Insomnia, aka 'interrupted nighttime sleep', is a persistent problem in the elderly. Age-related sleep problems are frequently and mistakenly considered to be a normal part of aging. It's been reported that more than 50% of people over 65 experience regular insomnia.
50% of Seniors Experience Insomnia
Insomnia in the elderly is typically under-treated and not addressed by health care professionals.
Your patient has insomnia when s/he reports 'disrupted sleep' that occurs at least three nights per week and lasts at least three months.
Insomnia Interferes with Medical Treatment
Not addressing your patient's sleep disorder can cause medical treatment of other conditions to be compromised. Additionally, your patients are at risk for the following conditions when insomnia is not managed:
- asthma attacks
- increased sensitivity to pain
- high blood pressure
- heart disease
Insomnia Can Exacerbate Safety Risk at Home
Insomnia causes daytime sleepiness...an immediate safety concern. Reduced mental alertness increases the risk of falling and other accidents in the home. Lack of sleep frequently causes anxiety and depression.
Chronic insomnia can shorten a patient's life expectancy. An analysis of 16 studies that covered over 1 million participants and 112,566 deaths looked at the correlation between sleep duration and mortality. The studies found that people sleeping less than 7-8 hours a night increased risk for death by 12 percent, compared to those who slept seven to eight hours per night.
Patient Teaching for Healthy Sleep Patterns
- Remove technology from the bedroom. Remove television and computer from the bedroom.
- Keep napping to a minimum. Some people can take a short afternoon nap and still sleep well at night. Encourage the elimination of napping for your patient with a sleep disorder.
- Minimize alcohol and other mind-altering substances: tobacco, excess caffeine and drugs also interfere with restful sleep. Alcohol is a depressant. Tobacco and caffeine are stimulants and can cause increased anxiety.
- Experiment with mattresses, pillows, sheets. Encourage the patient to experiment with different levels of mattress firmness, pillows and sheets that provide support and comfort. If a mattress is too hard, the patient can add a foam topper for additional softness.
- Make two (2) hours BEFORE bedtime a period of peace and quiet. Advise the patient to avoid triggers that cause worry or anxiety before bed, i.e. news or graphic television shows.
- Keep bedroom room dark during sleep hours, keep the noise level down and reserve bed for sleeping.
- Avoid large meal within two hours of bed. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods as bedtime snacks.
- Encourage bed-time snacks that DO help sleep: glass of warm milk and half a turkey or peanut butter sandwich, whole-grain, low-sugar cereal or granola with low-fat milk or yogurt, a banana and a cup of hot chamomile tea.
- Remind the patient its normal to wake briefly during the night. Advise the patient to stay relaxed and if s/he has been awake for more than 15 minutes, try getting out of bed and doing a quiet activity. Keep the lights dim so as not to cue the body clock that it’s time to wake up.
American Sleep Association. (2007). Sleep hygiene tips. Web: https://www.sleepassociation.org/about-sleep/sleep-hygiene-tips/. Crowley, K. (2011). Sleep and sleep disorders in older adults. Neuropsychology Review, 21(1), 41-53.Bhaskar, S., Hemavathy, D., & Prasad, S. (2016). Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353813/
What is Insomnia? (n.d.). Retrieved from https://www.sleepfoundation.org/insomnia/what-insomnia
Patel, D., Steinberg, J., & Patel, P. (2018, June 15). Insomnia in the Elderly: A Review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991956/
Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA, 281(11), 991-999.
Ohayon, M. M., & Vecchierini, M. F. (2005). Normative sleep data, cognitive function and daily living activities in older adults in the community. Sleep, 28(8), 981-989.
Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7.
Wurtman, R. J. (2012). Use of melatonin to promote sleep in older people. European Neurological Review, 7, 90e1.