Sleep problems are more common as we get older. Over half of older adults experience disrupted sleep. This can be attributed to medical problems, such as pain from arthritis, a heart condition causing shortness of breath when you lie down, and heartburn, which is frequently worse at night. You may have to get up to go to the bathroom one or more times. Such nervous system disorders as Parkinson’s disease and Alzheimer’s disease are often accompanied by sleep disturbances. Some medications may affect sleep quality.
No matter the cause, sleep problems pose a significant concern. Poor sleep can result in irritability, problems with concentration, and driving accidents. Falls and hip fractures are another consequence of disrupted sleep.
Q: Jody, NJ - What are some things I can try to overcome insomnia?
A: Dr. O'Neil - If you drink caffeinated beverage or alcohol in the evening, they should be eliminated. They may stimulate you or affect the quality of your sleep. In addition, exercising just before you retire might energize you and make it more difficult to get to sleep. Although many people read or watch television in bed before going to sleep, you should avoid these activities if you have insomnia.
Part of your “training” for proper sleep is to restrict the use of the bed to sleep and sex. Such measures as a comfortable mattress and a quiet environment make sense, but most studies suggest that none of these things really solves the problem for someone who truly has insomnia. There are other behavioral treatments that can be tried with the guidance of your physician.
Q: Eric, PA - What medicines can cause sleep problems?
A: Dr. O'Neil - Some medicines have adverse effects on sleep. Beta-blockers used to treat high blood pressure and heart conditions sometimes cause nightmares. Caffeine may be included in various over-the-counter pain relievers. Caffeine in the evening can make it difficult for you to get to sleep, and you may tend to wake up more frequently.
Some cold remedies contain pseudoephedrine which may stimulate you and keep you awake. If diuretics force you to get up at night to go to the bathroom, take them earlier in the day. Some asthma medicines have stimulatory effects and make it difficult to get to sleep. If you are experiencing sleep problems, let your doctor review your medicines to see if any of them are contributing to the problem.
Q: Barbara, AZ - I take medicine for sleep but wake up during the night and cant get back to sleep?
A: Dr. O'Neil - Most commonly people have to get up to go to the bathroom. Try restricting fluids before bed time and avoiding caffeinated beverages late in the day. Sometimes pain can wake you also. If you have pain, try some Tylenol before bed but avoid the “PM” products that contain diphenhydramine as they can have undesirable side effects.
Q: Anna, IL - Are naps ok during the day?
A: Dr. O'Neil - Frequent and lengthy naps can affect sleep quality at night. If someone is having sleep problems at night, I suggest avoiding napping or at least reducing their length and frequency. Getting outside and getting some fresh air and sunlight can be helpful for one’s energy and mood.
Q: Carol, IL - Do people need more or less sleep as they age?
A: Dr. O'Neil - Older adults need as much sleep as younger adults. However, age may be associated with medical or mental health conditions that can affect sleep quality. There may be more difficulty going to sleep and staying asleep. Some have difficulties with the “sleep-wake” cycle—some may get tired and fall asleep very early in the evening and awake very early in the morning or others may not fall asleep to very late at night and then sleep most of the next morning.
Q: Joe, MA - What is the recommended amount of sleep per night?
A: Dr. O'Neil - Sleep requirements change over our lifetime. Children and adolescents need more sleep than adults. However, older adults need as much sleep as younger adults—generally about 7-9 hours. Many older adults do not get as much sleep as they should. Some may have more difficulty getting to sleep. Others may awaken more frequently at night. Sleep deprivation can lead to depression, attention and memory problems, falls, daytime sleepiness, a higher risk for cardiovascular disease and diabetes, and use of over-the-counter and prescription sleep medicines which may have undesirable consequences for older adults.
Q: Peter, MA - When is the best time of day to exercise to aid with a better night’s sleep? Does exercise contribute to a better night’s sleep?
A: Dr. O'Neil - Exercise is a great way to improve sleep quality. However, avoid exercising vigorously just before retiring as it may stimulate you and make it more difficult to get to sleep.
