There are a remarkable number of similarities between infancy and the elderly, and one of them is the difficulty in sleeping though the night. Infants awaken frequently because they need to eat — there is no doubt about their need for sleep. And yet when the elderly complain of not being able to sleep through the night we tend to think that as we age we need less sleep instead of assuming that – same as with young children – we are being awoken by the impact of needing to go to the bathroom or because of medications or illness.
People over the age of sixty who can’t fall sleep or who suffer from interrupted sleep most commonly experience this as a result of pain, sleep disorders, the need to go to the bathroom or as a result of their medication. They are frequently prescribed medication as a solution to the problem, yet those very sleep aids are far more dangerous at their age than for any other age group. As the body’s metabolism ages it slows, leaving sleeping aids and other medications in the body longer. This means that older people stay groggy into the morning and are vulnerable to falls.
Though prescribing sleeping pills is the easiest route for health care providers, their use in the elderly is questionable. A study conducted at the University of Toronto showed that the medications increased cognitive problems, physical problems and daytime fatigue while only helping sleep quality by a small amount. The research concluded that “in people over 60 the benefits of these drugs may not justify the increased risk.”
So what’s the answer for those over 70 who are having a hard time getting the sleep that they want and need? According to Dr. John W. Winkelman, chief of the sleep disorders clinical research program at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School, “I can almost promise people that they’re going to sleep better.” That may not mean that they are sleeping eight solid hours, but they’ll definitely show improvement. Winkelman says, “That’s why being a sleep doctor is so great: There are so many ways I can help people sleep.”
The truth is that though people believe that the elderly don’t need as much sleep as they did in earlier years, the decline in the amount of sleep that we need happens well before we hit seventy years old. Michael V. Vitiello, a professor of psychiatry and behavioral science, gerontology and geriatrics and biobehavioral nursing at the University of Washington says that our greatest decline in sleep quality need happens between our teenage years and the time that we are sixty. After sixty our sleep need remains relatively constant. According to Vitiello, “In the past we assumed it was a never-ending decline. But the changes in sleep that occur from 60 to 90 are not that great.”
So why do so many older people experience insomnia? First let’s make sure that we understand exactly what insomnia is. It’s defined as missing sleep for at least three nights a week for a period of at least three months, with an impact on the quality of life. It is a pretty common occurrence among those over sixty – in fact, nearly half report experiencing insomnia. Though it was originally thought that insomnia was caused by depression, health advocates now realize that the two are separate conditions that should each be treated on their own.
According to Winkelman, sleep is a result of people either not successfully suppressing their alertness or being able to make themselves go to sleep. Left untreated insomnia can lead to a number of other serious conditions and actions, including depression, suicide, heart conditions and cognitive or memory problems.
Winkelman says that the first step in treating senior insomnia is in identifying the habits that people have that are interfering with their sleep. Electronic devices such as tablets or televisions, drinking coffee or alcohol late at night, or napping are all prime culprits. The same is true of a number of common physical conditions that interfere with sleep and that become more prevalent as we age. These include restless leg syndrome and obstructive sleep apnea.
The best way to approach these problems is by diagnosing physical conditions and treating behavioral issues with cognitive behavioral therapy. This is a several week long program that educates people about their sleep habits and how to improve hem. It teaches them to recognize thoughts and actions that are interfering with sleep as well as to defeat beliefs that are working against them. Relaxation exercises are also offered, as well as tips on how to create a regular sleep schedule. The program has been shown to be one of the most effective ways to approach insomnia in all ages, including in those in their 90s.
As for using medication, sleep specialists agree that they have their place but their use must be judicious. The problem is that because most internists and general practitioners either don’t have the time or knowledge needed to treat sleep issues, they frequently just write a prescription. A study conducted by Dr. Suzanne Bertisch of Beth Israel Deaconess in collaboration with Dr Winkelman found that five percent of those over the age of eighty have been prescribed sleeping pills, despite the risks that they pose to the age group.
Dr. Bertisch says that it’s her approach to take new patients off of any sleep medications that they’ve been prescribed so that she can get a sense for what is causing their sleep problems, and then if she thinks that patients will be helped by their use she prescribes them herself but only for a limited period of time. “I want to see improvement or I start weaning them off the medication.” Still, she acknowledges that for older people, they may be very helpful, and understands that taking people off of them may have a profound impact. “It really leaves them helpless ad I don’t think that’s a position we want to leave people in.”