To Sleep, Perchance to Dream: How to Treat Sleep Problems in the Elderly

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Old age causes loss of sleep. Rita tells us all about sleep disorders and how to deal with it, in the weekly column, exclusively in Different Truths. An in-depth study.

Older adults need the same seven to nine hours of sleep that younger adults do. However, if you are an older adult, you might find that a good night’s sleep is but a dream. You have trouble falling asleep and awake after only a few hours. As a result, you suffer debilitating daytime fatigue that may be so overwhelming that you can’t drive or participate in other normal activities. As age catches up with us, we find sleep patterns and habits changing and we may:

  • have trouble falling asleep
  • sleep fewer hours
  • wake up frequently in the night or early morning
  • get less quality sleep

While many seniors complain of poor sleep, relatively few have true sleep disorders and even smaller numbers need commonly prescribed sleep medications. However, almost half of those who complain to their doctors about poor sleep end up with a prescription drug. Not only are these unnecessary but they also are habit-forming and can cause side effects, according to sleep researcher Michael Vitiello, PhD, a professor of psychiatry and behavioural sciences at the University of Washington in Seattle.

“It is far better for people to consider what simple changes could be made to improve their sleep–and to understand how sleep patterns with age”, Vitiello writes in the /December 1999 issue of the journal Gerontology.”Compared with younger adults, even carefully screened non-complaining older adults exhibit the sleep pattern changes described,” writes Vitiello.

What Causes Sleep Problems in Older Adults?

Primary sleep disorders

A primary sleep disorder means there isn’t another medical or psychiatric cause. Primary sleep disorders can be:

  • insomnia, or difficulty falling asleep, staying asleep, or restless sleep
  • sleep apnea, or brief interruptions in breathing during sleep
  • restless leg syndrome (RLS), or the overwhelming need to move your legs during sleep
  • periodic limb movement disorder, or involuntary movement of the limbs during sleep
  • circadian rhythm sleep disorders, or a disrupted sleep-wake cycle
  • REM behaviour disorder, or the vivid acting out of dreams during sleep

Insomnia is both a symptom and disorder. Conditions like depression, anxiety, and dementia can increase the risk for sleep disorders.

Medical conditions

Studies report that older adults who had trouble sleeping were more likely to have existing conditions and be less physically active.

These conditions include:

  • Alzheimer’s disease
  • chronic conditions like arthritis pain
  • cardiovascular disease
  • neurological conditions
  • gastrointestinal conditions
  • lung or respiratory conditions
  • poor bladder control

Medications

Many older adults are on medications that can disrupt sleep. These include:

  • diuretics for high blood pressure or glaucoma
  • anticholinergics for those with chronic obstructive pulmonary disease (COPD)
  • antihypertensive drugs for high blood pressure
  • corticosteroids (prednisone) for rheumatoid arthritis
  • antidepressants
  • H2 blockers for gastroesophageal reflux disease (GERD) or peptic ulcers
  • levodopa for Parkinson’s disease
  • adrenergic drugs for life-threatening conditions like attacks or cardiac arrest

Common substances

Caffeine, and smoking may also contribute to sleep problems in the elderly.

How are Sleep Disorders Diagnosed?

To make a diagnosis, your will ask about your symptoms and conduct a physical examination to look for any underlying conditions. Your may also ask you to complete a sleep diary for one to two weeks to learn more about your sleeping patterns. If your suspects a primary sleep disorder, they will send you for a polysomnogram, or a sleep study.

Sleep Study

A sleep study is usually done at night in a sleep lab. You should be able to sleep as you normally would at home. A technician will place sensors on you to monitor your:

  • body movement
  • breathing
  • snoring or other noises
  • heart rate
  • brain activity

You may also have a finger device to measure the oxygen in your blood.

The technician will watch you through a video camera in the room. You can talk to them if you need any help. During your sleep, the devices will continuously record your information on a graph. Your doctor will use this to diagnose if you have a sleep disorder.

How Therapy helps Sleep Disorders

For older adults, it’s recommended to use non-pharmaceutical treatments like behavioural therapy first. This is because older adults tend to already be taking multiple medications. Therapy can happen over six weeks or longer and include sleep education, stimulus control, and time in bed restrictions.

A randomised controlled trial showed that cognitive behavioural therapy (CBT) largely improved sleep quality for people with insomnia. The study suggests that CBT is more effective because it helps target the quality of sleep rather than the transition into sleep.

Treatment

Relieving chronic pain and controlling medical conditions such as frequent urination may improve sleep in some people. Treating depression can also improve sleep.