Q: Cindy, MA - What can I do to stop leg cramps at night?
A: Dr. O'Neil - Nocturnal leg cramps are sudden painful spasms of the calf and occasionally the foot muscles that jolt you out of a sound sleep. Often they respond to massaging the muscles. No one really knows what causes them, but your doctor will check to make sure there is no underlying medical problem. A simple stretching exercise before you go to bed can help reduce or eliminate them.
Stand at an arm’s length from a wall with your palms against the wall. Keeping your feet flat and your back straight, move toward the wall by letting your elbows bend. You will feel the stretching in the calf muscles in back of your legs. Hold this position for about a half a minute and then straighten up. Repeat the exercise several times. Occasionally drug treatment is required—if simple stretching exercises don’t work, ask your doctor about medicines that may help.
Q: Dave, IL - What about the use of quinine for leg cramps?
A: Dr. O'Neil - Quinine is not routinely recommended because there may be some adverse drug reactions the most serious being suppression of the bone marrow. However some people find that a glass of tonic water before bedtime may be useful. If simple stretching exercises before bed don’t help check with your doctor about a prescription.
Q: Madelyn - CA - What is restless leg syndrome and how is it treated?
A: Dr. O'Neil - Restless Leg Syndrome (RLS) is the very uncomfortable sensation of something crawling or creeping under your skin. You might feel that your legs are jumpy or restless. There is an irresistible urge to move the legs. It usually occurs at night when relaxing and often forces you to get up and move around or massage your legs. Treatment involves good sleep hygiene, avoidance of alcohol and caffeine; and eating a well-balanced diet. Limit those activities that you notice tend to aggravate the condition.
A doctor should check you for iron deficiency and recommend iron supplements if necessary. In some cases, other medications are tried, including levodopa carbidopa, sedatives, pain relievers, or antiseizure drugs, such as gabapentin (Neurontin). In 2005, a drug used for Parkinson’s disease called ropinirole (Requip�) became the only FDA-approved drug fro the treatment of moderate to severe RLS. As always, you have to weigh the benefit versus the risk of taking medication.
A: Camilla, NY - How can I prevent Jet lag?
Q: Dr. O'Neil - Eat well-balanced meals and avoid excessive alcohol or caffeine. Drink plenty of liquids while flying. Try to adjust to the new time schedule by going to bed a little later for a few days before a westward trip and a few hours earlier before an eastward trip. Get regular exercise on your trip, but avoid strenuous exercise before going to bed. Sleep medication may be helpful, but discuss this with your doctor. Such medications can also cause side effects and may need to be avoided depending on your medical condition and your other medicines. Some individuals find melatonin helpful, but there is the potential for side effects also. I do not recommend this for older adults.
Q: Janice, OH - What is sleep apnea?
A: Dr. O'Neil - Apnea means absence of breathing. Sleep apnea describes those individuals who have periods during sleep when they transiently stop breathing. There are three types. Central sleep apnea is due to a problem in how the brain regulates breathing. This is usually due to a neurological disease, such as a stroke, or it may be related to heart or kidney failure.
A potentially serious and actually quite common cause of daytime tiredness, headache, and high blood pressure is obstructive sleep apnea (OSA). This condition is more common in older persons and in those who are overweight or drink too much alcohol. Their spouse often complains about their snoring. They may have no clue about the problem. Mixed apnea is a combination of central and obstructive sleep apnea.
Q: Sandy, IL - What is the best treatment for obstructive sleep apnea?
A: Dr. O'Neil - Most physicians will try nonsurgical treatments first. These include weight loss, positional therapy and medication. Also oral appliances may be tried. The definitive treatment for OSA in most people is with nasal continuous positive airway pressure (CPAP). A CPAP nasal mask is applied over the nose, and pressurized air flows from a small machine that attaches to the nasal mask. A sleep clinic will help to diagnose and recommend the best treatment.
Q: Joanne, IL - How much exercise is recommended for older adults?
