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Late-life Sleep Problems: What's Normal?

Posted Aug 24 2008 1:49pm
ANNOUNCER: The good news is that today many of us will live into our 80s, 90s or even further. The bad news? As many as 25 percent of healthy seniors report sleep difficulties, and it's higher in those with health problems.

CHARLES REYNOLDS, MD: The highest rates of insomnia, difficulty falling or staying asleep, not feeling well rested, occur in older Americans, more commonly in women than in men, and are perhaps even more common among elderly with fewer psychosocial or economic resources.

ANNOUNCER: There are, of course, a variety of age-related physical conditions and medications that can deprive the sleeper of a good night's rest.

CHARLES REYNOLDS, MD: Heart disease causes angina at night or difficulty breathing, and can thereby lead to disturbed sleep. Arthritis, pain at night. The rate of sleep disordered breathing, what doctors call sleep apnea, tends to increase with age.

ERIC NOFZINGER, MD: Certainly if there's any type of major brain change or structural problem or a dementia of some type, then those things can severely fragment sleep at nighttime.

ANNOUNCER: Frequent trips to the bathroom, a common problem aging adults know all too well, can disrupt sleep.

CHARLES REYNOLDS, MD: I think that's a big deal, having to go to the bathroom during the night. Generally, as we age, our ability to concentrate urine diminishes, so we have to go to urinate more often. One of the ways that we try to help older people diminish the impact of frequent urination at night is to tell them to gently fluid restrict themselves after five or six in the evening.

ANNOUNCER: The mind as well as the body can influence sleep.

ERIC NOFZINGER, MD: Things such as depression is one of the major problems that we see. Grief and bereavement, major stressors of late life, going into retirement and suddenly having a lot of time on your hands, not being as active during the daytime can lead to some difficulties, anxiety disorders.

ANNOUNCER: Even something as simple as what you do and how you feel before bed can affect sleep quality.

ERIC NOFZINGER, MD: Thinking about problems, ruminating about things, trying to deal with legal issues right before going to bed, all of these things would not be a good idea, because they can be activating or arousing.

CHARLES REYNOLDS, MD: Too much heat, too much cold, noise. Many older people have a lower arousal threshold, so even soft noises in the environment can lead to arousal. And light, also a factor waking people up

ANNOUNCER: Finding ways to improve sleep may lie in simple things the sleeper can do to help themselves.

CHARLES REYNOLDS, MD: Curtail daytime napping. Maybe a 30-minute nap early to mid-afternoon is okay, but not after four or five.

ERIC NOFZINGER, MD: Decreasing the amount of time in bed if they're not sleeping at nighttime, perhaps delaying the time that they get into bed can help with sleep consolidation at nighttime.

CHARLES REYNOLDS, MD: A hot bath, many people find, helps them to relax and be ready for sleep. Conversely, vigorous physical or mental exercise in the evening can arouse you. If you get your head in high gear, it's hard to get it to low gear and fall asleep.

ANNOUNCER: There are over-the-counter and prescription medications, which help problem sleep. Prescription sleep medications fall into two classes, benzodiazepines and non-benzodiazepines. The elderly need to be especially cautious about which they choose.

CHARLES REYNOLDS, MD: There is considerable information in the medical literature that the use of sleeping pills in elderly people can lead to daytime sleepiness and associated increased risk for cognitive impairment, say, with attention or memory.

ERIC NOFZINGER, MD: I think some of the newer non-benzodiazepine sedative hypnotics tend to be a little bit better tolerated in the elderly.

ANNOUNCER: It's always important to recognize how vital good sleep really is, and that sleep problems late in life are not inevitable.

CHARLES REYNOLDS, MD: We think that sleep is very important at meeting the challenges of old age, whether that's caregiving, whether it's adjusting to loss or bereavement, or whether it's staying well from the point of view of mental and physical health. I think that sleep plays a critical role, and that steps taken by elderly people and their families to improve the quality of sleep repays in terms of health dividends.

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