Sleep and aging and ability to cope with age related medical conditions

Main Category: Restless Legs Syndrome
Also Included In: Sleep / Sleep Disorders / Insomnia;  Seniors / Aging
Article Date: 26 Mar 2004 - 0:00 PST


The US National Sleep Foundation (NSF) 2003 Sleep in America poll suggests that untreated sleep problems may be interfering with many seniors' ability to cope with age-related medical conditions.

While many Americans aged 55 to 84 have normal and healthy sleep patterns, the NSF poll found as many as 37 million in this age group suffer from frequent sleep problems. Moreover, the poll found a strong correlation between quality of sleep and certain diagnosed medical conditions.

"The 2003 Sleep in American poll indicates that poor health and not age is a major reason why many older people in this country report sleep problems, providing an important wake-up call that identifying and treating these sleep problems must be a priority concern," NSF executive director Richard L. Gelula said of the findings.

"The fact that a person is 60 or 70 years old doesn't preclude the possibility of sleeping well and benefiting from this restorative process to remain vital and active. That's why we must drive home the message that sleeping well is vital to aging well."

The poll findings would seem to reinforce Gelula's call for the need to more aggressively identify sleep problems in this segment of the population. While about two-thirds of older adults reported frequent sleep problems, fewer than one in eight said their problems had been diagnosed.

The NSF poll found sleep problems were associated with specific medical conditions and were more likely to occur proportionate to the number of medical conditions reported (see box below). Sleep problems were also associated with frequent pain (77%); obesity (77%) and overweight (64%); and among those with ambulatory limitations (84%).

In 2003 the National Center on Sleep Disorders Research (NCSDR) issued its revised National Sleep Disorders Research Plan. While recognizing that medical illness can affect sleep quality, NCSDR says it is less clear how sleep quality affects disease progression and morbidity.

Sleep-disordered breathing (SDB), a group of disorders of which obstructive sleep apnea is the most common, has been identified as a risk factor for adverse cardiovascular outcomes in the elderly, including hypertension and coronary heart disease. The medical risks associated with other sleep disorders, including more common conditions like insomnia and restless legs syndrome, are yet to be fully ascertained.

"There have been extensive studies that have made it very clear that sleep apnea is an independent risk factor for cardiovascular disease as well as for mortality," says Carl E. Hunt, MD, director of the National Center on Sleep Disorders Research.

"Obesity and high blood pressure often go together and patients who are obese are more likely to have sleep apnea and more likely to be hypertensive. But independent of those relationships, sleep apnea has its own independent association with risk for cardiovascular disease. This is important as we age because the risk for sleep apnea increases as we age.

"The other very common condition which has an incidence rate close to insomnia is restless leg syndrome. It's quite common and affects all ages. In terms of insomnia, it is complicated by the fact that you can have a secondary or primary condition. There are lots of medical and psychiatric conditions that secondarily cause insomnia, depression being the most notable. Any kind of medical condition that involves pain or inflammation can have secondary effects on sleep. Other chronic illnesses associated with secondary insomnia have not yet received much research attention, but we know it's an important area."

There is also reason to believe that sleep disturbances can have an adverse effect upon a patient's ability or willingness to manage the chronic conditions that are more prevalent among older Americans.

"That is an area that hasn't been well studied," says Dr. Hunt "but we know that adherence to treatments - lifestyle and behavioral interventions as well as medications - is a major issue in clinical practice. The information that we do have shows that chronic lack of sleep could have a major adverse effect and make our basic adherence much worse. Another point to make, relating to chronic illness in general as well as to adherence issues, is that some of the treatments for chronic illness may themselves cause sleep problems. In addition to the chronic illness itself affecting sleep, treatments for the chronic illness may also affect sleep and could therefore affect adherence to the regimen treatment.

"We know that many adults and older adults do not necessarily go to the doctor with sleep complaints because they have a sense that it's part of the background and normal for that age, but that isn't the case. The important issue is that the whole area of sleep medicine is relatively new. People in general, and the healthcare community, are not necessarily well versed on what we now know today because we know so much more than we did just recently.

"There have been improvements in drug therapies for sleep disorders. There are new medications to treat specific disorders like narcolepsy which in the past were difficult to treat. We have continued to develop newer drugs to treat insomnia - drugs that have more rapid onset and shorter half lives - so they can have better clinical effects with fewer side effects. There's a lot of research on identifying drugs that would be effective for sleep apnea as well, but there has been no success yet.

"A critical take home message is that if someone is spending enough time in bed to be well-rested but is still feeling unrefreshed in the morning and is sleepy during the day, that situation should dictate medical evaluation. In the absence of a specific medical condition affecting sleep, they may well have a sleep disorder and can receive important symptom relief with diagnosis and treatment of that sleep disorder."

From Physicians Weekly:
http://www.physweekly.com/article.asp?issueid=118&articleid=1228

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