By Himanshu Rath
Anxiety and sleep disorders are common in the older population. Individuals of all ages can be affected by sleep disorders.
Insomnia is one of the most common medical complaints, especially in the elderly. It often coexists with medical, psychiatric, sleep, or neurological disorders. Insomnia may also be associated with stress, medications, poor sleep habits, or changes in the sleep environment.
Older Persons who had trouble sleeping were more likely to have existing conditions and be less physically active. Health conditions that may cause sleep problems includes:
- Parkinson’s disease: More than 40 percent of people with Parkinson’s disease have obstructive sleep apnea
- Alzheimer’s disease: May cause daytime drowsiness and difficulty staying asleep at night
- Chronic pain like arthritis pain
- Cardiovascular disease
- Neurological conditions like multiple sclerosis and traumatic brain injury
- Gastrointestinal conditions such as Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS)
- Lung or respiratory conditions like chronic obstructive pulmonary disease (COPD) and asthma
- Poor bladder control
These conditions may increase the risk of obstructive sleep apnea.
Anxiety and Depression
Symptoms of anxiety and depression are also typically intertwined with insomnia, and there appears to be a bidirectional relationship between anxiety and depression with insomnia. Moreover, reduced sleep quality is associated with increasing age, making insomnia more prevalent in older cohorts. Several studies suggest that almost two-thirds of the elderly population report sleep difficulties.
An important consequence of increased levels of symptoms such as anxiety, depression, insomnia, and reduced function in older cohorts, is an increased demand for health services with associated socioeconomic costs.
It has been suggested that sleep quality acts as a mediator between depression and quality of life in older persons. Symptoms of depression increase with age and there are no clear gender differences.
Management of Sleep Disorders
At any age, managing insomnia is a challenging issue that may require lifestyle changes. The recognition of insomnia is especially important in the elderly due to age‐related increases in comorbid medical conditions and medication use as well as age‐related changes in sleep structure, which shorten sleep time and impair sleep quality.
When daytime sleepiness or sleep problems are present in older people, it is essential to assess whether sleep duration, quality, and timing are adequate. Mental disorders or medical conditions that may cause insomnia should also be checked. Loss of appetite and interest in addition to insomnia may suggest depression. In addition, delirium related to dementia, anxiety disorders, alcoholism, psychological factors, and life events – loneliness, the death of a partner/spouse, or hospitalization, may also cause insomnia in the elderly.
There are both non-pharmacological approaches and pharmacological treatments for insomnia. Sleep hygiene education should be the first approach because the development of good sleep habits benefits all insomnia sufferers. When other sleep disorders or mental/physical illnesses related to insomnia are suspected, prompt screening for each condition is needed. In parallel, treatment for insomnia is recommended. Good sleep hygiene includes regular exercise and meals, the avoidance of stimulants such as caffeine and tobacco, and the creation of a comfortable sleep environment.
Take regular exercise. Adequate aerobic exercise improves the ability to fall asleep. Exercise in the early morning and early evening promotes deep sleep and improves sleep quality; however, exercise just before bedtime should be avoided.
Keep the bedroom dark and quiet. Noises and dim light can interrupt sleep. Maintain a comfortable bedroom temperature below 750 Fahrenheit. During the summer season, consider using an air conditioner.
Keep regular eating patterns, 3 times a day. When you feel hungry, eat a light snack – cheese, milk, nuts, or carbohydrates but avoid heavy meals before bedtime.
Limit fluid intake before bedtime
Limit fluid intake before bedtime to reduce the frequency of urination during sleep. In cases of cerebral infarction or angina pectoris, follow the instructions of your primary physician.
Caffeine intake before bedtime may result in sleep initiation and maintenance problems. Limit caffeinated foods and beverages – Green tea, tea, coffee, cola, and chocolate, to the equivalent of three cups of coffee and ingest them no later than 4 hours before bedtime.
Alcoholic beverages promote sleep initiation but cause fragmented and unrefreshing sleep.
Avoid smoking. Nicotine acts as a stimulant, interfering with sleep.
The writer is head of the Agewell Foundation USA Inc. It is a 501(c)(3) registered Non-Profit initiative, committed to working for the welfare of destitute Old People desperately needing assistance.