Evie Summers
Sleep patterns tend to change as people age. Older adults spend a lower percentage of their sleep time in REM sleep compared to younger adults, and the time it takes to fall asleep increases. The number of arousals and total time awake after falling asleep also increases with age. REM Sleep Behaviour Disorder (RBD) is a sleep disorder that predominantly affects older adults, causing patients to act out their dreams, which are often violent. RBD is associated with neurological diseases such as Parkinson's, Lewy Body Dementia, and multiple system atrophy. Treatment for RBD is pharmacological and behavioural, with Clonazepam being an effective medication.
| Characteristics | Values |
|---|---|
| REM sleep behaviour disorder (RBD) | A sleep disorder that predominantly affects older adults, in which patients appear to be enacting their dreams while in REM sleep. |
| RBD behaviours | Typically violent, in association with violent dream content, leading to serious harm to the patient or their bed partner. |
| RBD prevalence | 0.4–0.5% in adults, but much higher in certain neurodegenerative diseases, especially Parkinson's disease, Lewy Body Dementia, and multiple system atrophy. |
| RBD risk factors | Higher in males than females, with a mean age of onset of 60.9 years. |
| RBD diagnosis | Detect loss of muscle atonia during REM sleep using PSG with EEG and EMG. |
| RBD treatment | Pharmacological and behavioural treatments, such as Clonazepam and Melatonin. |
| Sleep patterns in older adults | Changes in the quality and duration of sleep, with a harder time falling asleep and more frequent awakenings. |
| Total sleep time | Remains the same or slightly decreases (6.5 to 7 hours per night) in older adults. |
| Deep sleep | Older adults spend less time in deep, slow-wave sleep and REM sleep compared to younger adults. |
| Circadian rhythms | Circadian rhythms change with age, leading to disrupted sleep patterns and an earlier sleep-wake cycle. |
| Sleep disorders in older adults | Sleep-disordered breathing, insomnia, circadian rhythm sleep-wake disorders, and parasomnias, including RBD, are common in older adults. |
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What You'll Learn
REM sleep behaviour disorder (RBD)
RBD occurs due to a lack of normal muscle atonia during REM sleep, which is when the body is typically paralysed. This results in vigorous motor behaviours related to dream reenactment. The violent nature of the actions during RBD can lead to serious harm to the patient or their bed partner. Therefore, preventive measures are recommended to improve the safety of the sleep environment, such as using a hospital-style bed with padded and raised side rails and removing any sharp or heavy objects from the immediate sleeping area.
The diagnosis of RBD is done using PSG with EEG and EMG to detect the loss of muscle atonia during REM sleep. Treatment for RBD is both pharmacological and behavioural. Clonazepam is an effective medication, but potential adverse consequences in older adults must be considered. Melatonin is another alternative therapy that is better tolerated by older individuals.
RBD is significantly more common in males than females. It is often associated with neurological diseases, and in some cases, RBD may precede the onset of neurodegeneration by several years. The five-year risk of developing a neurodegenerative condition after the onset of RBD ranges from 18 to 45%. Therefore, careful neurological monitoring and patient counselling are necessary to manage RBD effectively.
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Circadian rhythm changes
Circadian rhythms change as people age, often leading to disrupted sleep patterns. The circadian rhythm, controlled by the SCN, influences when people get hungry, when the body releases certain hormones, and when a person feels sleepy or alert. As people get older, the function of the SCN deteriorates, which can disrupt circadian rhythms and directly influence when people feel tired and alert. Circadian rhythm sleep-wake disorders occur frequently in older adults.
Research shows that older adults go to sleep earlier in the evening and wake up earlier in the morning due to the progressive advancement of the circadian rhythm. Older adults also spend a lower percentage of their sleep time in REM sleep compared to younger adults. The percentage of REM sleep decreases about 0.6% per decade, with the best estimate of when this decline stops being the mid-70s. However, a small increase in REM sleep is observed after this point due to an increase in REM minutes, even as total sleep time continues to decline.
Older adults also experience a decrease in melatonin secretion, which contributes to the dampening of the circadian rhythm amplitude. Melatonin supplements are safe for short-term use and can help older adults fall asleep more quickly. However, it is important to note that melatonin should only be used as recommended and under the guidance of a healthcare provider.
Additionally, older adults may benefit from improving their sleep hygiene and developing habits that encourage quality sleep. This includes maintaining a consistent sleep schedule, avoiding stimulants before bed, and creating a relaxing bedtime routine. While naps during the day can help improve sleep quality, it is recommended to avoid napping too frequently or for too long, as this can disrupt nighttime sleep.
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Insomnia
The sleep architecture of elderly people differs from that of younger individuals. Polysomnographic studies have shown that older people experience a lower percentage of slow-wave NREM and REM sleep, resulting in more frequent awakenings during the night and affecting their alertness in the morning. Additionally, the deepest stages of non-REM sleep are often reduced or non-existent in the elderly, although REM sleep tends to be preserved. Age-related changes in the circadian rhythm can also contribute to insomnia, as older adults tend to go to bed earlier and wake up earlier.
