The importance of sleep cannot be overstated. Sleep supports physical, mental, and emotional well-being, but it's often hard to come by we age.
The older we get, the harder it can be to find a good night’s sleep. There are a number of reasons seniors struggle with slumber, including circadian rhythm sleep disorders (CRSD).
CRSD can be complicated, negatively impacting a senior’s overall health. Properly understanding the condition, the treatments available, and when to ask for help can go a long way to finding relief and improving quality of life.
Understanding Circadian Rhythm Sleep Disorders
Circadian rhythms are the 24-hour cycles the body follows, regulating the sleep-wake cycle. Circadian rhythm sleep disorders are disruptions in this natural biological clock.
Our circadian rhythms are heavily influenced by light exposure and other environmental factors, dictating when we feel alert and when we feel sleepy.
Circadian rhythm sleep disorders in seniors include conditions like:
- Non-24-hour sleep-wake rhythm disorder (N24SWD): Most commonly seen in seniors with vision loss, N24SWD is typically characterized by sleep time moving later and later, causing the body’s rhythm to fall out of sync with the 24-hour daily cycle.
- Advanced sleep-wake phase disorder (ASWPD): With this disorder, sleep time comes earlier than desired. Leads to earlier bed times and earlier wake times.
- Irregular sleep-wake rhythm disorder (ISWRD): Sleep and wake times occur irregularly and unpredictably over the course of the day. This condition is seen most commonly in seniors with dementia or other degenerative brain diseases.
What Causes Circadian Rhythm Sleep Disorders?
Circadian rhythm sleep disorders often occur when the body’s “clock” is thrown off.
In the brain’s hypothalamus is a cluster of cells called the suprachiasmatic nucleus (SCN) that makes up this clock. The SCN is what processes the external cues that “run” the sleep-wake cycle.
There are several possible reasons for this disruption in the “clock” leading to circadian rhythm sleep disorders in seniors. The most common include:
Age-Related Changes
As we age, we often experience shifts in sleep patterns, leading to earlier bedtimes and earlier wake times.
Older adults produce less melatonin, the hormone that regulates sleep, contributing to CRSD.
Medical Conditions
Chronic illnesses, like dementia or heart disease, can disrupt sleep patterns. Similarly, vision impairments can disrupt the experience of light and dark, preventing the body from receiving the proper sleep-wake signals.
Medications used to treat some health conditions can have side effects that interfere with natural sleep cycles.
Lifestyle Factors
There are a handful of lifestyle factors that can reduce sleep quality, including:
- Lack of physical activity
- Social isolation
- Air travel, especially across time zones
- Work stress, particularly shift work
Why Are Circadian Rhythm Sleep Disorders Common in Seniors?
Biological Factors
There are many changes that occur in the brain and body as we age. Some of these changes impact sleep regulation.
As mentioned before, melatonin levels decrease with age, typically staying around daytime levels, interrupting the natural circadian rhythms. On top of this, the magnitude of the circadian rhythms is reduced in older adults, including body temperature regulation and cortisol production.
Seniors are more likely to have comorbid conditions like osteoarthritis, cardiovascular disease, diabetes, and dementia. These illnesses, combined with the medications used to treat them, can contribute to CRSD.
It is possible that aging eyes let in less light, particularly short wave light, preventing the brain from picking up on the changing light conditions over the course of a day. In fact, some seniors see improvements in sleep quality following cataract surgery.
Environmental Influences
Natural light plays a critical role in our circadian rhythms. Inadequate exposure to natural light can disrupt the cycles and complicate sleep.
Seniors, especially those in long term care settings, often spend less time outdoors and more time in artificial light, further complicating the sleep-wake cycle.
Mental Health Considerations
Anxiety and depression can impact sleep. These mental health concerns can exacerbate sleep disorders and create an ongoing cycle of disruption that is difficult to remedy.
For example, depression can disrupt sleep cycles and disrupted sleep can increase depression.
Recognizing the Symptoms of Circadian Rhythm Sleep Disorders in Seniors
The symptoms of CRSD can vary. They largely depend on the individual and on the particular sleep disorder experienced.
Some key symptoms that may indicate circadian rhythm sleep disorders in seniors include:
- Difficulty falling and staying asleep
- Excessive daytime sleepiness
- Inverted sleep-wake cycles like sleeping during the day and being awake at night
- Waking earlier than desired
- Fatigue
- Headaches
- Depression
- Irritability
Treatment Options for Circadian Rhythm Sleep Disorders
The specific treatments for circadian rhythm sleep disorders in seniors will depend on the specific disorder, the health of the individual, and their current lifestyle.
Treatment options for CRSD include:
Sleep Behavior Adjustments
Sleep hygiene is a set of habits, behaviors, and environmental factors that can help the brain and body prepare itself for a restful sleep.
Good sleep hygiene can help seniors avoid significant sleep disruptions.
To improve sleep hygiene, try to:
- Keep the bedroom dark, cool, and quiet
- Limit naps to earlier in the day and for no longer than 30 minutes
- Get some exercise, especially outdoor exercise
- Turn off the television and avoid screen time at least 1 hour before bedtime
- Eat a healthy diet rich in fruits and vegetables
- Avoid or limit alcohol, caffeine, and tobacco after lunchtime
- Avoid liquids and large meals before bed
- Use the bed for sleeping and intimate activity only
- Set a consistent time for going to sleep and for waking
- If you cannot sleep, get up and do something else
These practices can help strengthen the connection in the brain between bed and sleep.
Adjust Lighting
The SCN is connected to the eyes. Bright light keeps us awake while dim light can help us prepare for sleep. This makes sense when you consider natural daylight and the typical sleep-wake cycle.
Whenever possible, try to use bright lighting in the morning to help you wake up and switch to dimmer light in the evenings.
Cool light has a lot of blue wavelengths which can stimulate the brain. Limit blue light exposure to daytime. This includes limiting screen use as you near bedtime. Warm, yellow, light can help you prepare for sleep.
Medication
Sometimes, medications or supplements can help with CRSD.
Melatonin supplements or sleep medication can help the body correct its clock and reset the circadian rhythm.
Before trying any supplements or medications, consult your healthcare professional. They can help you determine if this is a direction that works well for you. You want to be mindful of medication interactions.
Melatonin can make people very drowsy during waking hours so you want to have professional support when navigating dosages to find the best fit for you.
Seek Support for Circadian Rhythm Sleep Disorders
Circadian rhythm sleep disorders can be disruptive at any stage of life. But for seniors, it can be particularly complicated as disruptive sleep can exacerbate other conditions.
Some level of sleep disturbance is a normal part of aging as our hormones and bodies change but persistent and chronic problems sleeping can be a sign that something bigger is going on.
If you or a loved one are finding it difficult to sleep, especially after making the lifestyle adjustments listed above, it is important to speak to your health care provider. It is possible that cardiovascular disease or some other illness is the root of the problem. Addressing or properly managing that condition could improve sleep quality.
At Care Indeed, we understand the complications posed by sleep disorders in seniors. We can work with you or your loved one to create a personalized care plan that supports the efforts to promote better sleep.
Whether at home or in a long term care facility, our caring and experienced team can address your unique needs and increase quality of life.
Contact us today for quality senior care in the Bay Area.
