Most Healthcare providers fail to diagnose sleep disorders in male baby boomers

Among health-related concerns, sleep problems are the most common in male baby boomers. Despite their inability to get a good night’s rest, men between 50 and 64 appear to adapt their perception of acceptable amounts of sleep and, therefore, do not report a problem to their doctors. Physicians, too, exacerbate the situation because most are not trained to recognize sleep disorders in this population or they wrongly assume these disorders are just a normal part of aging. As the youngest of 76 million boomers are now move through their 40s, their chances of enjoying restful sleep steadily decrease. The older the adult, the more likely chronic insomnia will become a health issue. Men especially over 40 are more likely to have sleep disorders than women.

Baby boomers complaints of excessive daytime sleepiness should be a strong indicator to doctors that there may be an underlying sleep disorder. These problems need to be addressed by referring patients for evaluation at a sleep lab. Statistically, fifty percent of all men over age 50 snore . After age 60, more than 60 percent of men will snore. As their age increases so does their sleep problems.

With advancing age, circadian rhythms shift earlier--relative to clock time. As a result, Baby boomers commonly report that they can hardly stay awake until bedtime, but are often awake before the sun rises in the morning. A typical full nights sleep for adults compromise roughly 50 percent shallow sleep (non-REM stages 1 and 2), 25 percent deep sleep (non-REM stages 3 and 4) and 25 percent REM sleep. With advancing years, a dwindling proportion of our sleep is spent in either REM sleep or deep delta sleep. Instead, more of our sleeping patterns migrate to a shallower sleep (non-REM stages 1 and 2). Deep delta sleep, which is the most restorative phase of sleep, declines from about 25 percent of total sleep in early adulthood to less than 5 percent by middle age. As a result, baby boomers are getting very little deep delta sleep. When sleep falls short in quantity or quality, people pay a heavy price by experiencing side effects such as depression, impaired mental and social performance, less reflex control behind the wheel, and poorer health. This is particularly alarming as sleepiness is responsible for more deaths on the roads than alcohol or drugs. However, male boomers typically blame this array of difficulties on other things.

Some of the medications older men take as a part of their health regimen may affect sleep. These include central nervous system stimulants, beta-blockers, bronchodilators, calcium channel blockers, decongestants, stimulating antidepressants and thyroid hormones. At other times, the causes of issues such as insomnia are behavioral due primarily to using alcohol, caffeine, nicotine and over-the-counter herbal medicines.  

Although we know certain facts about sleep, misconceptions abound. One is that people need less sleep as they age. This is untrue.  Older men don’t need less sleep, they just get less sleep. Oftentimes this may be because sleep is shallower, and so it is more easily disturbed by light, noise and pain. Too often, the sleep disruption is dismissed as a normal part of aging, while the underlying causes are not investigated or treated. The effect of sleep disturbance in baby boomers manifests itself as difficulty sustaining attention, poor physical response time and decreased mental performance with memory. This may lead to even more problems, such as the incorrect diagnosis of dementia. In reality, these men simply need more sleep. Another myth that should be debunked is that snoring is the sign of deep, restful sleep. The National Sleep Foundation (NSF) conducted a poll in 2003, which focused on adults between 55 and 84.

The NSF found that about one-third of those surveyed (32 percent) reported snoring at least a few nights per week in the past year. Four in 10 people aged 55-64 (41 percent) said they snored. This contrasts with about one-fourth of people 65-74 years old (at 28 percent) and also contrasts with 75-84 years old (at 22 percent). This clearly signifies a trend among baby boomers. Men were significantly more likely than women to report snoring at least a few nights per week (40 percent versus 26 percent). We may think we are sleeping well because of snoring but it actually indicates quite the opposite. In fact, loud snoring is one of the primary symptoms of a dangerous sleep disorder—OSA, short for obstructive sleep apnea. About 37 percent of American adults ages 30-69 have at least mild OSA. In a sleep apnea cycle, breathing stops, blood oxygen levels drop, and the person wakes briefly gasping for breath. This continues hundreds of times throughout the night. Apnea is classified as a complete cessation of breathing. Each episode of sleep apnea lasts a minimum of 10 seconds; the person must have at least 15 events per hour of sleep before an OSA diagnosis is made.

