Article Archive
July/August 2021

Clinical Matters: Helping Older Adults Sleep Easier
By Jack Huber
Today’s Geriatric Medicine
Vol. 14 No. 4 No. 8

Innovative stent-based therapies resolve breathing issues, improve sleep, and enhance quality of life.

Sleep disorders have become a significant health issue in the United States, with 22 million Americans living with sleep disordered breathing (SDB)—a potentially serious sleep disorder in which breathing repeatedly stops and starts. What’s more, 80% of the cases of moderate and severe obstructive sleep apnea (OSA)—repeated collapse or partial collapse of the upper airway—go undiagnosed. Between 40% and 70% of older adults have chronic sleep issues, with up to one-half being undiagnosed.

Age-related sleep changes include advanced sleep phase and decreased slow-wave sleep, caused by reduced homeostatic sleep pressure and reduced circadian signals. This leads to fragmented sleep and early awakening, which can affect sleep quality and cause insomnia. Older adults can also experience increased stress levels and sleep disorders, inability to breathe through the nose, sleep deprivation, narcolepsy, restless legs syndrome, and insomnia.

A recent study found that the risk of dementia was higher and associated with adults in their 50s and 60s with a sleep duration of fewer than six hours. This emphasizes the importance for older adults not only to be screened for sleep disorders but also to maintain and improve their sleep quality with sleep aid devices, such as nasal stents, which increase oxygen supply and contribute to more relaxed sleep.

Airway stents also provide an alternative to health care providers seeking to shift away from treating sleep issues among older adults with sedatives due to their addictive nature and side effects, such as impaired memory and focus.

Causes of Sleep Issues
Common causes of sleep issues in older adults include the following:

• Snoring: An estimated 45% of adults snore occasionally and 25% snore regularly, which often causes them to wake up throughout the night.

• Pain: Discomfort and pain can create a cycle in which less sleep can lead to more pain.

• Nocturia: Known as nighttime urination, nocturia affects up to 80% of older adults.

• Daytime drowsiness: This affects about 20% of older people and may be a sign of an underlying health condition, such as SDB, cognitive impairment, or cardiovascular issues.

• OSA: This causes fragmented sleep and can affect oxygen levels in the body, leading to headaches, daytime sleepiness, and difficulty thinking clearly.

• Restless conditions: Restless leg syndrome affects 9% to 20% of older people, while periodic limb movements of sleep affect 4% to 11%, leading to significant impact on sleep and quality of life.

• Poor REM cycles: REM sleep behavior disorder can cause people to act out their dreams, sometimes violently, often leading to wakefulness during the night.

• Drugs: Many over-the-counter and prescription drugs can also contribute to sleep issues. Antihistamines and opiates can cause daytime drowsiness, while antidepressants and corticosteroids can lead to insomnia, with medication interactions also influencing sleep.

• Sedentary lifestyle: Lifestyle also contributes to poor sleep. Typically, older adults work less and nap more, leading to a less structured sleep schedule. Other significant life changes, such as lack of independence and social isolation, can increase stress and anxiety—leading to sleep disruption.

Impact of Sleep Deprivation
More than one-third of American adults don’t get enough sleep each night, despite an increased risk of developing chronic conditions, such as obesity, diabetes, high blood pressure, heart disease, stroke, and mental illness.

Sleep deprivation is also associated with growth hormone deficiency and elevated cortisol levels, both of which have been linked to obesity. Disrupted, poor sleep quality can also impair metabolism and lead to significantly increased risk for diabetes. Shorter sleep times in individuals treated with both insulin and oral glucose-lowering medication have been associated with higher risks of all-cause and cardiovascular disease mortality.

Treatment for sleep issues among older adults can be divided into nonpharmacological and pharmacological options. Aging increases body fat and reduces total body water and plasma proteins, resulting in increased drug elimination half-life and the potential risk of adverse effects. Therefore, older adults should be treated first with nonpharmacological options before using pharmacological options.

