Lifestyle Choices

Elderly people have trouble sleeping for the same reasons as people from other age groups. But there are additional factors.

• Chronic illnesses. The elderly often suffer from chronic mental and physical illnesses that make it difficult to fall asleep or stay asleep. For example: An enlarged prostate is often associated with a frequent need to urinate. Dementia may be associated with confusion and heightened fear after dark (known as sundowning). Painful conditions such as bone fractures due to osteoporosis (especially in women), arthritis and vascular disease can make sleeping difficult. Depression, quite common in the elderly population, often causes insomnia as well.
• Medication. Older people have stronger reactions to medication. Notable effects that these medications such as tranquillizers and hypnotics, have on the elderly include frequent nightmares, insomnia and hypersomnia.
• Caffeine and alcohol. The elderly are also more vulnerable to the effects of caffeine and alcohol; that cup of tea after dinner that may not have kept a twenty-year-old up all night might do so for a seventy-year-old.’
• Nursing home and hospital environment. You would think that nursing homes and hospitals would he places where elderly people would be able to get their much-needed rest. Unfortunatel_y, this is not the case. A recent study has shown that, on average, nursing home residents are exposed to thirty-two loud noises each night.’ This includes staff members talking, sometimes even shouting, use of the intercom, doors slamming and other patients screaming. In addition to the noise, nurses make rounds several times a night, waking up residents to give them their medication. Some residents are even woken up to take their sleeping pills!

• Fatigue. Many elderly people suffering from the fatigue associated with lighter and inconsistent sleep go to bed earlier to make sure they get enough sleep. This makes the problem worse because rather than sleeping longer, they often simply wake up earlier.
• Dwindling melatonin. Research suggests that we produce less natural melatonin as we age.’ Since melatonin is responsible for inducing sleepiness, it is likely that lower melatonin production in older people contributes to the change in sleeping patterns and to nocturnal insomnia.

Treatment of Insomnia in the Elderly

The medications currently being used to help the elderly sleep are mostly tranquillizers and painkillers. Because some of these drugs have undesirable side-effects and the elderly are particularly susceptible to them, the threat of over-medication needs to be considered. Other methods to induce sleep with fewer side-effects are being sought. One study showed that lavender oil had a mild sedative effect that brought about sleep in elderly subjects to the same extent as the sleep medication they had been taking. Subjects were also less restless during sleep.’

For some elderly who suffer from dementia, but are able to recognize friends and relatives, a familiar friendly person to keep them company at bedtime may help reduce some of the confusion and fear that they experience at night.’

Insomnia is also a part of the advanced sleep phase syndrome that often accompanies old age. Many elderly people wake up very early in the morning, and need to nap in the afternoon. Assuming the change in sleeping pattern is a result of natural ageing and is not because of other problems associated with ageing, there are some remedies:

• Chronotherapy. In chronotherapy, bedtime is set later every few days until the desired bedtime is reached, thereby resetting the internal biological clock and its circadian rhythm.
• Melatonin therapy. A recent study showed that melatonin therapy helped bring sleeping patterns in the elderly closer to those of younger people.” In this study, melatonin was administered in the form of a special controlled-release formula. It is necessary to consult a doctor about taking melatonin.

Strategies to Help the Elderly Sleep Better

Fifty per cent of adults over the age of sixty-five claim to get irregular sleep, although experts point to studies that indicate that the number might be as high as 90 per cent.

• Avoid caffeine

Restrict caffeine intake after 6 P.M. As we get older, coffee, tea, cola drinks and chocolate may make it more difficult to fall asleep.

• Monitor prescriptions

Consult your doctor about the sleep side-effects of medications you are taking. Some medicines cause drowsiness, and others cause sleeplessness.

• Avoid over-the-counter sleeping remedies

Stay away from over-the-counter sleep medications. Although they can make it easier to fall asleep, they often cause light a_nd fragmented sleep, as well as early-morning waking up.’

• Get outdoors during the day

Studies have shown that exposure to natural light results in better night-time sleep.”

• Stay mentally active

Engage in hobbies, academic courses, volunteer work and social activities that will keep you mentally alert in the daytime and early evening.

• Stay physically active

A late-afternoon or early-evening stroll will help you sleep more deeply at night.

• Limit naps

If you feel the need to take a daytime nap, don’t sleep longer than twenty minutes. Longer naps will make it more difficult for you to get to sleep at night.

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