Test your “sleep and aging” IQ

Written by Zergabachew Asfaw and Yohannes Endeshaw 

"And if tonight my soul may find her peace in sleep, and sink in good oblivion, and in the morning wake like a new-opened flower then I have been dipped again in God, and new-created." ​-  D.H. Lawrence

"O Sleep, O Gentle Sleep, Natures Soft Nurse, How Have I Frightend Thee, That Thou No More Wilt Weigh my Eye-Lids Down And Steep My Senses In Forgetfulness?" ​-  William Shakespeare

And if tonight my soul may find her peace
in sleep, and sink in good oblivion,
and in the morning wake like a new-opened flower then I have been dipped again in God, and new-created.
​-  D.H. Lawrence

"O Sleep, O Gentle Sleep, Natures Soft Nurse, How Have I Frightend Thee, That Thou No More Wilt Weigh my Eye-Lids Down And Steep My Senses In Forgetfulness?"
​-  William Shakespeare

Normal aging is associated with changes in all organ systems, and the following questions are intended  to whet your appetite in the area of sleep and aging.

1	Older adults do not need as much sleep as  middle-aged adults	True	False
2	​The sleep of older adults is deeper and shorter
3	The sleep of older adults is shallower and longer
4	Dozing off while sitting and reading or watching TV is a normal part of aging.
5	Older adults have increased sleep complaints in comparison to younger adults
6	Sleep apnea is not as common in older adults as it is in middle-aged adults
7	Among older adults, difficulty going to sleep is more common than difficulty staying asleep
8	Day time physical activity (physical exercise) improves night time sleep
9	Daytime exposure to outside light improves night time sleep at night
10	Older adults better tolerate time zone changes in comparison to middle-aged adults
11	Acting out one's dream occurs in most older adults,  and it is a normal part of the aging process.
12	Older adults who use sleep aids usually report better sleep quality.

​Several studies have reported changes in sleep quality associated with aging.  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.   Another age related change in sleep architecture is increase in the number of arousals (by EEG) and may be awakenings during the night.  In addition, changes in the activities of the  circadian timing system has been reported with aging, such that the circadian rhythm may show phase advance (occur at earlier time)  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).   
However, the mere presence of these changes do not necessarily correlate with self-reported problems with sleep.   Healthy older adults with no significant morbidity do not have increased sleep related complaints despite the changes described above. 
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.  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.  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. 
Taking a nap during the day (siesta) may be a normal habit, and more common in some cultures than others.  However, this is different from dozing off (falling asleep unintentionally) while reading,  watching TV or even driving.  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.   
Both short-term and long-term improvement in sleep has been reported after cognitive behavioral therapy among older adults.  In addition, physical exercise as well as exposure to outside light during the day are associated with better sleep.  Use of hypnotics is usually indicated for short term treatment of insomnia.   There is no good data to show that long term use of sedative hypnotics improve night time sleep and daytime activity.  However, significant adverse effects have been reported with the use of these medications among older adults.   Speaking of sleep aids, beware of over the counter medications that are used as sleep aids.  The active ingredient in most of these medications is diphenylhydramine, which has a strong anti-cholinergic effect.  Acetylcholine is one of the major neurotransmitters involved in cognition and medications with anti-cholinergic effect may counteract its effect.  Use of medications with anti-cholinergic effect may be associated with adverse effects in the GI, GU, CV systems as well.