Our Sleep Process Changes as we Age

As we age, many changes happen in our bodies. Some parts of our body and mind start to deteriorate and other parts slow down. How many of these changes are part of normal aging and how many are pathologic conditions? In the area of sleep, some changes that occur are a result of normal aging and there are many others that are pathologic.

A second issue is the perception that older people have about their sleep. What is debilitating and disturbing to one older person, may feel normal to another. While one older person who sleeps only 6 hours a night might complain of trouble sleeping, another older person might adjust and have no complaints whatsoever.

Many surveys have been conducted about sleep in older people. Most older people report an increase in the number of awakenings experienced during the night, a decrease in total sleep time, an increase in the number of sleeping medications taken (particularly in women), an increase in daytime sleepiness, and consequently, an increase in napping behavior.

Our brain waves change with age, both in wake and in sleep. The alpha activity decreases, and in certain parts of the brain there is an increase in slow brain wave activity. In fact, slowing of the EEG is very common and has little pathologic significance in older, non-demented individuals.

Along with these changes in brain waves, there are some changes in sleep architecture (that is, our sleep cycles) and in quality of sleep. Sleep efficiency (how much we sleep when we are in bed) decreases to about 80%. The amounts of stage 1 and stage 2 sleep increase, and correspondingly, the amounts of stage 3 and stage 4 sleep (that is, deep sleep) decrease. This decrease in deep sleep actually begins at around 20 years old. The time in our first REM period, which is 90 to 100 minutes in younger adults, also decreases.

Some of the sleep disturbances seen are secondary to specific conditions that are prevalent in elderly, such as nocturia, cardiovascular disease, pulmonary disease, diabetes, osteoarthritis, rheumatoid arthritis, and menopause. Other disturbances are secondary to medications.

Other changes also occur in sleep. There may be an increase in autonomic activity, for example, heart rate or blood pressure. Older people may become more sensitive to the environment. For example, they may hear more noises that will disturb their sleep. And also, there are changes that occur in our biologic clocks or circadian rhythms.

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