Nonpharmacological approaches include relaxation techniques, improving sleep hygiene, and cognitive behavioral therapy. These options can be effective even for older adults with cognitive impairment. For proper sleep hygiene, individuals should avoid daytime naps; maintain a regular sleep schedule; limit substances such as caffeinated beverages, nicotine, and alcohol; and exercise at least six hours before bedtime.

Cognitive behavioral therapy should consist of six to 10 sessions with a trained therapist who focuses on cognitive beliefs and counterproductive behaviors that interfere with sleep. Relaxation techniques include progressive muscle tensing and relaxing, guided imagery, paced diaphragmatic breathing, and meditation.

The Impact of Breathing Issues
Breathing issues can have wide-ranging effects, including the following.

The most common symptoms of SDB include loud snoring, gasping for air during sleep, waking with a dry mouth, morning headache, insomnia, excessive daytime sleepiness, and poor concentration and mood.

Common among older people, SDB can lead to cognitive impairment, mood changes, compromised quality of life—often attributed to reduced social functioning and vitality—and higher risk of stroke and comorbidities, with up to 50% of patients with mild symptomatic chronic heart failure having SDB.

In fact, individuals with untreated severe SDB have an increased incidence of coronary heart disease, myocardial infarction, heart failure, stroke, and mortality after adjusting for established cardiovascular risk factors. One study found that older adults with untreated severe SDB had increased all-cause mortality. Additional outcomes of particular interest in older people may include glaucoma, falls with fractures, impaired quality of life, decreased pain tolerance, frailty, and mortality.

Untreated OSA can lead to high blood pressure, congestive heart failure, atrial fibrillation, stroke, and other cardiovascular problems. This disorder is also associated with type 2 diabetes and depression and is a factor in a large number of traffic accidents due to persistent drowsiness.

Treatments for breathing issues include weight loss, smoking cessation, increased cardiovascular exercise, enhanced sleep opportunity and environment, optimized medical management of comorbidities, and reduction in caffeine, alcohol, and sedatives.

Continuous positive airway pressure (CPAP) therapy is a common treatment for OSA. CPAP pushes air into the airways to keep them open with a pump that controls airflow, a tube carrying air from the machine to the user, and a mask that goes over the mouth, nose, or both. Typical problems with CPAP, however, include discomfort, leaky masks, trouble falling asleep, stuffy nose, and a dry mouth. Other treatments include oral appliances, surgery, and sleep aid devices.

The most effective sleep aid devices support natural nasal breathing, which is essential for optimal health because they filter, warm, and humidify inhaled air. This protects the lungs, leads to better oxygen supply to the body, stimulates the calming nervous system, and reduces snoring and SDB. All of these factors contribute to a stronger immune system and improved quality of life.

Benefits of Stent-Based Therapies
Among the most promising sleep aid devices, innovative stent-based therapies not only support healthy, natural nasal breathing but also enhance physical performance, mitigate symptoms of chronic sinusitis and other quality of life conditions such as allergies, rhinitis, chronic rhinitis, sinusitis, allergic rhinitis, and many autoimmune diseases.

This medical device can be inserted by the patient into the nose and throat at night and removed in the morning—in a manner comparable to the ease of wearing contact lenses. Airway stents can transform unhealthy sleep patterns and improve nasal breathing to increase oxygen supply and result in more relaxing sleep.

In addition, they are clinically proven to support the upper airway passage to allow for better airflow and easier breathing, improve nasal breathing, and enhance sleep.

The most effective airway stents are made of nitinol, a nickel-titanium alloy that has super-elastic characteristics. Health care providers should also look for airway stents that have been clinically tested for treatment of patients struggling with OSA and snoring and that are designed to support healthy, natural nasal breathing at night and during the day. The best stents available can be worn comfortably for up to 18 hours at a time for optimal breathing—and a better night’s sleep for older adults.

— Jack Huber is president of Alaxo Airway Stents.