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Sleep Apnea in the Elderly

Man with sleeping apnea and CPAP machine asleep in bed

Obstructive sleep apnea—when a person briefly stops breathing multiple times during the night—can lead to health and cognitive issues at any age, but it can be even more of a problem in older adults. They are more likely to have obstructed breathing at night, but are less likely to be properly diagnosed.

My husband did not think he had sleep apnea, but in order to rule that out as the cause of some cognitive problems he was having, he spent a night in a sleep lab. He was able to sleep long enough for the technicians to discover that he stopped breathing about 28 times an hour! He was told that he needed to wear a mask to keep his airways open at night—a treatment known as Continuous Positive Airway Pressure (CPAP). He is still struggling to get used to sleeping with the head gear, but when he does have a good night, I think there is an obvious difference in his mood and cognitive abilities. For those who go untreated, often no amount of sleep means feeling well-rested.

According to a 2009 article in the Internet Journal of Internal Medicine and quoted in The Beaver County Times, sleep disordered breathing affects between 20 percent and 50 percent of older adults, and the prevalence of sleep disorders increases with age—adults age 70 to 80 are twice as likely to be affected than those around age 40. Obstructive sleep apnea has been linked to numerous other diseases, including hypertension, congestive heart failure, stroke and coronary artery disease. The dangers of sleep apnea increase with age.

A large neck, obesity, extra tissue in the back of the airway and loss of muscle tone that helps to keep the airways open are only some of the reasons obstructive sleep apnea can occur. Loud snoring or gasping during sleep and issues such as memory loss, daytime fatigue or sleepiness are some of the most common signs.

Without treatment, the blocked breathing of sleep apnea can force the heart to pump harder to get oxygen. Low oxygen levels in the blood can affect the oxygen supply to the brain, causing cognitive issues, stress to the body and a variety of other symptoms:

  • Restless sleep, night sweats, choking, snoring
  • Daytime drowsiness, lack of concentration
  • Headaches
  • Moodiness, anxiety and depression
  • Leg swelling

A 2010 article in the New York Times titled “When Sleep Apnea Masquerades as Dementia,” explains, “Most of the time, cognitive problems won’t evaporate when seniors are treated for sleep apnea. But researchers find that with C.P.A.P., many older patients see marked improvement. ‘They’re not dozing off during the day, they’re not dragging,’ said Dr. Bradley Boeve, a neurologist at the Mayo Clinic. ‘Quality of life improves. 

”Life gets easier for their caregivers, too, a key concern in trying to keep people out of nursing homes….And, as Dr. Ancoli-Israe, professor of psychiatry at the U. of CA, San Diego, pointed out, ‘If you’re waking up hundreds of times a night and you’re not getting enough oxygen to the brain, of course you’ll see the effect.’ ….But when someone with apnea does stick with the treatment, ‘you’ll see the effects within a month or so,’ Dr. Boeve said. ‘Sometimes even within a week.’

“Now Dr. Ancoli-Israel is investigating whether C.P.A.P. therapy might help reduce the cognitive damage from Parkinson’s disease. ‘This isn’t just Alzheimer’s,’ she said. ‘Any time there are symptoms of dementia, you should think about sleep apnea and discuss it with your doctor.’”

Elderly people may have other medical issues that sleep apnea only makes worse, causing them to not be as independent as they could be or to suffer in other ways. In diabetics, for example, sleep apnea can make it very difficult to control blood glucose levels at night, and like having very high blood pressure or cholesterol, it can even cause death.

If you think you, a loved one or anyone you’re caring for might have sleep apnea, we encourage you to talk to a specialist in sleep disorders. Getting treatment could make life easier and more enjoyable for everyone concerned. 

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