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Age-related sleep disorders: you do not snooze, you lose

Article
September 14, 2022
By
Olena Mokshyna, PhD.

Sleeping well can improve overall condition, and a proper approach to sleep hygiene and maintenance is inseparable from a healthy and long life.

Highlights:

  • During aging, sleep inevitably changes due to the change in the circadian rhythm functionality, melatonin deficiency, and decreased homeostatic regulation
  • The most common age-related sleep problems include insomnia, obstructive sleep apnea, movement, and sleep-wake cycle disorders
  • Sleep disturbances increase the risk of multiple disorders, including cardiovascular disease, dementia, and depression
  • Previously existing conditions, such as diabetes, can trigger sleep disorders, thus creating an unhealthy feedback loop
  • Multiple strategies exist to correct sleep problems. They range from sleep hygiene to pharmacological solutions.

Introduction: Poor sleep as a risk factor for the aging population 

By 2030, it is estimated that approximately one in five people in the United States will be over the age of 65. The aging population requires addressing age-specific health issues to ensure that people live not only long but healthy. One of the prominent aging problems is changes in sleep physiology, leading to the emergence of sleep disorders. As many as 50% of older adults complain about insufficient sleep quality. Poor sleep can lead to a diversity of problems, such as impaired cognition, increased risk of cardio- and cerebrovascular disorders, and a higher probability of falls.

Image 1

As we age, our sleep patterns change

During aging, sleep becomes progressively lighter with an increased number of awakenings, resulting in reduced sleep efficiency and lesser total sleep time (1). Compared to young adults, the elderly tend to go to bed and wake up earlier.

This shift in sleep architecture and time is linked to the changes in the circadian rhythm, which is controlled by a part of the hypothalamus called the suprachiasmatic nucleus (SCN). Aging leads to a decrease in the SCN sensitivity to environmental changes, leading to a 24-hour day/night cycle malfunction. 24-hour cycle malfunction leads to decreased quantity of deep sleep. Plainly, this means that elderly spend a lot of time sleeping, but the quality of sleep drops. The amplitude of circadian rhythms, including body temperature and cortisol levels, becomes less pronounced in the elderly due to changes in neural connections in the brain and decreased number of neurons (2, 3).

Another significant change is a decrease in melatonin levels – a sleep hormone produced by the pineal gland (a small gland located near the center of the brain). Melatonin production is linked to the circadian rhythm and is increased at night. However, with age, night-time production of melatonin diminishes, which may result from the calcification of the pineal gland itself (4).

Except for circadian regulation, sleep is also regulated by homeostatic processes. When an individual gets an insufficient amount of sleep, this loss is compensated by extending subsequent sleep (5). Research shows that aging decreases this regulative capacity, partially leading to the deficit in total sleep time (6).

All the above-mentioned changes are relevant to older adults in perfect health, which is rarely the case. If sleep disturbance stems only from such changes, it is called primary sleep disorder. Many elderly have multiple comorbidities, such as osteoarthritis, cardiovascular disease (CVD), diabetes, or cancer (7). These comorbidities, along with the increased use of medications (such as glucocorticoids or beta-blockers), can trigger further detrimental effects on sleep.

Image 2

Most common sleep disorders

One of the most well-known sleep disorders in the elderly is insomnia. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, insomnia can be defined as “reported dissatisfaction with sleep quantity or quality, associated with difficulty with sleep initiation, maintenance, or early-morning awakening, that causes clinically significant distress or impairment, occurs at least three nights per week for three months, occurs despite adequate opportunity for sleep, and is not better explained by another disorder or substance abuse” (7). As indicated by studies, the prevalence of insomnia in the elderly population can be as high as 70% (8). However, there is a wide variation among different groups. Some reports indicate a higher prevalence of insomnia in nursing homes and rural areas (9,10). Also, there are prominent gender differences, with insomnia being generally more frequent in women (11).

