From Jason Strauss, MD
Director, CHA Geriatric Psychiatry Fellowship Program and Instructor in Psychiatry, Harvard Medical School
As we age, we often sleep less than we did in the past and also have more difficulty getting to sleep. It's not realistic to expect to sleep as well at 75 as we do at 20. But some sleep disorders are common for older adults, and illnesses and medication can contribute to the problem.
You may feel powerless in helping older adults with sleep problems. But a basic understanding of the issues can go a long way. Here's some information you can use to talk to your patients or clients about sleep related issues.
What are common sleep disorders in older adults?
Two common sleep disorders affecting older adults are obstructive sleep apnea and restless legs syndrome.
Obstructive sleep apnea occurs when there is a blockage of the upper airways during sleep, leading to brief but frequent awakenings and next-day fatigue. This is often related to heavy snoring. People with restless legs syndrome experience uncomfortable sensations in their lower limbs and have a strong urge to move their legs to relieve these sensations. If your patients or clients are experiencing the symptoms described above, you should set up an appointment for them to be evaluated by their doctor. Can depression or other illnesses play a part in issues with sleep? And what about medication? All psychiatric illnesses including depression can affect sleep. People who are depressed often wake up early and cannot get back to sleep. Depressed individuals may also spend their days in bed, making it difficult to fall asleep at night. Other medical problems that can affect sleep are urinary frequency issues, gastroesophageal reflux disease (GERD), and chronic obstructive pulmonary disease (COPD). Medications may also adversely affect sleep. Psychiatric medications, blood pressure medications, pain medications, and medications used to treat Alzheimer's dementia and Parkinson's disease are all known to impact sleep. In addition, other factors such as interactions between medications and dosing changes may keep you awake. How many times is waking up during the night "normal" for an older adult? It depends.If there are any environmental factors that may be negatively impacting sleep, these should be addressed. You should always treat medical conditions (such as urinary frequency) that may contribute to multiple nighttime awakenings. It really comes down to how alert a person feels the next day and how well they believe they are able to function.
Do you have any suggested habits that could help older adults with sleep disorders?
It is important for older adults to maximize their "sleep hygiene." Lifestyle changes that may improve sleep include:
1. Decreasing late-day fluid intake to minimize nighttime urination
2. Exercise regularly, but not within three hours of bedtime
3. Minimizing caffeine, alcohol, and tobacco use prior to bedtime
4. Eat a light snack for dinner instead of a heavy meal if you struggle with GERD symptoms at night
There are also ways to improve environmental conditions that affect sleep:
1. Use dark curtains or a sleep mask to minimize noise and light
2. Maintain a consistent sleep schedule
3. Use the bed only for sleeping, not for reading or watching TV. Do not sleep with the TV or radio on
4. Use relaxation strategies such as meditation tapes and deep abdominal breathing before bed
I hope this will help you discuss sleep related issues with your patients or clients. If you have any questions about the information above, feel free to contact me via email at [email protected].
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