Insomnia (described as difficulty falling asleep, difficulty staying asleep, waking up too early, frequent nighttime awakenings or not getting a good night’s sleep) affects more than half of all elders. Sleep is essential for good health; it helps improve memory, allows the body to repair itself from any cell damage, and refreshes the immune system, which in turn helps to prevent disease. Alternatively, trouble with sleeping is associated with poor health outcomes; one of the most significant for elders is that of falling.
Recent reports have linked insomnia with a greater likelihood of falling. There are many possible ways in which insomnia can lead to falls:
• Elders with insomnia may get out of bed in the middle of the night, running into or tripping over objects in the dark or just becoming confused about their surroundings.
• Insomnia can cause daytime sleepiness and clumsiness, as well as cognitive deficits. It slows down a person's reaction time, which could reduce the likelihood of quick corrective maneuvers that might prevent a fall from happening.
• The side-effects of sleep medications (dizziness, drowsiness, difficulty keeping balance, cognitive impairment, blurred vision, drunken movements, etc.) contribute to the risk of falls and fractures.
Aging and Sleep
Sleep needs remain relatively constant with age. With increasing age, however, persons often experience normal changes in their sleeping patterns; sleep gets more fragile, it becomes lighter and more easily disrupted. As a result, elders tend to become sleepy earlier, wake up earlier, or enjoy less deep sleep. Although these changes are a normal part of aging, disturbed sleep, waking up tired every day, and other symptoms of insomnia are not a normal part of aging.
Sleep needs are unique. Some people can get by on six hours, while others need at least eight hours of sleep. For most people, somewhere around seven hours is the ideal amount. You can tell if you're not sleeping well if you fall asleep while watching the evening news or feel tired all the time.
What Causes Trouble Sleeping?
A number of lifestyle and health conditions may interfere with sleep as one gets older. Many of these conditions, when combined with insomnia, can lead to falls.
• Nervous system disorders, such as Parkinson's, Alzheimer's and other forms of dementia, can cause nighttime disorientation, wandering, and confusion.
• Sleep disorders, such as restless legs syndrome (nighttime leg cramps) and sleep-disordered breathing (snoring and sleep apnea) occur more frequently in elders.
• Pain can interfere with good sleep; disorders such as arthritis, bursitis, and spinal stenosis are associated with nighttime distress.
• A number of conditions (such as bladder/prostate problems and certain heart conditions) are associated with nighttime need to toilet, which can interfere with sleep.
• Insomnia is a side effect of many common medications, including antidepressants, antihypertensives, and anti-seizure drugs.
• Stimulants (such as caffeine and nicotine) can interfere with falling asleep. Caffeine can be found in coffee, tea, cola drinks, chocolate, and some cold medicines.
• Taking some medicines at night (such as water pills) may cause individuals to wake up in the middle of the night.
People who suspect their medications are causing insomnia should check with their doctor or pharmacist.
• Psychological factors, such as grief, depression, and anxiety can cause sleeplessness. In fact, psychological factors are more likely to cause insomnia than illness or medications.
Sleep Habits and Environments
• Poor sleep habits (such as irregular sleep hours or too much late-night screen time with the television or computer) can cause insomnia. .
• Light (too much or too little, depending on the time of day), noise, uncomfortable temperatures, and poor mattress quality can cause sleeplessness.
• A partner's sleep habits (such as snoring or restless legs syndrome) can impair sleep.
Lack of Exercise
• If you are too sedentary, you may not feel sleepy or feel sleepy all of the time. Elders are more likely to be sedentary than active with increasing age.
Getting a Good Night’s Sleep
Sleep loss is not inevitable. While elders are more susceptible to many conditions that can cause insomnia, here are a few tips on getting a good night’s sleep (and hopefully avoiding a fall):
Regardless of the causes of insomnia, lifestyle changes can help improve the quality of sleep:
• Establish a regular time for going to bed and getting up in the morning.
• Use the bed for sleep only (not for reading, watching television, etc).
• Do something relaxing an hour before bedtime.
• Keep the bedroom relatively cool and well ventilated.
• Do not look at the clock; obsessing over time makes it difficult to sleep.
• If distracted by a sleeping bed partner, move to the couch or a spare bed for a couple of nights.
If you don’t feel fully alert during the day, a brief nap can improve alertness. Napping should be
• Short (15-45 minutes in duration).
• Early (nap early in the afternoon; napping too late in the day can disrupt nighttime sleep).
• Comfortable (nap in a comfortable environment with limited light and noise)
• Avoid caffeine (from coffee, tea, soft drinks, etc.).
• Avoid alcohol as a sleeping aid (it might make you sleepy but actually disrupts your sleep).
• Avoid big meals or spicy foods before bedtime. Eat dinner at least 3 hours before bedtime.
• Avoid liquid intake at least 1 hour before bedtime (this helps avoid mid-night runs to the bathroom).
Exercise is one of the best ways to promote healthy sleep (it’s as good, if not better, than using sleeping pills). Exercise releases chemical in the body that promote sleep.
• Regular aerobic exercise (walking, swimming, cycling) during the day, at least three hours before bedtime, is particularly useful.
• Yoga can benefit sleep. Yoga uses meditation, deep breathing techniques, and movements that emphasize stretching and balance.
Talk to Your Doctor
If attempts to solve sleep problems are unsuccessful, talk to your doctor; he or she may be able to help. If you (or a loved one) experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder:
• Trouble falling asleep even though you feel tired?
• Trouble getting back to sleep when awakened?
• Don’t feel refreshed after a night’s sleep?
• Feel irritable or sleepy during the day?
• Difficulty staying awake when sitting still, watching television, or driving?
• Difficulty concentrating during the day?
• Rely on sleeping pills or alcohol to fall asleep?
• Trouble controlling your emotions?
Click here to read Dr. Rein Tideiksaar’s blog, “Has Fear of Falling Got Your Down? : Time to Get Back On Your Feet.”
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at firstname.lastname@example.org
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