The following common disorder is obstructive sleep apnea (OSA), characterized by instability of the upper airway during sleep, which results in reduced or absent airflow (12). OSA prevalence in older adults may reach 70% in men and 56% in women (13).

Movement sleep disorders include restless legs syndrome (RLG, also known as Willis-Ekbom disease) and rapid eye movement sleep disorder (RBD). RLG is linked to unconscious leg movements accompanied by abnormal sensations and sleep maintenance problems (14). The exact pathogenesis of RLG is unknown but might be related to dopamine dysregulation. RLG prevalence in older people can reach around 35%. RBD is a condition that occurs during the fast (rapid eye movement) stage of sleep when affected people display a variety of movements, like talking, shouting, or thrashing limbs. The etiology of RBD is also unclear, but it is most prevalent among older males (15).

Altered circadian rhythm leads to multiple sleep-wake disorders, the most common among older adults being advanced sleep-wake phase schedule (ASWPS) disorder (16). With ASWPS, individuals tend to become sleepy between 7 and 8 PM and wake up between 3 and 4 AM (the time where sleep is supposed to be the deepest), which can result in insufficient sleep quality. ASWPS frequently gets misdiagnosed as insomnia, but the treatment approach for it differs.

Image 3

Sleep disorders and consequences 

The danger of sleep disorders lies not only in the discomfort from lack of quality sleep but also in the consequences for overall health. Research suggests that lack of sleep is strongly linked to increased mortality (17). 

Multiple reports have found an association between sleep disturbances and increased incidence of CVD. A study in a Japanese population demonstrated that long sleep duration combined with poor sleep quality correlated with a higher mortality risk due to CVD (18). Similar tendencies were observed in aged American Indians suffering from insomnia (19). OSA was associated with an increased risk of ischemic stroke.

Another risk connected with sleep disorders is various types of dementia. In their meta-analysis, Shi et al. (20) analyzed the influence of various sleep disorders. The authors concluded that sleep-disordered breathing, like OSA, was a risk factor for all-cause dementia, Alzheimer’s disease, and vascular dementia. By contrast, insomnia increased only the risk for Alzheimer’s disease. Moreover, sleep-disordered breathing in middle age can serve as an accurate predictor of the development of dementia later in life. Chronic RBD has also been associated with neurodegenerative disorders like Lewy body dementia and Parkinson’s disease (21).

Sleep disorders, quite expectedly, are linked to multiple mental health and cognitive issues common in the aged population (22). Anxiety and depression are widely spread in the elderly and can result from changes in sleep physiology. Usually, sleep changes are regarded as secondary to depression. However, recent studies indicate that sleep disorders precede the occurrence of depression and increase its risk in the long run (23).

 

Treatment strategies

An approach to treatment depends on the specific sleep disorder (16). Treatment of insomnia must include a thorough management of a regular sleep-wake schedule, optimizing treatment of comorbidities, and (if possible) elimination of medicines contributing to the condition. Cognitive therapy has shown robust improvements as a first-line treatment (24). Pharmacotherapy is widely applied but should be exercised with caution in the elderly due to the multiple side effects. The main used classes of drugs, such as benzodiazepines, can lead to adverse effects, such as drug dependence, rebound insomnia, and tolerance when on prolonged use (25). Non-benzodiazepines carry a lower risk but still might lead to an increased risk of falls or worsening cognitive impairment. Melatonin supplements, herbal remedies (such as valerian), and musical therapy are widely applied, though their application is not regulated by FDA. Natural sunlight exposure, especially sunset, can also be beneficial due to the prevalence of the red tones, which stimulate the pineal gland and improve sleep.

OSA can be improved by applying continuous positive airway pressure therapy, which was shown to improve cognition, memory, cardiovascular condition, and sleep in the elderly. A promising approach could be also a hypoglossal nerve stimulation, such as Nyxoah, with clinical trials being carried out. Movement disorders usually are treated with benzodiazepines or melatonin, while circadian rhythm disorders are best tackled by bright light therapy.

