The 1993 Report of the National Commission on Sleep Disorders Research stated that the deaths, illness and damage due to sleep deprivation and sleep disorders represent a substantial problem for American society. More than 70 million Americans suffer from a sleep problem and 60% of that number have a chronic problem. It is also known that 25% of children aged 1 to 5 have a sleep disturbance and more than half of our population over 65 have a sleep disorder. The graying of America will only make this health burden worse.
Though aging in itself is not a sleep disorder, many associated conditions may make sleeping more difficult for the elderly. Physiological and lifestyle changes, such as less production of certain chemicals (melatonin and growth hormone) that regulate sleep, lack of exercise, light exposure, dietary habits and lack of mental stimulation contribute to poor sleep. The higher incidence of chronic conditions (arthritis, bladder dysfunction, anxiety and many more) adds to the problems older people face at night. The first article in this series covered the actual change in the architecture of sleep as the aging process occurs, with less deep sleep and more abrupt transition between sleep and awakening.
True sleep disorders number more than 100 at the last count. A sleep disorder may be any disruptive pattern of sleep but can be simply categorized into the following groups:
Problems with Staying and Falling Asleep Insomnia of any type may be transient, lasting for a few days and associated with reversible factors such as pain, stress and chemical intake (caffeine, alcohol and other drugs). It also may be chronic especially in situations associated with chronic medical conditions (depression, restless leg syndrome and arthritis). Behavioral habits from going to bed too early to exercising to close to bedtime will interfere with normal sleep patterns. Whatever the cause, insomnia is the most common sleep disorder.
Problems Staying Awake Other than narcolepsy, a genetic condition that causes sudden episodes of irresistible daytime sleepiness triggered by emotional events, this category ismade up of events that interfere with night time sleep. Sleep apnea is caused by partial airway obstruction that occurs during sleep. Snoring can get to the point that soft tissues close off the airway and breathing stops. Blood oxygen levels fall and the individual wakes, gasps for breath and falls back asleep. When this occurs over and over during the night, restful sleep is never attained and excessive daytime sleepiness occurs. Though often thought of as a middle aged, obese male problem, sleep apnea equally affects both males and females, obese or not, in the 65 and older population. Other causes of excessive daytime drowsiness include respiratory muscle weakness (polio), obstructive airway diseases and certain rare forms of central (brain) apnea.
Irregular Sleep Schedule This category includes jet lag, shift work and households with newborns. Seasonal changes affecting light exposure can reset sleep/awake cycles and disrupt restful sleep.
Sleep Disruptive Behaviors These changes are more common in children between the ages of 2 and 12 and include sleep walking and nightmares. Older individuals with organic brain syndrome may also be affected.
Treatment is available for sleep deprivation if it is recognized. Why do some people jump out of bed in the morning and feel refreshed while others feel irritable, with no energy and diminished ability to concentrate? How many fall-asleep accidents occur because of sleep disorders? If you feel that you are not sleeping well, read the next article in this series, Treatment of Sleep Disorders, and discuss your concerns with your health care practitioner.