Older People and Sleep Reconsidered
Sometimes it seems that wisdom consists of admitting ignorance. For instance, a few years ago, we published a blog that summarized research, new at the time, showing that reduced sleep is a normal part of aging. We quoted Dr. Dave Hinda, the editor of Sleep Magazine who said, "We always thought the older you got, the more sleep you needed to rejuvenate…[But] the reason older folks need less sleep is because they get a better quality of sleep. That means the older the brain, the more effectively it cycles through the stages of sleep."
Now it seems that insight has gone the way of "the world is flat" theory. New research out of Beth Israel Deaconess Hospital in Boston and the University of Toronto Health Sciences Center tells us (or at least indicates) that reduced sleep among the elderly is not the function of better-quality snoozing, but rather, the result of losing brain cells.1 It turns out that there's a cluster of neurons in the brain that regulates sleep. When we're young, our brain has a generous supply of these neurons, and so they form a nucleus that acts as a sort of switch that turns the brain off for sleeping, and then turns it back on when it's wake-up time.
As we age, though, we lose brain cells along with skin tone and muscle mass, and that means the number of these regulatory neurons in our brain decreases. The new study shows not only that elderly people do, in fact, have a diminished supply of these neurons, but also, that having fewer of these neurons leads to disturbed sleep. According to study director Clifford Saper, MD, "The more of these cells you lose from aging, the harder time you have sleeping."
Apparently, by the time people reach their 70's, they sleep an hour-and-a-half less, on average, than they did in their 20's. Again, the reason isn't that they've lost the need for sleep. Rather, it's the result of brain cell die-off. The upshot is that older people often complain of insomnia and feel exhausted, plus, they age even faster. The relationship between lack of sleep and health conditions such as hypertension, diabetes, coronary disease, and cognitive decline has been well documented.
This research on the link between brain-cell die off and insomnia began in the mid 1990s with animal studies.2 Dr. Saper discovered back then that there was a group of neurons that essentially turned off the arousal system in the brains of rats to allow them to sleep. Rats lacking a sufficient supply of these neurons slept "only about 50 percent as much as normal [with] their remaining sleep being fragmented and disrupted." That research was followed in 1997 with human studies involving 1000 people who were recruited at age 65. Every few years thereafter, the subjects were asked to wear a device on their wrists for seven to 10 days so that their movements could be recorded. (Earlier research had shown that an excessive amount of nighttime movement is a good indicator of poor sleep.) The subjects also agreed to donate their brains to the research project upon their demise.
Sure enough, when Dr. Saper performed autopsies on the brains of the deceased subjects, he found that those brains with the fewest of the neurons belonged to individuals with the most disturbed sleep. Even more, those who had Alzheimer's had the most depleted supply of these neurons.
"The surprise finding was that people with Alzheimer's disease lose these cells particularly quickly," said Saper. "Those were the ones with the very fewest neurons and the most disrupted sleep."
As with most research that uncovers a deficit in the human machinery, these findings have lit the collective imagination of the pharmaceutical-minded. The experts want to develop medications that would simulate the action of the inhibitory neurons to help older people sleep well. Such medications, they say, might be particularly useful for Alzheimer's patients. If effective, they might prevent dangerous nighttime wanderings of those with Alzheimer's, even allowing them to avoid institutionalization.
Current pharmaceuticals, like Ambien, slow overall brain activity to promote sleep, but they aren't targeted to affect the particular region of the brain that these inhibitory neurons emanate from.3 Because they affect the overall nervous system, Ambien-like drugs have many undesirable side effects, plus they don't work that well. As Jon Barron pointed out in a 2007 blog, "…a new study from Oregon State University and the National Institutes of Health shows that sleeping pills don't really do very much. For an average of about $3.50 a pill, you fall asleep on average about 12.8 minutes faster than with a placebo -- and get about 11.4 minutes more sleep (again, on average) in total than the placebo group." Theoretically, at least, medications targeted to simulate the action of the missing neuron cluster should work far better for elderly patients.
As for the earlier-mentioned assertion that getting less sleep is fine for the aged, in separate new research, it turns out that disturbed sleep in the elderly correlates to a pronounced increase in suicide risk.4 In fact, a study of 14,456 seniors, out of the Stanford School of Medicine, found that sleep problems were a better indicator of suicide risk in the aged than even depression. Those subjects who reported poor sleep had almost a 50 percent higher likelihood of killing themselves compared to the well-rested subjects. The researchers said that since insomnia carries less stigma than other risk factors for suicide, it may be a particularly effective front to focus suicide prevention efforts on.
Perhaps the drug companies eventually will produce a miracle and figure out how to brew up a side-effect-free product that simulates the action of the missing neurons. In the meantime, if you're over age 65 and have been bothered by insomnia in spite of our earlier report that you should just accept sleeplessness as par for the course in your advanced years, you can try the natural, non-pharmaceutical insomnia remedies that Jon Barron has written about many times.
But keep in mind, every treatment we've talked about so far deals with the "effects" of an aging brain, not the "causes." With that in mind, you might want to consider a supplementation regimen that keeps your hormones in balance as you age, which not only helps slow down cognitive decline,5 but also helps maintain muscles mass. And you'll probably want to include an L-carnosine based formula to protect against neural cell degeneration as well as insulate all your organ tissue, including your skin, against the ravages of protein glycation. Who knows--this regimen just might protect your sleep neurons as well.
- 1. Almendraia, Anna. "Older People Sleep Less. Now We Know Why." 22 August 2014. Huff Post. 22 August 2014. http://www.huffingtonpost.com/2014/08/20/elderly-sleep-less-neurons_n_5692504.html
- 2. "Research helps explain why elderly have trouble sleeping." 20 August 2014. Beth Israel Deaconess Medical Center. 22 August 2014. http://www.eurekalert.org/pub_releases/2014-08/bidm-rhe081814.php
- 3. "How does Ambien work?" 20 May 2012. Addiction Blog. 22 August 2014. http://prescription-drug.addictionblog.org/how-does-ambien-work/
- 4. Sandoval, Laurie. "Older people with sleeping problems have higher suicide risk." 16 August 2014. Tech Times. 22 August 2014. http://www.techtimes.com/articles/13132/20140816/older-people-with-sleeping-problems-have-higher-suicide-risk.htm
- 5. Anna M. Barron and Christian J. Pike1. "Sex hormones, aging, and Alzheimer's disease." Front Biosci (Elite Ed). Jan 1, 2012; 4: 976--997. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511049/