Besides listed treatments, non-pharmacological management might be most beneficial as the first-line approach for older patients. Regular physical exercise is a simple strategy because it promotes relaxation, which could help initiate and maintain sleep. Another essential strategy is maintaining proper sleep hygiene by controlling the schedule and sleeping conditions.

optional

Tips for professionals

  • Assess the individual sleep quality if the client has complaints such as chronic fatigue. Propose the client to use a simple sleep quality checklist marking daily activity, caffeine intake, sunlight exposure, food before bed, etc.
  • Inform your client about possible physiological reasons for the sleep disturbances while considering their accompanying health problems. Explain the risks connected with insufficient amount and quality of sleep.
  • Suggest starting with simple steps by improving their sleep habits and tracking the changes in sleep quantity and quality. Wearables, such as smartwatches and sleep trackers, are one of the most convenient tools for monitoring sleep quality.
  • Melatonin supplements or herbal products may be one of the safer options to try.
  • If your client’s condition allows, suggest introducing a simple exercise routine two hours before sleep.
  • In case of severe disturbances, recommend a specialist who can advise on pharmacological treatment.

Conclusions: sleep maintenance 

Sleep disturbance in the elderly requires consideration of multiple risk factors and an individual approach toward treatment. Changes in sleep patterns are a part of the aging process, but they must be treated individually to minimize the damage. Sleeping well can improve overall condition, and a proper approach to sleep hygiene and maintenance is inseparable from a healthy and long life.

References

 

1.     Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan. Sleep. 2004 Oct;27(7):1255–73.

2.     Duffy JF, Zitting KM, Chinoy ED. Aging and Circadian Rhythms. Sleep Med Clin. 2015 Dec;10(4):423–34.

3. Björk, V., 2021. Aging of the Suprachiasmatic Nucleus, CIRCLONSA Syndrome, Implications for Regenerative Medicine and Restoration of the Master Body Clock. Rejuvenation Research, 24(4), pp.274-282.

3.     Tan D, Xu B, Zhou X, Reiter R. Pineal Calcification, Melatonin Production, Aging, Associated Health Consequences and Rejuvenation of the Pineal Gland. Molecules. 2018 Jan 31;23(2):301.

4.     Deboer T. Sleep homeostasis and the circadian clock: Do the circadian pacemaker and the sleep homeostat influence each other’s functioning? Neurobiol Sleep Circadian Rhythms. 2018 Jun;5:68–77.

5.     Dijk DJ, Groeger JA, Stanley N, Deacon S. Age-Related Reduction in Daytime Sleep Propensity and Nocturnal Slow Wave Sleep. Sleep. 2010 Feb;33(2):211–23.

6.     Comorbidity of five chronic health conditions in elderly communityresidents: determinants and impact on mortality. J Gerontol A Biol Sci Med Sci. 2000 Feb 1;55(2):M84–9.

7.     American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [Internet]. DSM-5-TR. American Psychiatric Association Publishing; 2022 [cited 2022 Jul 17]. Available from: https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

8.     Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Fam Med Prim Care. 2016;5(4):780.

9.     Sleep Quality of Older Adults in Nursing Homes in Turkey: Enhancing the Quality of Sleep Improves Quality of Life. J Gerontol Nurs. 2007 Oct;33(10):42–9.

10.   El-Gilany AH, Saleh N, Mohamed H, Elsayed E. Prevalence of insomnia and its associated factors among rural elderly: a community based study. Int J Adv Nurs Stud. 2017 Apr 15;6(1):56.

11.   Spira AP, Stone K, Beaudreau SA, Ancoli-Israel S, Yaffe K. Anxiety Symptoms and Objectively Measured Sleep Quality in Older Women. Am J Geriatr Psychiatry. 2009 Feb;17(2):136–43.

