Good Sleep and Health: Sleep Disorders and Treatment in the Elderly

By Li Haogang, Attending Physician, Department of Psychosomatic Medicine, Taichung Tzu Chi Hospital

Sleep disorders are one of the most common outpatient complaints among the elderly, but the so-called "Insomnia"This is just a description of symptoms, not a precise diagnosis. The causes of sleep disorders are diverse, and differential diagnosis must be performed clinically."

Four out of ten elderly people suffer from insomnia and need targeted treatment.

Insomnia in older adults can be caused by various physical or mental illnesses, such as being unable to lie flat due to heart disease, or having a reversed day-night cycle due to dementia combined with delusions.Most cases of "insomnia" are secondary, meaning they are caused by various other physiological or mental illnesses. The proportion of "primary insomnia," where the cause cannot be found, is less than 20%.

For patients with sleep disorders, firstIn order to treat insomnia effectively, it is essential to identify the possible underlying causes, rather than simply administering sedatives or hypnotics.

Many people mistakenly believe that older adults need less sleep. In fact, their sleep "ability" declines with age. The fact that older adults often feel sleepy during the day indicates that their nighttime sleep is insufficient or inadequate.

Approximately 42 percent of older adults have sleep disorders, a higher proportion than other age groups.

To help the elderly sleep well, first find the cause.

The following is a brief introduction to the types of sleep disorders, common causes of insomnia, and treatment methods related to the elderly.

「Primary insomniaThis refers to "psychophysiological insomnia," which accounts for 20% of chronic insomnia. It is defined as...Insomnia lasting more than a month and not caused by other physical illnesses, substances or drugs, or other specific sleep disorders.

Another type of "Secondary insomnia",butInsomnia includes insomnia caused by physical illness, insomnia related to mental illness, and insomnia caused by drugs or substances.This type of insomnia is often caused by one or more factors.

Insomnia due to physical illness

Approximately 80 percent of elderly people have one or more physical illnesses, such as gastroesophageal reflux causing nighttime coughing and sleep disruption, stroke and degenerative neurological diseases, which can also cause nighttime awakenings, and other conditions such as chronic obstructive pulmonary disease, congestive heart disease, cancer, arthritis, kidney dialysis, benign prostatic hyperplasia, or the use of diuretics, which often cause sleep disorders.

Sleep disorders associated with dementia

Approximately 60% of people with dementia experience sleep disturbances.The reasons include: changes in sleep physiology caused by aging, such as sleep disturbances at night and daytime drowsiness; and reduced physical activity, social activities, and exposure to sunlight, which often lead to a sleep disorder pattern of sleeping during the day and insomnia at night.

in additionThe most common sleep disorder associated with dementia is sunset syndrome, which is caused by brain degeneration in dementia patients, affecting their sleep patterns.Typically starting around 3 PM, the child will exhibit mental confusion and restlessness, which can significantly impact the caregiver's stress levels.

Sleep aids without sunset anxiety

General principles for managing sleep disorders in the elderly

■ Go to bed and wake up at the same time every morning and evening. Do not try to go to bed early or stay in bed longer.

■ Do not take a nap.

■ Do not lie in bed during the day.

■ Develop a regular exercise routine every day.

■ Don't look at watches or clocks.

■ If you can't fall asleep after lying in bed for 30 minutes, get up and do some light activities.

■ Coffee and tea should be consumed in the morning if possible, and should not be consumed after noon.

■ Avoid eating or drinking heavily before bed.

■ Avoid strenuous exercise before bed.

■ Control the bedroom environment, such as temperature, noise, light, and mattress, and adjust it as comfortably as possible to facilitate sleep.

Sunset syndrome caused by Alzheimer's disease is recommended.

■ Exercise during the day can make the elderly feel tired before bedtime and fall asleep more easily.

■ The same family members and staff should care for the same dementia patients every day.

■ Provide daily reminders to help you feel a sense of direction.

■ Provide appropriate environmental stimulation and maintain adequate indoor lighting every day.

■ It is best to give sunlight therapy in the afternoon, around 4 to 5:30 pm.

■ Ensure that the elderly person's glasses and hearing aids are placed in a fixed location and can be accessed at any time.

Behavioral therapy for insomnia

Behavioral therapy: Insomnia patients are prone to reacting to external environmental stimuli and are unable to relax, leading to insomnia.Through relaxation techniques and biofeedback training, learn to relax all the muscles in your body and control your breathing and heartbeat to reduce anxiety and relieve tension. By manipulating the sleep environment and external stimuli, remove the conditioned responses to adverse stimuli that cause insomnia and find new conditioned responses that can help you sleep.

Sleep disorders are one of the most common clinical symptoms in the elderly.Understanding normal sleep physiology and developing correct cognition can help reduce anxiety about occasional (transient) insomnia.Sleep disorders have many causes, and a doctor's evaluation is needed to determine the cause.To achieve the best therapeutic effect, it is necessary to address the underlying causes of sleep disorders and to integrate these issues with a holistic approach that considers environmental, physiological, behavioral, and psychological factors.

News Source:Tzu Chi Medical Humanities Monthly - Human Medicine Transmission