Common Causes of Insomnia in the Elderly

Common Causes of Insomnia in the Elderly

1. Issues that may lead to an environment that is not environment that is not conducive to sleep conducive to sleep.

Specific examples include: noise or uncomfortable bedding. You can teach the patient sleep hygiene techniques that will

increase the likelihood of a restful night’s sleep.

2. The use of prescription, over-the-counter, alternative,prescription, over-the-counter, alternative, and recreational drugs and recreational drugs might affect sleep.

Patients should be counseled to avoid caffeine and alcohol avoid caffeine and alcohol for four to six hours before bedtime. for four to six hours before bedtime. Common Causes of Insomnia in the Elderly

3. Sleep apneaSleep apnea is common in the elderly, occurring in 20% to 70% of elderly patients.

Obstruction of breathing results in frequent arousal that the patient is typically not aware of; however, a bed partner or family member may report loud snoring or cessation of breathing during sleep.

4. In restless leg syndromerestless leg syndrome, the patient experiences an irresistible urge to move the legs, often accompanied by uncomfortable sensations.

5. In periodic leg movementperiodic leg movement and REM sleep behaviorREM sleep behavior disorderdisorder, the patient experiences involuntary leg movements while falling asleep and during sleep respectively.

As in sleep apnea, the sleeper is often unaware of these behaviors and a bed partner or family member may need to be asked about these movements. Common Causes of Insomnia in the Elderly

6. Disturbances in the sleep-wake cycle Disturbances in the sleep-wake cycle include jet lag and shift work.

7. Patients with depression and anxiety depression and anxiety commonly present

http://www.aafp.org/afp/2015/1215/p1058-s1.html

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with insomnia. Common Causes of Insomnia in the Elderly

Any patient presenting with insomnia should be screened for these disorders.

8. Patients with shortness of breath due to cardiorespiratorycardiorespiratory disordersdisorders often report that these symptoms keep them awake.

9. Pain or pruritusPain or pruritus may keep patients awake at night.

10. Those with GERDGERD may report heartburn, throat pain, or breathing problems.

These patients may also have trouble identifying what awakens them.

Detailed questioning may be needed to elicit the symptoms of this disorder.

11. Elderly patients with hyperthyroidismhyperthyroidism frequently do not present with typical symptoms such as tachycardia or weight loss, and laboratory studies may be required to detect this problem. Common Causes of Insomnia in the Elderly

12. Circadian rhythms change, with older adults tending to get sleepy earlier in the night. In advanced sleep phaseadvanced sleep phase syndrome (ASPS)syndrome (ASPS), this has progressed to the point where the patient becomes drowsy at 6 to 7 p.m. If they go to sleep at this hour, they sleep a normal seven to eight hours, waking at 3 or 4 a.m. However, if they try to stay up later, their advanced sleep/wake rhythm still causes them to awaken at 3 or 4 a.m. This can be difficult to distiguish from insomnia.

References

Yaremchuk K. Sleep disorders in the elderly. Clin Geriatr Med. 2018 34(2):205-216. doi: 10.1016/j.cger.2018.01.008.

https://www.ncbi.nlm.nih.gov/pubmed/29661333
https://doi.org/10.1016/j.cger.2018.01.008

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SLEEP HYGIENE TEACHING Dr. Lee tells you, “Poor sleeping habits can also cause insomnia. Here is a handout on sleep hygiene. For some patients, simply correcting their sleep habits by following these tips will correct their quality of sleep.” Common Causes of Insomnia in the Elderly

You review the handout.

Good Sleep Hygiene

Your Personal Habits

Fix a bedtime and an awakening time.Fix a bedtime and an awakening time. The body “gets used to” falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.

Avoid napping during the day.Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a “sleepy time.” Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30 to 45 minutes and can sleep well at night. Common Causes of Insomnia in the Elderly

Avoid alcohol four to six hours before bedtime.Avoid alcohol four to six hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in the blood start to fall, there is a stimulant or wake-up effect.

Avoid caffeine four to six hours before bedtime.Avoid caffeine four to six hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.

Avoid heavy, spicy, or sugary foods four to six hoursAvoid heavy, spicy, or sugary foods four to six hours before bedtime.before bedtime. These can affect your ability to stay asleep.

TEACHING POINTTEACHING POINT

https://www.umms.org/midtown/health-services/sleep-disorders/patient-information/sleep-hygiene

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Exercise regularly, but not right before bed.Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the two hours before bedtime, however, can decrease your ability to fall asleep. Common Causes of Insomnia in the Elderly

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Your Sleeping Environment

Use comfortable bedding.Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.

Find a comfortable temperature setting for sleeping andFind a comfortable temperature setting for sleeping and keep the room well ventilated.keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.

Block out all distracting noiseBlock out all distracting noise, and eliminate as much light as possible.

Reserve the bed for sleep and sex.Reserve the bed for sleep and sex. Don’t use the bed as an office, workroom or recreation room. Let your body “know” that the bed is associated with sleeping.

Getting Ready For Bed

Try a light snack before bed.Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep. Common Causes of Insomnia in the Elderly

Practice relaxation techniques before bed.Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.

Don’t take your worries to bed.Don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a “worry period” during the evening or late afternoon to deal with these issues.

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Establish a pre-sleep ritual.Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep. Common Causes of Insomnia in the Elderly

Get into your favorite sleeping position.Get into your favorite sleeping position. If you don’t fall asleep within 15 to 30 minutes, get up, go into another room, and read until sleepy.

Getting Up in the Middle of the Night

Most people wake up one or two times per night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15 to 20 minutes, then do not remain in the bed “trying hard” to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.

A Word About Television

Many people fall asleep with the television on in their room. This is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. This also applies to computers, tablets and smart phones. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

References

University of Maryland Medical Center. Insomnia. Accessed June 21, 2018.

https://www.umms.org/ummc/patients-visitors/health-library/in-depth-patient-education-reports/articles/insomnia

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Also check: Self-Assessment of Clinical Skills

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