12.   McNicholas WT. Diagnosis of Obstructive Sleep Apnea in Adults. Proc Am Thorac Soc. 2008 Feb 15;5(2):154–60.

13.   Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, et al. Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons: ASSESSMENT AND MANAGEMENT OF SLEEP DISORDERS IN OLDER PERSONS. J Am Geriatr Soc. 2009 May;57(5):761–89.

14.   Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med. 2014 Aug;15(8):860–73.

15.   Oksenberg A, Radwan H, Arons E, Hoffenbach D, Behroozi B. Rapid Eye Movement (REM) sleep behavior disorder: a sleep disturbance affecting mainly older men. Isr J Psychiatry Relat Sci. 2002;39(1):28–35.

16.   Tatineny P, Shafi F, Gohar A, Bhat A. Sleep in the Elderly. Mo Med. 2020 Oct;117(5):490–5.

17.   Ferrie JE, Shipley MJ, Cappuccio FP, Brunner E, Miller MA, Kumari M, et al. A Prospective Study of Change in Sleep Duration: Associations with Mortality in the Whitehall II Cohort. Sleep. 2007 Dec;30(12):1659–66.

18.   Suzuki E, Yorifuji T, Ueshima K, Takao S, Sugiyama M, Ohta T, et al. Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: A population-based cohort study. Prev Med. 2009 Aug;49(2–3):135–41.

19.   Sabanayagam C, Shankar A, Buchwald D, Goins RT. Insomnia Symptoms and Cardiovascular Disease among Older American Indians: The Native Elder Care Study. J Environ Public Health. 2011;2011:1–6.

20.   Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Med Rev. 2018 Aug;40:4–16.

21.   Lai YY, Siegel JM. Physiological and Anatomical Link Between Parkinson-Like Disease and REM Sleep Behavior Disorder. Mol Neurobiol. 2003;27(2):137–52.

22.   Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge: Sleep in elderly. Psychogeriatrics. 2018 May;18(3):155–65.

23.   Buysse DJ. Sleep Health: Can We Define It? Does It Matter? Sleep. 2014 Jan 1;37(1):9–17.

24.   Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological And Behavioral Treatment Of Insomnia: Update Of The Recent Evidence (1998–2004). Sleep. 2006 Nov;29(11):1398–414.

25.   Chouinard G. Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. J Clin Psychiatry. 2004;65 Suppl 5:7–12.

Highlights:

  • During aging, sleep inevitably changes due to the change in the circadian rhythm functionality, melatonin deficiency, and decreased homeostatic regulation
  • The most common age-related sleep problems include insomnia, obstructive sleep apnea, movement, and sleep-wake cycle disorders
  • Sleep disturbances increase the risk of multiple disorders, including cardiovascular disease, dementia, and depression
  • Previously existing conditions, such as diabetes, can trigger sleep disorders, thus creating an unhealthy feedback loop
  • Multiple strategies exist to correct sleep problems. They range from sleep hygiene to pharmacological solutions.

Introduction: Poor sleep as a risk factor for the aging population 

By 2030, it is estimated that approximately one in five people in the United States will be over the age of 65. The aging population requires addressing age-specific health issues to ensure that people live not only long but healthy. One of the prominent aging problems is changes in sleep physiology, leading to the emergence of sleep disorders. As many as 50% of older adults complain about insufficient sleep quality. Poor sleep can lead to a diversity of problems, such as impaired cognition, increased risk of cardio- and cerebrovascular disorders, and a higher probability of falls.

Image 1

As we age, our sleep patterns change

During aging, sleep becomes progressively lighter with an increased number of awakenings, resulting in reduced sleep efficiency and lesser total sleep time (1). Compared to young adults, the elderly tend to go to bed and wake up earlier.

This shift in sleep architecture and time is linked to the changes in the circadian rhythm, which is controlled by a part of the hypothalamus called the suprachiasmatic nucleus (SCN). Aging leads to a decrease in the SCN sensitivity to environmental changes, leading to a 24-hour day/night cycle malfunction. 24-hour cycle malfunction leads to decreased quantity of deep sleep. Plainly, this means that elderly spend a lot of time sleeping, but the quality of sleep drops. The amplitude of circadian rhythms, including body temperature and cortisol levels, becomes less pronounced in the elderly due to changes in neural connections in the brain and decreased number of neurons (2, 3).

