Published September 1, 2018
“Fail fast and pivot” is an important concept in entrepreneurship relating to the need to quickly identify what does not work, iterate based on real data, and change course. While applicable to a great many problems, this idea has particular importance in health care and the ability to improve health. Unfortunately, health care providers have been slow to notice that many adults and older adults are struggling to get the sleep they need.
As a result of poor sleep, older adults often experience negative daytime consequences, such as difficulty concentrating and excessive daytime sleepiness. Frequently, they attempt to self-manage by taking sleeping medications at night and stimulants during the day. A CDC nationally representative survey found that sleeping medication use increased with age, with the highest consumption among older adults above 80 years. This cycle of medication use related to poor sleep can lead to adverse health events and poor outcomes, especially in this older population.
It is time to pivot to the future.
My research has identified that poor sleep is associated with higher levels of functional limitations among adults over 40 years of age. People coped with these disabilities by limiting their activities, such as climbing stairs less often.
It is never too late – even in cases of significant cognitive impairment – to help older adults improve their sleep quality and ability to complete activities of daily living. Improvements in sleep and functioning were seen with a program that included walking, weightlifting and social activities.
It is possible that our failure to pivot to treat sleep disturbance in older adults can be attributed to our social understanding of aging. While we have created an arbitrary retirement age of 65 years that has come to represent old age, aging does not occur at a given point in time. Instead, aging is a gradual, continuous process of spontaneous change that begins at birth and continues throughout all stages of life. The process of physiological decline begins during our 20s when our brains begin to lose neurons and our lung capacity begins to decline. Many sleep disorders also begin before retirement age, with obstructive sleep apnea commonly diagnosed during our 40s and insomnia afflicting over 40 percent of people by age 65.
The physiological process of decline described above is accelerated in adults with chronic diseases, such as multiple sclerosis (MS). Symptoms of MS commonly begin in the prime of life in the 20s to 40s and include disturbed sleep. Research has shown that sleep disturbances in this population are significant and usually undiagnosed, though attention has shifted to improving sleep in this population over the last several years.
My research in improving sleep in this MS population echoes my earlier research regarding sleep in older adults and reinforces the importance of sleep for overall physical functioning, especially in the context of illness. This research has also highlighted the need for better screening for disrupted sleep and sleep disorders, along with appropriate referrals to sleep specialists.
Until we appreciate the impact of sleep disturbance on overall functioning and pivot our approaches to improving health to include improving sleep, we will continue to fail our patients. It is time to pivot our care to the future.
-REBECCA LORENZ, PHD, RN
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