1999-12-22 14:34:00
Larry Schuster - WebMD

(WebMD) -- Sleep: that treasured time of rest and relaxation. For many, it's as easy as turning off the light and pulling up the covers. But for some -- including many older people -- sleep is a challenge.

Insomnia affects up to one-half of healthy seniors, according to the Emory University Sleep Disorder Center in Atlanta. It's even more likely in older adults, who may have medical or psychiatric illnesses that interfere with sleep.

But as sleep research progresses, insomnia among the elderly is becoming less of a mystery. Some new studies, for instance, suggest that altered sleep patterns are just a natural progression of aging.

Contrary to popular belief, changed sleep patterns are not caused by dwindling levels of melatonin -- the so-called sleep hormone -- according to a study published in the November 1999 issue of the American Journal of Medicine.

Boston researchers found new evidence indicating that the elderly have about as much of the natural hormone as people who are much younger. This would seem to rule out melatonin levels as a factor in insomnia in the elderly. So if melatonin supplements aren't going to work, what will? It depends on the cause of the sleep problem.

A symptom with a cause

Many cases of insomnia are caused by underlying but very treatable causes. Insomnia, rather than being a distinct condition of its own, "is best thought of as a manifestation of many conditions," says Mark Mahowald, M.D., director of the Minneapolis Regional Sleep Disorders Center. "There's no one treatment that can be applied for the complaint of insomnia."

The researcher says "restless legs syndrome," for example, affects about 10 percent of adults, or up to 12 million people in the United States. People with this syndrome experience abnormal sensations when they go to bed. They describe the feelings as tingling, cramping, burning, creeping, itching, pulling or aching. Other descriptions include numbness, a crawling sensation or the feeling that water is flowing under the skin, pins and needles or an "antsy" feeling.

"It's so easy to treat, and regrettably a sizeable portion of practicing physicians are unfamiliar with the condition," Mahowald says. Taking vitamins or eliminating caffeine, for instance, can help.

Learned by experience

Others have conditioned or learned insomnia, Mahowald says. People who have had heart attacks or have suffered a loss, for instance, will naturally have trouble sleeping. If they lie in bed and try to force themselves to sleep, their bodies eventually learn not to sleep.

"If this goes on for five to seven nights, the original cause -- which may be very legitimate -- has disappeared, but the learned response persists," Mahowald says.

Mahowald puts such patients in a program to teach them how to sleep again -- usually without sleeping pills, which are no cure either.

Other approaches

Sleeping pills are usually approved by the Food and Drug Administration for use up to two weeks. But some people use them for years, and for them the drugs may be more of a psychological boost than a real sleep aid, says Charles M. Morin, M.D., of the school of psychology at the Universite Laval in Quebec.

In his research, to be published in the Journal of Gerontology next spring, Morin found that the sleep of people who use sleeping pills was just as disrupted as those who don't.

Behavioral modification may be the way to go, suggests a study published in the March 17, 1999 issue of The Journal of the American Medical Association. Drug therapy, the researchers concluded, was more effective for short-term management of insomnia.

For long-term improvements, the researchers found that changing habits, sleep schedules and beliefs made a difference for many of the patients -- many of whom held the assumption that eight hours of sleep every night was necessary.

Just how much sleep older people need is a matter of dispute. Several researchers, including Morin, say they believe seniors' sleep needs are no different than they were when they were younger. It's just that their sleeping becomes more fragile.

But Charles Pollak, M.D., director of the division of sleep medicine at Ohio State University, has uncovered new evidence that suggests older people simply don't need as much sleep. "They're not only sleeping less, but they need less," he says.

But while most seniors need less sleep, says Pollak, they still plan for the same eight hours in bed. What's more, older people are often unaware that it's normal for their sleep patterns to shift as they age. They feel sleepy earlier in the evening than they're used to, and wake up earlier in the morning. This causes many to think they aren't getting a full night's rest, says Pollak.