July 24, 2006 Help may be available for the more than 50 percent of older adults who have difficulty sleeping and have come to accept their problem as part of growing older, according to Saint Louis University geriatricians.
"Sleep requirements and patterns change throughout life, but sleep problems in the elderly are not a normal part of aging," says Julie Gammack, M.D., assistant professor of geriatrics at Saint Louis University, and an author of a review published in the American Journal of Medicine.
"Sleep disturbance in the elderly is associated with decreased memory, impaired concentration and impaired ability to function. It contributes to an increased risk of accidents, falls and chronic fatigue."
It's important to address sleep problems, which can make life miserable and frequently can be solved, Dr. Gammack says.
She suggests patients with sleep problems keep a diary for a week or two that includes tracking usual wake-up and bedtimes, timing and size of meals, amount of exercise, medications and descriptions of how much and how restful sleep was each day.
"The first step in evaluating sleep problems in the elderly is to establish that the person truly has insomnia," Dr. Gammack says.
She suggests doctors try treating sleep problems by changing the routines of patients before prescribing medications. Lifestyle changes also can be beneficial even if sleep medicines are given.
"A daytime walk with correctly timed daylight exposure is useful for insomnia," she says. "Appropriate temperature control, adequate ventilation, and dark sleep environment may also lead to dramatic improvement in sleep quality."
Among the other lifestyle medications she suggests:
* Increase exposure to bright light and natural light during the day and early evening.
* Avoid napping after 2 p.m. and allow yourself at most one half-hour nap a day.
* Check the effect of the medications you are taking on sleep.
* Wait until you're sleepy to go to bed.
* Avoid heavy meals before bedtime. If you're hungry, eat a light snack.
* Limit liquids in the evening.
* Keep a regular schedule.
* Rest and retire at the same time each day.
* Eat and exercise regularly.
* Manage stress by discussing worries long before bedtime and tapping into relaxation techniques.
While many senior adults experience unpleasant side effects when they take traditional medications for insomnia, a new group of medicines that work on a different mechanism are promising, she adds.
"There are several newer sleep medications on the market that potentially could better assist with sleep and have fewer side effects," Dr. Gammack says.
"Given the prevalence of insomnia in the elderly population and the availability of effective treatment, it is important to screen older individuals for the presence of sleep disorders. Patients must be educated on normal sleep-related changes but also made aware that sleep problems are not a part of normal aging. Sleep impairment may have a negative impact on health and health-related quality of life."
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