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What should you practice if an older person complains of not sleeping well at night?

Experts do believe that "normal aging" brings on some changes to sleep. (See this post for more on how sleep changes with aging.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.

Then it'due south probably not realistic to expect that as yous get older, y'all'll slumber as long or equally soundly as when yous were younger.

That said, although crumbling by itself does alter sleep, it's likewise quite common for older adults to develop health problems that tin crusade slumber disturbances. Then when your older relatives say they aren't sleeping well, you'll want to help them bank check for these. Figuring out what's going on is always the first pace in being able to improve things.

And recall, getting plenty good quality sleep helps maintain brain wellness, physical health, and mood.

Recently, I did a little research to identify the top causes of sleep problems in older adults. In this article, I'll share what I plant out. I'll also tell yous about what approaches accept been proven to work, to help care for indisposition and sleep problems in older adults.

Last but non least, if you (or your older relative) accept experienced the very mutual combination of waking upwards to pee at dark and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this: 092- Interview: Addressing Night Urination & Insomnia in Crumbling.

5 Common Causes of Sleep Issues in Older Adults

ane. Sleep bug due to an underlying medical problem.Although older adults do often endure from what'south called "primary" slumber disorders, many sleep problems they experience are "secondary" slumber problems, meaning they are secondary to an underlying medical condition whose main symptoms are not sleep related.

Mutual health conditions that tin can disrupt sleep in older adults include:

• Heart and lung conditions which affect breathing, such equally heart failure and chronic obstructive pulmonary disease
• Gastroesophageal reflux disease, which causes heartburn symptoms and can exist affected past big meals late at night
• Painful atmospheric condition, including osteoarthritis
• Urinary problems that cause urination at night; this can be caused by an enlarged prostate or an overactive bladder
• Mood bug such every bit low and anxiety
• Neurodegenerative disorders such every bit Alzheimer'southward and Parkinson'southward
• Medication side-effects

If an older person is having difficulty sleeping, it'southward important to brand sure that one of these common atmospheric condition isn't contributing to the problem. Treating an underlying problem — such as untreated hurting at night — can ofttimes improve sleep. It can also help to talk to a pharmacist nearly all prescription and over-the-counter drugs, to make sure that these aren't contributing to indisposition.

Alzheimer'due south and related dementias pose special considerations when it comes to sleep, which I write nearly in this post: How to Manage Slumber Issues in Dementia.

2. Snoring, Slumber Apnea, and other forms of Slumber-Related Animate Disorders. Sleep-related breathing disorders ("SRBD"; it'south also sometimes called sleep-matted breathing) is an umbrella term covering a spectrum of bug related to how people breathe while comatose.

Sleep apnea is a common status which is of import to diagnose since it'southward been associated with many other health problems (especially in middle-aged adults). In slumber apnea, a person has frequent pauses in their breathing during sleep. The virtually common form is obstructive sleep apnea (OSA), in which the breathing pauses are due to obstructions in the animate passages. OSA is frequently associated with snoring. A less common grade is key sleep apnea, in which the breathing pauses are related to changes in the encephalon.

How common it is: The likelihood of having slumber-disordered animate disorders goes up with age. It's besides more common in men, and in people who are overweight. In one study of 827 healthy older adults anile 68, 53% were establish to have signs of SRBD, with 37% meeting criteria for pregnant sleep apnea. Interestingly, virtually participants did not complain of backlog sleepiness.

Why it'southward a problem:Studies have found that untreated OSA is associated with poor health outcomes including increased mortality, stroke, coronary artery illness, and center failure. Nevertheless,  studies also suggest that these associations are strongest in people aged 40-70, and weaker in older adults. For older adults with symptomatic OSA, handling can reduce daytime sleepiness and better quality of life.

What to practice if you lot're concerned: Helpguide.org'southward page on sleep apnea has a useful list of common symptoms and take a chance factors for slumber apnea. You tin also ask the doctor almost further evaluation if you've noticed a lot of daytime sleepiness. To be diagnosed, you'll demand to pursue polysomnography (objective sleep testing) either in a sleep lab or with a dwelling slumber testing kit.

Whether or not you pursue an official diagnosis for SRBD, fugitive alcohol (and probably other sedatives) is likely to aid.

three. Restless leg syndrome (RLS).This condition causes sensations of itching, crawling, or restlessness as a person is trying to fall asleep. The symptoms are unpleasant but not usually painful, and meliorate with movement. The exact biological underpinnings of this problem remain poorly understood, just information technology seems to be related to dopamine and iron levels in the encephalon. It is not thought to be related to neurodegeneration.

How mutual it is: Studies suggest that 5-15% of the general population meet criteria for RLS, but only ii.5% of people are idea to take clinically astringent symptoms. Poor wellness, older historic period, low iron levels, and beingness female person are some risk factors. It also tends to run in families.

Why it'south a problem:RLS has been associated with depression, anxiety, and sleep-onset insomnia. It can as well go worse with sure types of medication.

