Guide to sleep for older people

Key points:

• Older people are more likely to experience sleep problems and be affected by sleep disorders than the general population

• Sleep disorders may include: sleep apnoea, insomnia and hypersomnolence conditions

• As people age, they are more likely to gain weight, develop irregular sleeping patterns, habits and acquire other health conditions which may lead to developing sleep disorders

This edition of Aged Care Guide covers all that senior citizens need to know about sleep, such as disorders and their prevention. The introduction to this article will address how much sleep an older person should get and when a lack of, or potentially an excess of, sleep becomes a problem which warrants attention.

It is important to know that daily or chronic exhaustion is not normal, with approximately one in five Australians estimated to feel the impact of a major sleep disorder and requiring help. Sleeping problems can ultimately lead to mood swings, a sharp decrease in personal and professional productivity, inattention, confusion and potentially falling asleep in inappropriate settings.

As people start to recognise that they are ageing over the course of time, family, friends and carers make a note of their ability to function and cognitive awareness, as well. For this reason, those who want to live independently and stay in charge of their own lives may wish to take control of sleeping patterns before someone mistakes a bad night’s sleep for mental decline.

How much sleep should I get?

A minimum of seven and a half hours of sleep is recommended for an older person, although the recommended amount of sleep is considered to be hours spent resting, rather than simply hours laying in bed. If you are laying in bed and unable to sleep, regularly waking up and feeling tired the next day as a result or falling asleep unintentionally, you may have an underlying sleep disorder.

Symptoms of exhaustion include:

• Confusion
• Poor focus
• Delayed reflex, wit or physical response
• Decreased performance at work or in performing daily activities
• Yawning
• Aggression or unusual changes in mood or behaviour
• Headaches

To combat existing or prevent foreseeable sleep troubles:

• Avoid medications, narcotics, nicotine or alcohol (unless otherwise advised by a health professional)
• Cut down on screen time or over-stimulating tasks at night
• If necessary and manageable, set aside some time to nap during the day to avoid erratic patterns of sleep
• Diet and exercise to reflect the sleep structure you wish to establish (ie. exercise during the day to feel tired at night, don’t eat before bed or consume carbohydrates/sugars which could potentially elevate your excitement)

Let the cat out of the bag and become a tiger in the bed — communicating with your partner, expressing potential sources of stress or anxiety and physical intimacy can all serve as sources of relaxation

Sleep disorders

Insomnia

People with insomnia experience persistent troubles with falling asleep on-time and for the recommended duration. Those with the condition may find that despite their best efforts, they cannot experience the same refreshing sensation upon waking up, should they be able to close their eyes and attempt to get some rest.

It is important to discuss insomnia with your doctor as soon as you recognise an ongoing problem with exhaustion over a week or longer. Insomnia has a high rate of comorbidity (overlap) with other conditions, which may either prevent you from getting to sleep or otherwise disrupt your sleep. If your doctor is aware of your concerns regarding insomnia, they may be able to adjust existing polypharmacy interaction for existing diagnoses, which means that one or a combination of medications could lead to adverse effects.

Obstructive sleep apnoea (OSA)

OSA is a sleep disorder which prevents someone from breathing for 10 to 90 seconds, causing the person to wake up, known as an arousal, adjust themselves and go back to sleep intermittently. Although the person themselves may be unaware due to their sleeping status, the impact can be felt the next day as a result of inconsistent rest. Apnoeas (pauses in breathing) relate to a blocked airway (obstructive) in people with OSA, as opposed to central sleep apnoea (CSA), which is related to how the body regulates breathing itself.

Older people and those who may be classed as overweight have an increased risk of OSA, which, in turn, may lead to a higher risk of:

• Cardiovascular disease
• Diabetes
• Headaches
• Decreased sex drive

For people with moderate to severe OSA or central sleep apnoea (CSA), a continuous positive airway pressure (CPAP) machine — which pumps air and holds the throat open for safe breathing — may be required as a form of treatment.

Hypersomnolence

Hypersomnolence is defined as a greater sense of feeling tired, with disorders in this category — in particular, narcolepsy, defined by an inability to stay awake during the day and function as per usual.

Some people with narcolepsy have what is known as narcolepsy-cataplexy (also known as narcolepsy type-one). A cataplexy attack is a brief moment where a person will feel their nervous system or ability to function begin to decline prior to falling asleep (slurred speech, droopy eyelids or unusual movement). People who do not experience cataplexy are considered to be ‘type-two’ narcoleptics.

Narcolepsy may be caused by:

• A dysfunction in the hypothalamus (think of it as the boss of your nervous system)
• Deficiency in wake-proteins such as orexin or hypocretin
• Poor sleeping habits

Narcolepsy may lead to:

• Potentially passing out or falling asleep in an undesirable situation
• Sleep paralysis (feeling immobile and/or mute after waking up for a brief period of time)
• Hypnagogic hallucinations (not quite asleep, not quite awake — inability to tell reality from dreams; seeing or hearing things which are not there)

Who can help?

If you or another person you know begins to fall asleep or seems constantly out-of-it, it may not necessarily be a sleep disorder, dementia, Alzheimer’s disease or simply ‘old age.’ However, if you relate to the information presented in this guide, consider checking out the following resources:

• Sleep Foundation

• Sleep Health Foundation Australia

• Sleep Disorders Australia

• Health Direct (Australian Government)

• Beyond Blue

For more information about seniors getting some shut-eye, please refer to the Aged Care Guide on the importance of sleep as it is packed full of tips, tricks and a laundry list of the benefits one might expect. If you’ve enjoyed this article and others like… Yawn…

Zzzzz…

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Mental health services for older people in aged care