Why do elderly face sleep issues?

What can we do to manage our declining sleep quality as we age

Pavitra Jayaraman

Sleep issues are not uncommon among the elderly. In fact, most people above the age of 60 suffer from sleep issues of varying degrees. While this is a natural part of the aging process, lack of sufficient and quality sleep can severely interfere with the mental health and wellbeing of the elderly. To understand how sleep plays a role in your wellbeing, let's begin by understanding sleep. 

What is sleep? 

Sleep is a behavioral and physiological state in which, though our internal organs are working, we aren't actively interacting with the world around us. During sleep, our body synthesizes protein, removes toxins produced during the waking hours, synthesizes neurotransmitters and creates neural networks and repairs. Quality sleep is necessary to ensure efficient and constant interaction with our environment during our waking hours. 

The average person requires anywhere between 6-8 hours of sleep to feel rejuvenated and set to take on the tasks of a new day. But while this is true for most adults, the quality and quantity can be affected due to the individual's lifestyle, sleep-related disorders and age.

What happens to sleep as we age? 

Like most other functions in our body, the quality and structure of sleep becomes less efficient with age. If we look at the science of sleep, we understand that there are two different types of sleep - REM (Rapid Eye Movement) and NREM (Non-Rapid Eye Movement) sleep. NREM is the restorative period when the repair of wear and tear in our bodies take place. It is also associated with many physiological functions, such as creation and release of hormones.  

NREM sleep is the first to be susceptible to age-associated changes, especially in men. "By the age of 60, the NREM sleep in men, which is 15% of the total sleep, comes down to 3-4%. The presence of higher estrogen levels among women help them slow the process down marginally," says Dr Bindu Kutty, professor at the department of neurophysiology at NIMHANS.

The NREM sleep, especially slow wave sleep(or deep sleep), is reduced significantly with aging. This impacts a person's ability to sleep at a stretch. It's also during this phase that our memories are consolidated - and the lack of NREM sleep may impact memory. With age, there is also an overall change in the circardian cycle, which means that the total amount of time spent asleep shortens and the frequent awakenings affect sleep continuity. Age associated changes in hormone functions, especially the growth hormones, melatonin and cortisol also affect the sleep quality and function. 

Of the eight hours of sleep, two are for REM (Rapid Eye Movement) sleep. This is not very affected until the age of 70, after which most people start to have fragmented REM sleep as well.

How does disturbed sleep lead to mental health issues? 

"About 15% of the aged population suffers from insomnia," say Dr Bindu Kutty explaining that  Insomnia includes problem with both sleep initiation and sleep maintenance. The average sleep latency (the time required to go to sleep) is usually 15 minutes, but for persons with insomnia, this is prolonged. This can result in mood swings in them, which can affect the mental health of their family.  

Often, people with insomnia start to worry about their sleeplessness, causing it to deteriorate further. Chronic insomnia can cause depression, worry and anxiety, fear, and disturbed mood. 

But it’s important to note that sleep issues also afflict the younger generation that lives a 24/7 lifestyle in which we are constantly active. Non-communicable diseases, which are on constant rise, are also comorbid with sleep deprivation. In-fact, 10-30% of the world's population is believed to be sleep deprived.

What's the solution? 

While sleep issues among the elderly are largely caused by biological reasons, there are some practices that can improve the quality of sleep. 

Exercise and yoga: Cortisol increase and melatonin decrease during aging can be regulated by yoga, exercise and meditation. Meditation can enhance the quality of sleep and can also take care of the physiology of sleep. 

Sleep hygiene: 

  • Human-beings are diurnal in nature and should ideally stay awake in the day time. 

  • Avoid naps in the day and respect your sleep time during the night. Condition your brain to understand that your bed is only meant for sleep in the night. This also means that you should leave all gadgets outside your bedroom. Maintaining a proper sleeping and waking time which helps the system to function properly. 

  • Avoid alcohol and caffeine in the evening as these interfere with the sleep. 

  • Try to have a relaxed evening and learn to wind down as your day ends.

This article has been written with inputs from Dr Bindu Kuttyprofessor at the department of neurophysiology at NIMHANS.