Sleep and Health for Older Americans -- Sonia Ancoli-Israel, PhD -- 04/01/03

Last Editorial Review: 10/23/2003

By Sonia Ancoli-Israel
WebMD Live Events Transcript

Every year the National Sleep Foundation conducts an annual Sleep in America poll to determine Americans' sleep patterns, disorders, and sleep-related concerns. This year's poll focuses on the more than 10,000 Americans who are turning 50 and are four times more likely to suffer from sleep disorders. We discussed the poll results and answered members' sleep disorders questions when sleep expert Sonia Ancoli-Israel, PhD, was our guest.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Hello Dr. Ancoli-Israel. Welcome to WebMD Live. Can you explain the annual sleep poll? Who conducts the poll and what were they looking for this year?

Ancoli-Israel: The poll is conducted for the National Sleep Foundation that hired a marketing research company, WBA Market Research. They conducted the 2003 sleep poll using telephone interviews with a random sample of 1,506 adults aged 55 to 84. The point of the poll was to learn about aging.

Moderator: And what did they find?

Ancoli-Israel: What we found was that:

  • More than half of all older adults get seven or more hours of sleep a night. It's very consistent with sleep of younger adults.
  • Two-thirds of the older adults reported frequent sleep problems, but only a fraction of those ever had those problems diagnosed.
  • I think the most exciting finding of the poll was that it found a direct correlation between health and sleep, meaning it became very clear that much of the sleep complaint problems of older adults are related to their health, primarily to medical illnesses. 80% of those with four or more medical problems reported a sleep problem compared with about 50% of those with no reported medical conditions. Sleep problems were reported by:
    • 82% of people diagnosed with depression
    • 81% of people suffering with stroke
    • 76% of those being treated for heart disease
    • 75% of those with lung disease
    • 72% of those being treated with diabetes or arthritis
    • 71% of those diagnosed with hypertension
    • 77% of people with chronic pains also reported a problem

This confirmed for us something that other research has shown, that aging on its own does not cause sleep problems. Problems that we see in older adults are secondary to medical illnesses, medications, specific sleep disorders, stress, and things of that nature.

Member: So what about the assumption that older people need less sleep? Is it just a myth?

Ancoli-Israel: The question of need is a very interesting one. We don't believe that older people necessarily need less sleep; we believe older adults have lost their ability to sleep. In fact, they usually need about the same amount of sleep they needed when they were younger, it's just harder for them to get that sleep now.

Moderator: Has the National Sleep Foundation come up with recommendations based on the study results?

Ancoli-Israel: The National Sleep Foundation can't give advice based on results of polls, however, as an expert in sleep, I can give suggestions for older adults.

Before one can deal with the problem, you need to find out what's causing the problem. So the first thing that an older adult who is having difficulty sleeping needs to do is talk to their healthcare professional to figure out exactly what is causing that particular sleep problem. Is it a medical illness? Is it the medications that the person is taking? Is it a primary sleep disorder?

Once that is identified then appropriate treatments can get started. Along with all treatment, we always recommend good sleep hygiene. That would include:

  • Going to bed and getting up in the morning at the same time each day.
  • Keeping the bedroom environment comfortable and relaxing, which means a comfortable temperature and very dark at night.
  • Not spending too much time in bed not sleeping. For example, if you want to sleep seven hours, you shouldn't spend nine or ten hours in bed.
  • Avoid alcohol in the evening because the alcohol makes you sleep initially, but several hours later it wakes you up again.
  • Exercise to the best of your ability.
  • Try to get lots of bright sunlight exposure, particularly in the late afternoon or early evening, because the light during the day helps us sleep better at night.

Member: I am sleeping 12 hours a night and getting up sore all over. I have arthritis and am taking medication for that but not anything new. I am a very happily married woman and am not depressed. I do exercise but probably not enough. I am 70 years old. Can one sleep too much?

