Insomnia - Difficulty Sleeping

by Dr. Karen Leggett

General Information

Insomnia is not exclusive to elderly patients, but it is a common accompaniment of the aging process.

Insomnia is unsatisfactory sleep. Some patients have trouble falling asleep. Others have difficulty remaining asleep, either frequently waking at night or waking early in the morning. The result is daytime fatigue and often daytime naps, which compound the problem. Often the insomnia is transient and seems related to an acute stressful circumstance. Under some circumstances, this insomnia can convert to a chronic problem.

Sleep patterns frequently change with aging. Daytime naps often compensate for nocturnal awakenings. Tiredness then prompts an early bedtime, which is spoiled by a long interval before sleep comes. This becomes a vicious circle.

Sleep disturbances cause different problems for caregivers than they do for patients. They are a major cause for institutionalization.

Important Points in Treatment
Management of insomnia begins with attention to an optimum sleep environment.

  • Establish a regular bedtime for the patient. Do not have the patient spend time in bed except to sleep.
  • Limit the number and duration of daytime naps.
  • Adjust things to feel right—the right bed, right level of darkness, right level of quiet, and right temperature.
  • Do not send the patient to bed hungry or inebriated or immediately after exercise or an emotional event.
  • Avoid administering sedatives (sleeping pills) except as directed by the patient’s physician.
  • Avoid giving a heavy meal or a highly spiced meal immediately before bedtime.

Some medications can cause sleeplessness, an effect that can often be avoided by adjusting the timing of the medications. Seek the counsel of the patient’s physician in this regard. Similarly, if the patient wakes with an urge to urinate, offer fluids earlier in the evening rather than just before bedtime to allow uninterrupted sleep. However, this should be a shift in drinking habits, not discontinuance of adequate fluid intake.

Work with the patient’s physician to find a solution that avoids drugged sleep whenever possible. Sedatives should be used only under the guidance of the patient’s physician. Take special care to prevent falls at night when the patient is partially sedated. Sedatives may cause confusion and thus the inability to remember what other medicines have been taken.

Notify Our Office If

  • The patient’s insomnia persists beyond a week. For a few people with insomnia, associated disease is the cause of the sleeplessness.
  • The patient experiences excessive daytime tiredness with frequent naps. Sleep disturbances may be subtle.

Disorders of sleep-wake cycle

General Information
Disorders of the sleep-wake cycle are not exclusive to elderly patients, but they are common accompaniments of the aging process.

All humans live with a normal, almost 24-hour rhythm called the circadian rhythm. The sleep-wake cycle is part of this rhythm. Disturbances in the control of the rhythm occur with increased frequency as individuals grow older. The changes that may occur include:

  • Delayed sleep onset—patients fall asleep 4 to 5 hours after the desired time and often oversleep the same number of hours. The actual duration of sleep time may be normal.
  • Advanced sleep phase—patients fall asleep earlier than the desired bedtime but also awaken earlier than desired. The actual duration of sleep time may be normal. Daytime sleepiness may be a problem in these patients.
  • Irregular sleep-wake phase patients have no real schedule.

Anyone can experience a temporary shift or abnormality of the sleep-wake cycle, but when a changed sleep-wake cycle pattern persists for more than a week, it should prompt a visit to your physician.

Important Points in Treatment
Abnormalities of the sleep-wake cycle take different forms, but there are a few general guides to management. Management begins with attention to an optimum sleep environment. Your physician can help resolve some problems, but your cooperation and participation are necessary to correct emerging bad sleep habits. Several rules are important to follow:

  • Always go to bed with the intention of going to sleep. Do not read or watch television in bed. If you cannot sleep, get up and engage in some activity until you tire.
  • Approach bedtime in a restful state of mind. Avoid excitement just before bedtime.
  • Adjust things to feel right—the right bed, right level of darkness, right level of quiet, and right temperature.
  • Don’t go to bed hungry or inebriated or immediately after exercise or an emotional event.

If you wake with an urge to urinate, drink fluids earlier in the evening rather than just before bedtime to allow uninterrupted sleep. However, this should be a shift in drinking habits, not discontinuance of adequate fluid intake.

Sedatives (sleeping pills) should be used only under the guidance of your physician. Take special care to prevent falls at night when partially sedated. Sedatives may cause confusion and thus inability to remember what other medicines have been taken.

Notify Our Office If ...

  • You experience excessive daytime tiredness with frequent naps. Sleep disturbances may be subtle.
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