Geriatric Sleep Disorder Treatment & Management

Updated: Oct 14, 2016
  • Author: Glen L Xiong, MD; Chief Editor: Ana Hategan, MD, FRCPC  more...
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Treatment

Approach Considerations

The geriatric population is the largest group of people who use hypnotic drugs. People older than 60 years receive 33% of all hypnotic prescriptions, although they constitute only 14% of the population. The use of sedative-hypnotics by the elderly population has been associated with falls, hip fractures, and daytime carryover symptoms. When evaluating a patient, exclude primary sleep disorders and review medications and other contributory medical conditions.

Patient education on age-related changes in sleep and good sleep hygiene may be adequate treatment for many older adults. If the initial history and physical examination findings do not reveal a serious underlying cause, a trial of improved sleep hygiene is the best initial approach.

The common recommended measures include the following:

  • Maintain a regular wake-up time
  • Maintain a regular sleeping time
  • Decrease or eliminate daytime naps
  • Exercise daily but not immediately before bedtime
  • Use the bed only for sleeping or sex
  • Do not read or watch television in bed
  • Do not use bedtime as worry time
  • Avoid heavy meals at bedtime
  • Limit or eliminate alcohol, caffeine, and nicotine before bedtime
  • Maintain a routine period of preparation for bed (eg, washing up, brushing teeth)
  • Control the nighttime environment with a comfortable temperature, quietness, and darkness.
  • Wear comfortable, loose-fitting clothes to bed
  • If unable to sleep within 30 minutes, get out of bed and perform a soothing activity, such as listening to soft music or reading, but avoid exposure to bright light during these times
  • Get adequate exposure to bright light during the day
  • Avoid daytime naps; explaining to the patient that daytime naps decrease nighttime sleep is helpful

People who are overweight and habitually snore loudly may be helped by weight loss. All people who snore loudly should abstain from alcohol or other sedatives before going to bed. They should also take measures to avoid supine sleeping (eg, by taping a tennis ball to the back of their bedclothes).

In the absence of obstructive sleep apnea (OSA), contributing conditions, such as allergies, nasal pathology, or nasopharyngeal enlargement, should be sought and adequately managed by intranasal corticoid sprays or evaluated by an ear, nose, and throat specialist. If the sleep problem is secondary to a medical problem, treat the primary problem rather than the sleep problem. Polysomnography is indicated when primary sleep disorders such as SA or periodic limb movements in sleep (PLMS) are suspected.

Consultation with appropriate specialists may be indicated, depending on the underlying causes of the sleep disorder, such as psychiatric consultation for severe depression and pulmonary or surgical consultation for obstructive sleep apnea. Psychologists may provide cognitive-behavioral therapy for insomnia.

For older patients who are computer savvy, computerized cognitive-behavioral therapy for insomnia (CCBT-I) may be a more attractive approach than the traditional face-to-face therapy sessions. In a meta-analysis, CCBT-I using Internet programs improved several sleep parameters and showed a high treatment adherence rate. [32]