Sleep disorders in the elderly

Definition

Sleep disorders in the elderly involve any disruptive pattern of sleep such as problems with falling or staying asleep, excessive sleep, or abnormal behaviors associated with sleep.

Causes, incidence, and risk factors

Sleeping problems are common in the elderly. In general, older people require less sleep, and their sleep is less deep than that experienced by the young. Some causes or contributors to sleep disturbances in older adults include:

• A need to urinate frequently at night
• Chronic pain caused by diseases such as arthritis
  • Chronic diseases such as congestive heart failure
  • Depression (depression is a common cause of sleep problems among people of all ages)
  • Neurological conditions
  • Alzheimer's disease
  • Organic brain syndrome
• Prescription drugs, recreational drugs, or alcohol
  • Sedentary lifestyle
  • Stimulants such as caffeine

Symptoms

• Difficulty falling asleep
• Difficulty telling the difference between night and day
• Early morning awakening
• Waking up frequently during the night

Signs and tests

The health care provider will perform a physical exam to rule out medical causes. Diagnosis is also based on the patient's history of sleep disturbances and other contributing factors.

Treatment

The relief of chronic pain and control of underlying medical conditions such as frequent urination may improve sleep in some people. Effective treatment of depression can also improve sleep.

Sleep-promoting interventions such as a quiet sleep environment and a glass of warm milk before bed may improve the symptoms. Other ways to promote sleep include following a healthy lifestyle and the following steps:

• Avoid large meals shortly before bedtime.
• Avoid stimulants such as caffeine.
• Get regular exercise, early in the day.
• Go to bed and wake up at the same time every day. (Don't 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.

The use of sleeping pills to promote sleep on a long-term basis should be avoided, if possible. They can lead to dependence and worsening sleep problems over time if not used correctly.

• If needed, sleeping pills such as Ambien and Lunesta are relatively safe when used properly.
• It is best to NOTtake sleeping pills on consecutive days or for more than 2 - 4 days a week.
• Alcohol can make the side effects of all sleeping pills worse and should be avoided.

WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving. Ask your doctor about these risks.

Expectations (prognosis)

Most people see improvement in sleep with treatment or interventions. However, others may continue to have persistent sleep disruptions.

Complications

A complication is alcohol use or drug abuse with the intent of improving sleep.

Calling your health care provider

Call for an appointment with your health care provider if a lack of sleep or too much sleep is interfering with daily living.

Prevention

Eliminating as many causes of sleep disruption as possible and encouraging regular exercise may help control sleep problems.

References

Mahowald MW. Disorders of sleep. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 429.

Kamel NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006 Jun;119(6):463-9.