Another significant change is a decrease in melatonin levels – a sleep hormone produced by the pineal gland (a small gland located near the center of the brain). Melatonin production is linked to the circadian rhythm and is increased at night. However, with age, night-time production of melatonin diminishes, which may result from the calcification of the pineal gland itself (4).

Except for circadian regulation, sleep is also regulated by homeostatic processes. When an individual gets an insufficient amount of sleep, this loss is compensated by extending subsequent sleep (5). Research shows that aging decreases this regulative capacity, partially leading to the deficit in total sleep time (6).

All the above-mentioned changes are relevant to older adults in perfect health, which is rarely the case. If sleep disturbance stems only from such changes, it is called primary sleep disorder. Many elderly have multiple comorbidities, such as osteoarthritis, cardiovascular disease (CVD), diabetes, or cancer (7). These comorbidities, along with the increased use of medications (such as glucocorticoids or beta-blockers), can trigger further detrimental effects on sleep.

Image 2

Most common sleep disorders

One of the most well-known sleep disorders in the elderly is insomnia. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, insomnia can be defined as “reported dissatisfaction with sleep quantity or quality, associated with difficulty with sleep initiation, maintenance, or early-morning awakening, that causes clinically significant distress or impairment, occurs at least three nights per week for three months, occurs despite adequate opportunity for sleep, and is not better explained by another disorder or substance abuse” (7). As indicated by studies, the prevalence of insomnia in the elderly population can be as high as 70% (8). However, there is a wide variation among different groups. Some reports indicate a higher prevalence of insomnia in nursing homes and rural areas (9,10). Also, there are prominent gender differences, with insomnia being generally more frequent in women (11).

The following common disorder is obstructive sleep apnea (OSA), characterized by instability of the upper airway during sleep, which results in reduced or absent airflow (12). OSA prevalence in older adults may reach 70% in men and 56% in women (13).

Movement sleep disorders include restless legs syndrome (RLG, also known as Willis-Ekbom disease) and rapid eye movement sleep disorder (RBD). RLG is linked to unconscious leg movements accompanied by abnormal sensations and sleep maintenance problems (14). The exact pathogenesis of RLG is unknown but might be related to dopamine dysregulation. RLG prevalence in older people can reach around 35%. RBD is a condition that occurs during the fast (rapid eye movement) stage of sleep when affected people display a variety of movements, like talking, shouting, or thrashing limbs. The etiology of RBD is also unclear, but it is most prevalent among older males (15).

Altered circadian rhythm leads to multiple sleep-wake disorders, the most common among older adults being advanced sleep-wake phase schedule (ASWPS) disorder (16). With ASWPS, individuals tend to become sleepy between 7 and 8 PM and wake up between 3 and 4 AM (the time where sleep is supposed to be the deepest), which can result in insufficient sleep quality. ASWPS frequently gets misdiagnosed as insomnia, but the treatment approach for it differs.

Image 3

Sleep disorders and consequences 

The danger of sleep disorders lies not only in the discomfort from lack of quality sleep but also in the consequences for overall health. Research suggests that lack of sleep is strongly linked to increased mortality (17). 

Multiple reports have found an association between sleep disturbances and increased incidence of CVD. A study in a Japanese population demonstrated that long sleep duration combined with poor sleep quality correlated with a higher mortality risk due to CVD (18). Similar tendencies were observed in aged American Indians suffering from insomnia (19). OSA was associated with an increased risk of ischemic stroke.

