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The importance of sleep for healthy longevity

Article
January 10, 2022
By
Dita Eckhardtová

Sleep issues are linked to various symptoms, from anxiety and Alzheimer's disease to cardiovascular disease and obesity.

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Highlights:

  • Chronic short sleep is associated with increased risks of obesity and diabetes heart disease and all-cause mortality
  • Most of the elderly suffer from sleep disorders, with the most common being insomnia
  • Sleep patterns of inhabitants of Okinawa could be a good example of healthy sleeping habits


Introduction


Snoring, insomnia, sleep deprivation, sleep apnea… Almost half of the adult population experiences some kind of sleep issue. This global epidemic threatens not only the health and quality of life but is also one of the causes of injuries and death in sleep-related accidents. In the United States alone, sleepy drivers are involved in 100,000 accidents yearly. Several of the most infamous workplace accidents are directly or indirectly linked to sleep deprivation, from the Chernobyl nuclear plant meltdown to the Space Shuttle Challenger explosion. 



Why is healthy sleep important?

Sleep that puts each day to rest. Sleep that relieves the weary laborer and heals hurt minds. Sleep, the main course in life's feast, and the most nourishing." 

William Shakespeare, Macbeth.

Both everybody's personal experience and medical studies unanimously conclude that sleep is one of the vital components of well-being and health. This is even more valid for the longevity that is associated with regular sleep patterns and maintenance of the deepest phase of sleep - slow-wave sleep (1). Sleep health, creating and maintaining sleep of adequate length and quality, is crucial for healthy living. Sleep disorders or chronic short sleep are associated with increased risks of

  • Obesity and diabetes
  • Heart disease
  • High blood pressure
  • All-cause mortality (2)

In a nutshell, sleep may impact health and quality of life in general; therefore, it is crucial to understand how it affects your patients.

Night-time sleep changes in the elderly

Aging brings along many changes in physiology, including sleep. Those age-induced changes are independent of other factors and usually consist of night sleep shortening, increasing awakening frequency and volume, and increasing the number of naps. When it comes to sleep quality, older age usually brings along a decrease in restorative slow-wave sleep (3). Poor sleep quality for older adults brings many negative health effects, especially in cognition. It was, for example, also associated with an increased risk of falls and recurrent falls in the Chinese elderly (4).

With age,


  • Total sleep time decreases (from 10.5 for young adults to 8.1 hours for older adults) and plateaus after 60 years of age (5).
  • Sleep initiation (ability to fall asleep) increases with age and does not increase after 60 years of age.
  • Waking frequency and duration increased with age and is attributed to older people spending more time in lighter sleep stages(6).
  • Sleep efficiency (​​the percentage of time spent asleep in bed) decreases in adulthood and declines very slowly) (7).
  • The number of times when a person wakes up during the night (arousal) and their duration (wake after sleep onset, total number of minutes being awake during the night) also increases till the age of 60 and plateaus.
  • Deep (slow-wave) sleep decreases.


Most of the elderly suffer from sleep disorders, with the most common being insomnia. Almost every fourth older American sleeps less than 6 hours (8). The prevalence rate of sleep disorders in the aged population varies with geography. 

Different phases of sleep interact together: preserved or enhanced rapid eye movement sleep may compensate for otherwise disrupted sleep in advancing age, such as decreased slow-wave sleep (9).

Daytime napping and sleepiness

When talking about sleep, we need to take into account also daytime sleep and napping.

This practice is partly culturally ingrained, being usual in Mediterranean countries, China, and Latin America. How does napping change with age?

  • Nap duration seems to be the same for younger and older individuals (10).
  • Older adults naps more often than younger adults (11); in Japan, 27% of older adults take a nap more than four times a week, compared to young (12% and middle-aged 14%) adults (12).

Circadian rhythm dysfunction is also associated with dementia - circadian rhythm of temperature was disturbed in 59.0% of dementia patients and in only 12.5% of the control group. (13)

There is also an association between napping and excessive daytime sleepiness, which is reported by a fifth of older adults. As you will see later, napping may be part of beneficial strategies for sleep health. 


