Sleep and Aging

As our aging parents continue to live longer than any other generation, many of us are increasingly involved in their health and well-being, whether they live with us or not.

One woman is roused from sleep every morning at 4:00 A.M. by the sounds of her 80-year-old mother making oatmeal in the kitchen. By the time she hears the clang of the pot going into the sink to be washed, the sound of the stainless-steel spoon scraping round and round and round the pot as her mother stirs the oatmeal has already raised her blood pressure and driven sleep away.

Another eighty-something woman, who lives on her own, has started calling her niece on the phone in the middle of the night. “I have to get to the hospital!” she demands tearfully. “Your uncle needs me!” Her niece gently reminds the elderly woman that her husband died two years ago, then spends an hour consoling the grief-stricken woman.

With help from geriatric doctors, professional caregivers, and therapists who specialize in the challenges of old age, most of us painstakingly work these issues out.

But as we do, we’re torn between the need to help and the need to sleep. Eventually, usually in the middle of a dark, restless night, we begin to realize that if we want to sleep, we need to help them get to sleep as well.

A study at Harvard Medical School reveals that bright-light therapy can reduce “sundowning,” the agitated behavior that frequently occurs in those with Alzheimer’s disease at sundown. The more severe the behavior, the more effective the therapy.

Until recently, most of us simply assumed that getting old meant nodding off in our chair during the day and sleeping less at night. After all, that’s what our aging parents have been complaining about, right?

But scientists have recently begun to question our assumptions about what’s keeping our aging parents up. In fact, they’re beginning to think that insomnia is not a natural consequence of aging but is actually the result of some very specific problems that have very specific solutions.

The problems seem to fall into four areas, says researcher Sonia Ancoli-Israel, Ph.D., a professor of psychiatry at the University of California at San Diego and a recent president of the Sleep Research Society.

For one thing, “the older we get, the more problems we have with our health,” she explains. “Depression, pain from arthritis or from cancer, neurological disorders like Alzheimer’s, and organ system failures that are a result of heart disease, pulmonary disease, and kidney failure—all these things will interrupt sleep.”

Second, “all the medications we give older adults to treat all these medical and psychiatric illnesses can also interfere with sleep—particularly medications that are stimulating or activating when taken in the evening.”

A third cause is the increase in sleep disorders (see page 180) that seems to occur with aging—restless legs syndrome and sleep apnea, in particular—and a fourth is changes in our biological clocks.

ldquo;Changes in our body’s circadian rhythms make the ability to get the sleep we need more difficult,” explains Dr. Ancoli-Israel. “As we get older, our biological rhythm advances such that older people get sleepier earlier in the evening—around 6:00, maybe 7:00 or 8:00 P.M.

ldquo;If they went to bed at that hour, they would sleep their regular amount of time—that is, about seven or eight hours. But do the math: That means that they would wake up at 3, 4, or 5 in the morning, which, of course, is the biggest complaint of older adults: I’m waking up in the middle of the night, and I can’t get back to sleep.

ldquo;The reason that they can’t is that their biological clock is waking up,” says Dr. Ancoli-Israel. “Their physiological night is over.”

In many cases, however, our aging parents are not going to bed at 7:00 or 8:00 P.M., when they first get sleepy. Instead, they try to stay awake until the more acceptable bedtime of 9:00, 10:00, or 11:00 P.M.

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