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Sleeplessness in older adults and its negative impacts on health
Like exercise and a wholesome diet, restful sleep is an essential component of mental and physical health. However, an estimated 50% of adults 55-years and older, especially women, have some form of sleep difficulties, including initiating and maintaining sleep. Thus, sleep disturbances pose a significant medical and public health concern for aging populations. Sleeplessness can increase the risk of medical conditions: high blood pressure, heart attack, stroke, depression, obesity, and diabetes. Sleep disorders can also influence both memory and concentration, decreasing performance at work or school, while increasing the risk of an accident or injury. Despite the medical consequences of sleep problems, older adults with moderate sleep disturbances seldom seek any treatment for this disorder.
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Misconceptions & facts about sleep patterns and rhythms in older adults
It is a common misconception that need-for-sleep declines with age. In fact, our sleep-needs remain constant throughout adulthood. Changes in the patterns of our sleep do occur as we age, and this may contribute to sleep problems. Sleep occurs in multiple stages including dreamless periods of light- and deep-sleep, and occasional periods of active dreaming, with periods of Rapid Eye Movement sleep (or REM). The sleep cycle may be repeated several times during the night, and although total sleep time tends to remain constant, older people tend to spend more time in the lighter stages of sleep than in the deep refreshing stages of sleep. Studies on the sleep habits of older Americans show an increase in the time it takes an older person to fall asleep (sleep latency), an overall decline in REM sleep, and an increase in what is called sleep-fragmentation (waking up during the night) with age.
Other factors affecting sleep are the circadian rhythms that coordinate the cyclical timing of our bodily functions, including sleep. For instance, older people generally tend to become sleepier in the early evening and awake earlier in the morning, compared to younger adults. This pattern is called advanced sleep phase syndrome. The sleep rhythm is shifted forward so that 7 or 8 hours of sleep are still obtained, while the individuals will wake up relatively early due to the timing of their sleep. Moderate sleep problems in older adults are often associated with raised levels of fatigue, disturbed mood, and reduced quality-of-life, and may even lead to the onset of clinical insomnia. When effects are serious and remain untreated, insomnia can take a toll on a person’s health.
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Conventional therapies and their shortcomings
Patients with clinical insomnia are normally treated with pharmacotherapy. Although this form of therapy can help some patients temporary, it is not considered to be a long-term cure and there are also risks of side effects and drug-dependency. Cognitive or Psycho-behavioral therapies are recognized as alternative, non-pharmacological treatments for insomnia. These non-pharmacological therapies have advantages over pharmacotherapy in that they are moderately effective at improving sleep for both short-term and long-term periods and have no serious contraindications. However, cognitive behavioral therapies, are pricey, intensive, and require administration by highly-trained therapists, and are generally intended for patients with clinical insomnia, not for people with moderate sleep disorders.
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Alternative ways to treat sleeplessness in older adults
Previous research has shown that T’ai Chi—movements based on meditation—can improve sleep quality in older adults. Moreover, scientists at the UCLA Mindful Awareness Research Center further demonstrated that mental practices associated with meditation can significantly improve sleep quality in older adults. The formal study, which appeared in the Journal of the American Medical Association (or JAMA) Internal Medicine (Black et al., 2015 175: 494-501), revealed promising aspects of Mindfulness Meditation, as follows:
The Research included 49 people who were at least 55 years old, with moderately disturbed sleep problems, but were otherwise healthy. The subjects were divided into 2 groups: one group attended Sleep Hygiene Education (SHE), a universal behavioral program, where they learned about sleep biology, characteristics of healthy and unhealthy sleep, stress reduction, self-monitoring of sleep behavior, relaxation methods for improving sleep, and weekly behavioral sleep hygiene strategies. (Note: The SHE educational and behavioral content is based on National Institutes of Health and National Sleep Foundation tips for better sleep). The other group participated in Mindful Awareness Practices (MAPs) where participants learned mindfulness meditation with a certified teacher with more than 20 years of mindfulness practice. Mindfulness exercises included mindful sitting meditation, mindful eating, appreciation meditation, “friendly” or loving-kindness meditation, mindful walking, and mindful movement. Participants engage in a mean of 10 to 30 minutes of mindful experiential meditation in each class. Mindfulness practice homework began with 5 minutes daily and then progressively advanced to 20 minutes daily by session six.
The result—after six-weeks of the comparative experimental treatments—showed that participants in the Mindful Awareness Practices or MAPs group, exhibited better sleep and enhanced quality of life parameters during the daytime, when compared with those in the Sleep Hygiene Education or SHE group. Troublesome daytime impairments, including symptoms of insomnia, fatigue, and depression were found to be substantially lessened in the Mindfulness Meditation group as well.
In terms of mind-body medical intervention, Mindfulness Meditation is concluded to be an efficacious relaxation technique, which decreases physiological arousal, and may make it easier for one to fall asleep, while improving one’s mood and reducing fatigue. This evidence-based UCLA study is important in that it demonstrates that simple guided meditation techniques can also be therapeutically beneficial. For an aging population, with increasingly limited mobility, the value of applied Mindfulness Meditation Practices may reside in a good night’s sleep.
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