HOW TO PREVENT CANCERS

Our expert: Professor David Hillman

Most of us have heard that we need less sleep as we age. So when older people spend hours awake in the middle of night or wake before the sun comes up, they tend to accept it as a normal part of ageing.

But do you actually need less sleep as you get older?

No, says Professor David Hillman, chair of the Sleep Health Foundation, older adults need the same amount of sleep as young people.

"Adult sleep requirements are pretty stable from about the age of 20 on. Sleep does change as you get older, but the sleep requirements remain pretty constant once you've established that in your early 20s," he says.

Hillman says it is remarkable how many older people endure feeling sleepy without seeking help, because they think it is a natural part of ageing. But in many cases there is a reason for this poor sleep, and once a sleep disorder is identified and treated, older adults can feel years younger.

"If people notice a change in their sleep requirements as they get older, such as spending longer in bed for less benefit, and waking up unrefreshed despite getting the same amount of sleep that used to refresh them, then that implies there's something wrong with sleep itself," he says.

"It's really a gratifying area to work in because there are actually easy wins in those areas and people just feel younger again," Hillman says.

Your "body clock", which is actually the circadian centres in your brain, dictates your propensity to sleepiness and wakefulness across day and night. These centres are generally influenced by light and darkness, but can also be affected by other aspects of your daily routine, such when you eat and when you exercise.

While some people have quite robust sleep patterns and still get the rest they need despite changing their daily routines, many people's body clocks rely on fairly constant habits.

Your body clock also controls the production of a hormone called melatonin, which promotes sleep. As you grow older you produce less of this hormone, which may make it more difficult for you to sleep.

Older adults are also more likely to experience advanced sleep phase syndrome, which means you get sleepier earlier in the evening so while you may still be sleeping for eight hours, you might find yourself awake before the birds.

Also, while your body is programmed to sleep at night, some of us find ourselves feeling sleepy in the afternoon. Given that older adults are less likely to be at work, they sometimes have an afternoon nap. But napping in the afternoon, especially later in the afternoon, will affect how well you sleep at night.

There are also specific health issues related to ageing that can have a significant impact on sleep, especially your ability to fall asleep, these include:

aches and pains, especially conditions such as arthritis and osteoporosis,anxiety and depression, Alzheimer's disease and dementia,reflux, which many older adults experience after a meal, especially if it's exacerbated by lying down,men with prostate problems may need to get up during the night to urinate,sleep apnoea is also common among older adults, and can cause significant sleep disturbances, some medications such as antidepressants, blood pressure tablets, and diuretics, can also hinder the ability to fall asleep. While they might not be the cause of sleep problems, it's best to review your medications with your doctor if you have concerns.

If any of these factors are affecting your sleep then it's important to talk to your doctor about them, as treating an underlying condition that is causing poor sleep often leads to better sleep.

And if you don't have an underlying issue, but still have constant difficulty dropping off to sleep, or going back to sleep after waking during the night – then you may have insomnia. Insomnia is not necessarily linked to ageing, so it's best to speak with your doctor about your options for treating insomnia.

Although older people do face many challenges in achieving a good night's sleep, following a few simple rules can help.

Allow an adequate amount of time for sleep on a daily or near daily basis.Go to sleep at the same time each night.Supplement a lack of sleep with short afternoon naps between 30 minutes and one hour.Eat at regular times and don't eat a big meal late at night.Avoid caffeine after mid-afternoon – if you want a warm drink before bed have weak tea or a decaffeinated coffee.Ensure your bedroom environment is conducive to sleep – dark, a comfortable bed, the right temperature and no television.Try not to bring your worries to bed – if needed spend some time just before bed writing down your worries and a plan for the coming day.Speak with your doctor if your sleep changes after starting new medications.

Professor David Hillman is an anesthesiologist and sleep physician and chair of the Sleep Health Foundation. He spoke to Jenny Pogson.

Published 14/11/2013

by Dyani Lewis

Headlines often highlight the perils of getting pregnant over 35. But how much does being an older mum affect a woman's health or her baby's?

In recent decades, Australian women having their first child have been older. The average age for a first child has crept past the age of 30, and women aged 35 to 39 years have been outbreeding their 20 to 24-year-old sisters since 2005.

