Sleep patterns change with age. Sleep problems in the elderly typically include difficulty falling asleep or sleeping soundly, sleeping too much, early-morning awakening, and less total sleep time. A mild deterioration in sleep quality may be normal in seniors, but if nighttime sleep is significantly disrupted or daytime functioning is affected because of excessive sleepiness, problems must be evaluated.
Poor sleep habits such as irregular sleep-wake times and too much daytime napping may contribute to insomnia. A poor sleep environment that includes consumption of alcohol before bedtime, and falling asleep with the TV on, can impair sleep. Caffeine and some medications can have stimulating effects and disrupt sleep; diuretics can promote repeated awakening to go to the bathroom; and the potential sedating effects of certain medications can cause excessive daytime sleepiness. Certain health conditions that cause discomfort, pain, shortness of breath, etc., may delay sleep onset and shorten the duration of sleep. Psychiatric disorders such as depression or Alzheimer’s can cause distress and may also interfere with sleep. If you’re experiencing sleep problems, check with your doctor if you have a sleep disorder, such as sleep apnea, restless leg syndrome, periodic limb movements or REM-behavior disorder. The rare REM-behavior disorder occurs most commonly in elderly persons.
Not getting enough sleep can have a significant impact on daily function, alertness, and overall quality of life; consequences can include car accidents, work-related accidents, poor daily performance, depression, and anxiety. Sleep disorders may lead to systemic diseases, too.
Implementation of good sleep habits, avoiding as many causes of sleep disruption as possible, and daily physical activity should help create an environment conducive to restorative sleep. Establish a relaxing bedtime ritual each evening, and set regular sleep and wake times. Avoid spending excessive time in bed; use it only for sleeping–not for watching TV, reading books, etc. Avoid going to bed just after eating (especially after eating large meals) or when hungry. Refrain from drinking fluids before bedtime. The bedroom environment should be quiet, soothing, and relaxing: pick a mattress and bed linens that meet comfort level; and make sure that the level of light, and temperature in your bedroom, are good for sleeping. Avoid taking naps. Stay away from caffeine, alcohol and nicotine after midday. Avoid taking sleeping pills or other sleep aids unless instructed to by your doctor. Do regular physical activity in the daytime–but not just before bed, especially strenuous exercise. Exercise releases endorphins that can boost mood and reduce stress, depression, and anxiety. Consult with your health care provider before starting an exercise program. Try to get at least two hours of sunlight a day; bright sunlight helps regulate melatonin and sleep-wake cycles.
Keep a sleep log that covers all sleep over a period of several weeks to establish your sleep patterns. It’s wise to exhaust behavioral interventions before resorting to drug therapy. If drug therapy is to be used, consider it as a short-time option to help reset your “sleep clock,” and not as a lifestyle. Sleep is a basic human need. Sleep disorders, if neglected, can greatly diminish your quality of life.
