Disrupted sleep and daytime sleepiness in older adults

May 19, 2019 @9.51pm

healthcaretoday, sleep apnea, daytime sleepiness, disrupted sleep, tiredness, CPAP, obesity, snoring

Apneic spells may result in feeling unrested after a night's sleep, experiencing daytime sleepiness, or waking up with a headache.

By Dato Dr Rajbans Singh
Consultant physician and geriatrician
Pantai Hospital

Sleep apnea is a serious disorder in people aged over 65 years old that causes your breathing to stop repeatedly while you sleep.

The term “apnea” means the absence of or without breathing (“a” – meaning without and “-pnoia” – meaning breathing). Sleep apnea is diagnosed by the presence of at least five apneas within an individuals sleep cycle. The effects of no oxygen getting into the lung and ultimately into the blood stream during sleep (blood-oxygen saturation) can be devastating.

Types of sleep apnea
There are few types of sleep apnea; obstructive sleep apnea (OSA), central sleep apnea and mixed sleep apnea.

Obstructive Sleep Apnea (OSA)
OSA is the most common type of sleep apnea.

A common cause is enlarged tonsils or adenoids, overweight or the tone of the muscles are weak.

When you sleep at night, the muscles collapse which causes breathing difficulty. Basically, you are experiencing 'apneic spells’, where there’s a lack of oxygen to the brain which causes you to stop breathing for a while. The brain then sends the message to wake up, before you go back to sleep again.

This happens up to four to 30 times a night, which can be quite bad. You might feel not rested after a night's sleep, feeling sleepy during the day or wake up with a headache.

Your bed partner may notice that while you sleep; you stop breathing, often snore loudly, gasp or choke and that you toss and turn.

Central Sleep Apnea
This type of sleep apnea still occurs quite frequently but it does not occur due to physical blockages to the air passage.

The central type is associated to neurological disease such as Parkinson, stroke, dementia, heart conditions such as atrial fibrillation which affects the gate - more of a central core where the message to the brain is not sent to say that they’ve stop breathing for a while.

Mixed Sleep Apnea
This is simply a mixture of both obstructive and central sleep apneas.

Preventing sleep apnea
Obesity is one area that aggravates sleep apnea. You may be able to treat mild sleep apnea by getting outside and exercising. Not only does it help you feel better during the day, but helps you relax when the day comes to a close.

Creating a healthy bedtime routine such as going to bed at the same time and waking up at the same time helps your body get the sleep it needs.

Avoid alcohol as studies have shown that alcohol actually limits the depth into which you can sleep, and therefore, you do not reach the brain-healing deep sleep. This results in tiredness the following day, even if you went to bed early.

Limit nighttime snacking as it causes heartburn and weight gain. Heartburn is uncomfortable when you are upright and when you lie down, it gets even worse.

Treatment
If lifestyle changes doesn't help, you may need to use a continuous positive airway pressure (CPAP) machine that helps you breathe while you sleep. CPAP works by gently blowing pressurized room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a “splint.”

The pressure is set according to the patient’s needs at a level that eliminates the apneas that cause awakenings and sleep fragmentation.

Untreated sleep apnea can lead to serious problems such as high blood pressure, an abnormal heart rhythm, heart failure, coronary artery disease (CAD) or stroke, depression and diabetes.