Are medicines making it hard for me to sleep? I was asked this question after my last post. Many people, including seniors, need more and better sleep to feel good and live well. National Sleep Week (March 12-18, 2023) highlighted that sleep is a health issue in a sleepless world.
There were 3 points I emphasized in my post about the importance of sleep.
- Sleep is different from rest. The body and brain do important work that occurs only with sleep, not with rest.
- Good sleep means more than a recommended number of hours. Quality is as important as quantity.
- Older people vary widely. A sleep pattern that works for one person may not work for another.
A. Normal age-related changes
Sleep patterns change as people get older. This affects some people more than others in the same way that some babies snooze better than others. Older people tend to have lighter sleep. It’s harder to fall. “Sleeping like a log” is uncommon. Fragmentation results in shifts between stages of sleep. Semi-awake periods last seconds to minutes. The result is that seniors have less actual sleep when sleeping the same number of hours as other people. Aging can also shift the body’s clock, known as the Circadian rhythm. There is a shift to earlier sleep and earlier awakening.
B. Sleep disturbances
Sleep apnea affects as many as 25% of adults and is even more common in seniors. Sleep is interrupted by periods in which a person stops breathing normally. A typical finding is loud, irregular snoring. Sleep apnea decreases sleep efficiency and is harmful to health. Its causes include poor health, brain dysfunction, and hormonal changes.
Other disturbances are also more common with aging. Restless leg syndrome is an aching, throbbing or creeping sensation in the legs. There is a reflex urge to shake the leg. A related problem is periodic limb movement disorder. There is uncontrolled jerking or twitching of the leg when asleep.
Primary insomnia is an uncommon condition in which there is no clear cause for insomnia. It is a lifelong condition which starts early in life.
C. Urinary Issues
Older people go to the bathroom more often at night. This is due to a combination of a weaker bladder and lighter sleep. Prostate problems in men cause frequent urination.
D. Neurologic disease
Many neurologic conditions result in sleep disturbances. The most common ones in older adults are Parkinson’s Disease and Alzheimer’s Disease. Dementia results in time disorientation, sleep fragmentation and impaired deep sleep. In the most severe situations, there is day/night reversal, asleep all day and awake all night.
E. B.A.D. S.L.E.E.P.
Poor sleep is often due to issues that are not directly related to sleep. In the presence of these problems, good sleep habits are not the solution. See the box for a checklist of factors that can result in “BAD SLEEP”. It’s important to address the underlying issue first.
For instance, it’s difficult to fall asleep when a person is short of breath. Patients with COPD, asthma, or congestive heart failure can have problems laying flat. Coughing and wheezing also make it hard to fall and stay asleep.
Anxiety, stress, and depression all set off alarm signals. This makes it difficult to relax even when a person is tired. It’s not logical to think that a person can sleep well after a distressing day. This is a frequent finding among caregivers. It is vital to achieve a manageable routine with daily activities, joy, and connection.
Seniors take an average of more than 5 prescription drugs. As a result, half of all seniors experience a drug side effect. Over the counter drugs, alcohol, and caffeine can also aggravate symptoms. Some medicines cause tremulousness and restlessness. Be sure to rule out drug side effects as a cause of sleep troubles.
A chaotic environment results in poor sleep. The hospital is an example of this. Alarms go on and off. The patient is hooked up to IV’s. Strangers walk in and out. A sick person is in another bed in the same room. The environment is too stressful. In the same way, a stressful home environment interferes with good sleep.
As people age, an unhealthy diet is more likely to cause problems. Excess caffeine is more likely to result in sleeplessness. It also increases urination. Alcohol can help a person feel drowsy, but the quality of sleep is impaired with less deep sleep and less rest. With aging, the stomach has less capacity to digest large or fatty meals. In addition, seniors take more medicines that can upset the stomach. As a result, seniors are more likely to have indigestion when eating meals that are heavy or spicey. Excess processed or prepared food results in tissue inflammation and injury. Sugary foods cause fluctuations in blood sugar levels. In summary, there are many reasons an unhealthy diet impairs sleep.
Chronic pain is more common with aging. Half of all seniors have joint arthritis, back, or neck problems. Fibromyalgia is a condition which causes tension and pain in the tissues. Pain causes decreased mobility and inability to find a comfortable position. It then results in a persistent cycle of restlessness, pain, and sleeplessness.
Eight Steps to Good Sleep
Advice about how to sleep is regularly in the news. But articles with titles such as “Eight Steps to Good Sleep” are too simple. That’s why this post is about understanding the factors that are important in a specific person. Addressing these factors is key. My next post will be about problem solving to improve sleep. Each person needs a custom approach.
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.