What to do if yous're concerned:Read up on RLS (Helpguide.org's page seems very good) and so talk to a doc. More often than not, you don't need polysomnography but y'all should probably be checked for low iron levels. You tin read about possible not-drug and pharmacological treatment options at Helpguide.org.

four. Periodic Limb Movements of Slumber (PLMS). This condition is not easily treatable, but I'm listing information technology since I've discovered information technology'south much more mutual than I realized. PLMS causes intermittent movements while asleep, normally in the lower limbs. Information technology tin can affect the toes, ankles, knees, or hips. The movements may or may not wake the person up; they can be annoying to a bed partner.

How mutual it is: Studies guess that 45% of older adults experience PLMS. Many such older adults are otherwise healthy. Nonetheless, PLMS is too oftentimes associated with other sleep problems, such as restless legs and sleep apnea. Experts believe that it's adequately rare for people to experience clinically meaning slumber disturbances solely due to PLMS.

Is it a problem?PLMS can be an issue mainly because it'south associated with other slumber problems. Well-nigh people who feel PLMS don't notice it much, although some do discover it bothersome. But a few studies take attempted to care for isolated PLMS, and it's not clear that there is a reliable way to treat this. In its 2012 guideline on treating restless leg syndrome and PLMS, the American Academy of Sleep Medicine concluded that in that location was "insufficient evidence" to recommend pharmacological treatment.

5. Insomnia.Insomnia means having difficulty falling asleep or staying asleep, despite the opportunity to do so (east.one thousand. being in bed), and experiencing decreased daytime function because of this. I consider this the grand-daddy of all sleep problems, considering it affects so many people in center-age and older age.

How common is information technology: Very common, and it becomes even more common with aging. One study institute that 23-24% of older adults reported symptoms of indisposition.

Why it'due south a problem: Insomnia has been associated with anxiety, low, fatigue, worse quality of life, cognitive decline, and a diversity of other worse long-term wellness outcomes.

What to do if you're concerned:The main affair to practise is assess the problem, by tracking sleep and using a sleep periodical. And and then seek help. For older adults, it is especially important to not simply rely on prescription or non-prescription (e.g. alcohol, over-the-counter pills) substances to help with sleep. That's because all such substances worsen encephalon function and increase the risk of cognitive pass up. (Run across "4 Types of Brain-Slowing Medication to Avoid if You're Worried Well-nigh Memory" for more details.)

Proven Ways to Treat Insomnia in Older Adults

Insomnia is a very common complaint amid family caregivers and older adults. Fortunately, enquiry has shown that it'southward possible to treat insomnia effectively, although it does often take a little time and effort.

Why Sedatives Aren't the Way to Go and Proven Means to Taper Off Them

Before I go into the recommended treatments, let me say it again: you should but use sedatives every bit a terminal resort. That'southward because well-nigh medications that brand people sleepy are bad for brain part, in both the short-term and long-term.

Benzodiazepines such as lorazepam, alprazolam, diazepam, and temazepam (Ativan, Xanax, Valium, and Restoril) are also habit-forming. Information technology can be a lot of work to wean people off these drugs, merely enquiry has proven it'southward possible.

For instance, in this randomized control written report, many older adults who had been on benzodiazepines for sleep (mean duration of use was xix.3 years!) were able to taper off their sleeping pills. 63% were drug-free after seven weeks. (Yep!)

Plus, in my ain personal experience, it becomes extremely difficult once a person has started to develop a dementia such as Alzheimer'due south, because then their behavior and thinking can become a lot worse if they are a piffling sleep-deprived or anxious. (In the short-term, almost everyone who tapers off of sedatives has to endure a little extra restlessness while the body adapts to existence without the drug.) But letting them keep to use their benzodiazepine puts the states in a pickle, considering it also keeps them from having the best brain role possible, is associated with faster cerebral refuse, AND increases autumn run a risk.

I promise yous encounter what I'chiliad getting at. If either you or someone you lot intendance for are taking benzodiazepines for slumber or anxiety, and yous aren't dealing with a dementia diagnosis, now is the time to exercise the work of trying to get off these drugs. (If you lot are dealing with a dementia diagnosis, you should nonetheless inquire the doctors for help trying to reduce the use of these drugs, but it volition all be harder. It's however often possible to at least reduce the doses being used.)

The key to successfully stopping sedatives for sleep is to very slowly taper the drug under medical supervision, plus add together cerebral-behavioral therapy or other sleep-improving approaches if possible.

For more than on this topic, and for a handy (and enquiry-proven) consumer handout that helps older adults cease benzodiazepines, see "How You lot Can Help Someone Cease Ativan." This article also addresses the question of whether it'due south ever okay for an older person to be on benzodiazepines.

Now, let's review some proven approaches to improving sleep in older adults.

