RECIPES FOR A GOOD NIGHT S SLEEP Maribeth Gallagher, PMHNP-BC, MS Hospice of the Valley Objectives: Describe the most common changes in sleep that occur in older adults. Discuss the possible negative effects sleeping medications may have on some older adults. Identify at least three non-pharmacological approaches to improve sleep. DISCLOSURE Maribeth Gallagher, PMHNP-PC, MS does not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and or provider(s) of commercial services discussed in the presentation. The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 180 2008 All Rights Reserved
Slide 1 Recipes for a Good Night s Sleep Maribeth Gallagher, Psych NP, MS Dementia Program Director Hospice of the Valley Mgallagher@hov.org Slide 2 Objectives 1. Describe the most common changes in sleep that occur in older adults. 2. Discuss the possible negative effects sleeping medications may have on older adults. 3. Identify at least 3 non-pharmacological approaches to improve sleep. 4. Stay awake during this presentation. Slide 3 Sleep Changes & Aging Compared to younger adults, older adults Wake briefly a bit more often at night May spend less time in deep sleep Show a decline in melatonin levels Sleep 30-60 minutes less than younger adults Neurology Now (2006) The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 181 2008 All Rights Reserved
Slide 4 Dispel the Myth Chronic sleep problems are NOT a normal part of healthy aging. But the older you are, the more careful you may need to be about bedtime habits. "Most people believe that poor sleep is an inevitable consequence of getting older. But NSF s poll findings reinforce the relationship between good sleep and good overall health, particularly in older individuals. National Sleep Foundation President James K. Walsh, PhD Slide 5 Factors Challenging Sleep Poor sleep may be an indicator of health status (e.g., Sleep apnea, depression, restless leg syndrome, urinary problems, GERD, CHF.) Pain -Vicious cycle-lack of sleep can increase sensation of pain which can interfere with sleep Medications / drug interactions Older adults use more prescription and OTC medications (as compared to rest of population) Do not overlook possible alcohol abuse or the fact alcohol interacts with many drugs. Slide 6 Inadequate Sleep Men (sleep < 7 hours /night) have a 26% greater death rate over next 2 decades Rotating shift workers may have lower serotonin levels associated with anxiety & depression (Sleep, 2007) Reduced energy & excessive daytime sleepiness Poor attention and memory Depression, anxiety, suicide risk Numerous health problems (e.g., cardiovascular) Greater risk for accidents, including falls & car crashes Work performance and relationships can suffer www.sleepfoundation.org The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 182 2008 All Rights Reserved
Slide 7 Dementia and Sleep Changes Alterations in sleep/wake cycles Nocturnal sleep is light (more Stage I) Fragmented-frequent awakenings Lower sleep efficiency (% of time spent asleep in bed) May result in: More daytime sleeping & functional interference Increased memory & attention deficits Increased depression & anxiety Correlated with increased risk of behaviors, falls, & caregiver burden Slide 8 Sleeping Medications in Older Adults Potential Side Effects Excessive daytime drowsiness Dizziness, orthostatic hypotension Cognitive disruptions Gait instability, falls & fractures Car accidents Tolerance and addiction to medications Current sleep medications may help attain light sleep, but usually not restorative sleep. Slide 9 Non-pharmacological Approaches Principles of Sleep Hygiene Behavioral changes Environmental changes Cognitive behavioral therapy (CBT) helps people overcome bad sleep habits and insomnia-related anxiety It is a very gradual process - may take weeks to months to experience positive changes in sleep. The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 183 2008 All Rights Reserved