Another risk connected with sleep disorders is various types of dementia. In their meta-analysis, Shi et al. (20) analyzed the influence of various sleep disorders. The authors concluded that sleep-disordered breathing, like OSA, was a risk factor for all-cause dementia, Alzheimer’s disease, and vascular dementia. By contrast, insomnia increased only the risk for Alzheimer’s disease. Moreover, sleep-disordered breathing in middle age can serve as an accurate predictor of the development of dementia later in life. Chronic RBD has also been associated with neurodegenerative disorders like Lewy body dementia and Parkinson’s disease (21).

Sleep disorders, quite expectedly, are linked to multiple mental health and cognitive issues common in the aged population (22). Anxiety and depression are widely spread in the elderly and can result from changes in sleep physiology. Usually, sleep changes are regarded as secondary to depression. However, recent studies indicate that sleep disorders precede the occurrence of depression and increase its risk in the long run (23).

 

Treatment strategies

An approach to treatment depends on the specific sleep disorder (16). Treatment of insomnia must include a thorough management of a regular sleep-wake schedule, optimizing treatment of comorbidities, and (if possible) elimination of medicines contributing to the condition. Cognitive therapy has shown robust improvements as a first-line treatment (24). Pharmacotherapy is widely applied but should be exercised with caution in the elderly due to the multiple side effects. The main used classes of drugs, such as benzodiazepines, can lead to adverse effects, such as drug dependence, rebound insomnia, and tolerance when on prolonged use (25). Non-benzodiazepines carry a lower risk but still might lead to an increased risk of falls or worsening cognitive impairment. Melatonin supplements, herbal remedies (such as valerian), and musical therapy are widely applied, though their application is not regulated by FDA. Natural sunlight exposure, especially sunset, can also be beneficial due to the prevalence of the red tones, which stimulate the pineal gland and improve sleep.

OSA can be improved by applying continuous positive airway pressure therapy, which was shown to improve cognition, memory, cardiovascular condition, and sleep in the elderly. A promising approach could be also a hypoglossal nerve stimulation, such as Nyxoah, with clinical trials being carried out. Movement disorders usually are treated with benzodiazepines or melatonin, while circadian rhythm disorders are best tackled by bright light therapy.

Besides listed treatments, non-pharmacological management might be most beneficial as the first-line approach for older patients. Regular physical exercise is a simple strategy because it promotes relaxation, which could help initiate and maintain sleep. Another essential strategy is maintaining proper sleep hygiene by controlling the schedule and sleeping conditions.

optional

Tips for professionals

  • Assess the individual sleep quality if the client has complaints such as chronic fatigue. Propose the client to use a simple sleep quality checklist marking daily activity, caffeine intake, sunlight exposure, food before bed, etc.
  • Inform your client about possible physiological reasons for the sleep disturbances while considering their accompanying health problems. Explain the risks connected with insufficient amount and quality of sleep.
  • Suggest starting with simple steps by improving their sleep habits and tracking the changes in sleep quantity and quality. Wearables, such as smartwatches and sleep trackers, are one of the most convenient tools for monitoring sleep quality.
  • Melatonin supplements or herbal products may be one of the safer options to try.
  • If your client’s condition allows, suggest introducing a simple exercise routine two hours before sleep.
  • In case of severe disturbances, recommend a specialist who can advise on pharmacological treatment.

Conclusions: sleep maintenance 

Sleep disturbance in the elderly requires consideration of multiple risk factors and an individual approach toward treatment. Changes in sleep patterns are a part of the aging process, but they must be treated individually to minimize the damage. Sleeping well can improve overall condition, and a proper approach to sleep hygiene and maintenance is inseparable from a healthy and long life.

References

 

1.     Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan. Sleep. 2004 Oct;27(7):1255–73.

2.     Duffy JF, Zitting KM, Chinoy ED. Aging and Circadian Rhythms. Sleep Med Clin. 2015 Dec;10(4):423–34.

3. Björk, V., 2021. Aging of the Suprachiasmatic Nucleus, CIRCLONSA Syndrome, Implications for Regenerative Medicine and Restoration of the Master Body Clock. Rejuvenation Research, 24(4), pp.274-282.

