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Sleep disorders in the elderly

Definition

Sleep disorders in the elderly involve any disruptive pattern of sleep such as problems with falling or staying asleep, excessive sleep, or abnormal behaviors associated with sleep.

Causes

Sleeping problems are common in the elderly. In general, older people require less sleep, and their sleep is less deep than that experienced by the young. Some causes of and contributors to sleep disturbances include the following:

• Sedentary lifestyle
• Depression among the elderly (depression is a common cause of sleep problems among people of all ages.)
• Chronic pain caused by diseases such as arthritis
• Chronic diseases such as congestive heart failure
• A need to urinate frequently at night
• Stimulants such as caffeine
• Prescription drugs, recreational drugs, or alcohol
• Neurological conditions
  • Alzheimer's disease
  • Organic brain syndrome

Symptoms

• Frequent night awakenings
• Difficulty falling asleep
• Early morning awakening
• Confusion differentiating between day and night

Exams and Tests

• History of sleep disturbances and history of contributing factors
• Physical examination to rule out medical causes

Treatment

The relief of chronic pain and control of underlying medical conditions such as frequent urination may improve sleep in some people. Effective treatment of depression can also improve sleep.

Sleep-promoting interventions such as a quiet sleep environment and a glass of warm milk before bed may improve the symptoms. Other ways to promote sleep include the following:

• Have a specific bedtime and awakening time each day.
• Do not take naps during the day.
• Use the bed only for sleep or sexual activity.
• Exercise early in the day.
• Avoid large meals shortly before bedtime.
• Avoid stimulants such as caffeine.

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.

The use of sleeping pills, such as benzodiazepines, to promote sleep is usually not recommended on a long-term basis, as these can produce dependence and lead to worsening sleep problems over time if used inappropriately.

However, other sleeping pills, such as Ambien and Lunesta, are relatively safe if used properly.

WARNING: The FDA has asked manufacturers of sedative-hypnotic 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.

Outlook (Prognosis)

Most people see improvement in sleep with treatment or interventions. However, others may continue to have persistent sleep disruptions.

Possible Complications

A complication is alcohol use or drug abuse.

When to Contact a Medical Professional

Call for an appointment with your health care provider if a lack of sleep or too much sleep is interfering with daily living.

Prevention

Eliminating as many causes of sleep disruption as possible and encouraging regular exercise may help control sleep problems.