Why do people in their 40s and 50s not sleep as well?

I have read that as people enter their 40s and 50s they don't sleep through the night as well. Can you tell me why?

The most useful strategy for examining a lack of sleep consolidation is the use of the differential diagnosis, a method that facilitates the search for a cause of a healthcare condition. We start by focusing on various signs and symptoms reported by the patient who is not sleeping through the night, and then rank the potential causes of the problem by order of likelihood.

If patients report waking up in pain, then pain is probably the main cause of their lack of sleep consolidation. However, what causes the pain may or may not be as obvious. Depending on the type and severity of pain, it could be related to a lousy mattress, fibromyalgia, cancer, and so on.

When we explore the awakenings that lead to a lack of sleep consolidation, the differential diagnosis is vast and includes no less than issues with pain, noise, temperature, comfort, breathing or leg movement disorders, cardiac arrhythmias, hormonal changes, insomnia or nightmares, light sleep, nasal or sinus congestion, reflux and indigestion, and nocturia (trips to the bathroom).

The list could go on and on, but notice the one thing not on the list: Aging! Many individuals mistakenly believe getting older directly impairs sleep or that it is natural to become a lighter sleeper or sleep less through the night. But, this impression is only accurate if and when the aging process affects other symptoms of the body, which then cause the sleeplessness problem.

If the above point seems too nuanced, you may find it easier to appreciate once you understand the pathophysiological mechanisms involved in this discovery process. For example, my favorite topic regarding aging involves nocturia (trips to the bathroom at night), because so many people believe nocturia is either natural once you hit 40, or they have grown so accustomed to waking up to urinate it no longer concerns them. Moreover, as we age we may develop bladder or prostate problems that certainly make us susceptible to waking up at night.

When we drill deeper into the actual pathophysiologic process of nocturia, however, (check out my video at www.nocturiacures.com), we discover a great deal of nocturia is caused by sleep-disordered breathing (SDB). How could a breathing disorder cause you to pee at night? Quite simply, SDB increases blood flow into the heart, which in turn triggers the release of a diuretic from the right atrium of the heart, which then triggers the kidneys to pass more water into the bladder, which then increases trips to the bathroom.

Most physicians or sleep patients have never heard of this phenomenon or the name of the diuretic (atrial natriuretic peptide) that is naturally released from the heart, so they assume other reasons for nocturia, the most common of which is excess fluid intake in the evening, enlarged prostate, or chronic bladder problems. Yet, even among patients with these three issues, it is quite common to see a decrease in nocturia episodes and therefore greater sleep consolidation when the SDB is successfully treated.

Digging deeper into what might seem like obvious causes on the surface may lead to the true etiology for fractured sleep. We often discover that aging’s effects may prove important but not for the reasons we initially imagined.

Another good example is the problem with restless legs syndrome (RLS) and periodic limb movement disorder (PLMD), both of which can fracture your sleep. Research consistently shows increasing rates of these leg movement disorders as we age, and one explanation for the problem appears to be deficiencies in iron storage as well as depletion of iron in specific brain cells. Here then is an example where it might be worthwhile to not only treat a patient’s RLS or PLMD with appropriate medications but also to investigate whether or not they suffer from low iron levels, which may require referrals to hematologists or gastroenterologists. By digging deeper, we may find that iron supplementation (do not take iron supplements without discussing first with your physician) is a major component of therapy for successfully improving sleep consolidation.

With just these two examples, I trust you can see that aging may be involved in sleep fragmentation, because as we grow older perhaps the airway dilator muscles do not work as well to keep us breathing properly during sleep, or as we grow older perhaps our ability to absorb iron decreases, which then exacerbates leg movements.

So, yes, aging is related to how we might develop sleep fragmentation problems, but instead of simply imagining we sleep worse due to aging, we need to look for more precise answers to the problem of sleeplessness to lead us toward evidence-based treatments, some of which really do help us to sleep just like a baby again.

Barry Krakow MD


Dr Krakow’s 27 years of sleep research have focused on the complex relationship between physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.

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