A: O'Neil - National recommendations for all older adults are 30 minutes of modest aerobic activity (such as walking, swimming, bicycling) on most if not all days of the week. If you have not been active, start slowly and gradually build up. The fitness activities can be done at one or more times a day (for example 10 minutes one time and 20 minutes at another time—strive for a minimal interval of ten minutes). Also recommended are strengthening exercises at least two days a week. Some may use weights. Others may prefer resistance bands or special machines.
It is important to get proper instruction from an exercise instructor, physical trainer, or physical therapist so you don’t hurt yourself. Do some stretching for several minutes before aerobic or strengthening exercises. A great resource is available free from the National Institute on Aging called Exercise and Physical Activity. You can order it online at www.nia.nih.gov (under Publications) or by calling toll-free 800-222-2225.
Q: Joseph, TX - Are there any safe herbal remedies for sleep?
A: Dr. O'Neil - My recommendation is to avoid these. The most commonly used is melatonin, but review of the research literature by the National Center of Complementary and Alternative Medicine showed that melatonin is not effective in treating most primary and secondary sleep disorders. There was also no evidence to support its efficacy in treating the sleep disturbance associated with jet lag. It is important to remember the “placebo effect”—if you think it is helping you, it just might. On the downside, melatonin has been associated with side effects, including dizziness, headaches, and nausea.
Q: Georgia, TX - Is it OK to watch TV in bed?
A: Dr. O'Neil - This is a common practice and not recommended, especially for those folks who are having sleep problems. Television viewing can act as a stimulant and make getting to sleep difficult. Bed should be reserved for two things—sleep and sex.
Q: Ken, IL - What are recommended activities pre-bedtime to aid sleep?
A: Dr. O'Neil - Nighttime rituals can be helpful to induce sleep. Avoid vigorous exercise for three hours before retiring. Caffeine and alcohol should be eliminated in the evening. Both can adversely affect sleep quality. Avoid drinking a lot of fluids in the evening, as you may have to get up to urinate in the middle of the night. Smoking prior to retiring is not only dangerous, but nicotine is a stimulant.
There are many ways a doctor can help you quit if you still smoke. Avoid large meals just before retiring. Listening to soft music, relaxing in a warm bath, or reading a good book can alert your body that it is time to wind down. Your room should be dark, a little on the cool side, and quiet as possible. Make sure there is a lamp that can easily be turned on near the bed and a phone that is readily accessible.
Q: Fred, TN - When is a sleeping pill recommended?
A: Dr. O'Neil - Physicians are usually reluctant to prescribe medications on a continual basis for sleep. The main reason is that you might develop a physical or psychological dependency, which can be difficult to break. Treatment will be aimed at the underlying cause for the sleep disorder. However, there are situations in which short-term use of sleeping pills is helpful, such as an acute life stress (death of a spouse or loss of a job), if the sleep deprivation augments the stress.
The important principle is to limit the medications to no more than two or three weeks. Occasional use for sporadic episodes of insomnia is reasonable. If you require sleeping pills for longer periods of time, you should try not to use the pills more than two or three times a week.
Q: Barbara, IL - What are the best sleeping medicines for older persons?
A: Dr. O'Neil - The ideal sleeping medicine is one that works quickly, has no side effects, and does not accumulate in the body over time. Of course, there is no such drug, but some safer sleep medicines have become available. Tranquilizers such as Valium and Librium should be avoided since they can hang around in the body for days, causing daytime drowsiness and other undesirable side effects. Dalmane is a sleeping pill that should be avoided in older adults Halcion is a short-acting sleep medicine, but it tends to cause rebound insomnia when it is discontinued.
Newer drugs such as Ambien, Rozerem, and Lunesta are preferred by most doctors because they have less chance for withdrawal problems and generally fewer side effects; however, remember that we are all different and some individuals may not tolerate them. These drugs should be used short-term over maybe a few weeks and used intermittently rather than nightly.
Dr. O'Neil - I enjoyed being with you today. We are sorry that some of you may have had problems with submitting your questions. This is a technical glitch that we have corrected. Please join us next month on September 16th when we will discuss "Reducing Your Cancer Risk".
Best wishes for an Optimum Life, Dr Kevin.