Sleep Cycle Disturbances in the Elderly

Sleep cycle disturbances in the elderly can be a result of natural changes in circadian rhythms, andropause (male menopause) and menopause, illness, Alzheimer's disease, anxiety or depression and the ingestion of certain medications. Sleep quality can be enhanced by pursuing a healthy lifestyle and by avoiding poor sleep habits that disrupt normal sleep patterns.

Circadian Rhythms

• Circadian rhythms are affected by exposure to light.

  Each person has an internal 24-hour biological clock, called a circadian rhythm. These diurnal and nocturnal rhythms are internal and are not affected by external cues except for artificial or natural light. Our circadian rhythms are controlled by a region of the brain's hypothalamus called the suprachiasmatic nuclei (SCN). The SCN is the "master clock" that regulates our sleep patterns.

  We also have "local clocks" within our tissues and body organs, which are controlled by our genes. Scientists believe that the SCN, or "master clock," is responsible for synchronizing the "local clocks" within the organs of the body and that aging may disrupt this natural process.

  According to David N. Neubauer, M.D., of Johns Hopkins Sleep Disorders Center in Baltimore, "The elderly tend to have delayed sleep onset, fragmented sleep, early-morning awakening and decreased time in sleep stages 3 and 4."

  Seniors can offset these sleep difficulties by maintaining a healthy weight, exercising, avoiding stimulants before bedtime and by avoiding daytime naps and late "night owl" schedules, which tend to disrupt sleep patterns. Natural sunlight should be taken in the morning and bright light avoided before bedtime, since circadian rhythms are greatly affected by light-dark cues.

Sleep Cycle Disturbances During the "Change of Life."

• Hormonal decline in both men and women can contribute to loss of sleep.

  A decline in sex hormones can affect the sleep patterns of both sexes. According to psychobiologist, Monica Levy Andersen, "The decreasing sleep efficiency and numbers of REM sleep episodes ... observed in older men are associated with lower concentrations of circulating testosterone."

  Postmenopausal women who urinate frequently at night may suffer from stress incontinence. The vaginal wall is less supple due to a decrease in estrogen and may be unable to support the urethra and bladder.

  Frequent urination is also common in older men with an enlarged prostate.

Physical and Psychological Factors

• Depression is more common in the elderly and can lead to insomnia.

  Two common ailments that affect sleep in the elderly are restless leg syndrome and obstructive sleep apnea.

  Restless leg syndrome is described as an uncomfortable buzzing or "crawly" feeling in the legs, which causes the sufferer to want to change position.

  When the throat or airway relaxes during sleep, it can lead to shallow or irregular respiration. This is called sleep apnea and can lead to heart disease or stroke.

  Anxiety and depression can lead to ruminative thoughts at bedtime or during the night. Racing thoughts can be an occasional occurrence or an indication of an obsessive compulsive disorder, or OCD.

  According to the Mayo Clinic, "Alzheimer's may reverse a person's sleep-wake cycle, causing daytime drowsiness and nighttime restlessness."

  Persons who are sleep-deprived because of physical maladies or mood disorders should be diagnosed and treated by a physician.

Medication

• Prescription medication can disrupt sleep cycles.

  Avoid medications that induce insomnia. A partial list includes Zoloft (sertraline hydrochloride) and Prozac (fluoxetine), anticonvulsants, amphetamines, decongestants and some blood pressure medicines.