Sleep disorders are fairly common in the elderly. Older individuals tend to experience less deep sleep and wake up frequently in the night, which can lead to daytime fatigue. The elderly may also have trouble falling asleep and may also wake up early in the morning. Sleep disorders in the elderly can be caused by a number of factors, including medication, diseases, and poor sleeping habits. Depending on the cause, there are a number of different treatment options.
Primary Sleep Disorders
There are several primary sleep disorders associated with aging. If you have a primary sleep disorder, you may have trouble falling asleep, wake up frequently throughout the night, and feel excessively tired during the day. Primary sleep disorders include:
- sleep apnea, which causes brief interruptions in breathing while sleeping. Snoring is also common in individuals with this disorder.
- restless legs syndrome, which causes discomfort in the legs and a strong urge to walk around
- periodic limb movement disorder, which causes muscle contractions and movement of the arms and legs during sleep
- circadian rhythm sleep disorders, which are a variety of conditions that affect the body’s waking and sleeping cycle
- REM-behavior disorder, a rare condition that causes thrashing and other movements during sleep
The elderly may also experience sleep problems due to underlying medical conditions. These conditions include:
- Parkinson’s disease (a brain disorder that causes shaking and difficulties with coordination and walking)
- Alzheimer’s disease
- chronic pain, such as that caused by arthritis
- cardiovascular disease, such as congestive heart failure
- neurological conditions
- gastrointestinal conditions
- pulmonary (lung) conditions
- conditions affecting the bladder and causing frequent urination
- psychiatric conditions, such as depression, anxiety, or dementia
Many elderly individuals are also on medications that can disrupt sleep. Medications commonly associated with sleep problems include:
- diuretics: often taken for high blood pressure or glaucoma
- anticholinergics: bronchodilator drug often prescribed for those with chronic obstructive pulmonary disease (COPD)
- antihypertensive drugs: often used to treat high blood pressure
- corticosteroids (prednisone): used to treat conditions like rheumatoid arthritis
- antidepressants: these drugs can often have sleeping-related side effects
- H2 blockers (Zantac, Tagamet): often used to treat gastroesophageal reflux disease (GERD) or peptic ulcers
- levodopa: a medication used to treat Parkinson’s disease
- sympathomimetics: drugs used in more serious situations, such as an asthma attack or extremely low blood pressure
Caffeine, alcohol, and smoking may also contribute to sleep problems.
When you are having problems with sleeping, your doctor will begin by asking you about your symptoms. Your doctor will also conduct a physical examination to look for any underlying physical conditions that may be causing your sleep problems. If your doctor suspects a primary sleep disorder, he or she will send you for a sleep study, also called a polysomnogram.
A sleep study is usually done at night in a sleep lab. For this test, you will have electrodes placed on your face and scalp to measure facial movements and brain activity. A strap will be placed across your chest and a detector placed by your nose to monitor your breathing. You may also have a device placed on your finger to measure the oxygen in your blood. For this test, you will sleep as you normally would at home. During the night, a technician will watch you on a camera and monitor the information from the devices on your body to look for signs of a sleep disorder.
Developing proper sleeping habits can help solve sleeping problems. If you are having sleeping problems, your doctor may suggest you try home treatment methods before trying medical treatment. Good sleep habits include:
- going to bed and waking up at the same time each day
- avoiding naps
- using the bed only for sleep and sex
- getting up if you do not fall asleep within 20 minutes
- doing quiet activities, such as reading, before bed
- avoiding caffeine, nicotine, and alcohol
- avoiding large meals and large amounts of liquid before bed
- exercising regularly
- avoiding bright lights before bed
- keeping a cool and comfortable bedroom
- soaking legs and feet in warm water to help relieve restless legs syndrome symptoms
If you have underlying diseases that are interfering with your sleep, your doctor may prescribe medication to help ease the symptoms of these conditions.
Sleeping pills can also help to ease the symptoms of your sleep disorder. However, sleeping pills should only be taken for a short-term basis. You should also never drink alcohol while taking sleeping pills. Sleeping pills should be used no more than four days per week and should not be used for several days in a row.
Your doctor may also suggest melatonin, a synthetic hormone, to help you fall asleep faster and to restore your sleep-wake cycle.
Other medical treatments for sleep disorders in the elderly include:
- Continuous positive airway pressure (CPAP) device: This device is used to treat sleep apnea.
- Benzodiazepines: Alprazolam (Xanax) and clonazepam (Klonopin) are two common examples of benzodiazepines. These drugs are often used to treat anxiety, but can help with insomnia as well.
- Dopamine agents: These medications can help with restless leg syndrome, periodic limb movement disorder, and Parkinson’s disease, for example.
- Opiates: Oxycodone and Acetaminophen (Percocet) is one example of an opiate used to treat conditions like restless leg syndrome.
- Antihistamines: These drugs, commonly used to treat allergies, often induce drowsiness. These drugs should only be used in the short-term, as long-term use can cause complications, especially in the elderly (Mayo).