Eldercare at Home: Sleep Problems
Caregiving How Tos
Understanding the Problem
People of all ages can have trouble falling asleep or staying asleep or have poor quality sleep (insomnia). There are many possible causes including stress, changes in schedule, diet, or as a side effect of medicines. As people age, they generally spend less time in the deepest stages of sleep. After age 40, sleep becomes lighter and it is easier to wake up. Sleep is considered a problem only when the person is not satisfied with his or her sleep, when the person feels drowsy or has other related symptoms the following day, or when the sleep problem suggests a serious underlying illness.
Sometimes making a few simple lifestyle changes, such as getting more exercise during the day, is all that is necessary for a person to begin sleeping soundly. At other times a health problem such as stress, hormonal changes, poor nutrition, or drinking alcoholic beverages may cause insomnia.
The most common reason for a sudden change in sleep patterns is emotional stress or nervousness. Depression can keep people up and awakes them at early hours.
Dementia frequently alters sleep/wake patterns.
A person with dementia may sleep during the daytime then stay awake and even wander at night. Medicines such as diuretics, antidepressants, anti-anxiety medicines, painkillers, and drugs for Parkinson's disease can also affect sleep patterns.
Sometimes people show odd behaviors while sleeping, which may be noticed only by a spouse or companion. Behaviors such as moving the arms or legs, kicking, loud snoring, or choking sounds are signs of possible sleep disorders. These should be brought to the doctor's attention. One disorder to be concerned about is sleep apnea, a condition in which people briefly stop breathing while asleep. This causes them to wake up many times during the night. Sleep apnea can cause fatigue the next day and is associated with high blood pressure, heart disease, and heart failure.
Your goals are to:
- Encourage a set routine for going to bed and waking up
- Check all medicines to see if they could affect sleep
- Check the diet and use of caffeine and alcohol to see if they might be affecting sleep
- Make the bedroom safe and comfortable
Call the doctor or nurse immediately or go to the emergency room if any of the following symptoms occur
Sleep emergencies are not common. However, the following situation has been known to happen at night or bedtime:
- A sudden change in mood.
If the person you are caring for wakes suddenly during the night and acts agitated or confused, it is important to call a doctor right away. This could be a sign of a serious medical illness or a side effect of a prescription drug.
Call the doctor or nurse during office hours to discuss the following problems
- Sleep is not satisfying
Ask the older person to explain what about sleep is not satisfying.
- Sleep or fatigue cuts into daytime activities
Falling asleep during quiet time, such as watching TV is normal, but falling asleep in the middle of a conversation is not. Excessive daytime sleepiness is abnormal. Falling asleep while driving is abnormal and dangerous.
- You see or hear strange behaviors during sleep
Loud snoring, choking sounds, short periods when breathing stops, gasping, and leg and arm movements during sleep could all be signs of sleep apnea or other sleep disorders.
Know the answers to the following questions before calling the doctor:
- How long has sleeping been a problem?
- What other medical conditions does the older person have?
- What medicines does he or she take? (Include prescription and non-prescription drugs.)
- Could emotional stress be affecting sleep, such as the recent death of a family member?
- Is he or she feeling sad, depressed, or anxious?
- Is snoring a problem? If yes, do you notice daytime drowsiness and/or choking, gasping sounds during sleep?
- Are there complaints of indigestion, chest pain, or shortness of breath when the older person wakes up during the night?
- Is there evidence of use of alcohol, caffeine, or nicotine?
Here is an example of what you might say when calling for help:
"This is Joan Smedley, Harry Smedley's wife. My husband has been drowsy during the day for the past few weeks. He falls asleep very easily during the day, sometimes in the middle of a conversation, and I've noticed that he has trouble going to sleep at night."
- Use sleep medicines with caution
Many prescribed sleep medicines are meant to be taken for no longer than two or three weeks. After three weeks, many lose effectiveness and can cause drowsiness during the day. This is especially true of some of the older sleeping medicines. Over-the-counter sleeping pills can cause dry mouth, constipation, urinary problems, and confusion.
