Sleep is essential for good health at all stages of life, particularly when it comes to maintaining good cognitive function and for disease prevention1.
This Sleep Awareness Week (5-11 August), the Sleep Health Foundation is shining a light on dementia and sleep, examining the link between sleeping patterns, cognitive decline and neurodegeneration. Although sleep disturbances in people with dementia have long been recognised, researchers are now looking at disturbed sleep – including fragmented sleep, abnormal sleep duration – and sleep disorders, as a way to tell if a person is at risk of dementia2.
To support this message, it helps to have some context around sleep and ageing, and the many different factors that can influence sleep patterns.
Many people believe that older adults need less sleep, but in fact, adults require about the same amount of sleep (7-9 hours per night) from their 20s into old age3. For older adults, it is not the need for sleep but the ability to sleep that diminishes with age4. Older adults tend to be sleepier during the day as they may not be getting adequate quality sleep during the night due to a number of reasons, often medical-related4.
Most people over the age of 80 nap for more than one hour each day and they can take more than half an hour to fall asleep at night5. They also wake up more often and spend less time in the deep, refreshing stages of sleep5.
A person’s body clock gradually starts to change after middle age and the hormones that promote sleep – including melatonin – start to be released earlier in the day5. Older adults also tend to make less melatonin5.
Furthermore, brain damage caused by dementia can affect the ‘biological clock’ in the brain, impacting sleep patterns. These factors may help explain why many aged care residents sleep earlier in the night than they used to, have trouble falling asleep, and often wake up earlier in the morning.
According to the Sleep Health Foundation, two-thirds of residents in aged care facilities have problems with their sleep, many due to illness or the medications they take.
Some common chronic illnesses that interfere with sleep include arthritis (or other conditions that cause pain), osteoporosis, Parkinson’s, incontinence, indigestion, heart disease, enlarged prostate (for men), depression, dementia or Alzheimer’s disease, and lung diseases such as asthma or COPD5,6. The medications used to treat these conditions can further interfere with sleep6.
Such chronic conditions may be compounded by sleep disorders, including sleep apnoea, snoring, insomnia, and restless leg syndrome. Changes to the sleep environment may also affect sleeping patterns, including noise, uncomfortable bedding, heat, bright lights, or being in an unfamiliar environment such as moving to a new residential aged care facility6.
A review of the literature into sleep in residential aged care aimed to identify evidence based strategies to improve sleep7. It noted that there is a lack of systematic evidence supporting the effectiveness of antihistamines, antidepressants, antipsychotics or anticonvulsants in the treatment of insomnia, and suggests that medications for sleep – including long-acting benzodiazepines – should not be used a substitute for addressing the underlying causes of sleep disturbances.
The interventions that demonstrate most promise, according to the review, include:
1. Light therapy –Outdoor light in the morning and in the evening helps keep the body clock on a stable routine7.
2. Exercise –Regular activities such as tai chi for residents who are alert and mobile were shown to improve sleep over the long term.
3. Melatonin –A synthetic version of the hormone naturally produced by the body may help those experiencing insomnia.
4. Multifactorial interventions –Using multiple interventions together after an individual sleep assessment is made.
Take the time to discuss with the residents’ doctor if certain medications may be interfering with their sleep. If pain is the cause of poor sleep, pain relieving medication may help.
Also consider the residents’ dietary habits (are they consuming any stimulating foods or drinks before bed?) and the environment in which the resident is sleeping, taking into account temperature, lighting and even placement of mirrors in the bedroom (especially for patients with dementia, who may not recognise themselves and feel confused at times).
Finding the interventions that work for each resident and sticking to these routinely will go a long way to improving sleep hygiene and quality for those affected by poor sleep.
Read more about Sleep Awareness Week:https://www.sleephealthfoundation.org.au/key-events/about-sleep-awareness-week.html
1HelpGuide.org. (2019). Sleep Tips for Older Adults. [online] Available at:https://www.helpguide.org/articles/sleep/how-to-sleep-well-as-you-age.html[Accessed 27 Jun. 2019].
2Wu, M., Rosenberg, P., Spira, A. and Wennberg, A. (2017). Sleep Disturbance, Cognitive Decline, and Dementia: A Review. Seminars in Neurology, [online] 37(04), pp.395-406. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910033/[Accessed 27 Jun. 2019].
3Dixon, J. (2008). Why seniors are often sleep deprived. [online] WebMD. Available at:https://www.webmd.com/sleep-disorders/features/do-seniors-need-less-sleep#1[Accessed 27 Jun. 2019].
4Ancoli-Israel, S. (1997). Sleep problems in older adults: putting myths to bed. Geriatrics, [online] 52(1), pp.20-30. Available at:https://www.ncbi.nlm.nih.gov/pubmed/9003201[Accessed 27 Jun. 2019].
5The Sleep Health Foundation. (2019). Ageing and Sleep. [online] Available at:https://www.sleephealthfoundation.org.au/older-people-and-sleeping.html[Accessed 27 Jun. 2019].
6English, S. (2011). How Sleep Changes Throughout Your Life. [online] WebMD. Available at:https://www.webmd.com/sleep-disorders/features/sleep-changes#1[Accessed 27 Jun. 2019].
7Dawson, L., Moore, K., Tinney, J., Ledgerwood, K. and Dow, B. (2012).Sleep in residential aged care: A review of the literature. [online] Ajan.com.au. Available at:http://www.ajan.com.au/Vol29/29-4_Dowson.pdf[Accessed 27 Jun. 2019].
8The Sleep Health Foundation. (2011). Dementia and Sleep. [online] Available at:https://www.sleephealthfoundation.org.au/dementia-and-sleep.html[Accessed 27 Jun. 2019].