% of
middle-aged and older adults, according to a 1998
study.
Although the respiratory disturbance index (RDI) is correlated
with sleepiness in patients with OSAS, a relation
between SDB and sleepiness had not been clearly
demonstrated in the general population at that time.
The
1998 study suggests that as much as half of the middle-aged and
older adult population may be exposed to levels of RDI
that are associated with increased sleepiness.
Sleep-disordered breathing may therefore contribute
substantially to the population burden of excessive
sleepiness, an important cause of accidents, impaired
social performance, and reduced quality of life.
Study
by Daniel J. Gottlieb, M.D., M.P.H., and associates at The
Pulmonary Center, Boston University School of Medicine. |
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“Nonetheless, even if normal, we worry that
individuals with a high RDI who are untreated will begin to develop
pathophysiologic consequences over time, including increased risk of
cardiovascular disease,” said Dr. Shea.
“Thus, it may be worth considering treatment
regardless of symptoms. A high RDI in a younger individual is much more
uncommon and therapy would seem advisable in those cases, particularly
as there is some evidence that having sleep apnea can lead to worsening
of sleep apnea over time.”
Obstructive sleep apnea is a sleep-related
breathing disorder that causes one’s body to stop breathing during
sleep. It occurs when the tissue in the back of the throat collapses and
blocks the airway, preventing air from getting into the lungs. About
four percent of men and two percent of women have obstructive sleep
apnea, and millions more remain undiagnosed.
Scientific evidence shows that continuous positive
airway pressure (CPAP) is the best treatment for obstructive sleep
apnea. CPAP provides a steady stream of pressurized air to patients
through a mask that they wear during sleep.
This airflow keeps the airway open, preventing the
pauses in breathing that characterize sleep apnea and restoring normal
oxygen levels. CPAP users often express dramatic improvements in how
they feel. They are more alert, have more energy and are able to perform
at higher levels for longer periods of time.
PLMI predicts total sleep time
in older people with cognitive impairment, sleep disturbance
A higher periodic leg movement index (PLMI)
predicted less sleep at night in older people with cognitive impairment
and sleep disturbance, according to a study by Kathy C. Richards, PhD,
of the University of Pennsylvania.
It focused on 102 people (58 men and 44 women)
between the ages of 59-96 years who had a clinical diagnosis of
cognitive impairment (categorized as unspecified, Alzheimer disease,
other, mixed, multi-infarct, and mild cognitive impairment) as well as
average nightly sleep of seven or less hours and daytime sleep of 30
minutes or longer.
Ten characteristics associated with sleep
disturbance (including PLMI, time in bed, cognitive status, painful
conditions and depression) were assessed with one night of
polysomnography.
The participants also submitted to a Mini-Mental
State Examination (MMSE), a 30-item standardized screen of orientation,
registration, short-term memory, attention/concentration, language, and
constructional capacity items. MMSE scores range from zero to 30, with
greater numbers indicating higher cognitive functioning.
The average MMSE score was 17.3. In addition, 21.6
percent had at least one painful condition and 45.1 percent were
diagnosed with depression. The participants’ average PLMI was 17.3 with
33.3 percent having a PLMI greater than 15. Time in bed at night
exceeded eight hours, yet participants averaged only 5.5 hours of sleep.
PLMI, time in bed, and age explained 43.6 percent of the variance in
total sleep time.
“Sleep disturbance in persons with Alzheimer
disease and related dementias is a highly prevalent and disabling
symptom that often leads to caregiver exhaustion and
institutionalization for the person with dementia,” said Dr. Richards.
“Sedative-hypnotics are not effective and often
worsen daytime cognitive functioning and cause nighttime falls. This
study demonstrates that frequent periodic leg movements at night are
predictive of reduced total sleep time in older adults with Alzheimer
disease and related dementias.
“This finding is important because treatment of
periodic leg movements may result in improved nighttime sleep and
improved quality of life in this vulnerable population.”
Periodic leg movement disorder (PLMD) is a
condition that causes people to jerk and kick their legs every 20 to 40
seconds during sleep. As with restless legs syndrome, PLMD often
disrupts sleep -- not only for the patient, but the bed partner as well.
One study found that roughly 40 percent of older adults have at least a
mild form of PLMD.
Study concludes a daytime nap can benefit a person's memory
performance
A brief bout of non-REM
sleep (45 minutes) obtained during a daytime nap clearly benefits a
person’s declarative memory performance, according to a study authored
by Matthew A. Tucker, PhD, of the Center for Sleep and Cognition and the
department of psychiatry at Harvard Medical School.
It focused on 33 subjects
(11 males, 22 females) with an average age of 23.3 years. The
participants arrived at the sleep lab at 11:30 a.m., were trained on
each of the declarative memory tasks at 12:15 p.m., and at 1 p.m., 16
subjects took a nap while 17 remained awake in the lab. After the nap
period, all subjects remained in the lab until the retest at 4 p.m.
It was discovered that,
across three very different declarative memory tasks, a nap benefited
performance compared to comparable periods of wakefulness, but only for
those subjects that strongly acquired the tasks during the training
session.
“These results suggest
that there is a threshold acquisition level that has to be obtained for
sleep to optimally process the memory,” said Dr. Tucker.
“The importance of this
finding is that sleep may not indiscriminately process all information
we acquire during wakefulness, only the information we learn well.”
It is recommended that older adults get between
seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM)
offers the following tips on how to get a good night’s sleep:
● Follow a consistent bedtime routine.
● Establish a relaxing setting at bedtime.
● Get a full night’s sleep every night.
● Avoid foods or drinks that contain caffeine,
as well as any medicine that has a stimulant, prior to bedtime.
● Do not bring your worries to bed with you.
● Do not go to bed hungry, but don’t eat a big
meal before bedtime either.
● Avoid any rigorous exercise within six hours
of your bedtime.
● Make your bedroom quiet, dark and a little bit
cool.
● Get up at the same time every morning.
Those who suspect that they might be suffering from
a sleep disorder, are encouraged to consult with their primary care
physician or a sleep specialist.
SLEEP is the official journal of the Associated
Professional Sleep Societies, LLC, a joint venture of the AASM and the
Sleep Research Society.
● More information about obstructive sleep apnea
is available from the AASM at
http://www.SleepEducation.com/Disorder.aspx?id=7.
● More information about periodic leg movements
is available from the AASM at
http://www.SleepEducation.com/Disorder.aspx?id=10.
● For further details about sleep and growing
older, please visit
http://www.SleepEducation.com/Topic.aspx?id=30.
● For more information on CPAP, please visit
www.SleepEducation.com/CPAPCentral.
SleepEducation.com, a patient education Web site created by the AASM,
provides information about various sleep disorders, the forms of
treatment available, recent news on the topic of sleep, sleep studies
that have been conducted and a listing of sleep facilities.
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