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Generational Spotlight: Circadian Rhythm Disorders in the Elderly

Circadian rhythms can shift as we age.

old woman sleeping by Michael Vines 2014 CC

A reader reminded me this week that I have some work to do to update the section on Elderly Care:

“I think you left out important info in the Elderly Care section! I am elderly and have DPSD; you say NOTHING about that. OK, so perhaps having ASPD is more common, but I am 67, and have suffered from DSPD (now called DSWPD) my entire life. I REALLY THINK you ought to insert it in that section; people like me feel discriminated against enough!”—LS

ASPD stands for Advanced Sleep Phase Disorder and it’s quite common in older folks, as most of us who have a relationship with senior-aged loved ones can attest to.

The running cliché characterizes all elderly people as needing to eat dinner by 5pm (“Early Bird Special”) in order to be able to make their 7pm bedtime. That is the most familiar rendering of ASPD.

However, LS is right: not everyone in their golden years suffers from ASPD. Some continue to have DSPD (Delayed Sleep Phase Disorder, also called Delayed Sleep-Wake Phase Disorder, or DSWPD) and may have suffered with it their entire lives.

This circadian rhythm disorder is most certainly not exclusive to teens and college coeds. In fact, one of my best friends is at the edge of official “retirement age,” and she has not gone to bed earlier than 1am for most of her adult life.

Nor is ASPD territory only visited upon by senior citizens: my friend’s husband routinely left our shared dinner parties during those newly married years to sleep before 9pm and has been phase advanced his whole life, including during high school and while in college.

I especially appreciate LS’s comment about being discriminated against. That is the problem for most people with circadian rhythm disorders; their rhythms don’t easily align with societal norms, and that leaves them open to criticism from others who assume they lack a work ethic, are lazy, or irresponsible for not doing as something as simple as “use and alarm clock!” when, in fact, that’s not the problem at all.

Circadian rhythms can shift as we age. Some of these shifts are explained by medical conditions (such as arthritis, congestive heart failure, depression, and reflux).

Certain sleep disorders, like Restless Leg Syndrome (RLS), sleep apnea, and Periodic Limb Movement Disorder (PLMD), also break up healthy sleep without an older person even knowing it, sometimes.

Medications (especially related to breathing disorders, blood pressure, and heart disease) may also disrupt one’s rhythms and force new patterns of sleepiness and wakefulness.

In addition, women in menopause can attest to disruptions in their nightly sleep architecture, thanks to major hormonal shifts. Sleep is regulated by hormones, so it comes as no surprise that hormonal changes will lead to changes in sleeping patterns.

Getting enough sleep, for a retired person, may require sleeping more often in order to get adequate sleep because of problems with sleep fragmentation, in which patterns are disrupted enough that sleep no longer comes in a single, consolidated period.

Napping during the day, however, can disrupt one’s sleep drive (an important part of the sleeping process which let’s us know when we are ready for a new period of sleep), and this can cause sleep onset insomnia.

The elderly typically experience less of the healing stage of deep sleep (stage 3, or slow-wave sleep) and when they do get this critical sleep, it’s often for much shorter periods than it is for younger adults.

Sleep for them becomes lighter and broken up by brief arousals, or even longer periods of wakefulness at night. Enough disruption to a regular sleeping pattern can lead to sleeping all around the clock, unfortunately.

While sleep deprivation isn’t necessary a guaranteed reality for older adults, quality sleep may still be much harder for them to maintain. Just the fact that melatonin production increases with age explains this.

So the elderly may suffer disproportionately from chronic sleep loss, which creates opportunities for chronic health conditions such as Alzheimer’s disease, diabetes, or Parkinsonism to develop or worsen.

Here are some useful links to follow if you’re interested in learning more about circadian dysregulation of sleep in the elderly.

General Sleep Problems and Circadian Rhythm Patterns in Older Adults

MAR 28: Forbes
Just When Does A Sleepless Night Become A Sleep Disorder?

MAR 22: American Sleep Association
Sound Waves Help Older Adults Achieve Deep Sleep

MAR 17: Restonics Sleepblog
Myth Busted! Growing Older Does Not Mean Saying Goodnight to Restful Sleep

MAR 15: Health Environments Research & Design Journal
Seasonal Differences in Light Exposure and the Associations With Health and Well-Being in Older Adults Living in Care Homes

MAR 7: Sleep Medicine
Sleep problems, short sleep and a combination of both increase the risk of depressive symptoms in older people: a 6-year follow-up investigation from the English Longitudinal Study of Ageing (abstract)

MAR 3: Tuck
Dementia and Sleep Disorders

FEB 24: Cosmos
Body clock genes may protect against ageing

FEB 20: Journal of the American Medical Association
Timed Light Therapy for Sleep and Daytime Sleepiness Associated With Parkinson Disease (abstract)

FEB 1: Journal of Clinical Investigation
The aging clock: circadian rhythms and later life (abstract)

NOV 2007: SLEEP
Circadian Rhythm Sleep Disorders: Part II, Advanced Sleep Phase Disorder, Delayed Sleep Phase Disorder, Free-Running Disorder, and Irregular Sleep-Wake Rhythm

JAN 2001: Journal of Sleep Research
Illumination levels in nursing home patients: effects on sleep and activity rhythms

SEPT 2000: Clinical Psychology Review
Assessment and treatment of sleep disturbances in older adults

 

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