Sleep disorders in the elderly

Everyone knows that changes in sleep occur with age, but it has not been proven until now whether these changes are part of normal aging or pathology.

And one of the reasons for the ambiguity may be due to the different way of life in the regions, the differences among individuals. 

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of the sleep disorders in the elderly

Sleep disorders in the elderly can be the result of various effects - it can be stress, severe loss, anxiety, depression, retirement.

[10], [11], [12], [13], [14]

Symptoms of the sleep disorders in the elderly

The most widely held view that older people sleep less is false, since the total sleep time in the elderly does not decrease. Daytime nap and redistribution of sleep time compensate for a bad night's sleep.

One of the leading symptomatic complexes of sleep disorders in the elderly is insomnia. Insomnia is understood as the impossibility of sleep and is a symptom-complex rather than a diagnosis. Patients can complain about the difficulty of falling asleep and maintaining sleep, frequent nightly getting up, early rising with the inability to resume sleep, fatigue, irritability, impaired concentration during exercise. Insomnia is often accompanied by an undesirable nap during the day.

Forms

Transient insomnia - this is the result of some acute stressful situations, which can be hospitalization, surgery, loss of a loved one! Person, retirement. Usually this unfavorable condition can take place on its own within a week.  

 Chronic insomnia. If insomnia due to age-related changes and other conditions worries the patient for a month or more, then we can talk about the onset of a chronic form of insomnia.

About 1 / 3-1 / 2 patients who suffer from chronic insomnia have mental disorders. The main symptoms of this sleep disturbance in the elderly: anxiety, irritability, fatigue, impaired cognitive function.

Sometimes it is very difficult to assess and treat those patients who take long-term sleeping pills - their side effects are sometimes indistinguishable from the symptoms of insomnia.

When collecting an anamnesis, it is necessary to pay attention to chronic diseases, the manifestations of which can lead to insomnia. These include: osteoarthritis, nighttime dyspepsia, night exacerbation of chronic obstructive pulmonary diseases, cardiac asthma, nocturia (due to misdiagnosis of diuretics, urinary incontinence or inflammatory processes), thyroid disease or nighttime headaches. Many patients with depression complain of the inability to maintain sleep or early rising.

One of the causes of sleep disorders in the elderly due to frequent waking up is a nocturnal sleep apnea characterized by complete or partial cessation of breathing for more than 10 seconds due to obstruction of the upper respiratory tract (by closing the lower part of the soft palate, the back of the tongue and the posterior pharyngeal wall ). The syndrome of nocturnal apnea is one of the leading causes of sudden death at night.

In addition, sleep can be disturbed by inadequate daily routine, late eating, insufficient physical exertion, excessive coffee cravings, alcoholic beverages.

Specific sleep disorders in the elderly

[15], [16], [17], [18], [19]

Syndrome of insomnia associated with depression

Typically for depression - early rising and inability to sleep after that.

Insomnia, associated with medications used in the treatment of the cardiovascular and respiratory system. So, stopping the use of sedatives causes withdrawal syndrome; expectorant drugs containing ephedrine and beta-agonists can prolong the time of falling asleep; The same effect was observed when taking caffeine-containing medications. Hypotensive drugs of the beta-blocker group (propanolol) can cause breathing difficulties in patients with asthma and chronic obstructive pulmonary diseases, drugs like reserpine (adelfan, triresid) often cause depression and insomnia, and alpha-1 blockers can cause sleep disorders in the elderly .

A H2-histamine blockers (mainly cimetidine), used for peptic ulcer disease in old age, can cause nighttime delirium. Sinemet or Nakom can lead to nightmares. Diuretics prescribed for the night cause nocturia, which causes intermittent sleep.

Restless legs syndrome

Occurs at night and is described as a feeling of running on any surface. Symptoms of sleep disturbance in the elderly are reduced with the direct movement of the legs and return when they are stationary. This syndrome must be differentiated from seizures, in which the patient wakes up from pain in the calves and muscle spasm, and not from the sensation of movement.

