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过早醒来。这种情况甚至发生在没有睡眠问题或昼夜节律异常的健康、非抑郁的老年人身上。我们发现了一个与年龄相关的变化，在昼夜节律阶段，睡眠的后半部分仍然巩固和年龄相关的增加，在夹带的昼夜节律阶段的变化。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患病率的主要原因。这意味着在昼夜节律和睡眠之间保持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夜间光照来实现，尽管维持效果所需的持续时间和强度可能会使依从性变得困难。 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长波长的光更敏感。这表明，如果光富含较短波长，则可以使用较短的持续时间和/或较低的强度来实现用于实现睡眠与昼夜节律之间的最佳相位关系的光治疗。我们建议将使用新的蓝色富集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。我们将评估褪黑激素昼夜节律和睡眠时间之间的相位关系的变化，以及治疗夜晚和之后几个晚上的主观和客观睡眠质量的变化。 睡眠中断是导致健康老年人生活质量下降的一个重要原因，通常会导致过度使用睡眠药物，并产生不幸的生理和心理副作用。更好地了解导致与年龄相关的睡眠中断的机制，并仔细评估这种新治疗方法，对于开发实用的非药物治疗方法非常重要，并为改善老年人的健康和福祉提供了希望。

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.