Poor sleep is a common complaint in the elderly. In a Swedish questionnaire survey it was found that 10% of elderly men (aged 74 ± 6 years; mean ± SD) and 20% of elderly women were troubled by poor sleep. Frequent awakenings were reported by 21% and 27%, respectively, and difficulty in falling asleep after awakening was experienced by 22% and 41%, respectively. Eleven percent of men and 13% of women report frequent nightmares (Asplund and Aberg, 1992). Compared with the younger population, who are often troubled by difficulty in falling asleep at bedtime, elderly persons more often suffer from frequent awakenings and an increased length of time before falling asleep again. Their total sleep is shortened even though they spend more time in bed, and they have a smaller proportion of slow-wave sleep (SWS) (Morin and Gramling, 1989).

Sleep can be disturbed in several ways. The total amount of sleep can be increased (hypersomnia) or reduced (hyposomnia or insomnia), and it can be fragmented by frequent awakenings. There are also many sleep-disturbing diseases and symptoms, which make getting back to sleep difficult after nocturnal awakenings. Many elderly persons recognize poor sleep as an effect of deterioration of their 24-hour rhythm. They often try to compensate for this by increasing the regularity of their lifestyle, which is probably beneficial not only for their sleep but also for their health in general.

There is a high genetic disposition to develop sleep disorders. In twin studies in humans, good covariation has been demonstrated regarding different qualitative and quantitative sleep variables. Poor sleep is more common in elderly people if their parents have been troubled by sleep complaints (see Figure 71.1) (Asplund, 1995a).

In a study of a large group of elderly men and women, reports on a poor night's sleep were 50% more frequent in men and three times more frequent in women whose parents had sleep problems. Deterioration of sleep from year to year was found to occur three times as often among both men and women whose parents both had sleep problems, compared with those whose parents had been good sleepers (Asplund, 1995a). The total sleep time was shorter in both men and women if either of their parents had sleep problems and was further shortened if both parents had such problems, and the same was true for the length of time up to the first nocturnal awakening. Furthermore, in the corresponding groups, the time taken to get to sleep was prolonged, awakenings were more numerous, and it took longer to fall asleep again after waking up in the night. Sleep problems in childhood occurred four times as often in both men and women whose parents both had such disturbances, compared with those whose parents both had been good sleepers (Asplund, 1995a).

There are some evident differences in sleep between men and women. Women report more difficulties in initiating and maintaining sleep than men, whereas men

Handbook of Models for Human Aging

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