Fertility concerns aside, even women who naturally fall pregnant in their late 30s or 40s are often plagued with fears over the possible health risks their age poses for themselves and their babies. According to Associate Professor Mary Carolan from Victoria University, these fears are often overstated. "[Older women] get a lot of bad press," she says.

Carolan worked for many years as a midwife before embarking on an academic research career. She says older women's anxieties during pregnancy are often provoked by a barrage of information from healthcare professionals about potential risk factors associated with a mother's age. "I think it's very disheartening for them," she says.

Carolan has looked into what the risks are for women aged 35 years or older – women who are officially classified as being of advanced maternal age – who choose to have a baby.

"I felt that there needed to be some positive information out there for these women," she says.

"As we age – all of us – are more prone to certain things," says Carolan. "It's true, there is a connection between older maternal age and all sorts of adverse outcomes," she concedes, but notes that the data needs to be considered in the right context.

One of the most known risks associated with older motherhood is conceiving a baby with Down syndrome, in which a baby receives one too many chromosomes from their parents. Instead of having a total of 46 chromosomes, they have 47; an extra copy of chromosome 21 results in the child having a distinct appearance and intellectual disability.

Either parent can contribute the extra copy of chromosome 21, but in 90 per cent of cases it comes from the mother and is due to faulty cell division during egg development. The older a woman is, the more likely this is to occur.

The chance of having a baby with Down syndrome at age 30 is around 1 in 1000. By the age of 35, the risk has increased to 1 in 400, and by 40, to 1 in 100.

While the increase in risk might seem alarming, Carolan points out "your risk of having it is still very much smaller than your likelihood of having a normal baby".

Most foetuses with chromosomal anomalies resulting from faulty egg maturation often don't make it past the first few weeks of pregnancy. If this occurs early enough, a woman may not even know that she has been pregnant.

Screening towards the end of the first trimester – at 11 to 13 weeks gestation – is a further check for Down syndrome and other health problems that the foetus might have.

Other chromosomal conditions caused by incorrect cell division in the maturing egg include:

Klinefelter syndrome – an extra copy of the X chromosome in boysPatau Syndrome – an extra copy (trisomy) of chromosome 13Edward Syndrome – an extra copy (trisomy) of chromosome 18

As women age, the hormonal ebbs and flows that occur with clockwork regularity at 20 start to falter.

"The wheels start to come off a bit," explains Dr Mark Green, a reproductive biologist at the University of Melbourne.

One of the results is that the rate of multiple births increases. Women aged 35 or over are twice as likely to have a multiple birth as those under the age of 35.

Hormonal fluctuations are also often behind the "whoops" babies, as Green calls them. These are babies conceived when women make the mistake of thinking they've entered menopause, but instead their cycle has simply become more irregular as menopause approaches.

Older women pregnant with just one baby have slightly higher risk for certain conditions than younger women. These conditions include gestational diabetes, high blood pressure and stillbirth. But this risk is still low.

"As a woman gets older, the very small risk [of stillbirth] increases," says Carolan. But, she notes, the absolute risk is very small. "In places like Australia, it's so low that you can't really get reliable statistics on it."

In good news, a study conducted in Western Australia also shows that stillbirth in older women is decreasing.

While women aged 35 and over are twice as likely to get gestational diabetes, which can affect the baby's health, ethnicity and a mother's weight also influence a woman's risk of developing gestational diabetes.

"Women that are obese or significantly overweight are way more at risk than a woman who is lean and active," says Carolan. Also certain ethnicities are more at risk, including women from Vietnam, South Asia, Africa and the Mediterranean.

As obstetric and midwifery care have improved and complications, such as high blood pressure, are identified and treated early, outcomes for older women and their babies have also improved.

Another positive change is that many older women having babies now are fit and healthy when they go into pregnancy, which often has a greater impact on the pregnancy than age.

"What we can definitively say is that a woman that goes into a pregnancy over the age of 35, who doesn't have any of these pre-existing conditions, like diabetes, high blood pressure, and is within a normal weight range and eats well, you can say that her outcomes are likely to be really good," says Carolan.

A few years down the track, their children may even be doing better than those of younger women. Having waited for financial security, or to establish a career, older mothers can be better equipped to give their children the best start in life.

"Socially, the children of slightly older mothers do well," says Carolan. "They do better than many of the children of younger mothers."

Published 31/10/2013