Poor sleep risk factors

Sleep quantity and quality decline until the age of 60, and they tend to remain unchanged. But this is valid for healthy older adults, and over half  of older adults complain about poor sleep quality, which is related to physical and psychiatric problems, lifestyle, and environmental factors (7). The main risk factors for bad night sleep in the elderly are:

  • Illnesses: over two-thirds of older adults suffer from several diseases (comorbidities), and 90% take prescription medicine for chronic medical conditions. One-third of them are taking five drugs (polypharmacy) which is a worrying problem (14). Chronic medical conditions contribute to negative changes in sleep, such as insomnia or sleep apnea. Polypharmacy can result in excessive day sleepiness and induce comorbid insomnia.
  • Half of older adults with depression suffer from insomnia and vice versa, and insomnia may contribute to depression which is furthermore associated with excessive day sleepiness.
  • Primary sleep disorders (those that cannot be attributed to other health conditions) such as insomnia, sleep apnea, narcolepsy, or restless leg syndrome are much more frequent in older adults. The most frequent disorder being insomnia, present in more than 50% of older adults (15). Oher aging-related diseases also contribute to insomnia.
  • Being less physically and socially active, coupled with emotional distress, contributes to sleep problems as well.


Health problems associated with sleep

Quality sleep is one of the factors for maintaining physical and mental health. Anxiety and depression, very common in the aging population, are associated with sleep issues. There is recent evidence that sleep disturbances precede depression occurrence. Chronic pain, another prevalent issue, causes emotional distress and reduces sleep quality, which reduces pain thresholds. Cardiovascular disease risk increases with sleeping less than 6 hours per night, and sleeping less than four or more than ten is linked to increased mortality. Sleep apnea and insomnia are risk factors for Alzheimer’s disease (16).

There is also preliminary evidence that poor sleep quality and prolonged sleep duration are associated with frailty and pre-frailty in an elderly population (aged between 70–87 years) (17).

Most studies talk about sleep disorders and health issues being linked, associated, or risk factors. Even though sleep issues may not be the direct cause of those health problems, they improve your patients' overall health and, subsequently, the quality of life. What can improve their sleep? Let us take a look at the example of the longevity Blue Zones.


Village of longevity: good sleep results from lifestyle factors

Okinawa in Japan is known for the longevity of their inhabitants, with the highest average lifespan and the lowest death rate from the lifestyle-related diseases. How are those extremely healthy and very old people living?  

A study of 109 elderly Okinawa residents discovered  a clear relationship between lifestyle and sleep health of the elderly and that poor sleep health is related to poor physical and mental health (18).

Good sleeping older Okinawans:

  • Take regulars short naps
  • Do not doze, especially before bedtime
  • Exercise at least three times a week
  • Have a diet that includes more fish and seaweed
  • Have more social contact improving emotional adaptability

A study of centenarians in Utah concluded that sleep latency, life satisfaction (psychological), and attachment closeness (social) were predictive factors of more days lived within individual models, with sleep latency and life satisfaction being significant predictors of days lived (19).

Longevity Blue Zones habitants experience better sleep quality thanks to their lifestyles: short naps, exercise, and a healthy diet. Incorporating those healthy habits could be beneficial not only for elderly patients but for everybody.



Your patients' life is as good as their sleep.

There is no dispute that quality sleep is one of the main components of good health and quality of life. Sleep issues are linked to various symptoms, from anxiety and Alzheimer's disease to cardiovascular disease and obesity. The good news is that your patients may improve their sleep health by lifestyle factors inspired by the longest-living populations.


References

  1. Human longevity is associated with regular sleep patterns, maintenance of slow wave sleep, and favorable lipid profile, https://www.frontiersin.org/articles/10.3389/fnagi.2014.00134/full
  2. https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health#five
  3. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan, https://pubmed.ncbi.nlm.nih.gov/15586779/
  4.  Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study, https://www.sciencedirect.com/science/article/abs/pii/S0167494317302455
  5. CAMPBELL, S.S. and MURPHY, P.J. (2007), The nature of spontaneous sleep across adulthood. Journal of Sleep Research, 16: 24-32. 
  6.  Floyd JA, Medler SM, Ager JW, Janisse JJ. Age-related changes in initiation and maintenance of sleep: a meta-analysis. Res Nurs Health. 2000 Apr;23(2):106-17. doi: 10.1002/(sici)1098-240x(200004)23:2<106::aid-nur3>3.0.co;2-a. PMID: 10782869.
  7.  Li J, Vitiello MV, Gooneratne NS. Sleep in Normal Aging. Sleep Med Clin. 2018 Mar;13(1):1-11. doi: 10.1016/j.jsmc.2017.09.001. Epub 2017 Nov 21. PMID: 29412976; PMCID: PMC5841578.
  8.  https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319
  9. Dynamic Contributions of Slow Wave Sleep and REM Sleep to Cognitive Longevity

