Sleep can be evasive for many older people. It was no different for Shanta Radhakrishnan, a 76-year-old pediatrician from Bangalore who realized she had sleep issues in 2019. Sleep issues in elderly people are a major concern, say geriatricians.
Shanta’s lack of sleep has its roots in her caring for her late husband, who had Parkinson’s disease. Due to his urinary incontinence at night, she would wake up to help him to use the washroom. It soon became a habit for her to stay awake and wake up at midnight to check on him. “I would struggle to sleep afterward,” she adds.
Even after her husband passed away in 2019, Shantha’s sleep issues persisted. There are times when she isn’t able to sleep for three consecutive nights. “I would feel sleepy around 2am and wake up around 4am, finding it difficult to fall back asleep. Now it has become a concern for me, especially when people ask why I look disheveled,” she says.
What causes sleep issues in elderly people?
Older people have to deal with a disturbed sleep pattern due to a decrease in deep sleep in the non-rapid eye movement (NREM) stage caused by brain degeneration. “NREM decreases by 2% every decade. This is a normal physiological phenomenon — there is nothing to be alarmed about,” says Manjunath P H, consultant interventional pulmonologist, Gleneagles Hospitals Kengeri, Bengaluru. He also adds that melatonin deficiency occurs as we age as the levels of this hormone drop.
Extrinsic factors can also cause a disturbed sleep routine. Dr Lenny Da Costa, a Mumbai-based consultant geriatrician and preventive cardiologist, points out a few reasons why the circadian rhythm (the sleep-wake cycle in our body) gets disturbed. “As people age, they become light sleepers, due to which they become sensitive to the environment,” Dr Costa explains. “If they are exposed to noise while sleeping, they would immediately feel disturbed, causing them to wake up and have trouble falling back asleep,” he says.
What is the most common sleep issue affecting elderly people?
Sleeplessness in older people is rooted in a plethora of medical conditions. Dr Manjunath highlights insomnia as a predominant causative factor. “Insomnia makes them either stay awake throughout the night or sleep excessively during the day,” he explains. “It hampers their mood, making them feel exhausted and lethargic.” Dr Manjunath adds.
What are the other issues related to sleep seen in older people?
- Sleep apnea: While sleeping, this can cause disrupted breathing due to a blocked airway, leading them to choke or cough. “In addition to sleep apnea, cases of obstructive sleep apnea and central sleep apnea must also be ruled out,” reminds Dr D S Sowjanya, senior pulmonologist, Kamineni Hospitals, Hyderabad. “Obstructive sleep apnea is a result of obesity, due to which laxity of the muscle tone will be lost around the neck, causing spasms or decreasing the airway during sleep. Meanwhile, central sleep apnea prevents the brain from sending signals to control breathing, leading to heart failure in some instances,” she says.
- Issues related to cardiovascular health: In older people, the lack of sleep can also be attributed to hypomexia — the low level of oxygen in blood vessels. “Hypomexia is a concern especially if the person suffers from a heart condition. It can also lead to the increased risk of stroke during sleep,” says Dr Manjunath.
- Gut health issues: Gastroesophageal reflux disease (GERD) can cause discomfort while sleeping. “The laxity of the lower esophagus region will cause acid reflux, leading to heartburn,” explains Dr Manjunath.
- Urinary incontinence and enlarged prostate: Urinary incontinence, especially in women, and enlarged prostate in men can cause sleeplessness in the elderly as it would make them wake up from their sleep to urinate.
Other respiratory conditions that can cause sleeplessness in elderly people include sinusitis (inflammation in sinuses or mucosal lining of the nose) and tonsilitis (inflammation in the tissues at the back of the throat). Asthma, where the airways get narrowed, can also lead to breathing difficulty and disrupt sleep.
Screen time and sleep disorders in elderly people
The usage of smartphones and binge-watching shows or movies on the screen before sleeping also affect sleep in older people. According to Dr Da Costa, one must stay away from any form of gadget usage for at least 1.5 hours prior to bedtime. “Gadget usage at night does not allow you to sleep because it disturbs the pineal gland. This further affects melatonin production and the circadian rhythm regulation suffers,” he stresses.
Can working out help?
Dr Costa stresses that a healthy exercise routine can boost endorphin levels in the body for sound sleep.
In Shantha’s case, daily exercises have gradually brought in relief. “I make sure that I don’t sleep throughout the day. I go for brisk walks after dinner, if I don’t feel tired yet,” she explains. “I also make it a point to avoid watching TV or using my mobile phone before going to bed. Instead, I often read spiritual books and drift off to sleep,” she shares.
- Our circadian rhythm changes as we grow older, causing us to become light sleepers and experience sleep disorders.
- Several medical conditions such as insomnia, sleep apnea and urinary incontinence contribute to sleep disorders in elderly people.
- Increased screen time has also become a key factor causing sleep disorders in older people.
- A healthy sleep routine, exercise, a comfortable environment and timely diagnosis of underlying medical conditions can help prevent sleeplessness among elderly people.