Sleeplessness brings dreams of relief, cause for hope


July 20, 1993|By Judy Foreman | Judy Foreman,Boston Globe

Some lucky souls sleep like babies, no matter what their age.

But for 40 million of us, sleep disorders are a chronic misery, and for 20 to 30 million more, they are an intermittent problem, a national commission on sleep reported recently.

All of which might be bearable if we could look forward to sleeping better after the kids leave home, say, or after our midlife crisis is history, or when retirement finally means we don't have to get up early for work.

But it doesn't happen that way. Sleep typically gets worse the older we get -- and contrary to popular wisdom, the need for it doesn't decline with age.

After age 65, a whopping 52 percent of people who live at home report significant sleep disturbances, according to psychologist Andrew Monjan, chief of the neurobiology of aging division of the National Institute on Aging. And for those who live in nursing homes, the news is even worse.

The underlying biological cause of much of the poor sleep in later life is believed to be the deterioration of the "clock" in the brain that controls waking and sleeping. Instead of running down as cells die off, the aging clock actually speeds up, pushing body rhythms and triggering earlier onset of sleep in the evening and earlier wake-up times in the morning.

As a result, while young and middle-aged insomniacs often can't fall asleep until the wee hours and struggle to wake up at 7 or 8 a.m., many older people can't stay awake past 8 or 9 p.m. and wake up earlier than they want, often at 3 or 4 a.m.

Compounding this biological problem are the common bad habits of later life -- keeping rooms so dark the brain never knows whether it's day or night, napping on and off all day, or going to bed in the early evening out of loneliness and boredom.

Age can also bring on other sleep-destroying miseries, such as insomnia caused by drugs prescribed for other conditions, pain from arthritis or other diseases and "restless leg syndrome," an irresistible urge to move the legs frequently.(For restless leg sufferers, by the way, the recommended treatment is Sinemet, a drug also used for Parkinson's disease.)

Worst of all may be sleep apnea, the repeated cessation of breathing that affects 30 percent of people over 65. Though many sufferers don't know they have it, apnea can be fatal -- it deprives the heart and brain of oxygen. And even when it's not, it causes acute daytime sleepiness because the extreme need to breathe rouses the sleeper to near-waking every few minutes all night, according to Dr. John Winkelman, director of McLean Hospital's sleep disorder unit.

Dr. Winkelman says the best treatment for apnea is CPAP, or continuous positive airway pressure. Several companies make mask-like devices that, like reverse vacuum cleaners, gently pump room air into the nose to keep the airway open.

But for most people, it is the inappropriate timing of sleep and plain old insomnia that are the greater scourges of later life.

Drugs work initially

Too often, many older people turn to drugs. Older insomniacs are the group most likely to be given sleeping pills -- particularly nursing home residents, but at-home patients as well. Although pills help ease sleeplessness for a couple of weeks, they generally make things worse over time.

Fortunately for older night owls, research shows that a couple of nondrug treatments -- exposure to bright light in the evening and behavior modification -- can be very effective against age-related sleep problems.

Light is one key because it acts on the retina, which is connected by nerves to the biological clock, or suprachiasmatic nucleus, which sits at the base of the brain behind the eyes.

Human biological clocks actually seem to run on a more-than-24-hour cycle. But by using sunlight every day to reset their clocks, people bring themselves back into sync with the world.

Scientists have shown that if cells in the biological clocks of older hamsters are removed, simulating the cell loss of aging, the clocks start to run amok, ticking faster and loosening some of the normal controls over daily rhythms.

Dr. Charles Czeisler, director of circadian and sleep disorder medicine at Boston's Brigham and Women's Hospital, has shown that the same appears to be true in older people whose clocks run too fast, making the body "think" it's bedtime too early in the evening.

Though going to sleep early isn't itself a problem, he notes, waking up at 3 or 4 a.m. -- the chief complaint of 5 million older Americans -- certainly can be.

"It's very exasperating," he says. "That's a very unsocial time." And for caretakers, having an older person up regularly at 3 a.m., he notes, may be "the last straw that leads to institutionalization."

Body temperature

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