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Once the underlying risk factors that have brought on your sleep problems are identified and corrected, your insomnia or other sleep problems might disappear on their own. If they persist, there are many lifestyle and medical approaches that you can follow to start sleeping well again.
Non-Drug Therapies for Insomnia
Good sleep habits and any or all of the following approaches can make all the difference for getting a good night’s sleep, either at home or in long-term care facilities.
Simple improvements in your “sleep hygiene” (habits related to sleep) are often very effective.
During the day:
- Stick to a regular schedule of what time you go to bed and when you get up, even on weekends.
- Exercise every day, but not within three hours of bedtime.
- Get plenty of bright light during the day.
- Avoid napping.
- If you are taking a medication that may cause sleepiness (for example, sedating antidepressants), try to take it at bedtime if possible.
- Stay away from caffeine, alcohol, and tobacco, especially in the afternoon or evening.
- Develop a bedtime routine that is the same every night.
- Limit time in bed to no more than 7 or 8 hours a night.
- If hungry, have a light snack or some warm milk, unless you suffer from reflux (heartburn).
- Do not go to bed unless you are sleepy.
- Take a warm bath about 90 minutes before getting into bed.
- Keep bedclothes and room temperatures comfortable, and keep the bedroom dark and quiet (use ear plugs or a mask if they help).
- Try using a fan or white noise machine to block external noise.
- Use relaxation and stress control techniques before going to bed.
- Reserve your bed for only sleeping or having sex. , Do not eat, watch TV, or have phone conversations.
- If you cannot sleep after about 20 minutes, go to another room, keep lights dim, and read or listen to soothing music for about 30 minutes, then try sleeping again.
In addition to good sleep hygiene, behavioral therapy (a type of talk therapy) can have immediate and lasting benefit in the management of insomnia, especially for older people. Over a few sessions, you and your therapist will identify sleep habits to change and you will learn new behaviors such as:
- Sleep restriction. Time in bed is reduced to your estimated total sleep time (not less than five hours), then gradually increased as you sleep more.
- Relaxation techniques. These will involve biofeedback, meditation, muscle relaxation, imagery training, and self-hypnosis, especially if you have anxiety about your insomnia.
- Stimulus control. Keeping your sleeping area dark and quiet at night but getting bright light during the day.
- Cognitive therapy to help learn to have positive thoughts about sleep and bedtime.
Even brief courses of cognitive-behavioral therapy (for example, two in-person sessions plus two phone calls) are effective in older adults with chronic insomnia.
Exposure to bright light (sunlight or special lamps) is being used more often to help older people with disordered sleep-wake cycles as well as those suffering from depression. It is used when you wake up in the morning and also late in the day. This can perk up older people who become drowsy too early in the evening. You must consult a trained professional for this approach to be safe and effective.
Consult a healthcare professional with training in light therapy and do not try to undertake light therapy on your own. Never stare into a bright light or the sun. This can permanently damage your vision.
Non-Drug Therapies for Sleep Apnea
You may find that certain habit or lifestyle changes alleviate symptoms of sleep apnea. These approaches include:
- Losing weight if you are obese.
- Exercising the muscles of your upper airway.
- Avoiding alcohol, smoking, and sedative drugs.
- Sleeping on your side, rather than on your back (use pillows to keep you on your side).
CPAP: If you are diagnosed with sleep apnea, your healthcare provider may recommend a CPAP (continuous positive air pressure) device. This appliance consists of a pump and mask or tubes that gently deliver blown air into your nose and mouth. There are variations in the mask, so find one that is comfortable for you. It is the primary treatment for sleep apnea, and can be very effective in reducing sleepiness and improving quality of life. Patients with mild to moderate dementia who have sleep apnea tolerate CPAP devices well, and there is some evidence of a beneficial effect on cognition.
Oral appliances: You may benefit from a simple, individually fitted device that you place in your mouth before going to sleep. The device holds your tongue and jaw in a position that prevents airway collapse and blockage.
