Bad Sleep Leads to Early Death in Elderly

Poor Sleepers Were Twice as Likely to Die During 12-Year Period

From the WebMD Archives

Feb. 5, 2003 -- Sleep problems are common in the elderly, with more than half experiencing routine sleep disturbances that can affect their quality of life. Now new research suggests these disturbances may also lead to an earlier death.

The study of otherwise healthy older people found that those who routinely tossed and turned for 30 minutes or more before going to sleep or woke frequently during the night were twice as likely to die during follow-up as those without these sleep problems. Elderly subjects who spent too much or too little time in rapid eye movement (REM) sleep -- the sleep stage during which people dream -- were also at increased risk.

Researcher Mary Amanda Dew, PhD, says the findings indicate that even minor slumber difficulties could be an early warning sign of other health problems.

"Sleep problems may be subtle indicators that a person has something else wrong that is not yet pronounced enough to detect," Dew tells WebMD. "The people involved in our study had no obvious health problems, but the sleep changes we detected could have reflected unknown problems."

Dew and her University of Pittsburgh colleagues measured brain activity in 185 people between the ages of 60 and 90 during sleep. All the subjects were participants in studies conducted between 1981 and 1997, and all were perceived to be healthy and had no sleep complaints.

Twelve years later the researchers found that the 66 people who had died during that period had more sleep problems than participants who were still alive. They were more likely to lie awake for long periods during the sleep studies, they slept less efficiently through the night, and had abnormally high or low amounts of REM sleep. The findings are reported in the January/February issue of the journal Psychosomatic Medicine.

Sleep specialist David N. Neubauer, MD, tells WebMD that sleep disturbances tend to increase as people age for a variety of reasons, including more frequent use of medications that can interfere with sleep, illnesses, psychiatric disorders like depression or dementia, poor sleep habits and changes in circadian rhythms, also called sleep-wake cycles.

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"As we age, our circadian clock tends to shift and we get sleepy and wake up earlier," he says. "That means that someone who woke up at 6 a.m. during their working life might now be naturally waking up at 4 a.m. or even 3:30."

Because poor sleep and early waking are common signs of depression, he says many older people experiencing this normal circadian shift are mistakenly placed on antidepressants. .

"What we try to do is help people make time for sleep," he says Neubauer, associate director of the Johns Hopkins Sleep Disorders Center in Baltimore. "If someone is going to bed at the same time that they always have and waking up several hours earlier, that is a problem. They are not going to get the sleep they need."

Neubauer says circadian rhythm disturbances can often be minimized with light therapy, which involves reducing exposure to bright light in the morning and keeping the lights on for several hours during the evening. Some patients benefit from exposure to the therapeutic bright light boxes used to treat seasonal affective disorder (SAD).

His other recommendations for getting a good night's sleep include -

  • Cut back on or eliminate caffeine. He recommends that patients have no caffeine after lunch, but some people with sleep problems shouldn't have it at all.
  • Don't rely on alcohol for a good night's sleep. Neubauer says this strategy may help people get to sleep, but they will wake up more frequently during the night.
  • Keep naps short, or don't take them at all. He says naps are OK for some people, but those having trouble going to sleep at night might be better off without them.

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Sources

SOURCES: Psychosomatic Medicine, Jan/Feb 2003 • Mary Amanda Dew, PhD, professor of psychiatry, psychology and epidemiology, University of Pittsburgh School of Medicine • David N. Neubauer, MD, associate director, Johns Hopkins Sleep Disorders Center, Baltimore.
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