             https://link.springer.com/article/10.1007/s40675-018-0131-6

  1. CAMPBELL, S.S. and MURPHY, P.J. (2007), The nature of spontaneous sleep across adulthood. Journal of Sleep Research, 16: 24-32. 
  2.  Buysse DJ, Browman KE, Monk TH, Reynolds CF 3rd, Fasiczka AL, Kupfer DJ. Napping and 24-hour sleep/wake patterns in healthy elderly and young adults. J Am Geriatr Soc. 1992 Aug;40(8):779-86. doi: 10.1111/j.1532-5415.1992.tb01849.x. PMID: 1634721.
  3.  Furihata R, Kaneita Y, Jike M, Ohida T, Uchiyama M. Napping and associated factors: a Japanese nationwide general population survey. Sleep Med. 2016 Apr;20:72-9. doi: 10.1016/j.sleep.2015.12.006. Epub 2015 Dec 29. PMID: 27318229.
  4. M. Okawa, K. Mishima, Y. Hishikawa, S. Hozumi, H. Hori, K. Takahashi, Circadian Rhythm Disorders in Sleep-Waking and Body Temperature in Elderly Patients with Dementia and Their Treatment, Sleep, Volume 14, Issue 6, November 1991, Pages 478–485, https://doi.org/10.1093/sleep/14.6.478
  5.  Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002 Aug;55(8):809-17. doi: 10.1016/s0895-4356(02)00411-0. PMID: 12384196.
  6.  Crowley K. Sleep and sleep disorders in older adults. Neuropsychol Rev. 2011 Mar;21(1):41-53. doi: 10.1007/s11065-010-9154-6. Epub 2011 Jan 12. PMID: 21225347.
  7.  https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319
  8.  Associations of sleep quality and sleep duration with frailty and pre-frailty in an elderly population Rugao longevity and ageing study, https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1407-5
  9. Sleep health and lifestyle of elderly people in Ogimi, a village of longevity

            https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1819.2002.01014.x

  1.  Biological, Psychological, and Social Predictors of Longevity Among Utah Centenarians, https://journals.sagepub.com/doi/abs/10.1177/0091415018757211

Highlights:

  • Chronic short sleep is associated with increased risks of obesity and diabetes heart disease and all-cause mortality
  • Most of the elderly suffer from sleep disorders, with the most common being insomnia
  • Sleep patterns of inhabitants of Okinawa could be a good example of healthy sleeping habits


Introduction


Snoring, insomnia, sleep deprivation, sleep apnea… Almost half of the adult population experiences some kind of sleep issue. This global epidemic threatens not only the health and quality of life but is also one of the causes of injuries and death in sleep-related accidents. In the United States alone, sleepy drivers are involved in 100,000 accidents yearly. Several of the most infamous workplace accidents are directly or indirectly linked to sleep deprivation, from the Chernobyl nuclear plant meltdown to the Space Shuttle Challenger explosion. 



Why is healthy sleep important?

Sleep that puts each day to rest. Sleep that relieves the weary laborer and heals hurt minds. Sleep, the main course in life's feast, and the most nourishing." 

William Shakespeare, Macbeth.

Both everybody's personal experience and medical studies unanimously conclude that sleep is one of the vital components of well-being and health. This is even more valid for the longevity that is associated with regular sleep patterns and maintenance of the deepest phase of sleep - slow-wave sleep (1). Sleep health, creating and maintaining sleep of adequate length and quality, is crucial for healthy living. Sleep disorders or chronic short sleep are associated with increased risks of

  • Obesity and diabetes
  • Heart disease
  • High blood pressure
  • All-cause mortality (2)

In a nutshell, sleep may impact health and quality of life in general; therefore, it is crucial to understand how it affects your patients.

Night-time sleep changes in the elderly

Aging brings along many changes in physiology, including sleep. Those age-induced changes are independent of other factors and usually consist of night sleep shortening, increasing awakening frequency and volume, and increasing the number of naps. When it comes to sleep quality, older age usually brings along a decrease in restorative slow-wave sleep (3). Poor sleep quality for older adults brings many negative health effects, especially in cognition. It was, for example, also associated with an increased risk of falls and recurrent falls in the Chinese elderly (4).

