Patients over 65 -- and sometimes their doctors -- often behave as if sleep problems are as inevitable a part of aging as aches and wrinkles. It doesn't have to be that way, says a group of leading sleep doctors. But to get help, physicians need routinely to screen their older patients for signs of sleep disorders, and patients have to ask for help when they find they consistently can't fall asleep, awaken frequently or too early, have daytime sleepiness or experience unusual movements while sleeping.
There are "sleep hygiene" tips and treatments -- from cognitive behavioral therapy for insomnia to weight loss and breathing aids for sleep apnea -- that can remedy most sleep problems. And while the experts agreed they are overused, hypnotic sleep drugs can be a help for some patients.
In a slate of recommendations for the treatment of sleeping disorders in older patients, 10 leading sleep experts acknowledge that aging does bring changes in sleep patterns. Many of the sleep disruptions most commonly reported among seniors seem to come along with chronic medical conditions, many of which also grow more common with age -- diabetes, high blood pressure, cardiovascular disease, depression. When these are treated, sleep problems often get better.
But the medications that treat some of these conditions also can be implicated in sleep disturbances, said Dr. Harrison Bloom, a geriatrician with the International Longevity Center in New York City. Bloom chaired the consensus committee and was lead author of the paper, published this week in the Journal of the American Geriatrics Society. Certain antidepressants and medications for asthma can cause restless limbs and difficulty in falling asleep. Beta-blockers that treat heart failure can come with vivid dreams and insomnia, and even statins can keep some patients awake. Many narcotic pain relievers cause next-day hangovers with drowsiness, especially for older patients.
Physicians often fail to warn patients about these side effects, or to ask about sleep troubles when a patient comes in for follow-up.
The sleep experts also pointed a finger of blame at alcohol, caffeine, sedentary lifestyles and television in bedrooms. Older people frequently fall asleep soon after dinner -- often in front of a television -- and awaken at 2 a.m. unable to return to sleep. The result is fragmented sleep that night, sleepiness the next day and a vicious cycle of sleep disruption that can wreak havoc on a person's health and his wake-sleep cycle.
"The bedroom should be used for sleep and sex," said Dr. Bloom, "not for heated arguments, watching TV or reading important documents."
-- Melissa Healy