- Maintain a regular sleep/wake schedule
As much as possible, older people should get up and go to bed at the same time every day. But it is also important that they don’t go to bed until they are sleepy. It is not helpful to lie in bed awake worrying about not sleeping.
- Encourage getting out of bed if not asleep in 30 minutes
Getting out of bed and going into another room for a short period can help people who are having trouble sleeping. Listening to music or doing some light reading often helps feelings of tiredness to return. It is important to avoid bright light during these periods.
- Limit napping
Naps of up to one hour may be helpful in some people who need a rest during the daytime, especially if the nap is taken in the middle of the day (soon after noon). However, napping for more than an hour or close to bedtime will make it more difficult to sleep at night. People who have trouble sleeping at night may need to decrease or stop their daytime napping in order to sleep better at night.
Exercise is a good remedy for poor sleep. A brisk walk in the afternoon is best. Exercising just before going to bed can cause difficulty in getting to sleep.
- Limit or cut out alcohol, caffeine, and nicotine
Caffeine may lead to difficulty falling asleep. Alcohol may also lead to difficulty falling asleep and changing sleep time. It also may lead to daytime drowsiness that can disrupt nighttime sleep time. Nicotine also has similar effects on sleep, leading to difficulty in falling and staying asleep.
- Make the sleep environment a relaxing place
Don't use the bed to eat, read, or watch TV. When the bedroom is used just for sleeping, it becomes associated with sleep and can help the person you are caring for feel sleepy when in the room.
- Develop a bedtime routine
Activities like washing the face, brushing teeth, or other nightly routines before bed help a person relax and prepare for bed.
- Make the bedroom safe and comfortable
Have a soft, low nightlight in case the older person wakes up confused or agitated. For people who wander at night, secure doors and windows. Sometimes the noise of a fan running or a "white noise" machine helps people sleep.
- Keep a sleep diary
It can be helpful to record a one to two-week sleep diary for the older person to help the doctor understand the sleeping problem and determine what treatments would be beneficial. Sometimes a sleep diary shows that the older person's sleep is better than you thought. Some of the things you might write down in the sleep diary include:
- Times waking up and going to bed
- How long it took to fall asleep
- The number of times awake during the night and for how long
- What woke the older person during the night
- Any strange behavior during sleep, such as choking or gasping sounds, stopped breathing, or movements of the legs
- When and how long are naps
- Use of alcohol, caffeine, or sleeping pills
Problems You Might Have Carrying Out Your Plan
"If he stops taking sleeping pills, he won't be able to sleep."
Long-term use of sleeping pills may be contributing to or even causing the problems with sleep.
"Sleeping problems are normal for old people."
Not true. Although there are some changes in sleep as people get older, most sleeping problems can be solved or improved.
"She always takes a nap before dinner."
The nap may be the reason for being unable to sleep at night. If the nap is a needed rest period, then it is OK. If napping is because of boredom, it may lead to less sleep at night.
Think of Other Problems You Might Have Carrying Out Your Plan
What other problems could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?
Progress may be slow, especially at first. If you are setting up new routines to promote sleep, it usually takes time for people to get used to new routines and for the routines to be effective. Be on the lookout for sleep problems related to medical conditions or disorders, like sleep apnea, which require medical treatment.
Be on the lookout for sleep problems related to medical conditions or disorders, like sleep apnea, which require medical treatment.
Set realistic goals. A person is unlikely to sleep eight hours at night if for years he or she has slept only four to five hours a night.
What to Do If Your Plan Isn't Working
Be sure you have tried all of the suggestions in the "What You Can Do to Help" section of this section and be realistic about how quickly you can expect change. Brainstorm ideas of your own. You may find the best approach through trying different methods.
If problems with sleep are increasing and are of major concern to the person you are caring for, ask the doctor and nurse for help. Tell them what you have done and what the results have been.