Syndrome of periodic movement of limbs

This sleep disturbance in the elderly is found in 45% of patients older than 65 years. Occurs at night and is characterized by rapid one- or two-sided flexion of the big toe and partial bending of the knee and thigh. Movements last 2-4 seconds and are often repeated (sometimes in 20-40 seconds). The basis is the age-related impairment of neurotransmitter metabolism in dopamine receptors.

Treatment of the sleep disorders in the elderly

1.  Activities that contribute to the normalization of sleep:
   • To exclude daytime sleep, having occupied the patient with an interesting affair;
   • to limit reception of a liquid in second half of day, keeping daily its or her quantity or amount;
   • airing of premises before bed (the temperature in it should not exceed 22 ° C);
   • The bed should be stiff, and the blanket - warm and light;
   • recommended a short walk before going to bed;
   • you can not have sweets before going to bed;
   • it is recommended to take soothing decoctions;
   • taking sleeping pills as prescribed by the doctor;
   • the patient should sleep in silence, a short reading may help to fall asleep;
   • teaching the patient the methods of auto-training.
2. Tips for patients to improve sleep:
   • Follow the daily routine - go to bed and get up at the same time, as on weekdays, and weekends, holidays.
   • Perform routine activities before bedtime. Do daily evening exercise (brush your teeth, wash, set the alarm) - this creates a good mood for sleep.
   • Keep a calm environment around you. The room where you sleep must be dark, quiet, not hot and not cold.
   • A bed is a place to sleep. And so do not use it for food, reading, watching TV, etc., that is, for those activities that are associated with an active lifestyle.
   • Avoid bad habits that disturb sleep. Do not eat late and do not take coffee and alcohol before bed.
   • Do regular physical exercises. Exercises can help you fall asleep, yourself. But avoid exercise late at night, as they stimulate the cardiovascular and nervous system.
   • At excitement stop, calm down, relax. Stress and anxiety are the main enemies of sleep. If you can not fall asleep, read a little or take a warm bath.
3. Medication correction of sleep disorders in the elderly. If we consider the use of hypnotics in old age, then most often they are used by women (50%), men - much less often (10%). However, you need to pay attention to the following points:
   • Changes in the physiology of sleep in the elderly are not corrected by hypnotic drugs.
   • The use of drugs that depress the central nervous system can disrupt physiological functions already affected by insomnia (for example, aggravate nocturnal sleep apnea).
   • In the elderly, the risk of drug interactions is increased (for example, between tranquilizers, alcohol, beta-blockers, beta-agonists, antihistamines, (analgesics and other drugs).
4. Since the metabolism of drugs in the elderly is reduced, it can lead to undesirable effects (drowsiness during the day).
5. The use of hypnotics increases the risk of death.

Treatment of transient insomnia is not required, but sometimes to prevent the transition to a chronic form, you can prescribe sleeping pills for no more than Z-3 days in a row with a subsequent intermittent application. The minimum doses of drugs are prescribed. Preference is given to preparations of the benzodiazepine series (for example, phenazepam - 7.5 mg). Coffee and other stimulants are not prohibited, but should be applied no later than 12 hours before bedtime.

Necessarily, before the treatment of sleep disturbance in the elderly, inform the patient about normal age-related changes in sleep that can change his perception of a normal night's sleep (and thus get rid of most complaints). It is worth recalling the need to maintain adequate physical activity, sufficient communication with friends. A short, refreshing daytime drowsiness often does not disturb night sleep and somewhere even improves night sleep.

It is necessary before the beginning of treatment of sleep disorders in the elderly should be abolished sleeping pills, alcohol and other soothing.

For the treatment of insomnia with depression, pre-cexepin (not prescribed for glaucoma) or trazodone is preferable.

For the treatment of neurologic disorders, bromocriptine and L-dopa are usually effective, and in more severe cases, opiates are used.

When treating sleep apnea in mild cases, sleep should be avoided in the supine position, weight should be reduced; in severe cases - treatment, usually surgical (removal of excess soft tissues of the pharynx - effective in 50% of cases).