Many elderly people often suffer from insomnia and early awakening. Is this an objective physiological law that exists with age, or is it a sleep disorder that needs to be treated? When the elderly have insomnia and early awakening problems, how should they scientifically improve their sleep quality?
The sleep characteristics of the elderly themselves are about 6 hours of sleep per night, and the overall sleep time is shortened. From the age of 6 onwards, the amount of deep sleep decreases by about 2% every 10 years, and it is normal for older people to spend less time in deep sleep. Due to the increased proportion of light sleep, older people are susceptible to awakening due to external factors. With the increase of age, the level of melatonin secretion in the human body decreases, resulting in a lack of sleepiness at night in the elderly, and it is easy to have a black and white reversal of sleep. Therefore, a reasonable sleep expectation recommendation for the elderly is recommended to ≥ 6 hours of sleep per night with the goal of not affecting social activities during the day.
How to judge the quality of your sleep
Review your overall sleep over the past 4 weeks (or 2 weeks if memory is blurry) and if you have any of the following problems, you have a sleep disorder.
● Difficulty falling asleep: more than 30 minutes from getting ready to go to bed to falling asleep.
● Sleep maintenance disorder: the number of awakenings throughout the night≥ 2 times.
● Short sleep time: Sleep time < 6 hours at night.
● Circadian rhythm disorder: black and white reversed, no drowsiness at night.
● Daytime dysfunction: Decreased concentration and inability to concentrate.
What non-pharmacological treatments can help improve sleep
● Maintain a reasonable sleep expectation, and do not insist on the daily sleep time, falling asleep speed, and early waking time.
● Avoid fragmented sleep during the day, exercise appropriately within the physical range, and reduce napping and lunch breaks.
● Don't get frustrated by not getting a good night's sleep for a night or two, and stay relaxed before bedtime.
● Avoid eating too much before bedtime, do not drink coffee, tea and smoke after 4 p.m., and avoid reading or watching books, videos, etc. that cause excitement within 1 hour before bedtime.
Which medications can help improve sleep
Pharmacotherapy may be considered if older people are dissatisfied with the quality of their night's sleep and have interfered with their daytime social activities, and if non-pharmacological treatments do not respond well. Drugs for the treatment of sleep disorders are special national management drugs due to safety issues, and must be prescribed by a specialist doctor and cannot be taken by yourself. The basic characteristics and precautions for use of this class of drugs are as follows:
● Drug selection: According to the symptoms, it is recommended to choose zopiclone, dexzopiclone and zaleplon with a short duration of action for difficulty falling asleep; diazepam, alprazolam and clonazepam with a longer duration of action are recommended for sleep maintenance disorders; and it is recommended to choose ramertone and agomelatine to increase the level of melatonin for sleep rhythm disorders.
● Dosage: It is recommended to start with the minimum dose recommended by the drug label. 3~5 times a week intermittent medication instead of regular medication every day. It is recommended to reduce the current dose by 25% every 5 days, and gradually stop the drug slowly to avoid insomnia.
When taking medication to improve sleep, you should always pay attention to the safety of medication
Taking drugs for insomnia, the elderly should pay attention to the safety of medication while ensuring the efficacy and optimizing sleep: because if the drug causes a fall due to adverse reactions, it may cause a series of problems such as fractures and vascular embolism. However, if you can understand and keep an eye on the adverse effects of drugs, you can prevent them from happening. Older people should pay attention to the following points when taking medication:
● Identification of ataxia: unsteady gait and uncoordinated swing of the left and right arms when walking (as far as possible for a relatively long distance).
● Recognition of confusion: prolonged sleep time compared with before medication, unresponsiveness, and inability to answer questions correctly (especially pay attention to drugs such as diazepam and flurazepam).
● Identifying hallucinations: Seeing phenomena that others can't see, and having symptoms such as panic and delusions.
● Identification of fall risk: unsteady gait and difficulty standing (especially pay attention to drugs such as clonazepam and flurazepam).
Use drugs to improve sleep, whether there is a risk of addiction
When the drug is taken continuously for more than 2 weeks in sufficient amount, it is easy to produce physical or mental dependence, that is, drug addiction. To avoid the occurrence of addiction, the method of initial low-dose medication can be adopted, that is, the dose is lower than the [dosage] on the instructions, the efficacy is evaluated in time after 2 weeks, and the drug can be adjusted to other classes of drugs if there is no improvement in sleep; the drug can be gradually and slowly stopped, and the drug can be changed from continuous medication to intermittent medication, and the dosing interval can be gradually extended, and finally the drug is stopped.
Content Sources:
People's Medical Publishing House published "The Right Medicine for the Health of the Elderly - What the Elderly Must Know About Medication"
Editor-in-Chief of the book series:
Zhao Jie, chief pharmacist and professor of the First Affiliated Hospital of Zhengzhou University, an expert of the National Health Science Popularization Expert Database
Author of this article:
Guo Guiping, Xijing Hospital, Air Force Military Medical University
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