24/07/2022
Sleep disorders in the elderly
Compared with younger people, elderly people show age-related sleep changes, including an advanced sleep phase and decreased slow-wave sleep, which result in fragmented sleep and early awakening. People with chronic insomnia may have trouble falling asleep. Others wake up several times during the night, or wake up too early and are unable to fall back asleep. During the day, they often feel fatigued, are irritable, and have poor concentration and energy. Chronic insomnia also increases the risk of accidents such as falls and other health conditions, like depression, diabetes, heart disease, and cognitive impairment.
Understanding the causes of insomnia in your elderly parent and changing certain habits can help improve sleep.
1) Primary sleep disorders
Sleep apnea syndrome
Restless legs syndrome, periodic limb movement disorder
Rapid eye movement sleep behavior disorder
Circadian rhythm sleep‐wake disorders (advanced and delayed sleep‐wake phase disorder)
(2) Acute and chronic medical illness
Allergy (allergic rhinitis, hay fever); Pain (arthritis, musculoskeletal pain); Cardiovascular (heart failure, acute coronary syndrome); Pulmonary (pneumonia, chronic obstructive pulmonary disease); Metabolic (diabetes, thyroid disorders), Gastrointestinal (gastroesophageal reflux disease, constipation/diarrhea, acute colitis, gastric ulcer); Urinary (nocturia, incontinence, overactive bladder, benign prostate hypertrophy for men); Psychiatric diseases (depression, anxiety, psychosis, delirium, alcoholism); Neurological disorders (Alzheimer's disease, Parkinson's disease, cerebrovascular disease, epilepsy); Pruritus; Menopause
(3) Behavioral causes and psychological/physical stressors
Daytime napping; go to bed too early; use the bed for other activities (watching TV, reading); lack of exercise during daytime; death of a partner/spouse; loneliness; hospitalization
(4) Environmental causes
Noise, light, cold/hot temperature, humidity, uncomfortable bedding, lack of light exposure during daytime
(5) Medications
Psychostimulants; antidepressants (selective serotonin reuptake inhibitors); antihypertensives (beta‐blocker, alpha‐blocker); antiparkinsonian drugs (levodopa); bronchodilators (theophylline); steroids; antihistamines (H1 and H2 blockers); anticholinergics; alcohol; interferons
Chronic insomnia disorder
Criteria A‐F must be met
A. The patient reports, or the patient's parent or caregiver observes, one or more of the following:
1. Difficulty initiating sleep.
2. Difficulty maintaining sleep.
3. Waking up earlier than desired.
4. Resistance to going to bed on appropriate schedule.
5. Difficulty sleeping without parent or caregiver intervention.
B. The patient reports, or the patient's parent or caregiver observes, one or more of the following related to the nighttime sleep difficulty:
1. Fatigue/malaise.
2. Attention, concentration, or memory impairment.
3. Impaired social, family, occupational, or academic performance.
4. Mood disturbance/irritability.
5. Daytime sleepiness.
6. Behavioral problems (eg, hyperactivity, impulsivity, aggression).
7. Reduced motivation/energy/initiative.
8. Proneness for errors/accidents.
9. Concerns about or dissatisfaction with sleep.
C. The reported sleep/wake complaints cannot be explained purely by inadequate opportunity (ie, enough time is allotted for sleep) or inadequate circumstances (ie, the environment is safe, dark, quiet, and comfortable) for sleep.
D. The sleep disturbance and associated daytime symptoms occur at least three times per week.
E. The sleep disturbance and associated daytime symptoms have been present for at least 3 mo
F. The sleep/wake difficulty is not better explained by another sleep disorder.
Sleep hygiene
(1) Regular exercise
Take regular exercise. Adequate aerobic exercise improves the ability to fall asleep. Exercise in the early morning and early evening promotes deep sleep and improves sleep quality; however, exercise just before bedtime should be avoided.
(2) Bedroom environment
Keep bedroom dark and quiet. Noises and dim light can interrupt sleep. Maintain a comfortable bedroom temperature (below 24 degrees Celsius [75 degrees Fahrenheit]). During the summer season, consider using an air conditioner.
(3) Regular meals
Keep regular eating patterns, 3 times/day. When you feel hungry, eat a light snack (cheese, milk, nuts, or carbohydrates) but avoid heavy meals before bedtime.
(4) Limit fluid intake before bedtime
Limit fluid intake before bedtime to reduce the frequency of urination during sleep. In cases of cerebral infarction or angina pectoris, follow the instructions of your primary physician.
(5) Avoid caffeine
Caffeine intake before bedtime may result in sleep‐initiation and maintenance problems. Limit caffeinated foods and beverages (Green tea, tea, coffee, cola, and chocolate) to the equivalent of three cups of coffee and ingest them no later than 4 h before bedtime.
(6) Avoid alcohol
Limit alcoholic beverages, which may promote sleep initiation but cause fragmented and unrefreshing sleep.
(7) Avoid smoking
Avoid smoking in the evening. Ni****ne acts as a stimulant, interfering with sleep
