Clinton: Refusing to Leave the Stage
This Week in Elder News: 7 June 2008

Aging in the Land of Nod

category_bug_geriatrician.gif [EDITORIAL NOTE: The TGB Geriatrician is a semi-monthly column written by Dr. Bill Thomas for Time Goes By to give us the information we need to help us navigate the health issues of aging. Dr. Thomas also writes his own blog at Changing Aging.]

The comments about age-related changes in sleep patterns posted in response to Pinnacle of Adaptation, my last column here, reminded me of a patient I wrote about early in my practice.

”She slept an average of 16 hours a day, mostly in blocks of three to four hours at a time. It was clear that she was not distinguishing between night and day and that caused all kinds of problems for her caregivers. I saw the patient regularly and the good news is that, over the next three months, she started sleeping ten hours a day, almost all of them at night! Still, she was prone to napping in the middle of the day. I told the family not to worry; napping is normal at her age.”

Her mother and father were relieved by the changes, having a newborn baby in the house can be tough! It turns out that how we sleep changes as we age. Toddlers do not sleep in the same way a newborn does, nor does the 80-year-old experience sleep the same way a 30-year-old does.

So what do we need to know about age-related changes in sleep patterns? Not surprisingly, older people are more likely to develop sleep-related, medical disorders than younger people. Here are a few of the more common disorders along with their definitions:

  • Nocturnal Leg Cramps: This involves sudden, painful cramping of one or both calf muscles during sleep. The cramp can last for as many as 10 minutes, and the resulting pain from the cramp can last for much longer.
  • REM Sleep Behavior Disorder (RBD): The person is in REM (dreaming) sleep and acts out violent dreams through body movements and sounds. This disorder generally occurs in older men, but can occur in others as well.
  • Sleep Bruxism: Also known as teeth grinding during sleep, sleep bruxism is when a person involuntarily grinds or clenches their teeth while sleeping. This can lead to teeth wear and jaw discomfort. The method for treating teeth grinding is usually a mouth guard that is worn during sleep.
  • Sleep Talking: This usually occurs during a sleep/wake transition of the sleep cycle. The person can utter sounds or even entire sentences. The sleeper generally does not remember doing this in the morning.

  • Sleep Apnea: Changes in upper airway muscle tone during sleep make breathing difficult. The person experiences shortness of breath, wakes up, breathes and falls back asleep. The pattern can recur hundreds of times a night.

Most of these "parasomnias" have effective treatments you can discuss with your doctor.

Much more common are sleep-related problems that are caused by medications and medical conditions. It's always a good idea to tell your doctor about how you are sleeping even if she doesn't ask and even if you are sleeping well. Few physicians pay enough attention to sleep-related issues and patients are wise to raise the issue.

Sometimes small changes in medical treatment can make a big difference in how I sleep. I remember being a doctor-in-training and prescribing a "water pill" to a patient of mine. It was the right drug and the right dose, but the trouble was that I told her to take it in the evening. She was up half the night running to the bathroom because her doctor (me) didn't know what he was doing.

There are normal, age-related changes in sleep and sleep patterns. The most important thing is to understand what is normal and what is not normal. Here is a short list of normal changes:

  • Sleep efficiency is the ratio of the total time we spend in bed (not counting amorous adventures) and the total time we spend sleeping. Sleep efficiency generally decreases with age.

  • Daytime napping increases with age. It's normal. Enjoy it. Get used to it. Take pride in it. In medical school we used to joke that medical training also teaches students the value of a good nap. I still enjoy a mid-day nap when the opportunity arises.

  • Phase Advance is the fancy medical term for the experience of going to bed earlier in the evening and waking up earlier in the morning. The sleep phase advances as we age. Many older people fall asleep early in the evening, yet awaken much earlier than desired in the morning and cannot fall back to sleep easily.

Changes in sleep can be merely annoying or they can represent a symptom of a more serious medical situation (heart failure, depression, etc.) Sometimes not even your doctor can be sure which is the case. The general rule I follow is that when changes in sleep patterns are merely annoying, they are usually normal. When the changes cause real distress or are combined with other non-sleep related symptoms, it's time to make an appointment with your doctor.

Yawn. I think I'll take a nap.