Non-Drug Treatments for Restless Legs Syndrome
Following good sleep hygiene may be beneficial for older adults with restless legs syndrome. Other approaches that have proved effective include:
- Avoiding alcohol, caffeine, and tobacco.
- Rubbing legs (or arms if involved).
- Taking hot or cold baths.
Once your evaluation is complete and plans for non-drug therapies are in place, your healthcare provider will address your sleep problem by attempting to eliminate other risk factors using medical approaches. These include:
- Treatments for painful conditions (such as pain medications and physiotherapy).
- Adjusting medication if their side effects include insomnia or other sleep problems. Antidepressants, dementia medications, beta blockers, and other cardiovascular medications are common causes.
- Controlling frequent nighttime urination.
- Treatment of depression or anxiety (such as drugs and counseling).
Drug Treatments for Sleep Problems
Older people, in particular, should use caution when using sleep medications. These drugs are linked to:
- Daytime drowsiness
- Higher risk of falling and breaking a hip
- Mental effects like confusion and memory problems
Many sleeping pills are habit-forming. Even if you become dependent on them, their effectiveness may disappear with long-term use.
It is strongly advised to avoid using these medications at all. However, if you and your healthcare provider decide that it is appropriate to use them, try to use the smallest effective dose and only for a short time.
If you have tried non-drug therapies and still cannot sleep, your healthcare provider may recommend a sleeping pill specifically for your pattern of sleeplessness. For example, if you have trouble falling asleep, a short-acting agent may be all you need. If staying asleep is your greatest challenge, a more long-acting product may be best.
Avoid taking sleeping pills more than four times in a week to avoid feelilng groggy during the daytime. Remember that sleeping pills do not cure insomnia, but are only a temporary relief and have serious risks associated with them. You may have even more trouble sleeping after stopping sleeping pills, especially if you have become addicted to them.
Do not drink alcohol if you are taking sleeping pills. This may causethe side effects of the pills to increase significantly.
There are a large number of over-the-counter and prescription sleep aids. Most of them have only small benefits on sleep, but have the potential for causing serious side effects in older adults. As a result, they should be avoided in most cases, even for short-term use. Three main types of sleep aids are particularly problematic:
- Benzodiazepines, such as lorazepam and temazepam. In older adults, these drugs can increase risk of confusion and disordered thinking, falls, broken bones, and motor vehicle crashes.
- Benzodiazepine receptor agonists, such as zolpidem, zaleplon, and eszopiclone. Such as the benzodiazepines, these drugs can increase risk of confusion and disordered thinking, falls, broken bones, and motor vehicle crashes.
- Diphenhydramine and over-the-counter sleep aids that contain antihistamines. These medications can cause confusion, difficulty urinating, dry mouth, constipation, and other side effects.
The best solution for sleep problems usually comes from changes in diet, nighttime behaviors, and cognitive strategies to promote restful sleep. Ask your healthcare professional for help in managing your sleep problems.
Before recommending any drug treatment, your healthcare provider must consider the benefits of a sleep medication against the increased risk for daytime drowsiness, falls, and mental impairment.
Non-prescription (over-the-counter) Drugs
Common non-prescription drugs used by older people include antihistamines and melatonin.
You should not use antihistamines (especially if they contain diphenhydramine) to help you sleep. The side effects of antihistamines include constipation, delirium, drowsiness the next day, and difficulty urinating. You may easily develop a tolerance for this type of product also, which reduces its effectiveness.
Melatonin and valerian are complementary or alternative remedies that help with sleep. Melatonin improves sleep quality and duration and promotes sleep. . Let your healthcare provider know if you are taking these products, since they mayinteract with prescription medications.. Many people find herbal teas, such as chamomile, or a glass of milk help them relax at bedtime. For most people, these are safe approaches to try, but drinking fluids at bedtime may increase the number of times you have to get up during the night to go to the bathroom.
Check with your healthcare provider before trying a non-prescription (over-the-counter) sleep remedy. Even non-prescription products may become habit-forming or interact with other medications or alcohol.
Updated: May 2017
Posted: March 2012