When Older Folks Can't Sleep

For many, good sleep is as easy to get as turning off the light and pulling up the covers. But studies show more than half of America's elderly have at least some complaint about how well they sleep. Here are some 'sleep hygiene' tips

Dec. 14, 2001 -- For many, getting good sleep is as easy as turning off the light and pulling up the covers. But for many older people, sleeping is a challenge.

Scientists are learning that more than half of the older people in the U.S. have at least one complaint about how well they can sleep.

But as sleep research progresses, insomnia among the elderly is becoming less of a mystery. Some new studies, for instance, suggest that altered sleep patterns are just a natural progression of aging.

You may have been hearing about the sleep hormone called melatonin as well. Researchers are still trying to tease out just how it works in older people. Scientists have gone back and forth in determining what happens to the levels of this hormone in the body as people age.

Some reports show that the elderly seem to produce less of it than they did when they were younger, and those who complain of sleep problems have even less of the substance, compared with those the same age who get better sleep. But other studies show melatonin levels stayed the same as people aged.

Doctors still need to work out just how helpful melatonin treatment could be for those over age 65. But experts tell WebMD that it is going to take more than one type of treatment to help most folks with sleep problems, mostly because there are so many different reasons why sleep problems happen.

A Symptom with a Cause

Many cases of insomnia are caused by underlying but very treatable causes. Insomnia, rather than being a distinct condition of its own, "is best thought of as a manifestation of many conditions," says Mark Mayoral, MD, Director of the Minneapolis Regional Sleep Disorders Center. "There's no one treatment that can be applied for the complaint of insomnia."

The Minneapolis researcher says "restless legs syndrome," for example, affects about 10% of adults, or up to 12 million people in the United States. People with this syndrome experience abnormal sensations when they go to bed. They describe the feelings as tingling, cramping, burning, creeping, itching, pulling, or aching. Other descriptions include numbness, a crawling sensation or the feeling that water is flowing under the skin, pins and needles, or an "antsy" feeling.

"It's so easy to treat, and regrettably, a sizeable portion of practicing physicians are unfamiliar with the condition," Mayoral says. Taking vitamins or eliminating caffeine, for instance, can help.

Learned by Experience

Others have conditioned or learned insomnia, says Mayoral. People who have had heart attacks or have suffered a loss, for instance, will naturally have trouble sleeping. If they lie in bed and try to force themselves to sleep, their bodies eventually learn not to sleep.

"If this goes on for five to seven nights, the original cause -- which may be very legitimate -- has disappeared, but the learned response persists," says Mayoral.

Mayoral puts such patients in a program to teach them how to sleep again -- usually without sleeping pills, which are no cure either.

Other Approaches

The FDA usually approves of the use of sleeping pills for up to two weeks at a time. But some people use them for years, and for them, the drugs may be more of a psychological boost than a real sleep aid, says Charles M. Morin, MD, of the School of Psychology at the University Laval in Quebec. In his research, Morin found that the sleep of people who use sleeping pills was just as disrupted as those who don't take them.

Behavioral modification may be the way to go in the long run, since researchers are learning that drug therapy is most effective for short-term management of insomnia. For long-term improvements, researchers often find that changing habits, sleep schedules, and beliefs make a difference for many sleep patients -- many of whom think that they always need eight hours of sleep every night.

Just how much sleep older people need is a matter of dispute. Several researchers, including Morin, say they believe seniors' sleep needs are no different than they were when they were younger. It's just that it's more difficult for them to sleep well.

But Charles Pollack, MD, Director of the Division of Sleep Medicine at Ohio State University, has found that older people simply don't need as much sleep. "They're not only sleeping less, but they need less."

But while most seniors need less sleep, says Pollack, they still plan for the same eight hours in bed. What's more, older people are often unaware that it's normal for their sleep patterns to shift as they age. They feel sleepy earlier in the evening than they're used to, and wake up earlier in the morning. This causes many to think they aren't getting a full night's rest, says Pollack.

Sleep Tips

If you find it difficult to get the sleep you need, you might want to refine your sleep habits. Here are some things to consider. (And if you haven't done so, discuss the topic with your doctor, too.)

• Do you stay active? Many studies have shown exercise can be helpful for people 50-78 to regulate their sleep. Even getting enough sunlight during late afternoon can help, too.
• Do you have a few drinks before bed or drink a lot of coffee during the day? That can really affect your sleep. Alcohol might make you feel sleepy at first, but it actually makes it difficult for you to stay asleep and rest.
• Do you nap during the day? Doctors once frowned on the habit because it seemed that it could disrupt your sleep through the night and even lead to health problems. But research now hints that it could be helpful if you set limits on how long the nap lasts. So far, it looks like limiting a nap to no longer than 30 minutes works best.
• Again, talk with your doctor. If you have chronic conditions like arthritis, your sleep could suffer. Also, the medications you take could affect your sleep patterns. If you are having problems sleeping, bring all your medications in to your doctor appointment. If some of them can disturb sleep, you may be able to change the dosage or switch to others that may not be troublesome for you. You and your doctor should talk about this together.

By Dominique Walton-Brooks MD, MB