Sleep disorders across the lifespan

Sufficient sleep is an important health behavior across the adult lifespan. Factors that can contribute to insufficient sleep range from lifestyle to environmental changes. Insufficient sleep has also been associated with other conditions such as obesity, mortality and cardiometabolic disease (Grandner, 2012). Short sleep duration is identified by CDC (2017a) as less than seven hours in a twenty-four-hour period. Variations exist in short duration of sleep based on age, gender, socioeconomic status and geographic region. Other health risk factors influence sleep duration such as excessive alcohol, physically inactive, current smoker, and obesity (CDC, 2017).

One of the objectives of Healthy People 2020 is to increase the proportion of adults with sufficient sleep (ODPPM, 2019). In 2008, sixty-nine percent of adults had reported sufficient sleep. In North Carolina, 35% of the white population had short sleep duration of less than seven hours and blacks had a short sleep duration of 39.6% in 2014. (Sleep and Health, 2014). The lowest sleep duration of less than seven hours was found among Asians at 24.7%. Short sleep duration amongst genders in North Carolina showed no significant difference with men at 32.5% and women 32.3% (Sleep and Health, 2014). The age range with the highest percentage of short duration of sleep was between the age range of 45-54 at 35.6% in North Carolina (Sleep and Health, 2014). Based on the surveillance survey in North Carolina, sleep related health factors was more prevalent in adults with obesity followed by physical inactivity, current smoking and excessive alcohol (Sleep and Health, 2014). In North Carolina, chronic disease associated with insufficient sleep are highest among adults with arthritis, depression and asthma. In the United States (U.S.), southeastern states had the highest rate of short sleep duration of less than seven (2017). According to CDC (2016), people who were married had a higher healthy sleep duration compared to those who were never married, divorced, separated or widowed.

Sleep disorder is characterized by any alteration in sleep pattern.  According to CDC (2016), one in three adults do not get enough sleep. It can be classified as acute or chronic and patients may report problems initiating sleep, problems maintaining sleep or awaking early. Sleep disorders in older adults are likely due to age related changes and circadian rhythm. Shorter duration of sleep and sleep efficiency was associated with older age in men and women. Short nighttime duration of sleep is associated with increased risk for falls and fractures in the older population (Suzuki, Miyamoto, & Hirata, 2017). Sleep disordered breathing (SDB) is common among elderly patients who also have comorbidities and polypharmacy which may increase with age.  SBD describes disorders affecting respiratory patter or quantity of ventilation that occurs during sleep. In the elderly population it may be associated with sleep apnea. Elderly who develop SBD may be due to decreased laryngeal function as well as nocturia, which is common for older adults (McMillan & Morrell, 2016).

The U.S. Centers for Disease Control and Prevention, reported about twenty percent of all women aged 40 to 59 years old have trouble falling asleep on four or more nights in the prior week (CDC, 2017b).  In a twenty-four-hour period, among this age group 56% perimenopausal women were more likely to sleep less than seven hours than postmenopausal at 40.5% (CDC, 2017b). During times of hormonal change, women are more vulnerable to short duration of sleep of less than seven hours.  A recent observational study by Women’s Health Initiative Observational Study (WHI-OS) determined a significant association between sleep duration, insomnia, and sexual activity (Kling, Manson, Naughton, Temkit, Sullivan, Gower, Hale, Weitlauf, Nowakowski, & Crandall, 2017). Aging in men ranging between 45–75 years old is also associated with sleep problems. Sleep plays a significant role in the rate of testosterone secretion therefore the quality sleep pattern is important in satisfiable erection (Charandabi, Rezaei, Hakimi, Khatami, Valizadeh, & Azadi, 2016). From a socioeconomic status (SES) perspective, people living in areas where there is a high rate of crime and noise have more sleep disturbance than those in low crime areas (CDC, 2017a). Lower levels of education and unemployment is also associated with poor sleep quality. Other factors which contribute to sleep disorder include shift work, demands on the job, and stress.

The annual medical cost of sleep disorders is estimated at $16 billion dollars in addition to costs for lost productivity (Healthy People 2020, 2013). Sleep disorders account for approximately $16 billion.  Sleep disorders is also emerging as a global epidemic in western countries from Asia to Africa. The issue of sleep disorder in these countries may be unrecognized by public health due to the multiple disease burdens along with the agenda of undernutrition, a high burden of infectious disease, and an emerging burden of noncommunicable diseases. Sleep problems can be correlated with sociodemographic areas, quality of life and comorbidities. The consequences of sleep problems include depression, impaired work performance, and work- related/motor vehicle accidents. Globally it is estimated about 10%–30% of the population, some even as high as 50%–60% suffer from sleep disturbance (Stranges, Tigbe, Gómez-Olivé, Thorogood, & Kandala, 2012).

Nonpharmacological treatments for insufficient sleep recommended for adults include stimulus control, going to bed only when sleeping, eating healthy meals, regular exercise, and avoidance of stimulants such as caffeine and tobacco and creation of a comfortable sleep environment (Suzuki et al., 2017). It is also recommended for patients to keep a sleep diary of their sleep habits at least ten days before a doctor’s visit. The sleep diary is used to identify patients sleep pattern. Patients should be record sleep patterns at least an hour before getting up in the morning.

The National Sleep Awareness Roundtable (NSART) which consist of a national coalition of government professionals, volunteers and other organizations, contributes to sleep awareness by providing training workshops on healthy sleep for primary care providers, producing free local initiatives to educate primary care health providers on sleep and sleep disorder. NSART also promotes Drowsy Driving Prevention Week and National Sleep Awareness Week to educate the public, and by publishing research findings (CDC, 2017b). There are also several organizations which provide practice guidelines and recommendations to clinicians regarding sleep health such as the American Academy of Sleep Medicine, American Thoracic Society, American College of Physicians, and the Agency for Healthcare Research and Quality. Clinicians should advise patients if they are experiencing insomnia, narcolepsy, restless leg syndrome or sleep apnea to seek medical attention by a healthcare provider or a provider specializing in sleep medicine. Primary prevention measures to promote healthy sleep involves education and collaboration with public health. If nonpharmacological interventions are not effective, patients should be evaluated further for other conditions and may also require pharmacological intervention.

References

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