Proven ways to treat insomnia in older adults:

• Cognitive-behavioral therapy for indisposition (CBT-I).This means special therapy that helps a person avoid negative thought patterns that promote insomnia, along with regular slumber habits, relaxation techniques, and other behavioral techniques that improve sleep. It has a good track record in inquiry, which was recently covered by the NY Times. A new written report also confirmed that CBT-I also benefits people who have insomnia combined with other medical or psychiatric weather condition.
  • CBT-I tin exist washed in person, and is also effective when done through online programs. Two online programs with proven clinical efficacy are Sleepio (see here for the study) and SHUTi.
  • CBT-I may comprise several techniques such equally stimulus control, and sleep restriction therapy. This Mayo Clinic folio has a prissy list of specific behavioral therapy components that might exist included in CBT-I for indisposition.

• Brief behavioral treatment of insomnia (BBTI). This is a shorter variant of CBT-I; it's designed to be delivered in iv weeks. It also has a good track record in research.
  • A study also found that BBTI was constructive in reducing nighttime urination.

• Mindfulness meditation. A randomized control trial published in Apr 2015 found that mindfulness meditation was more effective than "slumber hygiene," to amend the sleep of older adults with a variety of sleep disturbances. Older adults assigned to mindfulness completed a weekly 2-hour, six-session group-based course.
  • Local in-person courses to learn mindfulness are often available; search online to find i near you lot. They may also be available at certain senior centers.
  • An online version of the form used in the study is available here.
  • Several smartphone based apps propose to help people with mindfulness. They are reviewed in the scholarly literature hither. I personally have used Headspace in the past and liked it.

• Exercise. Exercise is often thought of as a treatment for insomnia, merely the evidence seems weaker than for CBT-I. A review article published in 2012 ended that the effect is modest. A more contempo randomized trial comparing CBT-I to tai chi, for insomnia in older adults, constitute that CBT-I was more constructive.
  • Although practice is plain very important to health, don't rely on it every bit the primary way to endeavour to solve slumber problems.
  • It's also possible that practice may help insomnia, just a fascinating modest study covered in the NY Times suggested that in people with chronic insomnia, it can take a few months for exercise to have an effect on sleep.

Are there whatsoever medications or supplements that are safe and effective?

Benzodiazepine drugs and sleeping medications such as zolpidem (brand name Ambien) are definitely risky for older adults, as they dampen encephalon function and worsen balance. If you or your loved one is depending on such medications to sleep, I recommend you get help tapering off, as described above. Most older adults can learn to sleep without these medications, although it tin can have a little effort to wean off the drug and learn to get to sleep without them.

Many over-the-counter (OTC) medications that make people sleepy are also a problem, because most of them are "anticholinergic," which means they interfere with a key neurotransmitter called acetylcholine. A very normally used anticholinergics is diphenhydramine (brand proper noun Benadryl), a sedating antihistamine that is included in most night-time analgesics, only many prescription medications are anticholinergic as well.

Older adults should be very careful about using anticholinergics oftentimes for sleep, or actually for anything. That'south because they worsen brain function, and in fact, chronic use of these medications has been associated with developing Alzheimer's and other dementias. (For more than on this, run across seven Common Drugs that Are Toxic For Your Brain.)

Virtually all sedatives are included in the American Geriatrics Society Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.

So those are the medications to avoid if possible.

Now here are a few medications that seem to be less risky, and are sometimes used:

• Melatonin:Melatonin is a hormone involved in the slumber-wake cycle. A 2007 study found that melatonin improved the slumber of older adults and did not seem to exist associated with whatsoever withdrawal symptoms. However, in the U.Due south. melatonin is sold as a poorly-regulated supplement, and studies have found that commercially sold supplements are often of questionable quality and purity. So melatonin may work less reliably here than in Europe.
• Ramelteon: Ramelteon is a synthetic drug that mimics the effect of melatonin. A 2009 study reported that ramelteon did not impair center-of-the-night remainder or retentiveness in older adults. However, its efficacy has been questioned; a 2014 meta-analysis concluded that the clinical result appeared to be "small-scale."
• Trazodone: Trazodone is an older weak anti-depressant that is mildly sedating. It has long been used by geriatricians as a "sleeping pill" of selection, equally information technology is not anticholinergic and seems to be less risky than the alternatives. A small 2014 study found that trazodone improved sleep in Alzheimer'south patients.

For a detailed and technical review of sleep medicines in older adults, this commodity is good: Review of Safety and Efficacy of Slumber Medicines in Older Adults.

And again, if you or your older relative has been bothered by the need to urinate at night, I also want to recommend this BHWA podcast episode: 092- Interview: Addressing Nighttime Urination & Indisposition in Aging.

Now that we've covered the summit causes of sleep problems in older adults and some proven means to treat indisposition, I'd beloved to hear from you.

What sleep problems have you been concerned about? And what's helped y'all meliorate them so far?

For information on evaluating and managing sleep bug in people with Alzheimer's or other dementias, see this article: How to Manage Slumber Problems in Dementia.

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Source: https://betterhealthwhileaging.net/top-5-causes-sleep-problems-in-aging-and-proven-insomnia-treatments/