Insomnia In The Elderly

What is it?

  • Insomnia (in-som-nee-uh) is having trouble getting to sleep or staying asleep. Insomnia is also the feeling that you are not getting enough sleep. People over 65 years of age are more likely to have problems with sleep.


  • Adults need 7 1/2 to 8 hours of sleep each night. As people age their need for sleep actually stays the same or only decreases slightly (6 1/2 to 7 hours a night). Normal sleep happens in several stages. There are times in the night when you sleep lightly and do not dream. There are also periods of deep, dreamless sleep. Throughout the night you have several periods of active dreaming called REM (rapid eye movement) sleep. But, sleep patterns change as we grow older. The amount of time you spend in each type of sleep changes.


Signs and Symptoms: You may have one or more of the following symptoms of insomnia.

  • Harder time falling asleep.


  • Awaken more often (3 to 4 times each night) and have greater memory of being awake.


  • The difference between being asleep and awake is sudden. This can make you feel like you are a light sleeper.


  • Feel as though you are not getting enough sleep because less time is spent in deep, dreamless sleep. But, your total sleep time may not have changed.


  • "Internal clock" shifts so that you go to bed earlier in the evening and wake earlier in the morning.


  • Confusion between day and night.


Causes: Many things can cause insomnia in the elderly. Most of these causes can be treated. The causes of insomnia in the elderly are divided into 4 groups.

  • Physical:


    • Cardiovascular disease.


    • COPD, asthma, or other lung problems


    • Long-term pain.


    • Bladder or prostate problems.


    • Epilepsy.


    • Sleep apnea.


    • Dementia or Alzheimer's disease.


    • Joint disease, like arthritis or bursitis.


    • Gastroesophageal reflux.


  • Environmental/Behavioral:


    • Noise.


    • Late-night eating.


    • Late-night exercise.


    • Inactive lifestyle.


  • Drugs:


    • Caffeine (coffee, tea, cola drinks, chocolate, some cold medicines).


    • Alcohol.


    • Nicotine.


    • Some antidepressant medicines.


    • Stimulant medicines.


    • Medicine schedule. Taking some medicines at night may cause you to wake up at night, like diuretics (water pills).


  • Mental:


    • Anxiety.


    • Depression.


      • Retirement.


      • Loss of personal identity.


      • Death of spouse, family member, or friends.


    • Stress.


      • Financial problems.


      • Belief that you are in poor health.


Care:

  • Tests: You may need one or more of the following tests to help caregivers plan your treatment.


    • Health history: Caregivers will ask questions about your sleep habits as well as questions about your past and current medical history. They will need to know what medicines you take to include over-the-counter medicines. Caregivers will also ask questions about your life style and about any stresses you have.


    • Physical checkup: You will have a physical checkup to make sure that something physical is not causing your insomnia. The physical checkup may include one or more of the following tests.


      • EEG sleep studies.


      • Overnight oximetry.


      • Overnight polysomnography.


      • Mini-mental state exam.


      • Cardiopulmonary exam.


      • Upper airway exam.


      • Neurologic exam.


      • Musculoskeletal exam.


      • Blood or urine lab tests.


  • Treatment Options: Caregivers will first treat any physical, medicine, or mental problems that might be causing your insomnia. You may want to try some of the following things to help you sleep better.


    • Set a bedtime routine for yourself. Sticking to this routine will help good sleep habits develop with time.


      • Go to bed and get up at the same time every day. But, try not to go to bed until you feel sleepy.


      • Read or watch television before bedtime. This may help you feel sleepy and allow you to fall asleep naturally.


      • Take a hot bath before going to bed.


      • Avoid heavy eating late in the evening. But, a light bedtime snack may help. A glass of warm milk causes sleepiness naturally.


    • Make sure that your bedroom is quiet, peaceful, and comfortable.


      • Do not turn your bedroom into an office or den.


      • Make sure your mattress is comfortable.


      • Try to make your bedroom as sound-proof as possible so that noises do not wake you. Use earplugs or eye shades if necessary.


      • If you have a bedroom clock, make sure it does not tick or hum because this can awaken you.


    • Avoid taking naps during the day.


    • Avoid stimulants such as caffeine and tobacco within 6 hours of sleep.


    • Exercise regularly so that you will be tired naturally at bedtime. But, do not exercise 3 hours before bedtime.


    • Avoid alcohol before bedtime. Alcohol may make you sleep but it can wake you up later in the night.


    • Many people find that they "worry" about things when they are in bed. Try to deal with your worries before going to bed for the night. Try to turn off your mind. Focus on peaceful and relaxing thoughts. Play soft music or relaxation tapes. Ask your caregiver for help with relaxation training or stress management.


  • Medicine: Caregivers may give you sleeping medicine for a short time to set up regular sleep patterns. But, avoid taking sleeping medicines for long periods if at all possible. These medicines can be addicting and some have side effects, such as confusion. Do not take sleeping pills given to you by friends. Do not take over-the-counter sleeping pills or medicine that cause insomnia, like some cold medicines.


    • Always take your medicine as directed by your caregiver. If you feel it is not helping, call your caregiver. Do not quit taking it unless your caregiver tells you to.


    • Keep track of what medicines you are taking and when you take them. Bring a list of your medicines or the pill bottles when you see your caregiver(s). Learn why you take each medicine. Ask your caregiver for information about your medicines.


    • If you are taking antibiotics (an-ti-bi-ah-tiks), take them until they are all gone even if you feel well.


    • If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.


  • Coping: You may feel depressed or anxious because you are sleeping poorly. Talk about your feelings with your caregiver or with someone close to you. For more information, write or call one of the following support groups.


  • National Sleep Foundation
    729 15th Street, N.W., Fourth Floor
    Washington, DC 20005
    Web Address: http://www.sleepfoundation.org
  • National Heart, Lung, and Blood Institute
    National Center on Sleep Disorders Research
    NHLBI Information Center
    Phone: 1 (301) 251-1222
    Web Address: http://www.nhlbi.nih.gov

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about insomnia. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

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