EDITORIAL NOTE: You can subscribe to The TGB Geriatrician column by email by clicking here. Subscribe to the daily Time Goes By blog by email or RSS in the upper right corner of this page.

[At The Elder Storytelling Place today, Brent Green's story, Saving Us, is most appropriate for the 64th anniversary of D-Day today.]

Comments

I appreciate this advice, Dr. Thomas. I don't need it yet, but I can guess it's coming. :)

I mostly appreciate you taking the time to write for Time Goes By. Thank you!

My sleep pattern has changed drastically in the last eight years.

The most irritating part of it is falling asleep during a TV show I really wanted to see. This also happens in the afternoon when I am watching a movie. I don't even feel myself going. It's as if someone just turned out the light.

A good book has a different effect. If I am engrossed in it I am unable to put it down and go to sleep. Go figure.

Thanks for this post Dr. Thomas. It's always comforting to know that I'm aging normally.
Oh boy, seems I'm well into the process.

Thanks for the tips. I'm dealing with (I think) Bruxism - just bought a mouth guard that is dipped in boiling water and put in your mouth six seconds later to form. It's not easy getting used to. So far I've only made it through almost the whole night with it in my mouth.

But I also think the above is related to a mild blood pressure medication I began taking ten months ago. Atenolol. Apparently, one of the side effects is 'strange dreams' ...

No kidding. Every night it's like spending seven hours in an IMAX theater. And it's reminding me of certain experiences I had back in and around my college years that shall not be revealed here.

What I find interesting about getting older and dreaming: When I was younger, in my twenties, say - I would have your typical symbolic dreams. A recurring one was about my teeth falling out. Pure Freudian symbolism for losing your virility.

But when you get older there's no more symbolism in dreams. When I dream about my teeth falling out it's because I'm worried about my teeth falling out.

Dreams become much easier to interpret as you get older ...

Hey Chuck:

You can 'trim' that mouth guard with scissors after it is formed, if the sides are too high. That is usually where I get annoyed by them. You only really care about guarding the tooth surfaces. Just don't get it so small that you might swallow it!

I use them in the gym all the time, because the older I get the heavier those weights are and my teeth take a beating. I also clench when I am driving - I should just install one permanently. My husband would approve (hard to talk over a mouth guard ;->)

You can buy those mouth guards at Walmart for about $1.00 - in the sports section. EXACTLY the same thing as the "Dentists's Mouthguard" which is about $25.00 at Walgreen's - it doesn't come with the little 'tray', but you could probably buy a denture cup for $1.00 too. (OH MY GOD, I SAID WALMART! So sue me.)

Cap'n Jan

Yikes - so this is what I have to look forward to! I thank you for this post - I saw many of these things in my parents as they aged. My dad needed much more sleep as he aged where as my mom slept little - I seem to be starting to take after my mom...

I am so glad to have these issues explained. I like knowing I'm just getting older, and not going crazy.

I experienced that "Bruxism" issue for a time period about age 40 -- had to do with life situations.

Recall my mother ridding herself of leg cramping when she said she learned a certain vitamin or mineral was likely inadquate in her body and started a supplement. Was successful treatment for her, but now I can't remember what she took should I need it in the future.

I thought various ages (young and older people) talk in their sleep. Also, I've thought sleep apnea was mostly associated with being overweight, which, unfortunately, too many of us (myself included) are; also, that snoring generally occurred, too, as my husband did.

Good to know what to consider as being possibly sleep related.

Thank you! Now if I could just convince my boss that napping is a good idea :)

Joared, I think the supplement you are looking for is potassium. Bananas are rich in that and I eat one a day to avoid leg cramps.

This was such great stuff. I enjoyed all of it...and have had many of the issues. I'm such a bad sleeper...I was so glad to know part of it pertains to my age...and new sleep patterns.

Thanks Dorothy
from grammology
remember to call gram
www.grammology.com

My husband's sleep cycle caused huge problems between the two of us. Some sites which I found helpful:

www.sleepfoundation.org (Am I getting good sleep?)

http://nihseniorhealth.gov/sleepandaging/ (About sleep, sleep disorders, diagnosis, and treatment)

www.eldercare.com (Tips for good sleeping)

www.mayoclinic.com/health/sleeping-positions/LB00003_D
(Slide show of sleeping positions that reduce back pain)

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