3.     Tan D, Xu B, Zhou X, Reiter R. Pineal Calcification, Melatonin Production, Aging, Associated Health Consequences and Rejuvenation of the Pineal Gland. Molecules. 2018 Jan 31;23(2):301.

4.     Deboer T. Sleep homeostasis and the circadian clock: Do the circadian pacemaker and the sleep homeostat influence each other’s functioning? Neurobiol Sleep Circadian Rhythms. 2018 Jun;5:68–77.

5.     Dijk DJ, Groeger JA, Stanley N, Deacon S. Age-Related Reduction in Daytime Sleep Propensity and Nocturnal Slow Wave Sleep. Sleep. 2010 Feb;33(2):211–23.

6.     Comorbidity of five chronic health conditions in elderly communityresidents: determinants and impact on mortality. J Gerontol A Biol Sci Med Sci. 2000 Feb 1;55(2):M84–9.

7.     American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [Internet]. DSM-5-TR. American Psychiatric Association Publishing; 2022 [cited 2022 Jul 17]. Available from: https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

8.     Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Fam Med Prim Care. 2016;5(4):780.

9.     Sleep Quality of Older Adults in Nursing Homes in Turkey: Enhancing the Quality of Sleep Improves Quality of Life. J Gerontol Nurs. 2007 Oct;33(10):42–9.

10.   El-Gilany AH, Saleh N, Mohamed H, Elsayed E. Prevalence of insomnia and its associated factors among rural elderly: a community based study. Int J Adv Nurs Stud. 2017 Apr 15;6(1):56.

11.   Spira AP, Stone K, Beaudreau SA, Ancoli-Israel S, Yaffe K. Anxiety Symptoms and Objectively Measured Sleep Quality in Older Women. Am J Geriatr Psychiatry. 2009 Feb;17(2):136–43.

12.   McNicholas WT. Diagnosis of Obstructive Sleep Apnea in Adults. Proc Am Thorac Soc. 2008 Feb 15;5(2):154–60.

13.   Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, et al. Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons: ASSESSMENT AND MANAGEMENT OF SLEEP DISORDERS IN OLDER PERSONS. J Am Geriatr Soc. 2009 May;57(5):761–89.

14.   Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med. 2014 Aug;15(8):860–73.

15.   Oksenberg A, Radwan H, Arons E, Hoffenbach D, Behroozi B. Rapid Eye Movement (REM) sleep behavior disorder: a sleep disturbance affecting mainly older men. Isr J Psychiatry Relat Sci. 2002;39(1):28–35.

16.   Tatineny P, Shafi F, Gohar A, Bhat A. Sleep in the Elderly. Mo Med. 2020 Oct;117(5):490–5.

17.   Ferrie JE, Shipley MJ, Cappuccio FP, Brunner E, Miller MA, Kumari M, et al. A Prospective Study of Change in Sleep Duration: Associations with Mortality in the Whitehall II Cohort. Sleep. 2007 Dec;30(12):1659–66.

18.   Suzuki E, Yorifuji T, Ueshima K, Takao S, Sugiyama M, Ohta T, et al. Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: A population-based cohort study. Prev Med. 2009 Aug;49(2–3):135–41.

19.   Sabanayagam C, Shankar A, Buchwald D, Goins RT. Insomnia Symptoms and Cardiovascular Disease among Older American Indians: The Native Elder Care Study. J Environ Public Health. 2011;2011:1–6.

20.   Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Med Rev. 2018 Aug;40:4–16.

21.   Lai YY, Siegel JM. Physiological and Anatomical Link Between Parkinson-Like Disease and REM Sleep Behavior Disorder. Mol Neurobiol. 2003;27(2):137–52.

22.   Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge: Sleep in elderly. Psychogeriatrics. 2018 May;18(3):155–65.