Slide 10 BEHAVIORAL CHANGES Consistent sleep/wake cycles (including weekends) Exercise regularly during daytime hours If you must take a nap, keep it short & early in day Avoid caffeine, alcohol & nicotine late in the day Finish eating at least 2-3 hours before your regular bedtime (no heavy, spicy or sugary foods, restrict fluids). Balance fluid intake. Spend some wind down time before bed Go to bed only when truly sleepy Get out of bed & do something relaxing if you cannot fall sleep in 20 minutes Slide 11 ENVIRONMENTAL CHANGES Limit exposure to bright light at bedtime, but expose yourself to bright sunlight during the day A quiet, dark, and cool (60 and 75 F) and ventilated environment Minimize noise. Use earplugs or "white noise Comfortable mattress and pillows Limit your bedroom activities to sleep and sex only (no computers, TV, work materials) Do not watch the clock (turn it around) Slide 12 Pre-sleep Rituals Establish a relaxing bedtime routine Listen to soothing music-slower tempo & smooth melodic contours Pray or read comforting, light literature Gentle massage Warm bath (allow time to cool down afterward) Try lavender essential oil or scents that comfort Light snack Usually carbohydrates and dairy Turkey, bananas & warm milk have tryptophan The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 184 2008 All Rights Reserved
Slide 13 Alcohol, Caffeine and Nicotine Alcohol may speed sleep onset but leads to disrupted sleep later Caffeine taken too late in the day (in coffee, tea, soda, chocolate) may lengthen sleep latency. Nicotine Smokers were much more likely to report problems falling and staying asleep, along with daytime sleepiness Smokers are 4 Xs as likely to suffer from sleep apnea Nicotine withdrawal can lead to short-term sleep problems Use of a skin nicotine patch may also be associated with early morning awakenings and reduced total REM sleep http://www.sleepfoundation.org Slide 14 Exercise Physical exercise for sleep problems in adults aged 60+ Cochrane Review Sleep latency improved slightly Duration and quality of sleep improved significantly Duration of sleep for women increased by one hour http://www.cochrane.org/reviews/en/ab003404.html Slide 15 Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities (JAMA, 2008) Light (10 AM-6 PM) had a modest benefit improving cognitive and noncognitive symptoms in PWD. Melatonin is recommended only with light therapy because study noted that used alone it may cause negative changes in mood. The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 185 2008 All Rights Reserved
Slide 16 Relaxation Techniques University of Maryland Medical Center Try one or all the following Progressive Relaxation Toe Tensing Deep Breathing Guided Imagery Quiet Ears All of these methods are described on the website: http://www.umm.edu/sleep/relax_tech.htm Slide 17 Music Typical music to enhance sleep involves music that is pleasing to the listener, with slow tempo & smooth melodic contours Serenity vs sedation Music as mental floss May reduce muscle tension, heart rate, blood pressure, respiratory rate, stress & anxiety American Music Therapy Association (www.musictherapy.org) Slide 18 Lavender Essential Oil & Dementia Lavender oil showed modest efficacy in the treatment of agitated behavior in PWAD. Int J Geriatr Psychiatry 2002; 17: 305 308. Aromatherapy & massage decreased agitation in PWD Int J Geriatr Psychiatry 2001; 16: 1010-1013. Effective as an adjunctive therapy in alleviating agitated behaviors in Chinese PWD Int J Geriatr Psychiatry 2007; 22: 405 410. Although lavender is a potentially useful treatment, evidence is limited Int J Geriatr Psychiatry 2008; 23: 337 346. The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 186 2008 All Rights Reserved
Slide 19 Harvard Medical School Division of Sleep Medicine Videos, essays and interactive features about the science of sleep, why sleep matters, and how to achieve healthy sleep. To learn more. http://healthysleep.med.harvard.edu/index.htm Slide 20 Get Help from an Expert Seek a health provider s advice if insomnia lasts more than 1-2 weeks. Keep a sleep journal to track specific challenges related to sleep. Consult with a sleep specialist American Academy of Sleep Medicine http://www.aasmnet.org/bsmspecialists.aspx Slide 21 Additional Websites National Sleep Foundation www.sleepfoundation.org American Insomnia Association www.americaninsomniaassociation.org American Academy of Sleep www.sleepeducation.com The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 187 2008 All Rights Reserved
Slide 22 Thank you. Zzzzzzzzzzzzzzzzz The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 188 2008 All Rights Reserved