Sleep disorders in the elderly

Definition

Sleep disorders in the elderly involve any disrupted sleep pattern, such as problems falling or staying asleep, too much sleep, or abnormal behaviors with sleep.

Alternative Names

Causes, incidence, and risk factors

Sleep problems are common in the elderly. In general, older people need 30 to 60 minutes less sleep than younger people. Their sleep is less deep and more choppy than sleep in younger people. A healthy 70 year old may wake up four times during the night without it being due to disease.

Some causes or contributors to sleep disturbances in older adults include:

• Alzheimer's disease
• Chronic disease, such as congestive heart failure
• Depression (depression is a common cause of sleep problems in people of all ages)
• Neurological conditions
• Pain caused by diseases such as arthritis
• Prescription drugs, recreational drugs, or alcohol
• Sedentary lifestyle
• Stimulants such as caffeine
• Urination at night

Symptoms

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

Signs and tests

The health care provider will take a history and perform a physical exam to look for medical causes and determine which type of sleep disorder is causing the problem.

Treatment

Relieving chronic pain and controlling medical conditions such as frequent urination may improve sleep in some people. Treating depression can also improve sleep.

Sleeping in a quiet place and drinking a glass of warm milk before bed may improve the symptoms. Other ways to promote sleep include following these healthy lifestyle tips:

• 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.

Avoid using sleeping pills to help you sleep, if possible. They can lead to dependence and can make sleep problems worse over time if you don't use them correctly. Your health care provider should assess your risks of daytime sleepiness, mental (cognitive) side effects, and falls before you begin taking sleep medications.

• If you need sleeping pills, Ambien, Lunesta, Sonata, and Rozerem can be safe when used properly.
• It is best to NOT take sleeping pills several days in a row 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 certain 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.

Support Groups

Expectations (prognosis)

For most people, sleep improves with treatment. However, others may continue to have sleep disruptions.

Complications

• Alcohol use
• Drug abuse

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

Avoiding as many causes of sleep disruption as possible and getting regular exercise may help control sleep problems.

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References

Juergens TM, Barczi SR. Sleep. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 22.

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