An extra touch
Standard medical advice to promote good sleep is frequently not enough. Here are some tried and true and alternative approaches.
Show love and provide emotional and physical comfort. Have a bedtime chat or share a prayer. Give a gentle touch, hug, or massage. A stuffed toy or precious memory provides comfort for some people. Staying at the bedside until a person is asleep helps when a person is anxious.
"Rock-a-bye baby" is a lullaby we all know. Lullabies are not just for babies. Sound therapy soothes the mind. Try some favorite songs, melodies, nature sounds and piano sonatas.
Make warm milk or herbal tea a bedtime routine. Warm milk contains tryptophan which converts to melatonin. Chamomile tea contains flavonoids which have a calming effect. Valerian, also available as a tea, has been known for its calming effect for thousands of years.
Many natural plant extracts are available as a scent or a lotion. Lavender is used in aromatherapy to help people relax.
Melatonin is a hormone and antioxidant produced in the brain. It increases in the evening to promote sleepiness. However, production decreases with age. This can lead to difficulty falling and staying asleep. Melatonin supplements are widely used as a sleep aid, especially in older adults. They are available over the counter and safer than sleeping pills. Melatonin, taken in the evening, gently promotes sleep. Its long-term usefulness as a “snooze vitamin” is uncertain. There is no evidence that a dose higher than 6 mg works better. Higher doses may result in restlessness, vivid dreams, nightmares, daytime sleepiness, and morning grogginess.
Ramelteon (Rozerem), is a prescription drug that enhances the effect of melatonin. It decreases the amount of time needed to fall asleep. It is different from other sedatives and has less potential for dependency. More information is needed about its long-term effectiveness and safety in older adults.
Sleeping pills. Health care providers are hesitant to prescribe traditional sedatives to older adults. Side effects include confusion, impaired coordination, and falls. They are often habit-forming. Long-term use of sedatives is linked to cognitive impairment. Non-prescription sleeping pills are a special concern and should not be used in the elderly
Orenxin receptor antagonists are a new class of medicine for insomnia. There is evidence that they are safer for older adults but more studies are needed. Suvorexant (brand name Belsomra) is in this class.
Antidepressants are often prescribed for patients who have anxiety/depression and insomnia. Use of these medications should be carefully reviewed with a provider. Narcotics and muscle relaxants are used for both pain relief and sedation. Their use in older patients is especially problematic.
Acupuncture has been shown to improve sleep quality and duration in some people. It has not been well studied in older adults.
Cannabis/Marijuana has been promoted for sleep. Cannabis is only legal in certain states. The use of cannabis for older adults needs more research.
“Counting sheep” is not an effective approach for people with chronic insomnia. Progressive relaxation techniques are helpful but require mental concentration. They are unlikely to be effective for people who have dementia.
Your path to good sleep
Older people CAN get good sleep. However, stressing out will make the problem worse. If a person is wide awake, it’s better to get up and do a relaxing activity until sleepy. Don’t get frustrated. It takes trial and error, time and effort, to find the right routine and schedule.
Bill is an 82-year widower who lives with his divorced daughter. She works full- time and also cares for two of her own grandchildren. Bill is on oxygen for COPD. Breathing is so tough that he gets breathless walking across the room. He barely sleeps at night. His daughter gets up multiple times to help him go to the bathroom. The daughter is fed up. She screams that he just needs to sleep. His response is that things would be better if he were dead.
The family requested a sleeping pill. But we adjusted his meds and reviewed his daily schedule. We had a family meeting to figure out what would make things better. We provided support. Bill ended up with a routine that works for him. He takes long naps both during the day and at night. He prefers to sleep sitting in his adjustable electric lounge chair. The TV is always on. The grandchildren pop in and out but are supportive and respectful. It’s his path to better sleep.
A sleep clinic consultation can be helpful especially if there is a disorder such as sleep apnea.
Sometimes the most valuable consultant is a pet. Pets make the day enjoyable. Dogs need walking and promote physical activity. And pets are particularly good at snoozing and inviting people to snooze along.
My next post will be about sleep and dementia, a special challenge.
Warmest Aloha,
PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.
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Great article! Looking forward to part 2.
Very thorough and useful info here for the common problem of insomnia – something I fortunately don’t suffer from.