Written by Zergabachew Asfaw and Yohannes Endeshaw
Normal aging is associated with changes in all organ systems, and the following questions are intendedÂ to whet your appetite in the area of sleep and aging.
Several studies have reported changes in sleep quality associated with aging.Â The proportion of deep sleep decreases and the proportion of lighter sleep increases with aging, however the duration of sleep over a 24 hour period may not change.Â Â Another age related change in sleep architecture is increase in the number of arousals (by EEG) and may be awakenings during the night.Â In addition, changes in the activities of theÂ circadian timing system has been reported with aging, such that the circadian rhythm may show phase advance (occur at earlier time)Â and less tolerance to misalignment of the circadian sleep-wake cycle and sleep wake schedules of the individual (as seen during shift work and change in time zones).Â Â Â
However, the mere presence of these changes do not necessarily correlate with self-reported problems with sleep.Â Â Healthy older adults with no significant morbidity do not have increased sleep related complaints despite the changes described above.Â
Another sleep stage that may decrease with aging is rapid eye movement (REM)sleep , and this is the part of sleep where most dreams occur.Â It is interesting to note that most skeletal muscles are paralyzed during REM sleep, and this is a protective mechanism that prevents us from acting out our dreams.Â If and when REM sleep related paralysis of skeletal muscle is lost, individuals act out their dreams; and this may cause injury to self or to the bed partner.Â
Taking a nap during the day (siesta) may be a normal habit, and more common in some cultures than others.Â However, this is different from dozing off (falling asleep unintentionally) while reading,Â watching TV or even driving.Â Excessive daytime sleepiness usually indicates sleep debt (except when associated with hypersomnias of central origin), and these could be a result of intentional cutting back on night time sleep (usually observed among professionals who try to accomplish more during a 24-hour period) or the presence of primary or secondary sleep disorders.Â Â Â
Both short-term and long-term improvement in sleep has been reported after cognitive behavioral therapy among older adults.Â In addition, physical exercise as well as exposure to outside light during the day are associated with better sleep.Â Use of hypnotics is usually indicated for short term treatment of insomnia.Â Â There is no good data to show that long term use of sedative hypnotics improve night time sleep and daytime activity.Â However, significant adverse effects have been reported with the use of these medications among older adults.Â Â Speaking of sleep aids, beware of over the counter medications that are used as sleep aids.Â The active ingredient in most of these medications is diphenylhydramine, which has a strong anti-cholinergic effect.Â Acetylcholine is one of the major neurotransmitters involved in cognition and medications with anti-cholinergic effect may counteract its effect.Â Use of medications with anti-cholinergic effect may be associated with adverse effects in the GI, GU, CV systems as well.
Ethiopian Medical History
Photo: Dr. Melaku Beyan. Dr. Melaku Beyan became the first Ethiopian medical doctor to complete his education in the United states in 1935 (Dr. Workneh Eshete became the first Ethiopian doctor to obtain a modern medical education in 1882)
The non-governmental organization, People to People, has just released The Manual of Ethiopian Medical History by Enawgaw Mehari, Kinfe Gebeyehu and Zergabachew Asfaw. The purpose of the publication is to teach the future generation of Ethiopian medical students and health care professionals about Ethiopiaâ€™s medical history.
Mekele University and Bahir Dar University have reportedly agreed to incorporate the study into their medical education curriculum.
Enawgaw Mehari, MD
Kinfe Gebeyehu, MD
Zergabachew Asfaw, MD
Senior Graphic Editor: Matthew I. Watt