The senior sleep dilemma

Not catching enough “Zzzzzs” can be hard on anyone, but for older adults, the effects can be particularly challenging.  

“Extreme fatigue is a symptom I hear from many of my patients,” said Hani Issa, MD, a geriatrician with the AgeWell Center at Baptist Jacksonville. “Exhaustion can make it hard to drive or participate in normal activities. It can also lead to falls, confusion and memory problems.”

Sleep disorders are more prevalent as people age. Nearly half of adults 60 and older suffer from insomnia, reports the National Institute of Health.

“Insomnia in older adults is often caused by an underlying medical issue,” said Dr. Issa. “So, it’s important to see a doctor to rule that out first.”

Frequent urination, medication side effects, depression, anxiety and movement disorders such as restless leg syndrome are common sleep interrupters in older adults.

Sleep-related breathing disorders, like sleep apnea, are another culprit, and increase as people age. This temporary pause in breathing causes people to wake many times during the night. A sleep study can determine if this is happening, and if needed, a C-PAP machine can help regulate breathing.

Contrary to popular belief, people don’t need less sleep as they age. In fact, the recommended amount throughout adulthood doesn’t change – seven to nine hours. But adults over 65 have a harder time remaining asleep throughout the night. They experience less “REM” or deep sleep, which often leads to frequent waking through the night.

For those who experience anxiety while trying to fall asleep, cognitive behavioral therapy may help. This program is available at Baptist’s AgeWell Center for Health and helps patients replace thoughts and behaviors that prevent sleep with those that promote sound sleep.

Dr. Issa is reluctant to prescribe medications for insomnia, opting for non-drug treatments first.

“Medication is not a cure for insomnia,” he said. “If a prescription is temporarily needed, I avoid benzodiazepines (like Xanax) for any longer than two weeks because they are habit-forming and can cause falls, accidents and memory impairment.  An antidepressant, such as trazadone, is safer, and an even better option is a natural sleep aid like melatonin.” (Remember not to drive or operate machinery for four to five hours after taking any type of sleep aid.)

After ruling out underlying medical issues, Dr. Issa recommends improving your sleep “hygiene” – the daily habits you have when preparing for bed. Some tips (for any age) include:

1. Implement pre-sleep rituals. Doing the same activities each night, like reading, bathing or having a light snack can help your body transition to sleep.
2. Try to go to bed at the same time every night.
3. Don’t drink caffeine within six hours of bedtime.
4. Avoid alcohol and large meals before bedtime.
5. Avoid screen time. The light from a phone, TV or any electronic device can suppress the production of sleep regulating hormones.
6. Don’t take naps during the day.
7. Keep your bedroom dark, cool and quiet as possible.
8. Limit your beverages in the evenings to avoid bathroom trips.
9. Use your bedroom for sleeping only.
10. If you can’t fall asleep after about 20 minutes, get out of bed and try again after you start to feel sleepy.

Some patients benefit from cognitive behavioral therapy. This program is available at Baptist’s AgeWell Center for Health and helps patients replace thoughts and behaviors that prevent sleep with those that promote sound sleep.

The geriatricians at the AgeWell Center for Health specialize in treating the unique needs of older adults, including insomnia. For more information or to make an appointment, call 904.202.4AGE.