Sleep Disorder

Issues with falling or staying asleep, sleeping at the incorrect times, getting too much sleep, or behaving strangely while asleep all qualify as sleep disorders.

Sleep issues affect people of all ages, although the elderly are particularly affected. Patients over the age of 65 and women are more likely than males to report having a problem sleeping. Aside from physical ailments, sleep problems are the second most common reason the elderly visit a doctor.

Common Cause of Sleep Disorder

• Medication Side effects:
  • Aminophylline, phenytoin, and selective serotonin reuptake inhibitors are often at fault. Clonidine and alpha-methyldopa both cause people to sleep throughout the day.
• Psychophysiologic Insomnia:
  • Insomnia is a symptom of a condition characterized by a combination of somatized stress and learned associations with difficulty falling or staying asleep, leading to complaints of sleeplessness and impaired daytime performance. The worry usually starts off being about something outside of yourself, like money or family problems, but as the night goes on, it shifts to being about not getting enough sleep. Alcohol and caffeine use may make the situation worse.
• Advanced sleep phase syndrome:
  • Older people's circadian clocks may shift forward with age, causing them to feel drowsy sooner in the evening, maybe around 8 or 9 o'clock, rather than 10 or 11 o'clock. These people may get tired and go to bed early, where they will sleep well. Some of them could take a nap for an hour or more at some point during the day. They frequently find themselves awake at 3 a.m. and perplexed as to why they are unable to remain asleep.
• Nighttime awakening:
  • Reflux esophagitis, pain, dyspnea, urinary frequency, and other symptoms can all make it difficult to fall asleep or stay asleep. In elderly patients, the need to get up and urinate at night is the most common cause of weakness.
• Institutional Insomnia:
  • Many patients admitted to hospitals and nursing homes have insomnia.
• Jet Lag:
  • older persons traveling on a regular basis causes jet lag among most people. After traveling several times the traveler begins to feel sleepy at the usual bedtime in the home time zone.
• Sleep apnea:
  • Sleep apnea is defined as five apneic or ten hypopneic and apneic episodes per hour of sleep. Risk factors for sleep apnea include male sex, obesity, hypothyroidism, chronic obstructive pulmonary disease and certain neurodegenerative disorders.
• Nocturnal myoclonus:
  • Nocturnal also called periodic limb movement disorder, is characterize by repetitive, stereotypical, periodic jerking movement of the limbs that occurs at regular intervals during a night’s sleep.

Symptoms

A patient's symptoms may vary if they are experiencing sleep disturbances. They may complain of daytime sleepiness, nighttime awakenings, early morning awakenings, or difficulty falling or staying asleep. Pain, nocturia, or recurrent leg movements might all wake you up during night.

Treatment

There are many factors influencing the normal sleep-wake cycle among older adults, the approach to treating older people with sleep disorders must be highly individualized.

• Preparing for a regular sleep schedule is an effective non-pharmaceutical method for managing insomnia. If the patient isn't truly exhausted, they shouldn't go to bed. No one benefits from taking long sleep during the day.
• The sleep environment method is the next one. An atmosphere conducive to sleep should be prioritized. The room's temperature and lighting levels should also be optimized for restful slumber, while background noise should be kept to a minimum.
• Patients unable to get to sleep after 30 min should be connected to get out of bed and go to another room once they feel sleepy they should go back to bed.
• For a patient with psychophysiological insomnia, relaxation techniques may be helpful.
• The use of sedative-hypnotic medications is a common pharmacological therapy for sleep disorders. Sedative antidepressants like nortriptyline, doxepin, and trazodone might be an option. Prescriptions for hypnotics should be written for the shortest feasible duration and the lowest effective dose.
• The physician should attempt to reduce or discontinue medications believed to cause or contribute to insomnia.
• A nurse should observe the fluid intake pattern of the patient. The patient should be encouraged to reduce fluid during bedtime.
• For good sleep during the night, hospitals and nursing home staff should be careful about the sleep environment. Noise should be minimal during nighttime.
• Weight loss can be helpful for sleep apnea patients. Surgical intervention such as widening the upper way often eliminates snoring.
• To minimize the effects of jet lag, travelers should not immediately go to sleep on arrival (if arrival is day time).

The most common error in the management of insomnia is the excessive use of sedatives and hypnotics.

The Do's and Don'ts for someone with sleep disorder or a potential of sleep disorder are given below:

Do’s

• Go to bed at the same time each day
• Get up at the same time each day
• Get regular exercise each day
• Keep the temperature of bedroom comfortable
• Keep the bedroom quiet and dark when sleeping
• Use the bed only for sleeping and not for reading or watching TV
• Take medicines only as directed
• Before going to bed, relax the muscles beginning with the feet and way up to head

Don’ts

• Don’t exercise before going to bed
• Don’t engage in stimulating activity before bed
• Avoid caffeine especially late in the day
• Don’t read or watch television in bed
• Don’t use alcohol to help sleep
• Don’t take another person’s sleeping pills without consultation