By Brandon R. Peters, MD
As my 81-year-old grandma likes to remind me on occasion, "It's hell to get old." More than a nuisance, the cumulative decline that comes with aging can significantly compromise one's quality of life and health. What if some of the problems so often associated with growing older didn't need to occur? Better yet, what if some of these physical and mental impairments could be reversed? Consider the role of sleep apnea as an unexpected contributor to many ailments erroneously attributed to aging and the reversals possible with effective treatment.
Sleep Changes with Age
It is clear that sleep changes as we become older. In 2015, the National Sleep Foundation altered its recommended sleep needs for people who are older than 65 years (1). Previously, adults were encouraged to get 7 to 9 hours of sleep. Now it is suggested that older adults may only need 7 to 8 hours of sleep to feel rested. It may not be possible to sleep more. This is an important shift as it has implications in the development of insomnia.
If you need 7 hours of sleep at an older age, but you continue to spend 8 or even 9 hours of time in bed, you will start to spend more and more time awake at night. It will take longer to fall asleep. If you wake, it may take longer to fall back asleep, especially towards morning. This poor sleep may result in an earlier bedtime ("I'm tired--I'm going to bed.") or difficulty waking at a regular time. These changes only make the insomnia worse as excessive time is spent in bed (2).
The quality of sleep as we age also worsens. Patients often remark, "I don't know if I am supposed to feel this way; I've never been this old before." It is more likely for older people to have chronic medical conditions that may compromise sleep. They may have more pain that can disrupt sleep. Their medications may impact sleep. They may also wake more to urinate. Sleep disorders like obstructive sleep apnea and restless legs syndrome also occur more as we age. Sleep apnea deserves special attention as it may lead to many symptoms that may be misattributed to natural aging.
The Role of Sleep Apnea in Aging-Related Complaints
Much like aging itself, obstructive sleep apnea sneaks up on you. It is insidious, and its role may be overlooked. Those who are widows or widowers, or who simply sleep in separate bedrooms, may lack a witness to its occurrence. Sleep apnea occurs when the upper airway partially or completely collapses during sleep, triggering an awakening or a drop in blood oxygen levels (3). The person who experiences it, and the person lying next to them, may not be aware of it. Though it is extremely common, its impacts on daytime function and health should not be dismissed.
Our risk for sleep apnea is always based in our anatomy--the structure of the nose, throat, and jaw--but it is certainly worsened by aging. Loss of muscle tone may play a role. Woman in particular experience a dramatic 10-fold increase in the incidence with the onset of menopause (4). As estrogen and progesterone levels fall off, the muscle tone of the airway declines. The symptoms associated with this transition include night sweats, fragmented sleep, insomnia, snoring, weight gain, mood problems, and cognitive complaints. All of these are also symptoms of sleep apnea.
In fact, many of the symptoms we may associate with someone who is getting older may be linked to sleep apnea. Consider the following examples:
• Waking to urinate (nocturia)
• Daytime sleepiness
• Naps or dozing
• Fragmented sleep
• Early morning awakenings
• Heartburn at night
• Teeth grinding (bruxism)
• Mood problems (anxiety, depression, and irritability)
• Cognitive complaints (short-term memory, concentration, and attention)
Beyond these symptoms, there are important health consequences associated with untreated sleep apnea (5). It worsens high blood pressure (hypertension) and diabetes. It is strongly linked to atrial fibrillation. It may lead to a heart attack, stroke, or sudden death. It exacerbates heart failure. Poor sleep worsens pain tolerance. In addition, sleep apnea contributes to the development of dementia. How many older people do you know with one or more these problems? Probably every single one.
The Fountain of Youth: Reversing Sleep Apnea
The key difference between symptoms and disorders that are part of natural aging and those that are caused by sleep apnea is that treating sleep apnea will reverse the problems. If you have daytime sleepiness because you have fragmented sleep at night from sleep apnea, this sleepiness will go away when the sleep apnea does. If your high blood pressure isn't "essential" or "idiopathic" (of an unknown cause) or "familial," but instead is due to unrecognized sleep apnea, it will improve with treatment (6). As discussed previously, sleeping pills may not be the cause of dementia, but sleep apnea might be.
There are effective treatments for sleep apnea ranging from the use of continuous positive airway pressure (CPAP) therapy and oral appliances to positional therapy, weight loss, and treating allergies. First, you have to learn if you have the condition by seeing a board-certified sleep medicine physician and having a diagnostic test. Then, you have to start using an effective treatment that resolves your condition. If your symptoms improve, as they very well might, you have discovered a secret that many are still learning.
Modern medicine is often employed like a map to the fountain of the youth, seekers pursue remedies to reverse the ravages of aging, distracted by empty promises masquerading as hope. Sleep apnea may be an extraordinary exception that proves the rule. Some may argue that it is a natural part of aging--but so might be tooth decay without intervention. There is no reason to live your remaining years in unnecessary decline.
Sleep apnea and its impacts are reversible. If you have symptoms of sleep apnea, get tested and treated, and see if some of the ailments previously attributed to aging go away. By doing so, you will not only add years to your life, but life to your years.
And yes, my grandmother has treated her sleep apnea, and she feels better.
1. "National Sleep Foundation Recommends New Sleep Times." National Sleep Foundation. Published February 2, 2015.
2. "Shorter Time in Bed May Protect Against Chronic Insomnia." Penn Medicine. Published June 10, 2016.
3. "What Is Sleep Apnea?" National Institutes of Health. Published July 10, 2012.
4. Bixler EO et al. "Prevalence of sleep-disordered breathing in women: effects of gender." Am J Respir Crit Care Med. 2001;163:608-613.
5. Collop, N. "The effect of obstructive sleep apnea on chronic medical disorders." Cleveland Clinic Journal of Medicine. 2007 74:1.
6. Iftikhar IH et al. "Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis." Journal of Hypertension. 2014;32(12):2341-2350.
Brandon R. Peters, MD, is the creator of the Insomnia Solved program, the writer on sleep for Verywell.com, a neurology-trained sleep medicine specialist at Pulmonary and Sleep Associates of Marin in Novato, Calif., and consulting assistant professor at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. To learn more, visit us at: sleep.stanford.edu.