The identification and management of sleep disturbance in older patients is a critical, but often overlooked, aspect of offering high-quality care for this population. In fact, 40-70% of older adults have chronic sleep issues, with up to half going undiagnosed.
Significantly, a recent study found that the risk of dementia was higher and associated with adults in their 50s and 60s with a sleep duration of less than six hours. This emphasizes the importance for older adults to not only be screened for sleep disorders, but also to maintain and improve their sleep quality.
Poor sleep has been linked to chronic inflammation, which can lead to functional impairment and declining health. One study found that cognitive impairment was a key predictor for placing older adults into a long-term care facility. What’s more, frequent nocturnal wakefulness increases caregiver burden and stress.
Causes of sleep issues among older adults include snoring, pain and discomfort, nighttime urination, SBD, OSA,restless leg syndrome, REM sleep behavior disorder (RBD), medication side effects andsedentary lifestyle.
Sleep disorders are often associated with breathing issues, such as sleep disordered breathing (SDB)—a potentially serious sleep disorder in which breathing repeatedly stops and starts—and obstructive sleep apnea (OSA)—repeated collapse or partial collapse of the upper airway.
Health leaders and healthcare professionals should take sleep issues into consideration when providing “whole patient” care and understand the impact of breathing issues that often lie at the root of disrupted sleep.
Sleep deprivation has been linked to increased risk of developing chronic conditions, such as obesity, diabetes, high blood pressure, heart disease, stroke and mental illness. It has also been associated with growth hormone deficiency and elevated cortisol levels, both of which have been linked to obesity.
Poor sleep quality can also impair metabolism and lead to significantly increased risk for diabetes. Shorter sleep times in individuals treated with both insulin and oral glucose-lowering medication have been associated with higher risks of all-cause and cardiovascular disease mortality.
Nonpharmacological approaches to treating sleep issues among older adults include relaxation techniques, improving sleep hygiene and cognitive behavioral therapy (CBT). These options can be effective even for older adults with cognitive impairment.
CBT should consist of 6 to 10 sessions with a trained therapist that focuses on cognitive beliefs and counterproductive behaviors that interfere with sleep. Relaxation techniques include progressive muscle tensing and relaxing, guided imagery, paced diaphragmatic breathing or meditation.
Common among older people, SDB can lead to cognitive impairment, mood changes, compromised quality of life—often attributed to reduced social functioning and vitality—and higher risk of stroke and comorbidities, with up to 50% of patients with mild symptomatic chronic heart failure having SDB. Untreated OSA can lead to Type 2 diabetes, high blood pressure, congestive heart failure, atrial fibrillation, stroke and other cardiovascular problems.
Treatments for breathing issues include weight loss, smoking cessation and increased cardiovascular exercise, enhanced sleep opportunity and environment, optimized medical management of comorbidities, and reduction in caffeine, alcohol and sedatives.
Continuous positive airway pressure (CPAP) therapy is a common treatment for OSA. CPAP pushes air into the airways to keep them open with a pump that controls airflow, a tube carrying air from the machine to the user, and a mask that goes over the mouth, nose or both. Typical problems with CPAP, however, include discomfort, leaky mask, trouble falling asleep, stuffy nose and a dry mouth. Other treatments include oral appliances, surgery and sleep aid devices.
Sleep aid devices, such as airway stents that are inserted in the nose for up to 18 hours, support natural nasal breathing and optimize health by filtering, warming and humidifying inhaled air. This protects the lungs, leads to better oxygen supply to the body, stimulates the calming nervous system, and reduces snoring and SDB. All of these factors contribute to a stronger immune system and improve quality of life.
Stents enable better airflow for easier breathing during the day or night and representative a promising alternative to sedatives, which impair memory and focus among older adults.They have also been shown to mitigate symptoms of chronic sinusitis and other quality of life conditions, such as allergies, rhinitis, chronic rhinitis, sinusitis, allergic rhinitis and many autoimmune diseases.
Jack Huber is president of Alaxo Airway Stents