Ancoli-Israel: This doesn't sound like a sleep problem per se, because you are not complaining about sleep, but feeling sore in the morning. That probably is related to the arthritis. It may be related to your bed, but mostly that's the type of condition where you need to talk to your physician about giving you something to help you deal with your soreness and pain. The body will usually take the amount of sleep it needs. So if having no sleep problems and you're waking up, other than being sore, feeling alert, and you're not sleepy during the day, then you're probably not sleeping too much.

Member: I'm older and I was wondering if it is good to take naps during the day when I feel tired.

Ancoli-Israel: Naps in the early afternoon are physiologically very normal and natural. However, if the nap is so long that it begins to interfere with your being able to fall asleep later at night, then you need to avoid the nap. If you have no trouble falling asleep when you get into bed at night, then there's nothing wrong with taking a short nap in the early afternoon.

Member: Do heavy snorers always develop sleep apnea as they age?

Ancoli-Israel: Always is a difficult word. Heavy snorers are certainly at greater risk for having sleep apnea. If they don't have it now but they gain any weight then they are much more likely to develop it. They are also more likely to develop it as they get older. If the heavy snorer begins having other symptoms, such as daytime sleepiness, it would be good to discuss it with their physician.

Member: I am female, age 56, and I have been using a CPAP machine for five years (setting 8). For two months the apnea and heavy snoring seem to have stopped and I have not needed the CPAP. Could the apnea really disappear Like that? I have improved my general health recently also. What can I expect from the sleep apnea?

Ancoli-Israel: In general, if a patient with sleep apnea loses weight, that will sometimes get rid of the sleep apnea. In addition, sleep apnea is sometimes caused by swelling of the tissue in the airway. Long-term use of the CPAP helps reduce the swelling, so it's possible that is why you are sleeping well now without your CPAP. However, if the sleep apnea didn't really go away, then it will return once the tissues swell again. The best thing is for you to have your sleep retested to examine whether the apnea really is gone.

Member: Do sleep patterns change as we age? Is a night owl always a night owl? Is a morning person always a morning person?

Ancoli-Israel: Sleep patterns, such as our sleep architecture, do change with age. Older adults have less deep sleep than their younger counterparts. The tendency to be an "owl" or "lark" can follow a person throughout their life. However, in addition to what we believe is the genetic tendency to be an owl or lark, there is a natural shifting of this tendency throughout the life span. Teenagers tend to be owls. They like to go to sleep late and get up late the next morning. Most teens will outgrow this and, as adults, will sleep in the more acceptable pattern of 11-ish to 6 or 7-ish. But as we continue to age, the pattern continues to shift so that many older adults become larks. They get sleepy earlier in the evening and wake up earlier in the morning.

Member: Also, regarding when we feel sleepy or awake: Do studies show if one kind of sleep type lives longer than the other? It's a debate among my parents (he's up at the crack of dawn, she's up 'til 2 a.m.) I'd love to solve.

Ancoli-Israel: There are no data to suggest that one type of sleep is shorter or longer than another. The key is, no matter what type you are, to get a full night's sleep.

Member: Regarding sleep apnea -- does it help to have the uvula reduced in size?

Ancoli-Israel: There's controversy to that question. It depends on the type of apnea you have, and it depends on many aspects of your own anatomy. For some people it might be helpful, for some it might make no difference. That is the type of question you need to discuss with your physician or with a sleep expert who can examine you.

Moderator: Here we have two similar questions:

Member: Why sometimes when I wake up in the morning do I feel more tired than I did before I went to bed?

Member: I have no idea what it's like to wake up refreshed. I always feel like a truck ran over me when I wake up, no matter how much sleep I've had. Why is that?

Ancoli-Israel: Sleep is controlled in part by our circadian rhythm, which essentially is our biological clock. If we wake up at the wrong time of our rhythm, we might actually feel worse in the way you describe. Our sleep also has different stages to it. If you wake up out of one of sleep, you will indeed feel more tired than you did before you went to bed.