Several factors can influence insomnia in the elderly, including poor sleep habits such as irregular sleep-wake times and daytime napping. Certain substances like caffeine, alcohol, and specific medications can also interfere with sleep. Furthermore, underlying health conditions such as restless leg syndrome, periodic limb movement disorder, and sleep apnea can disrupt sleep patterns. It is important to address insomnia and its underlying causes, as sleep deprivation can lead to confusion and other mental health issues.
Treating insomnia in the elderly may involve implementing good sleep habits, daily physical activity, and improving sleep hygiene. While melatonin supplements and certain medications can aid in falling asleep, it is important to consult a healthcare provider before using any sleep aids, especially in older adults. Cognitive behavioural therapy has also been found to be helpful for persistent insomnia.
In summary, insomnia is a prevalent sleep disorder that affects many elderly individuals, leading to difficulties falling asleep or staying asleep. Age-related changes in sleep architecture and circadian rhythms contribute to insomnia in older adults. Treatment options include improving sleep habits, seeking medical advice for underlying conditions, and considering cognitive behavioural therapy for persistent cases.
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Less deep sleep
Sleep patterns tend to change as people age. Older adults spend less time in deep sleep and REM sleep compared to younger adults. Older people wake up more frequently during the night and earlier in the morning, and spend more time napping during the day.
There are several reasons for this change in sleep patterns. Firstly, the body's internal clock, located in the hypothalamus, undergoes changes with age, affecting the duration and quality of sleep. Circadian rhythms, which influence sleep patterns, also change with age. The circadian rhythm begins to shift earlier after the age of 20, causing older adults to feel sleepy earlier in the evening and wake up earlier in the morning.
Additionally, older adults experience a decrease in melatonin secretion, which contributes to changes in sleep patterns. Melatonin supplements may be helpful in promoting sleep for older adults, but should only be used short-term. Other recommendations for improving sleep hygiene in older adults include maintaining a consistent sleep schedule, avoiding stimulants such as caffeine, and creating a relaxing bedtime routine.
One notable sleep disorder that affects older adults is REM Sleep Behaviour Disorder (RBD). RBD is characterised by vigorous movements and the enactment of dreams, often with violent content. This disorder is associated with neurological diseases, particularly Parkinson's disease, Lewy Body Dementia, and multiple system atrophy. The risk of RBD increases with age, especially in older men, and can lead to self-injury or harm to bed partners. Treatment options for RBD include pharmacological interventions, such as Clonazepam, and behavioural measures to improve sleep safety.
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Risk of self-harm
Sleep patterns change as people age. Older adults spend less time in deep sleep and REM sleep, and they experience more disruptions during the night. These changes can be attributed to the body's internal clock, or the hypothalamus, which controls the circadian rhythm. Circadian rhythms influence when people feel sleepy or alert, and they tend to shift earlier as people age.
One notable sleep disorder that affects older adults is REM Sleep Behaviour Disorder (RBD). RBD is characterised by vigorous motor behaviours related to dream reenactment. During REM sleep, patients with RBD appear to act out their dreams, which are typically violent. This poses a significant risk of self-harm and harm to their bed partners. The prevalence of RBD in older adults is estimated to be between 0.38% and 0.5%, but it is much higher in neurodegenerative diseases like Parkinson's disease, Lewy Body Dementia, and multiple system atrophy.
The risk of self-harm in RBD is heightened due to the violent nature of the enacted dreams. Patients may punch, kick, or flail their limbs, leading to potential injuries such as bruises, cuts, or broken bones. The risk of self-harm is also influenced by the sleep environment, such as the presence of sharp or heavy objects nearby. Additionally, older adults with RBD may have underlying neurological conditions that further increase the risk of self-harm during sleep.
To mitigate the risk of self-harm, several preventive measures can be implemented. These include modifying the sleep environment by removing potential hazards, using a hospital-style bed with padded side rails, and considering separate sleeping arrangements for bed partners. Additionally, medical treatments like Clonazepam and Melatonin can be prescribed to manage RBD symptoms, although potential side effects in older adults should be carefully considered.
It is important to note that RBD can often precede the onset of neurodegenerative disorders by several years. Therefore, early diagnosis and treatment are crucial to minimise the risk of self-harm and improve overall sleep quality in older adults with RBD.
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Frequently asked questions
REM stands for rapid eye movement sleep. It is a stage of sleep during which the eyes move rapidly, and the body is temporarily paralysed.
Older adults spend a lower percentage of their sleep time in REM sleep compared to younger adults. Research has shown that the percentage of REM sleep decreases by about 0.6% per decade.
RBD is a sleep disorder that predominantly affects older adults. People with RBD may physically act out their dreams, sometimes violently. RBD is associated with neurological diseases, most often Parkinson's disease, Lewy Body Dementia, and multiple system atrophy.
Older adults can improve their sleep by focusing on improving sleep hygiene and developing habits that encourage quality sleep. This may include avoiding stimulants such as caffeine, exercising regularly, and practising relaxation techniques before bed.
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