Disrupted Sleep in the Elderly: Circadian Etiology

描述(申请人提供)：许多老年人抱怨睡眠维持、失眠和早醒。即使是在健康的、没有抑郁的老年人中也会发生这种情况，没有睡眠主诉或昼夜节律异常。我们发现了与年龄相关的昼夜节律阶段的变化，在此期间睡眠的后半部分保持巩固，并且与年龄相关的昼夜节律阶段的可变性增加。我们推测，这些与年龄相关的昼夜节律变化可能是老年人睡眠中断和早醒的高发原因。这意味着，在昼夜节律和睡眠之间保持一个理想的时间对于老年人的睡眠巩固至关重要。这种关系的调整可以通过晚光照射来实现，尽管维持效果所需的持续时间和强度可能会使遵守规定变得困难。 我们最近的研究表明，人类的昼夜节律系统对短波长的光比对长波长的光更敏感。这表明，如果光在较短的波长中丰富，则可以使用较短的持续时间和/或较低的强度来实现实现睡眠和昼夜节律之间的最佳相位关系的光治疗。我们建议将使用新获得的富蓝光源的光治疗方案与使用标准光源的相同治疗方案进行比较。我们将评估昼夜褪黑激素节律和睡眠时间之间的相位关系的变化，以及在治疗之夜和之后的几个晚上主观和客观睡眠质量的变化。 睡眠中断是健康老年人生活质量下降的重要原因，经常导致过度使用安眠药，带来不幸的生理和心理副作用。更好地了解与年龄相关的睡眠障碍的机制，并仔细评估这种新的治疗方法，对于开发实用的非药物治疗方法将是重要的，并为改善老年人的健康和福祉提供希望。

DESCRIPTION (provided by applicant): Many older people complain of sleep maintenance insomnia and waking prematurely. This occurs even in healthy, non-depressed older people without sleep complaints or circadian rhythm abnormalities. We found an age-related change in the circadian phases over which the latter part of sleep remains consolidated and an age-related increase in the variability of entrained circadian phase. We hypothesize that these age related circadian changes may account for much of the high prevalence of disrupted sleep and early waking in older people. This implies that maintaining an ideal timing between circadian phase and sleep is crucial for sleep consolidation in older people. Adjustment of this relationship can be achieved by evening light exposure, although the duration and intensity required to sustain an effect can make compliance difficult. Our recent studies have revealed that the human circadian system is more responsive to short than to longer wavelength light. This suggests that light treatments for achieving an optimum phase relationship between sleep and circadian rhythms may be achieved using shorter durations and/or lower intensities if the light is enriched in the shorter wavelengths. We propose comparing a light treatment regimen using a newly available blue-enriched light source with the same treatment using standard light sources. We will assess the change in phase relationship between the circadian melatonin rhythm and sleep timing, and the change in subjective & objective sleep quality on treatment nights and for several nights thereafter. Sleep disruption is an important cause of diminished quality of life in otherwise healthy older people, often leading to an overuse of sleep medications with unfortunate physiological and psychological side effects. Greater understanding of the mechanisms causing age-related sleep disruption, and careful evaluation of this new treatment will be important in developing practical, non-pharmacologic treatment methods, and offers promise for improving the health and well-being of older people.