“Our lifestyle is disrupting our sleep,” said Dr. Sanford Auerbach, director of Boston Medical Center’s sleep disorders center. “For older people, sleep is more fragile.”
Doctors see a growing epidemic of sleep disorders in patients over 50, especially insomnia and sleep apnea, with the prevalence and health risks increasing as people age. Because many seniors are stoic about their lack of shut-eye and avoid treatment, researchers believe the bulk of cases — as many as eight in 10 when it comes to sleep apnea — go undiagnosed.
The advice from doctors: If you have trouble sleeping, get it checked.
“Sleep disorders are treatable,” said Dr. Charles Czeisler, director of the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston. “But a lot of people don’t see sleep deprivation as a serious medical condition. We’re in a society where we’re taught to be tough, and concern about sleep is seen by some people as a weakness.”
Those who do seek interventions step into a world of forbidding face masks pumping air into nasal passages, smart watch apps tracking sleep abnormalities, and a raft of behavioral strategies to foil sleep deficits. Less invasive tactics include forgoing afternoon lattes and banishing frisky dogs and cats, pinging cellphones, and snoring partners from the bedroom.
The payoff is better health. Physicians say sleep disorders can lead to, or aggravate, chronic conditions that are especially common among seniors, including depression, hypertension, heart disease, diabetes, and cognitive decline. Those, along with motor vehicle and workplace accidents stemming from sleep deprivation, have cost the US health system about a cumulative $150 billion, consulting firm Frost & Sullivan estimates.
Clearly, many pine for restorative slumber. Forty-one percent of adults responding to a survey in September by the American Academy of Sleep Medicine said they’ll use their extra hour Sunday morning to catch up on sleep. That’s more than triple the number who said they’d use the hour to socialize with family and friends, do errands or housework, or pursue hobbies.
Doctors typically recommend seven to nine hours of sleep for adults. But the amount varies from person to person, as do the reasons for having trouble falling asleep.
The top sleep-robbing culprits for seniors are chronic insomnia and obstructive sleep apnea, each afflicting tens of millions of Americans. Insomnia, or habitual sleeplessness, plagues people of all ages but is more common late in life. It’s typically treated by behavioral changes, such as exercise and losing weight, as well as sleep meds such as Ambien or Lunesta.
Sleep apnea, a scourge of older adults, is marked by repetitive episodes of upper airway obstruction throughout the night, causing snoring, interrupted breathing, and spiking blood pressure. It is most often treated with breathing assistance devices, notably continuous positive airway pressure, or CPAP, machines. Other treatments include oral appliances, surgical implants that keep airways open, and improved diets, fitness, and weight loss. Doctors say sleep apnea can sometimes be reduced by changing positions — sleeping on your side rather than your back.
Once thought of as a disease caused by obesity, sleep apnea is now being diagnosed in a broader population — especially men in their 50s and 60s as well as postmenopausal women — as baby boomers grow older and sleep specialists gain a better understanding of the condition.
“Sleep apnea is virtually universal in patients over 70,” said Dr. Robert Thomas, a pulmonary disease specialist at Beth Israel Deaconess Medical Center in Boston and director of the sleep center at Beth Israel Deaconess hospital in Needham. “The only question is how severe it is.”
Even with a greater recognition of the prevalence of sleep apnea, it often goes untreated. In a recent study published in the journal Sleep Medicine, researchers from Brigham and Women’s, Beth Israel Deaconess, and Boston University found a critical flaw in the way patients are diagnosed. Up to 20 percent of those denied treatment by insurers should be eligible, the study said, citing their reliance on a metric established in the 1970s that doesn’t account for individual variation.
“We’re rejecting people who should be treated for sleep apnea,” said senior author Michael Prerau, an associate neuroscientist at Brigham & Women’s. “It’s going to be cheaper in the long run to treat these people than to treat the comorbidities that could develop.”
While insomnia and sleep apnea remain the big enchiladas of sleep medicine, smaller numbers of seniors and younger patients suffer from lesser known sleep disorders such as restless leg syndrome, narcolepsy (excessive drowsiness), sleepwalking, and night terrors.
Some in the sleep field complain their specialty still isn’t accepted in the medical mainstream and draws fewer research dollars than cancer or neurological disorders.
Scientists and entrepreneurs are working on easier-to-use devices and drug combinations that dilate the nose and nasal passages during sleep, making it easier to breathe. But sleep doctors caution that most of these experimental treatments won’t be available for years.
That will keep many older folks rolling over in their beds, longing for elusive z’s.
Even for those who don’t suffer from disorders, changes in the circadian rhythm — the internal process that governs a person’s sleep-wake cycle — are often accompanied by sleep disruption and fragmentation as they age. Many find themselves wide awake early in the morning but doze in the early evening, making it difficult to sleep soundly at night.
“People underrecognize the importance of biological shifts in circadian rhythms over the life span,” said Dr. Douglas Kirsch, medical director for sleep medicine at Atrium Health in Charlotte, N.C., who grew up in Massachusetts and formerly worked at Brigham & Women’s. “Understanding these shifts means changing your behavior to adapt to them.”
Tolerance for after-dinner cappuccino or late-night pinot noir, for instance, diminishes with age. A “nightcap” of wine or beer can help seniors drop off to sleep. But because older people metabolize alcohol more slowly, it can also wake them up a few hours later — or keep them up after the middle-of-the-night bathroom run that’s a calling card of growing older.
Seniors can also be more prone to stress than younger people. While some try meditating, counting sheep, or imagining a stroll on the beach, too many stay awake worrying about their health and finances, their children and grandchildren, even the state of the nation and world.
And one worry towers over all others for bleary-eyed seniors, said Auerbach at Boston Medical Center.
“A lot of people lie in bed,” he said, “thinking about why they’re not sleeping.”