What causes this high prevalence of sleep disordered breathing in baby boomers? It’s not just because they are ‘boomers’; rather, it is due to the continued changes of growing older.  Changes in airway anatomy occur with age. The soft palate gets longer, the pharyngeal fat pads increase in size, and the shape of bony structures around the pharyngeal airway change. All of these contribute to the increased prevalence of sleep apnea in baby boomers. Sleep-disordered breathing affects about 37 percent of men and women. However, being overweight increases sleep disordered breathing in boomers, up to 58. A little sleep apnea may be normal, but moderate-to-severe apnea is fatal.

The phenomenon of sudden unexplained death during sleep is well documented. Football legend Reggie White, a defensive end for the Green Bay Packers and Philadelphia Eagles, is regarded as one of the NFL’s greatest players. He died from complications related to sleep apnea and sarcoidosis at age 43. People with severe apnea die almost 1.5-2 years sooner than those who don’t have apnea. No matter what age the patient is, vigilance in treating disorders is imperative.

Sleep apnea has an insidious and damaging impact on a person’s health. It makes patients feel chronically tired, erodes their quality of life and impairs their ability to perform safety-critical tasks, such as driving a car. It also heightens the risk of high blood pressure, heart attacks and strokes. Untreated sleep apnea causes accidents and illness, undermines a person’s effectiveness in the workplace and imposes large burdens on the healthcare system. If you think you or someone you know has sleep apnea, order a sleep study. One option is a full polysomnogram performed in a hospital or sleep center which records the amount of snoring and sleep apnea in each stage of sleep. It also records oxygen desaturation throughout the night. Another option is a home sleep study, which records similar data without sleep staging. If there is a diagnosis of sleep apnea, there are various approaches to treatment available.  One is Behavioral

modification. This means changing apnea-aggravating circumstances that are within the patient’s control. These may include losing weight, avoiding alcohol and sedative drugs, trying to sleep only on one side and smoking cessation. Sleeping on one’s side helps prevent the tongue and soft palate from relapsing back into the throat. Quitting smoking alleviates irritation in the airway. Continuous positive airway pressure (CPAP).  This involves wearing a close-fitting mask over the nose. Continuously flowing air comes through a flexible plastic hose from a medical air pump to support and hold the upper airway open. Although CPAP has been the gold standard treatment for sleep apnea, some patients are claustrophobic and cannot tolerate CPAP. Few physicians have adequate experience with this treatment. Therefore, patients should consult with dentists who specialized in snoring and sleep apnea. At The Gelb Center, for instance, several types of oral appliances that maintain the jaw in the forward position are offered. They are designed to allow the advancement of the mandible and prevent the relapse of the tongue, palate and lateral pharyngeal walls into the airway. Oral orthotics  are recommended for treating sleep apnea in patients with moderate-to-severe OSA and in those who cannot tolerate CPAP treatment. This is a stepwise approach to OSA therapy that requires conservative interventions, before considering more aggressive treatments such as jaw realignment surgery.  If a nasal CPAP or an oral appliance is to be effective, patients need to breathe through the nose. This can be achieved by referring the patient to an ENT specialist who can evaluate the patient for septoplasty (correcting a deviated septum) or turbinectomy (reducing the turbinates). Palatal surgery, which reduces the size of the soft palate with laser or traditional surgery, is only about 50 percent successful at decreasing the loudness of snoring, but is not always successful at improving sleep apnea. Surgery should not be considered an option for patients with severe sleep apnea.

Even when providers correctly diagnose sleep disorders, many cannot offer effective treatments. The patient, therefore, has to work in conjunction with dentists, ENTs and pulmonologists. Clearly, public and professional awareness of this common yet life-threatening problem needs to be addressed.