With age,


  • Total sleep time decreases (from 10.5 for young adults to 8.1 hours for older adults) and plateaus after 60 years of age (5).
  • Sleep initiation (ability to fall asleep) increases with age and does not increase after 60 years of age.
  • Waking frequency and duration increased with age and is attributed to older people spending more time in lighter sleep stages(6).
  • Sleep efficiency (​​the percentage of time spent asleep in bed) decreases in adulthood and declines very slowly) (7).
  • The number of times when a person wakes up during the night (arousal) and their duration (wake after sleep onset, total number of minutes being awake during the night) also increases till the age of 60 and plateaus.
  • Deep (slow-wave) sleep decreases.


Most of the elderly suffer from sleep disorders, with the most common being insomnia. Almost every fourth older American sleeps less than 6 hours (8). The prevalence rate of sleep disorders in the aged population varies with geography. 

Different phases of sleep interact together: preserved or enhanced rapid eye movement sleep may compensate for otherwise disrupted sleep in advancing age, such as decreased slow-wave sleep (9).

Daytime napping and sleepiness

When talking about sleep, we need to take into account also daytime sleep and napping.

This practice is partly culturally ingrained, being usual in Mediterranean countries, China, and Latin America. How does napping change with age?

  • Nap duration seems to be the same for younger and older individuals (10).
  • Older adults naps more often than younger adults (11); in Japan, 27% of older adults take a nap more than four times a week, compared to young (12% and middle-aged 14%) adults (12).

Circadian rhythm dysfunction is also associated with dementia - circadian rhythm of temperature was disturbed in 59.0% of dementia patients and in only 12.5% of the control group. (13)

There is also an association between napping and excessive daytime sleepiness, which is reported by a fifth of older adults. As you will see later, napping may be part of beneficial strategies for sleep health. 


Poor sleep risk factors

Sleep quantity and quality decline until the age of 60, and they tend to remain unchanged. But this is valid for healthy older adults, and over half  of older adults complain about poor sleep quality, which is related to physical and psychiatric problems, lifestyle, and environmental factors (7). The main risk factors for bad night sleep in the elderly are:

  • Illnesses: over two-thirds of older adults suffer from several diseases (comorbidities), and 90% take prescription medicine for chronic medical conditions. One-third of them are taking five drugs (polypharmacy) which is a worrying problem (14). Chronic medical conditions contribute to negative changes in sleep, such as insomnia or sleep apnea. Polypharmacy can result in excessive day sleepiness and induce comorbid insomnia.
  • Half of older adults with depression suffer from insomnia and vice versa, and insomnia may contribute to depression which is furthermore associated with excessive day sleepiness.
  • Primary sleep disorders (those that cannot be attributed to other health conditions) such as insomnia, sleep apnea, narcolepsy, or restless leg syndrome are much more frequent in older adults. The most frequent disorder being insomnia, present in more than 50% of older adults (15). Oher aging-related diseases also contribute to insomnia.
  • Being less physically and socially active, coupled with emotional distress, contributes to sleep problems as well.


Health problems associated with sleep

Quality sleep is one of the factors for maintaining physical and mental health. Anxiety and depression, very common in the aging population, are associated with sleep issues. There is recent evidence that sleep disturbances precede depression occurrence. Chronic pain, another prevalent issue, causes emotional distress and reduces sleep quality, which reduces pain thresholds. Cardiovascular disease risk increases with sleeping less than 6 hours per night, and sleeping less than four or more than ten is linked to increased mortality. Sleep apnea and insomnia are risk factors for Alzheimer’s disease (16).

There is also preliminary evidence that poor sleep quality and prolonged sleep duration are associated with frailty and pre-frailty in an elderly population (aged between 70–87 years) (17).

Most studies talk about sleep disorders and health issues being linked, associated, or risk factors. Even though sleep issues may not be the direct cause of those health problems, they improve your patients' overall health and, subsequently, the quality of life. What can improve their sleep? Let us take a look at the example of the longevity Blue Zones.


Village of longevity: good sleep results from lifestyle factors

Okinawa in Japan is known for the longevity of their inhabitants, with the highest average lifespan and the lowest death rate from the lifestyle-related diseases. How are those extremely healthy and very old people living?  

A study of 109 elderly Okinawa residents discovered  a clear relationship between lifestyle and sleep health of the elderly and that poor sleep health is related to poor physical and mental health (18).