23.   Buysse DJ. Sleep Health: Can We Define It? Does It Matter? Sleep. 2014 Jan 1;37(1):9–17.

24.   Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological And Behavioral Treatment Of Insomnia: Update Of The Recent Evidence (1998–2004). Sleep. 2006 Nov;29(11):1398–414.

25.   Chouinard G. Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. J Clin Psychiatry. 2004;65 Suppl 5:7–12.

Article reviewed by
Dr. Ana Baroni MD. Ph.D.
SCIENTIFIC & MEDICAL ADVISOR
Quality Garant
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Dr. Ana Baroni MD. Ph.D.

Scientific & Medical Advisor
Quality Garant

Ana has over 20 years of consultancy experience in longevity, regenerative and precision medicine. She has a multifaceted understanding of genomics, molecular biology, clinical biochemistry, nutrition, aging markers, hormones and physical training. This background allows her to bridge the gap between longevity basic sciences and evidence-based real interventions, putting them into the clinic, to enhance the healthy aging of people. She is co-founder of Origen.life, and Longevityzone. Board member at Breath of Health, BioOx and American Board of Clinical Nutrition. She is Director of International Medical Education of the American College of Integrative Medicine, Professor in IL3 Master of Longevity at Barcelona University and Professor of Nutrigenomics in Nutrition Grade in UNIR University.

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Disease
Medicine

Acute aortic dissection can be caused by DNA methylation

November 17, 2022

In a recent study, DNA methylation was proven to be a risk factor for the acute aortic dissection.

Agnieszka Szmitkowska, Ph.D.
Article
Lifestyle
Longevity
Nutrition

The MIND Diet Promotes the Longevity of Cognitive Health

November 18, 2022

The MIND diet classifies 15 dietary components based on their effect on the brain, and recommends how many servings we should eat.

Jiří Kaloč
News
Aging
Longevity

Exploring microbiome diversity as a contributor to frailty

November 15, 2022

To evaluate the effect of microbiota diversity on health, Rashidah et al. reviewed microbiota composition, intestinal permeability, and inflammatory biomarkers in older adults.

Ehab Naim, MBA.
Article
Body
Supplements

Alpha-ketoglutarate in human trials against diseases and aging

November 11, 2022

Alpha-ketoglutarate (AKG) is a versatile endogenous compound that serves multiple functions in the body. It supports longevity thanks to its beneficial effects on cardiac, bone and muscle health.

Olena Mokshyna, PhD.
News
Aging
Disease
Longevity

Small extracellular vesicles from stem cells improve healthspan and lifespan in old mice

November 10, 2022

A recent study suggests that small extracellular vesicles could prevent age-related conditions and promote tissue regeneration.

Agnieszka Szmitkowska, Ph.D.
Article
Body
Lifestyle

How Much Exercise and What Type Is Needed to Live Longer?

November 6, 2022

Well planned exercise routine leads to prolonged healthspan. Several studies examined what is the ideal amount of exercise per week, or how many steps we should walk every day.

Jiří Kaloč
News
Prevention

Sleep duration during midlife and old age influences the risk of chronic diseases

November 4, 2022

A study examined the link between sleep duration and multimorbidity, and assessed whether sleep duration at the age of 50 influences the natural course of chronic diseases.

Ehab Naim, MBA.
Article
Disease
Lifestyle

Hypertension: How does high blood pressure influence the healthspan and lifespan?

November 3, 2022

1.2 billion people are affected by hypertension. Luckily, research shows that people can influence their blood pressure through simple changes in their diet and lifestyle.

Ehab Naim, MBA.
News
Aging

Inflammaging: How aging modulates the immune system

November 1, 2022

A study evaluated what is the impact of inflammaging on the adaptive and innate immune system.

Ehab Naim, MBA.
Article
Diagnostics
Aging

Epigenetic clocks: monitoring aging through DNA methylation

October 31, 2022

Epigenetic clocks provide one of the most accurate and easy ways to assess the real age of a human body. They also demonstrate encouraging results in the area of anti-aging intervention assessment.

Olena Mokshyna, PhD.
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