Chad Paxson, DO, Pulmonologist/Intensivist and Sleep Specialist with CHI Memorial Regional Sleep Center answers common questions about the benefits of sleep, potential sleep-related issues and how aging affects your ability to get a good night’s rest.
Q: Do older adults need the same amount of sleep as younger adults? How does aging affect one’s sleep?
A: The need for sleep stays fairly constant over the course of a person’s lifespan. Unlike kids who need more sleep relative to adults, seven to eight hours of sleep nightly is what most adults need to maintain normal physiologic function. The amount of sleep needed is similar for younger and older adults with a few small differences.
Specifically, the percentages that we spend in any one particular stage of sleep will be different from young adults versus older adults. Stages of sleep are generally divided into NREM (non-rapid eye movement) and REM (rapid eye movement) sleep. A typical adult cycles between NREM and REM every 90-110 minutes. REM sleep is the stage of sleep when we dream. And NREM sleep is further divided into N1 and N2, which are lighter stages of sleep, and N3 sleep, which is considered deep sleep.
Compared to younger adults, older adults spend more time in lighter stages of sleep and less in the deeper stages. Older adults may also have more periods of arousal or wakefulness after they fall asleep compared to the younger adult population. But the total sleep time should be fairly similar between the young adult and the older adult.
Q: What risks are associated with inadequate sleep?
A: Inadequate sleep or sleep deprivation has many adverse health consequences in the short and long term. This depends on the type of sleep deprivation, such as someone who chronically makes the decision to restrict their sleep or whether that person has a primary sleep disorder affecting total sleep time. Research suggests that both short and long sleepers are at increased risk for morbidity and mortality.
People who on average get less than six hours or more than nine hours of sleep per night are in a relative higher risk group. Chronic sleep deprivation is associated with increased inflammatory markers, alterations in our immune system response, increase in blood pressure, and elevated risk for cardiovascular disease and stroke. Reduced sleep has also been linked to insulin resistance and potential risk for diabetes. Research further suggests that sleep deprivation is associated with weight gain and obesity.
By virtue of being awake for longer periods – coupled with hormonal changes that occur with sleep deprivation – we tend to take in more calories while not expending enough energy.
In addition to the more common medical consequences of chronic sleep deprivation, there are other effects that go beyond cardiovascular and metabolic health. Sleep is vital for things like learning and memory. That means sleep impairment can adversely affect our ability to function at peak performance in our occupations, school settings and socially. We also know that sleep deprivation can negatively affect our mood, leading us to being more depressed, anxious or irritable, decreasing our overall quality of life.
Q: What are some common sleep-related issues that affect older adults?
A: Sleep apnea is a common condition that can impact sleep health. Estimates suggest that roughly 15-30% of men and 10-15% of women in North America will have at least mild obstructive sleep apnea. The risk for sleep apnea definitely increases with age and is more common in males than females. However, we tend to see the risk for sleep apnea rise in post-menopausal women – approaching the risk associated to their male counterparts.
Obesity is a very notable risk factor for developing sleep apnea. Obesity is prevalent in this area of the country, affecting as much as 35% of the Tennessee population according to the latest CDC statistics. Because of our obesity epidemic, sleep apnea prevalence will also be very high in our state and some of our neighboring states. I encourage patients to talk with their doctor if they think they have sleep apnea or suffer from symptoms like snoring, daytime sleepiness or breathing pauses during sleep. Sleep apnea can lead to sleep deprivation, poor sleep health, and place people at risk for adverse health consequences.
Insomnia is another sleep-related issue that commonly affects the older adult population.
Insomnia can come in the form of the inability to fall asleep, stay asleep, or waking earlier than desired. That means people with insomnia tend to not get the recommended seven to eight hours of nighttime sleep even though they may struggle and try.
While insomnia can develop without any inciting event, many people with insomnia have other chronic medical conditions or mental health problems. As the number of chronic medical or psychiatric illnesses increases, the risk of developing insomnia also increases. It can lead to issues of daytime fatigue, with or without sleepiness, irritability, lack of motivation, and impaired concentration, among others. This can be very distressing for patients and can cause decreased quality of life. The good news is that proper evaluation and management through the use of both non-pharmacologic and pharmacologic therapies, insomnia can improve – leading to greater sleep quality.
Q: What is the first step in improving your overall quality of sleep?
A: Our ability to get a good night’s sleep starts with the right environment and healthy habits that are conducive to restful sleep. Sometimes we are our own worst enemy when it comes to not getting enough quality sleep at night. From worrying about chaotic schedules, family or health issues, job stresses to the temptations of late night television watching or last call social media checks, we are surrounded by distractions that can take us away from the sleep we need. This is commonly seen in all age groups including our older adult population.
Healthy habits and sleep environments are known as your sleep hygiene. I encourage all my patients to consider the following sleep hygiene principles.
- The bedroom should only be used for sleep and sex.
- Have a constant bed time and wake time.
- Avoid alcohol and caffeinated beverages in the afternoon and evening.
- Avoid smoking, especially at night.
- Get daily physical activity or exercise.
- Make sure your bedroom environment is dark, comfortable and quiet.
- Avoid the use of any screen or light emitting technology in and around bedtime, including but not limited to televisions, phones, tablets, computers, etc.
- Limit daytime napping as this can inhibit the ability to fall asleep at night.
If you are struggling with falling asleep, staying asleep or any other sleep-related issue, you may benefit from a sleep study. To learn more or to schedule an appointment with Dr. Chad Paxson at CHI Memorial Regional Sleep Center, call (423) 495-7378.