Good sleeping older Okinawans:

  • Take regulars short naps
  • Do not doze, especially before bedtime
  • Exercise at least three times a week
  • Have a diet that includes more fish and seaweed
  • Have more social contact improving emotional adaptability

A study of centenarians in Utah concluded that sleep latency, life satisfaction (psychological), and attachment closeness (social) were predictive factors of more days lived within individual models, with sleep latency and life satisfaction being significant predictors of days lived (19).

Longevity Blue Zones habitants experience better sleep quality thanks to their lifestyles: short naps, exercise, and a healthy diet. Incorporating those healthy habits could be beneficial not only for elderly patients but for everybody.



Your patients' life is as good as their sleep.

There is no dispute that quality sleep is one of the main components of good health and quality of life. Sleep issues are linked to various symptoms, from anxiety and Alzheimer's disease to cardiovascular disease and obesity. The good news is that your patients may improve their sleep health by lifestyle factors inspired by the longest-living populations.


References

  1. Human longevity is associated with regular sleep patterns, maintenance of slow wave sleep, and favorable lipid profile, https://www.frontiersin.org/articles/10.3389/fnagi.2014.00134/full
  2. https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health#five
  3. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan, https://pubmed.ncbi.nlm.nih.gov/15586779/
  4.  Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study, https://www.sciencedirect.com/science/article/abs/pii/S0167494317302455
  5. CAMPBELL, S.S. and MURPHY, P.J. (2007), The nature of spontaneous sleep across adulthood. Journal of Sleep Research, 16: 24-32. 
  6.  Floyd JA, Medler SM, Ager JW, Janisse JJ. Age-related changes in initiation and maintenance of sleep: a meta-analysis. Res Nurs Health. 2000 Apr;23(2):106-17. doi: 10.1002/(sici)1098-240x(200004)23:2<106::aid-nur3>3.0.co;2-a. PMID: 10782869.
  7.  Li J, Vitiello MV, Gooneratne NS. Sleep in Normal Aging. Sleep Med Clin. 2018 Mar;13(1):1-11. doi: 10.1016/j.jsmc.2017.09.001. Epub 2017 Nov 21. PMID: 29412976; PMCID: PMC5841578.
  8.  https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319
  9. Dynamic Contributions of Slow Wave Sleep and REM Sleep to Cognitive Longevity

             https://link.springer.com/article/10.1007/s40675-018-0131-6

  1. CAMPBELL, S.S. and MURPHY, P.J. (2007), The nature of spontaneous sleep across adulthood. Journal of Sleep Research, 16: 24-32. 
  2.  Buysse DJ, Browman KE, Monk TH, Reynolds CF 3rd, Fasiczka AL, Kupfer DJ. Napping and 24-hour sleep/wake patterns in healthy elderly and young adults. J Am Geriatr Soc. 1992 Aug;40(8):779-86. doi: 10.1111/j.1532-5415.1992.tb01849.x. PMID: 1634721.
  3.  Furihata R, Kaneita Y, Jike M, Ohida T, Uchiyama M. Napping and associated factors: a Japanese nationwide general population survey. Sleep Med. 2016 Apr;20:72-9. doi: 10.1016/j.sleep.2015.12.006. Epub 2015 Dec 29. PMID: 27318229.
  4. M. Okawa, K. Mishima, Y. Hishikawa, S. Hozumi, H. Hori, K. Takahashi, Circadian Rhythm Disorders in Sleep-Waking and Body Temperature in Elderly Patients with Dementia and Their Treatment, Sleep, Volume 14, Issue 6, November 1991, Pages 478–485, https://doi.org/10.1093/sleep/14.6.478
  5.  Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002 Aug;55(8):809-17. doi: 10.1016/s0895-4356(02)00411-0. PMID: 12384196.
  6.  Crowley K. Sleep and sleep disorders in older adults. Neuropsychol Rev. 2011 Mar;21(1):41-53. doi: 10.1007/s11065-010-9154-6. Epub 2011 Jan 12. PMID: 21225347.
  7.  https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319
  8.  Associations of sleep quality and sleep duration with frailty and pre-frailty in an elderly population Rugao longevity and ageing study, https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1407-5
  9. Sleep health and lifestyle of elderly people in Ogimi, a village of longevity

            https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1819.2002.01014.x

  1.  Biological, Psychological, and Social Predictors of Longevity Among Utah Centenarians, https://journals.sagepub.com/doi/abs/10.1177/0091415018757211

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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