Long Term Care
Managing Sleep Disorders
Elderly patients are more likely to suffer from chronic insomnia characterized by difficulty maintaining sleep than difficulty initiating sleep. Despite being a common complaint among elderly people (aged 65 years and older), sleep disorders are rarely systematically diagnosed and treated, even by geriatric specialists. Insomnia is a serious problem among older individuals because of its widespread prevalence and because poor sleep can have detrimental consequences for many of the aspects of vitality and resilience required for successful aging.
Sleep disturbances among the elderly are associated with significant morbidity and mortality and increase the risk for nursing home placement. Insomnia is also correlated with risk for falls. Sleep maintenance, rather than sleep initiation, is the most commonly reported problem among older people with sleep disturbance and can have serious consequences. However, while a range of treatment options exist, there is currently a lack of pharmacological agents that provide an optimum combination of therapeutic benefits. Ideal pharmacologic outcomes would include sleep initiation, sleep maintenance without next-day residual effects, and, ideally, improved next-day functioning.
Hypnotic sleep aids and antidepressants are used frequently in Long Term Care to assist staff with maintaining appropriate sleep regiments. Many skilled nursing facilities utilize benzodiazepines, hypnotics, or antidepressants to manage chronic insomnia and frequent awakenings. The use of these sleep medications in the elderly can lead to undesirable and costly side effects, such as impaired memory and alertness, incontinence, daytime sleepiness, and imbalance, which are already problems for much of the skilled nursing patient population.
The 1982 National Institute on Aging performed a multicenter, epidemiologic study to assess sleep complaints among the geriatric population. Out of 9282 non-institutionalized, aged 65 years and older participants, (N = 9282; mean age = 74), the institute found that:
- 57% reported some form of chronic disruption of sleep (1)
- 12% reported no sleep complaints(1)
- 43% reported difficulty initiating sleep or maintaining sleep (1)
- 30% reported nocturnal awakening (1)
- 29% reported insomnia (1)
- 25% reported daytime napping (1)
- 19% reported trouble falling asleep (1)
- 19% reported waking too early (1)
- 13% reported waking not rested (1)
[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC427621/