Now, if you feel like a truck ran you over when you get up in the morning, then the quality of your sleep might be poor. It may well be that you have a sleep disorder that is causing your sleep to be fragmented so that you feel more tired in the morning. This may be worth discussing with your physician.

Member: Are there any long-term effects of getting minimal hours of sleep every night?

Ancoli-Israel: Studies suggest that people who don't get enough sleep at night are more likely to develop depression and other health problems. The question is what are the minimal hours of sleep? What is minimal for one person may not be for someone else. The key to knowing how much sleep you need is to determine what amount of sleep allows you to function at an optimal level during the day, meaning you don't fall asleep or fight to stay awake at the movies, at church, in a dark lecture hall, watching TV, etc.

Member: My husband and I both suffer with sleep apnea and he has the CPAP machine. It worked at first, but he is having trouble adjusting to it. What can he do now?

Ancoli-Israel: CPAP stands for continuous positive airway pressure. During an apnea, the airway collapses. CPAP pushes pressure throughout the airway and that pressure acts like a splint, which keeps the airway open at nights.

The mask can sometimes be uncomfortable if not properly fitted. The best way to adjust is first make sure the mask is the right size and the right type, because there are many different types of masks available. Practice wearing the mask during the day when you're awake to let your face adjust. Many people find that using a heated humidifier with the CPAP makes it easier to tolerate.

Member: Does using the CPAP machine influence the symptoms of GERD?

Ancoli-Israel: It can. Sometimes people with GERD also have sleep apnea. It's not unusual to see both disorders in a person. If using the CPAP is helping your GERD, there's no use in stopping using it, as you might also have some sleep apnea. If you haven't talked to your physician about your GERD, there are other treatments that can also be successful.

Member: Should I only sleep when tired, or should I force myself to sleep because I know I will be tired the next day if I don't go to bed?

Ancoli-Israel: In general, it is very important to go to bed and get up at the same time every day. However, you don't want to get into bed and then toss and turn if you're not tired enough to fall asleep. Go to bed when you're tired, but make sure you get up at the same time each morning, even if you didn't go to bed until very, very late. After a night or two, you should start getting tired at a more appropriate time in the evening, and then have an easier time falling asleep.

Member: Can you comment on sleeping with dogs in the bed? I read something about not allowing the animals in bed because they disturb sleep, but my husband likes to have the dogs with us. It isn't a question of allergies. And it isn't a question of space -- we have a king bed, plenty of room. It just seems sleep is less sound with the dogs in bed.

Ancoli-Israel: Sleeping with an animal on your bed can disturb your sleep because the animals are moving during the night, just as we do. If you find, as you say, that your sleep is less sound then you're probably better off having the dog sleep in another room or next to the bed. If your sleep is not bothered by the pet, there's nothing wrong with having them sleep with you, it's just a question of which way can you get a better night's sleep.

Member: Why do I feel tired throughout the day even after getting what I consider a good night's rest?

Ancoli-Israel: Feeling sleepy during the day almost always means that you're not getting enough sleep at night. There might be things disturbing your sleep you're not aware of. If you continue to feel sleepy during the day, then you should speak to your healthcare professional or your physician about that.

Member: What is involved in a sleep study?

Ancoli-Israel: A sleep study usually takes place at a sleep clinic or laboratory. Sensors will be placed on your scalp near your eyes, under your chin, under you nose. Breathing will get recorded. Your heart rate might be recorded, and depending on your complaints and symptoms, leg movements and other things might also be recorded. All these sensors will monitor the sleep and get recorded so that your doctor can look them over the next day. Some laboratories can do these same types of recordings in your home

Member: Dr. Ancoli-Israel, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Ancoli-Israel: I would just like to emphasize for our older members, remember that age, on its own, does not cause sleeping difficulties. If you are having trouble with your sleep, do not assume it's because of your age; it's not. It means that something else is going on. Make sure your physician works with you to figure out what that is. Everybody deserves a good night's sleep.

Moderator: Our thanks to Sonia Ancoli-Israel, PhD.

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