Test Your Knowledge

Maintaining optimal health is crucial to ensuring sleep quality among older people. Studies have found that older people in good health are more likely to report good sleeping habits than those with significant health issues. Not only does good health appear to be improve sleep, but impaired sleep also seems to be a cause of poor physical and mental health. In addition, older people who maintain a positive attitude, exercise regularly, are actively engaged in the community and have a good support network are less likely to report sleep problems.

Treatment of sleep disorders varies depending on the cause of the disorder. Underlying medical, neurological and psychiatric conditions may be treated if they are determined to be the cause of sleep disorders.

Some types of disorders can be treated (or prevented) by making lifestyle changes, such as:

• Avoid caffeine and alcohol. Foods and beverages that contain caffeine, such as chocolate, coffee and soft drinks, should be avoided during late afternoon or evening hours. Alcohol speeds the onset of sleep, but increases waking during the later half of the night.
  
  
• Avoid eating or drinking too close to bedtime. This can interrupt sleep. Also, avoid foods that may cause heartburn, such as tomato products and spicy foods. Lying down worsens heartburn and makes falling asleep more difficult.
  
  
• Avoid smoking. Cigarettes contain nicotine, which has been linked to difficulty falling asleep and problems waking. In addition, when smokers sleep they experience nicotine withdrawal, which may cause them to awaken.
  
  
• Maintain a healthy body weight. Many cases of sleep apnea (slowed or stopped breathing during sleep) occur among overweight or obese people. Weight loss can alleviate or eliminate the symptoms.
  
  
• Go to bed earlier. As people grow older, hormonal changes usually cause them to become sleepier earlier in the evening and to wake earlier in the morning. This is a natural occurrence. However, older people who continue to try to go to bed at the same time as they did when they were younger are more likely to have difficulty falling asleep and staying asleep.
  
  
• Exercise. Exercising 20 to 30 minutes a day often helps people sleep, although exercising too soon before bedtime can cause difficulties falling asleep.
  
  
• Find the right temperature for sleeping. Extreme temperatures can disrupt sleep.
  
  
• Get proper light exposure. Too little exposure to sunlight during the day can cause sleep problems at night. Bedrooms should be kept dark so light does not interfere with sleep.
  
  
• Control noise. Environmental noise can be minimized with ear plugs, rugs, heavy curtains or drapes or double-pane windows.
  
  
• Get a proper mattress. Mattress quality can impact sleep quality.
  
  
• Develop a routine to prepare for sleep. Performing the same relaxing tasks every night before bed, such as reading a book or taking a warm bath, can help prepare the body for sleep.
  
  
• Use the bed only for sleep and sex, and not for reading or television viewing.
  
  
• Only get into bed when tired.
  
  
• Maintain consistent sleep and wake times.
  
  
• Avoid or regulate nap times. Daytime naps may interfere with nighttime sleeping. Avoid naps or restrict nap times to a maximum of 20 or 30 minutes.
  
  
• Practice relaxation techniques before bedtime. These may include hot baths, relaxing music, progressive muscle relaxation, deep breathing techniques, meditation, guided imagery and self-hypnosis, and prayer.
  
  
• Spend time outside. Increased exposure to natural sunlight helps the body’s circadian rhythm (the “internal clock”) to work properly. Two hours of bright-light exposure helps keep the sleep-wake cycle in tune.

Medications are sometimes prescribed to treat sleep disorders. They include:

• Benzodiazepines. Medications that help slow down the CNS. They help suppress rapid eye movement (REM) sleep and limit arousal. They may be prescribed to treat parasomnias (disorders that involve partial arousal or interference with sleep stage transition), teeth grinding (bruxism) or short-term (acute) insomnia. Because these medications can interfere with the normal sleep stages, can result in physical dependence and addiction, and appear to be associated with an increased risk of falls in older patients, the are not generally recommended for this population.
  
  
• Non-benzodiazepine sedative hypnotics. These drugs appear to work by binding to receptors in the brain that cause sedation.
  
  
• Stimulants. Medications that act on the CNS to produce excitation, alertness and wakefulness. They may be used to treat narcolepsy.
  
  
• Antidepressants. Medications primarily used to prevent or treat depression, anxiety and problems with obsession. They are not approved by the U.S. Food and Drug Administration (FDA) for the treatment of insomnia, but can be beneficial if the insomnia is associated with these mental disorders or certain chronic pain conditions. 
  
  Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the FDA has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.
  
  
• Hormone replacement therapy (HRT). Women who experience hot flashes during menopause may find that these episodes disrupt sleep. HRT medications sometimes are prescribed for these patients, although these medications may carry certain health risks.
  
  
• Dopamine agonists. Medications that mimic dopamine, a neurotransmitter (brain chemical) essential to thought, motivation, short-term memory and some emotions. Dopamine agonists may be used to treat restless legs syndrome (RLS, a sleep disorder characterized by unpleasant sensations in the legs).
  

In addition, there are many over-the-counter (OTC) sleeping pills, most of which contain an antihistamine, or herbal supplements (e.g., chamomile, valerian), that claim to promote sleep and are available at pharmacies and other stores. However, health experts generally recommend avoiding the use of OTC sleeping pills, especially for long periods of time, since they may have undesired side effects (e.g., dizziness, prolonged drowsiness), tend to lose effectiveness over time, and may interact with other medications currently being taken by the patient. The use of herbal supplements has yet to be fully evaluated for safety or effectiveness in the treatment of insomnia.

Other techniques that may be used to treat sleep disorders include:

• Cognitive behavioral therapy (CBT). This may help patients identify thoughts and behaviors that contribute to sleep problems, such as anxiety.
  
  
• Continuous positive airway pressure (CPAP). A device specifically used to treat sleep apnea. It involves wearing a mask over the nose that blows air into the throat at a pressure level appropriate for the patient. It keeps the throat open during sleep and prevents airway restriction.

In addition, patients with conditions such as narcolepsy may benefit from attending support groups.

Patients are urged to follow any physician recommendations regarding methods to improve their sleep. For example, patients diagnosed with heart failure are more likely to experience shortness of breath while lying down, which can disrupt sleep. Such patients are often urged to sleep with their head elevated to prevent or reduce such shortness of breath.