Sleeping in a quiet room that isn’t too hot or too cold and having a relaxing bedtime routine may help improve symptoms. Other ways to promote sleep include these healthy lifestyle tips:

  • Avoid large meals shortly before bedtime.
  • Avoid stimulants such as caffeine after mid-.
  • Get regular exercise early in the day.
  • Go to bed and wake up at the same time every day.
  • Do not take naps.
  • Use the bed only for sleep or sexual activity.
  • If you can’t fall asleep after 20 minutes, get out of bed and do a quiet activity such as reading or listening to music. Trying to force sleep may make falling asleep harder.
  • Limit liquid before bed.
  • Avoid using sleeping pills to help you sleep, if possible. They can lead to dependence and can make sleep problems worse over time if you don’t use them the right way. Your provider should assess your risks of daytime sleepiness, mental (cognitive) side effects, and falls before you begin taking sleep medicines.
  • If you think you need sleeping pills, talk with your provider about which pills are safe for you when taken properly. Certain sleeping pills should not be taken on a long-term basis.
  • Be aware of the potential risks of sleep medication. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviours, including sleep-driving.

If these changes aren’t enough, then your doctor may recommend medication. Talk to your doctor to learn more about sleeping pills and other medical treatments. Ask your doctor about the risks involved.

Which Medicines help with Sleep Disorders?

If you have underlying diseases that are interfering with your sleep, your doctor may prescribe medications. However, please remember that medication shouldn’t replace good sleeping habits.

Melatonin

Melatonin, a synthetic hormone, helps induce sleep faster and restores your sleep-wake cycle.  0.1 to 5 milligrammes two hours before bedtime is recommended for several months if you have insomnia. But melatonin doesn’t improve the quality of sleep.

Sleeping Pills and Side effects

Sleeping medications may help ease the symptoms of your sleep disorder, especially as a supplement to good sleep habits. Your doctor may be able to recommend what drugs will work best for you and how long you should take them, depending on the cause of your insomnia.

It’s recommended to only take sleeping pills on a short-term basis. This means less than two to three weeks for benzodiazepine drugs and only six to eight weeks for nonbenzodiazepine drugs (Z-drugs).

Advantages of Sleeping Pills:

  • are good for short-term use to reset sleep cycle
  • are helpful for a good night’s sleep
  • can have minimal withdrawal symptoms with proper care

Disadvantages of Sleeping Pills:

  • can increase the risk of falls
  • can cause sleep-related activities like sleep-driving
  • dependence may occur with long-term use

Long-term use of sleeping pills can cause complications, especially in older adults. Other common side effects of benzodiazepines and Z-drugs include:

  • headaches
  • dizziness
  • nausea
  • fatigue
  • drowsiness

Do not drink alcohol at any time when you are using sleeping pills. Alcohol can make the side effects of all sleeping pills worse.

Other Medical Treatments

Other medical treatments include:

  • continuous positive airway pressure (CPAP) device to treat sleep apnea
  • antidepressants to treat insomnia
  • dopamine agents for restless leg syndrome and periodic limb movement disorder
  • iron replacement therapy for restless leg symptoms

Sleep remedies include over-the-counter (OTC) antihistamines, which induce drowsiness. But tolerance to antihistamines can build up in three days. Talk to your doctor before taking any OTC medications. They may interact negatively with medications you’re already taking.

What you can do now

In older adults, ongoing sleep disorders can lead to bigger concerns like depression and risk of falling. If the quality of sleep is the main issue, behavioural therapies may be more beneficial. This means developing good sleeping habits through sleep education, stimulus control, and time in bed restrictions. Changes can take up to six weeks or more.

If behaviour therapies don’t work, then your doctor may prescribe medication or other treatments. But sleep medication isn’t a long-term solution. You’ll find that the best way to get quality sleep is to take control of your sleeping habits.

References:

http://www.healthline.com/health/sleep/sleep-disorders-in-the-elderly#other-treatments5

https://medlineplus.gov/ency/article/000064.htm

http://www.webmd.com/sleep-disorders/news/19991207/combating-sleep-problems-elderly#1

©Rita Bhattacharya

Photos from the internet.

#SleepingIssues #ElderlySleepingIssue #ReasonsForLessSleep #SleepStudy #DifferentTruths

Rita Bhattacharjee

Rita Bhattacharjee

Rita Bhattacharjee is a communications consultant with extensive experience in managing corporate and internal communications for companies across diverse industries, including non-profit organizations. She is the co-founder of Mission Arogya and and has recently relocated from the US to India to channel her skills towards social entrepreneurship to increase awareness and reduce disparity in public health.She also writes poetry, some of which have been published in reputed international journals.
Rita Bhattacharjee
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