February 5, 2017

Some Problems the Elderly Have for Sleep

A doctor writes the article I am using for this blog and she chooses to label it, ”5 Top Causes of Sleep Problems in Seniors.” I am certain that Dr. Leslie Kernisan understands this topic far better than I do, but I do feel she left much out of the discussion on sleep apnea.

There are several warnings that should be issued. First, even though mortality is mentioned, there should be a clear warning about obstructive sleep apnea causing death and/or heart attacks. Even central sleep apnea can cause serious health problems.

I have had sleep apnea since 1999 and have had treatment since 2001. I use a CPAP mask every night. I have progressed from the original CPAP to a machine known as a Bi-PAP machine, which is much quieter and more efficient. I am not like many people that have problems and either won't wear the mask or only use it part of the night. Two friends have moved to an oral device and say they like the device better than the mask. Two other friends like using the mask and are using their machine every night, like I do.

Doctors use a language seldom used by patients. Sleep apnea is no different. They use sleep-related breathing disorders (SRBD) and it is sometimes referred to as sleep-disordered breathing (SDB). The SDB is an umbrella term covering a spectrum of problems related to how people breathe while asleep.

Sleep apnea (as most patients know it) is a common condition, which is important to have diagnosed since it has been associated with many other health problems, especially in adults of middle age. In sleep apnea, a person has frequent pauses in their breathing during sleep. The most common form is obstructive sleep apnea (OSA), in which the breathing pauses are due to obstructions in the breathing passages. OSA is often associated with snoring. A less common form is central sleep apnea, in which the breathing pauses are related to changes in the brain.

The likelihood of having sleep-disordered breathing disorders goes up with age. It’s also more common in men, and in people who are overweight. In one study of 827 healthy older adults aged 68, 53% were found to have signs of SRBD, with 37% meeting criteria for significant sleep apnea. Interestingly, most participants did not complain of excess sleepiness.

Studies have found that untreated OSA is associated with poor health outcomes including increased mortality, stroke, coronary artery disease, and heart failure. However, studies also suggest that these associations are strongest in people aged 40-70, and weaker in older adults. For older adults with symptomatic OSA, treatment can reduce daytime sleepiness and improve quality of life.

Helpguide.org’s page on sleep apnea has a useful 7-item questionnaire, to help you determine how likely it is that symptoms are sleep apnea. It also has a discussion on sleep apnea. You can also ask the doctor about further evaluation if you’ve noticed a lot of daytime sleepiness. To be diagnosed, you’ll need to pursue polysomnography (objective sleep testing) either in a sleep lab or with a home sleep testing kit.

Whether or not you pursue an official diagnosis for SRBD, avoiding alcohol (and probably other sedatives) is likely to help.

Other problems listed by Dr. Kernisan in addition to the above:

#1. Sleep problems due to an underlying medical problem.

#3. Restless leg syndrome (RLS).

#4. Periodic Limb Movements of Sleep (PLMS).

#5. Insomnia.

In my research, I found an article in Newswise that covers the problems with oral devices for obstructive sleep apnea. You may read about it here. It does discuss a French study with this opening statement: In patients with severe obstructive sleep apnea (OSA), oral appliances that treat the condition by moving the lower jaw forward appear to improve sleep but not reduce key risk factors for developing heart and other cardiovascular disease, according to new research published online, ahead of print in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

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