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More than 150 Center on Aging members, interested community members, and UCLA faculty, students and staff attended the Spring Community Meeting, "Restful Sleep, Healthy Aging," held May 22 on the UCLA campus.

The first speaker was Dr. Frisca Yan-Go, associate clinical professor of neurology at UCLA and medical director of UCLA's Sleep Disorders Center. Dr. Yan-Go addressed the importance of "sleep rhythms" to our daily well-being. The urge to sleep is controlled by an internal clock that governs our rhythms of rest and activity. Each day, the body encounters two "sleep threshold," the highest such threshold being from 12 midnight to 6 am. Our second sleep rhythm threshold occurs after lunch. Dr. Yan-Go stated that an individual's sense of well-being can suffer if they are out of sync with their sleep rhythm.

Dr. Yan-Go next discussed the two states of sleep: REM (Rapid Eye Movement) and NREM (nonREM) sleep. NREM sleep is divided into four stages, in which sleep progressively deepens; the fifth stage is REM, characterized by eye movement, twitching, and vivid dreams. During a normal night, individuals cycle between REM sleep and NREM sleep in regular patterns. A healthy night's rest is comprised of a mixture of sleep: 20 percent REM and 80 percent NREM.

According to Dr. Yan-Go, our sleep requirements remain constant throughout our adult lives. "But the distribution of sleep hours may change as we age," she said. "For example, older adults whose sleep time is shorter or more interrupted at night may start taking afternoon naps to get the rest they are missing."

However, she continued, about half of those over 60 years of age have sleep problems. There can be many causes for these problems, some as normal as the aging process itself. Some disorders that can impact sleep quantity or quality include apnea, periodic leg movements, and other medical problems. Additional causes can be an inappropriate sleep setting, such as a room that is too warm, light or noisy, a decrease in daily activity level, medical or psychiatric illness, or stress. Dr. Yan-Go advised that naps should be limited to 30 minutes, once a day, since excessive napping can also impact nighttime sleep.

Dr. Yan-Go suggested that good "sleep hygiene" practices can improve the quality of sleep. "Avoid caffeine for six hours before bed, and alcohol and smoking for one to two hours," she recommends. "Also, I recommend getting regular exercise at least four days a week as allowable and recommended by your general physician. Establish relaxing pre-sleep rituals such as a warm bath, a few minutes of reading, or soft music. And try to keep your bedtime consistent, but don't go to bed if you're not tired."

Finally, Dr. Yang-Go recommends that individuals of any age seek medical help or advice if they have sleep problems several times within a given month, or if sleep problems are interfering with the way they feel or function during the day.

Dr. Ronal Harper, professor of neurobiology at the UCLA School of Medicine and member of UCLA's Brain Research Institute, was the program's second speaker. As a neurobiologist, Dr. Harper is interested in the roles of the brain and body during sleep. He noted that during certain periods of sleep, in particular REM sleep, the body is paralyzed (except for occasional twitching, and movement of the eyes and some respiratory muscles).

The tongue, although critical to breathing because it moves forward to enlarge the airway in order to facilitate the intake of air, is also paralyzed during REM sleep. In some individuals, this lack of tongue movement, as well as paralysis of nearby airway muscles, can cause the airway to close down or collapse. When this happens, the flow of air ceases, and the individual struggles to breathe until the brain signals that it is not getting enough oxygen, and waken the subject; walking breaks the obstruction. Since the obstruction can occur hundreds of times during the night, with hundreds of wakening to restore breathing, some individuals will feel very sleep during the day.

"Different parts of the brain govern breathing," said Dr. Harper. "There is ongoing research aimed at clarifying which parts of the brain are involved in the breathing process. If we could modify the activity of these areas somehow, perhaps breathing during sleep could be assisted.

The final program speaker was Dr. Charles Reynolds, senior pharmacist with the UCLA Medical Enterprise. He stated that with regard to sleep, medication should not be the first line of treatment. "Your health care professional should first find out about any medical or psychological problems which may be affecting sleep. Next, he or she should examine problem behaviors or habits that are associated with sleep disorders. Third, they should educate you on different behavioral techniques such as relaxation and exercise that may improve your sleep. Finally, medications may be prescribed if necessary and appropriate."

Drugs commonly prescribed for sleep disorders can do one of three things, according to Dr. Reynolds. First, they may have no effect. Second, they may have a negative effect by making the sleep complaint worse because of side effects. Finally, they may help resolve the sleeping problem. If one of the first two possibilities occurs, the patients should consult their physician immediately.

Factors such as incorrect use of over-the-counter medications, nicotine, caffeine and alcohol are all disruptive to sleep. "And many do not realize that nutritional supplements that claim to aid in sleep may cause more problems than they resolve," Dr. Reynolds said. He reminded the audience that these supplements may not be produced in standardized doses or with pure ingredients like regular medicines because they are not regulated by the Food and Drug Administration. For these reasons, they should be used with care, and their use should always be communicated to all physicians taking care of the patient.