How to manage sleep disorders among the elderly

Most adults experience sleep disorders as they age. They complain of insomnia, disturbed sleep or incomplete sleep.

Research conducted by three Japanese researchers (Sleep disorders in the elderly: Diagnosis and management)  found that “in both men and women, older age was associated with shorter sleep duration, reduced sleep efficiency, and increased arousal. In men but not women, older age was independently associated with increased light stages of sleep (Stage 1 and Stage 2), while older women had more trouble falling asleep and tended to have more problems with waking up during the night and waking up too early.”

The most common symptom of sleep disorder is inability to sleep on time. The elderly keep tossing in their bed hoping for sleep to happen. Even worse, is the inability to maintain sleep. The sleep is not smooth. The elderly wake up several times in the night. In some cases, the elderly wake up early, and lie awake for large parts of the night.

Why does this happen? Doctors have classified sleep disorders into three broad categories. Two of these reasons – behavioural and environmental can be addressed, and can improve sleep. The third, chronic illness, is dependent upon the state of illness, medication etc. and is not easy to manage.

1.Behavioural causes: The tendency to sleep in daytime, also referred to as daytime napping, reduces sleep time at night. Night sleep is also affected by lack of exercise. Another reason can be going to bed early. This happens on account of changes in an individual’s body clock. Use of alcohol, caffeine or nicotine also impairs sleep.

2. Environmental causes: Sleep is also affected by noise or light. The bed, especially a hollow or beaten down mattress, can affect sleep.

3. Chronic illness: Sleep issues caused by diseases are most difficult to manage. They can be triggered by depression or anxiety. They can also be caused by neurological disorders such as Alzheimer’s disease or Parkinson’s disease. Chronic heart conditions or painful ailments such as arthritis can also cause sleep disorders. In elderly men, a particularly common reason is enlargement of prostrate which forces them to get up several times on account of increased urination urges.

The inability to sleep well leads to several side effects. The most common are fatigue, mood disturbances and irritability. The elderly can also be listless. They may lack energy and their motivation levels to engage with family members may go down.

What should you do in such situations as a caregiver?

If the sleep disorders are not triggered by chronic illnesses, then you can initiate / invite the elderly to do the following:

1.Exercise: The best way to drive listlessness and promote sleep is to encourage the elderly to exercise. The exercises should be light and can be done in the morning and if possible, in the evening.

2. Bedroom environment: A regular, well-designed bedroom can improve sleep. As far as possible, the elderly should be allowed to sleep in the room they have been using for long. Also, the positioning of the bed or other furniture in the room should not be disturbed too often. Care should be taken to reduce light levels. The bedroom need not be completely dark. At best, the light should be dim. Also, avoid activities that create noise once the elderly have gone to sleep. Noise can disrupt sleep and make it difficult for the elderly to go back to sleep.

3. Food discipline: It is important to maintain food discipline. The meals should be taken on time. A good policy is to have a doctor prescribe the meals. Heavy meals must certainly be avoided before bedtime

4. Fluid intake before bedtime: You should encourage elderly to reduce the intake of water before bedtime. This will reduce urination, a major cause for sleep disruption.

5. Avoid caffeine and nicotine: Foods that contain caffeine such as tea, coffee, cola, and chocolate should be avoided in the evening. Smoking is a definite no. The elderly must be discouraged to smoke, especially before bedtime. Both caffeine and nicotine disrupt sleep.

6. Avoid alcohol: Elderly must be persuaded to reduce alcohol consumption. Alcohol can make the elderly sleepy but it can lead to disturbed or fragmented sleep.

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