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Managing sleep problems in elderly

Star Health Desk
More than 50% of elderly people have insomnia. Sleep disturbance or insomnia is the third most common patient complaint, ranking behind headaches and common cold. However, in many cases, it is underdiagnosed and a major concern in the aged population. With some measures and appropriate treatment, geriatric population can lead a happy life with sound sleep.
Several diverse factors may contribute to sleep disturbances in a large percentage of the elderly population, including retirement, health problems like dementia and depression, heart failure, chronic pain disorder, itchy skin conditions etc. and certain medications such as sedative, antidepressants.
Changes in sleep patterns may be part of the normal aging process; however, many of these disturbances may be related to patho-
logical processes that are not considered a normal part of aging.
Patient education on age-related changes in sleep and good sleep hygiene may be adequate treatment for many older adults. If the initial history and physical examination findings do not reveal a serious underlying cause, a trial of improved sleep hygiene is the best initial approach.
The common recommended measures include the following:
•Maintain a regular wake-up time
•Maintain a regular sleeping time •Exercise daily but not immediately before bedtime
•Use the bed only for sleeping or sex; do not read or watch television in bed
•Do not use bedtime as worry time
•Avoid heavy meals at bedtime
•Limit or eliminate alcohol, caffeine and nicotine before bedtime
•Maintain a routine period of preparation for bed (e.g. washing
up, brushing teeth)
•Control the nighttime environment with a comfortable temperature, quietness and darkness
•Wear comfortable, loose-fitting clothes to bed
•If unable to sleep within 30 minutes, get out of bed and perform a soothing activity, such as listening to soft music or reading, but avoid exposure to bright light during these times; get adequate exposure to bright light during the day
•Avoid daytime naps; explaining to the patient that daytime naps decrease nighttime sleep is helpful
Consultation with specialist physicians may be indicated, depending on the underlying causes of sleep disorder, such as psychiatric consultation for severe depression and pulmonary or surgical consultation for obstructive sleep apnea. Psychologists may provide cognitive-behavioural therapy for insomnia.