Sleep disorder or insomnia is a complex disorder affecting the processes of falling asleep, sleep maintenance or sleep quality. Insomnia can manifest itself in a variety of ways: from difficulty falling asleep to frequent awakenings at night, from excessive sleepiness during the day to a complete change in sleep and wakefulness. Such disorders can seriously affect a person’s quality of life, physical and mental health.
Causes of insomnia
Insomnia in old age is widespread – it affects 80% of people over 59 years old. Specialists distinguish primary and secondary sleep disorders.
Primary insomnia in the elderly include:
- obstructive sleep apnea syndrome;
- restless legs syndrome.
Both of these pathologies occur in people of different ages, but the older a person is, the more likely they are to develop.
Obstructive sleep apnea syndrome is associated with snoring and periodically recurrent partial or complete cessation of breathing during sleep. In this case, the level of oxygen in the blood decreases and to replenish it, the person wakes up – literally for a few seconds. However, there can be so many of these micro-awakenings that the person ends up not getting enough sleep.
Restless legs syndrome is characterized by discomfort and pain in the lower extremities. The sleeper tries to reduce them, so he begins to involuntarily move his legs, because of which he eventually awakens.
Secondary insomnia in the elderly can be associated with:
- with diseases of internal organs, heart, joints – any disease in which pain and/or discomfort prevent sleep;
- endocrine pathologies (thyrotoxicosis, diabetes mellitus);
- unwanted side effects of medications;
- with the development of mental diseases (Alzheimer’s disease, Parkinson’s disease);
- age-related decrease in the synthesis of melatonin, a hormone that regulates the rhythms of sleep and wakefulness.
Because of this variety of causes, it is almost impossible to determine why an elderly person suffers from insomnia on your own. The help of a doctor, sometimes several doctors, is needed.
Non-medication treatment of insomnia in older people
At the first stage, sleep disorders are tried to correct without using sleeping pills. For this purpose, elderly people are recommended:
- Go to bed and get up in the morning at the same time, adhere to a strict regimen. Going to bed should be started only after the onset of drowsiness;
- If you can not fall asleep within 15-20 minutes, you can not stay in bed: it is better to get up, go to an armchair or in another room until you want to sleep again. If possible, the bed should be associated with sleep, not with insomnia;
- Do not sleep during the day. If severe drowsiness occurs, the recommended rest time is no more than 30 minutes;
- In the evening it is better to refrain from abundant, caloric food, too strong impressions, the use of tonic drinks;
- Sleep hygiene is important. Bedding should be fresh, mattress, pillow – comfortable. It is better if the bedroom will be cool. Curtains – dense, not transmitting light;
- Spend the evening hours quietly, for the same activities. You can use daily “rituals” to relax: take a shower, read before falling asleep, drink a mug of milk and so on;
- Increase physical activity in the morning. Muscle fatigue improves the quality of rest at night. After lunch or closer to evening, you can go out for a long walk;
- Avoid drinks and foods containing caffeine or other tonic substances (tea, coffee, chocolate, sweets, cocoa, etc.) after lunch;
- Refuse to drink alcohol. Alcohol does not replace sleeping pills: “drunken” sleep is superficial, does not give a full rest.
Medications for insomnia for elderly people
Medications are used only if compliance with general recommendations, correction of the regimen, diet and nutrition do not yield results. Sleeping pills are used with maximum caution:
- only in diagnosed insomnia (sleep disorders are recurrent for a long time and negatively affect the physical and mental state of the patient);
- the minimum effective dosage is prescribed;
- therapy is intermittent. Administration of the drug is allowed 2-3 times a week (not daily). Treatment courses are short, not exceeding 3-4 weeks;
- monitoring of the condition while taking the drug, gradual reduction of the dosage immediately after the results are obtained.
If sleep disorders are secondary, caused by an underlying disease, therapy is aimed primarily at its treatment. In primary disorders, medications are prescribed taking into account what problem provokes insomnia.
When prescribing any psychoactive, sedative and other drugs for elderly patients, the dosage is maximally reduced, taking into account the age, state of health. Do not independently increase the dosage or duration of the course – it is dangerous to develop drug dependence, negative impact on cognitive functions. Long-term continuous use of some sleeping pills may reduce concentration, attention, and thinking.
Sleep disorders and dementia
Severe insomnia develops in senile dementia and other deliriosis disorders. Elderly people themselves do not complain about it, but such sleep disorders become a serious problem for relatives nearby. The person does not fall asleep himself, does not let others sleep, the sleep and wakefulness regimen changes. Therapy in this case requires a special approach.
In dementia, sleep problems manifest themselves as a violation of the daily regimen: during the day a person experiences drowsiness, and closer to night there is an increase in anxiety, agitation. The patient may try to leave the house, pack, knit knots, experience hallucinations, etc. It is dangerous to use tranquilizers in this condition: they can worsen well-being, make the patient even more restless.
It is possible to use neuroleptics, correction of previously prescribed drug therapy. Doctors recommend changing the regime so that the main volume of activity falls during the daytime hours. This will help to restore the circadian rhythm, control it, and reduce the frequency of episodes of insomnia.
Psychological impact of insomnia on older adults
Sleep disorders in the elderly can have not only physical but also serious psychological consequences. Constant sleep deprivation, fatigue and anxiety due to insomnia can lead to depression, mood deterioration, reduced cognitive function and reduced quality of life. Sleep plays an important role in restoring mental health, and lack of sleep can exacerbate pre-existing problems such as cognitive impairment or chronic illness. Older people who suffer from insomnia often become irritable and restless, which can worsen their relationships with others and lead to social isolation. It is therefore important not only to treat insomnia itself, but also to address the psychological aspects by providing support and attention from loved ones and professionals.
Conclusion
Sleep problems in the elderly is not only a medical problem but also a social problem that affects the quality of life and physical and mental health. Insomnia can be caused by a variety of factors, both age-related changes and diseases or side effects of medications. It is important to realize that the approach to treatment should be comprehensive, including both non-medication methods and cautious use of medications. The key point is timely diagnosis and lifestyle adjustment, as well as attention to psychological aspects, which are no less important for improving the patient’s condition. The help of specialists, as well as support from close people play a crucial role in the fight against insomnia in the elderly.
