Original ArticleSleep and its disorders in aging populations
Introduction
Although many believe that with age, people sleep less, surveys examining sleep duration in different age groups have shown that, in general, older adults report sleeping around seven hours a night, an amount not very different from that reported by younger adults (Fig. 1) [1], [2]. Although sleep architecture changes with age, nearly all age-related changes in architecture occur in early and middle age [3]. Slow-wave sleep (SWS) decreases dramatically from 16 years to approximately 35 years, but stabilizes from 60 years onward, as do most sleep parameters [3]. Only sleep efficiency (SE) continues to decline with age [3]. While controversy remains about the need for sleep changes with age, it is clear that the ability to sleep decreases with age [4], [5].
This review will examine the various aspects of sleep in older adults and will discuss:
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insomnia in the elderly,
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consequences of poor sleep in older adults,
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the association between sleep symptoms and disease.
Section snippets
Insomnia in the elderly
Numerous studies have shown that the prevalence of insomnia is higher in older adults compared to younger adults [6], [7]. A survey of 3161 non-institutionalized adults found that 25% of older adults (65–79 years), compared to 16% of 18- to 64-year-olds, suffered from insomnia [6]. Furthermore, in the Outcomes of Sleep Disorders in Older Men Study (MrOS Sleep Study; as part of the Osteoporotic Fractures in Men Study [MrOS]) [8], it was found that 44% of men aged ⩾64 years, of which nearly
Consequences of poor sleep in older adults
The consequences of poor sleep in older adults are substantial and include poor health, decreased physical function, falls, cognitive impairment, and mortality.
Medical disease
Sleep difficulties are significantly associated with medical and psychiatric comorbidities, including cardiac and pulmonary disease, depression and osteoarthritis. Data from the 2003 National Sleep Foundation’s annual Sleep in America poll demonstrated that the incidence of TST < 6 h/night or any symptoms of insomnia were higher in patients with heart disease than in those without (OR 1.70 [95% CI 1.12–2.58] and 1.99 [95% CI 1.29–3.07], respectively) [14]. Similarly, pulmonary disease was
Conclusion
While there is still a question about the change in need for sleep with age, there is no question that the ability to sleep does decrease. But the decreased ability to sleep is associated with comorbidities and not with age per se. Older adults have a difficult time obtaining the sleep they require. In the absence of comorbidities, there is little change in sleep characteristics. Other factors associated with aging, however, such as medical and psychiatric illness, medications, and circadian
Disclosures
Consultant/Scientific Advisory Board for Ferring Pharmaceuticals, Inc., GlaxoSmithKline, Orphagen Pharmaceuticals, Pfizer, Respironics, sanofi-aventis, Sepracor, Inc., Schering-Plough, Teva (each less than $10,000).
Grants/contracts: NIH, Sepracor, Inc., Litebook, Inc. Supported by sanofi-avenis, Wolters Kluwer, NIA AG08415.
Acknowledgements
The author would like to thank Wolters Kluwer Health for providing editorial assistance. This assistance was supported by sanofi-aventis.
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